PONE-D-23-42611Noteworthy Trends in Maladaptive Coping Strategies and Hindrances to Help-Seeking Behaviour Among Adolescents Living in Malaysia's People’s Housing Project (PPR) During the COVID-19 Pandemic: A Qualitative StudyPLOS ONE

Dear Dr. Harun,

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Adobea Yaa Owusu, MA, PhD, MPH

Academic Editor

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1:  In this paper the authors conducted a qualitative study to examine coping strategies and barriers to help-seeking among adolescents living in people’s housing projects during the COVID-19 pandemic.

The vulnerability of the study population adds to the importance of this paper, and the emphasis on promoting adaptive coping strategies among this subgroup is a well-received take-home message.

A strength of the present study is its rigorous standard for study design and procedures, while the manuscript itself is clear and generally well-written.

Below are my specific comments that are aimed at strengthening the paper:

1. In the Introduction, the authors can provide contextual information on PPR and Klang Valley to help readers who are unfamiliar with the context appreciate why the study population are vulnerable and merit scientific importance, and better appreciate the paper’s contribution.

2. p.8, under the Externalization subheading: Describing participants as resorting to destructive behaviours such as hitting their mother sounded like it was done on purpose, which would be misleading in my opinion as R9’s quoted response seemed to suggest otherwise.

The authors may wish to clarify and/or revise accordingly.

3. p.13, under the Discussion section: The authors may need to expound further on the sentence “This trend was not only observed among the participants in this study but also occurred elsewhere.” The specific word “elsewhere” is vague, and here the discussion may be enriched with specific examples and/or citations to explicitly engage with the literature – either for similarly vulnerable adolescents within the Asian Pacific context or other sociocultural contexts.

Minor comments:

- The second sentence under the Methods section is a repeat of the first.

- There seems to be a typo in the second sentence of Strengths and Limitations: “we were able to capture”?

- If relevant, the authors may consider adding interview guidelines and/or structure as supplementary materials.

Reviewer #2:  Critical points and suggestions for improvement of the manuscript.

Introduction

1. The introduction does not clearly establish the novelty of the study. It would benefit from a more detailed explanation of how this study fills a specific gap in the existing literature on adolescents' coping strategies in Malaysia or similar settings.

2. The rationale for focusing on adolescents in Malaysia's People’s Housing Project (PPR) during the COVID-19 pandemic is inadequately explored. There's a need for more specific data or previous studies that highlight unique issues faced by this demographic that warrant this research.

Methods

4. The purposive sampling method is described but lacks a detailed justification for why this method ensures a representative sample of the adolescent population in the PPRs, potentially biasing the results.

5. The article mentions a semi-structured interview guide based on specific theories but fails to provide enough detail about the questions asked. This omission limits the replicability of the study.

6. While the study obtained ethics approval and parental consent, it does not discuss how it addressed potential emotional distress caused to participants discussing their coping strategies and mental health, which is crucial given the sensitive nature of the subject.

Results

7. The results section provides an aggregate view but lacks a detailed demographic breakdown that could reveal important patterns or differences in coping strategies among different age groups or between genders.

8. The claim of data saturation is made after 42 interviews, but there is no explanation of how this was determined or why additional interviews were conducted if saturation was achieved.

Discussion

9. The discussion does not adequately compare the study’s findings with existing research. For instance, how do the maladaptive strategies identified align or differ from those found in other cultural or socioeconomic settings?

10. The discussion makes broad generalizations about the prevalence of psychological distress and coping strategies among adolescents without considering the limitations inherent in qualitative research, such as the lack of generalizability.

11. The discussion does not address the methodological limitations, such as potential biases in self-reporting and the impact of the interviewer’s presence on participants' responses.

Conclusion

12. The conclusion emphasizes the need for interventions without a critical examination of the practical challenges or potential barriers in implementing such programs in the PPR context.

13. The paper does not suggest areas for future research or how subsequent studies could overcome the limitations identified in this study.

14. While the study aims to inform policy, it provides vague recommendations for policymakers without concrete steps or consideration of policy implementation challenges.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-23-42611R1Noteworthy trends in maladaptive coping strategies and hindrances to help-seeking behaviour among adolescents living in Malaysia's People’s Housing Project (PPR) during the COVID-19 pandemic: a qualitative studyPLOS ONE

Dear Dr. Subramaniam,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Dec 29 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Adobea Yaa Owusu, MA, PhD, MPH

Academic Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

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Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I thank the authors for addressing all my earlier comments in the revised manuscript. My concerns have been thoroughly addressed and I am of the opinion that the strengthened manuscript is ready for publication.

Reviewer #3: Reviewer report on noteworthy trends in maladaptive coping strategies and hindrances to help-seeking behaviour among adolescents living in Malaysia's People’s Housing Project (PPR) during the COVID-19 pandemic: qualitative study

1. Abstract

1. Clarity and Structure: The abstract could benefit from clearer wording, particularly in describing the research question and the study's significance. Opening with a concise statement on the specific challenges faced by adolescents in Malaysia’s People’s Housing Project (PPR) communities due to the COVID-19 pandemic would improve focus.

2. Relevance of the Research Question: Adding a sentence on why this study is particularly relevant to PPR communities in Malaysia would strengthen the justification and make the abstract more compelling.

3. Methods: Consider adding a phrase on the sample size (e.g., number of participants) and the specific methods used (e.g., semi-structured interviews), as this provides readers with a clearer understanding of the study's scope.

4. Results :To improve clarity, specify some of the maladaptive coping strategies and barriers identified (e.g., avoidance, lack of trust in mental health services). Including one or two specific examples would make the findings more tangible for the reader.

5. Conclusions and Implications: Strengthen the conclusion by mentioning potential implications for policy or practice. For example, a brief statement about how this research could inform mental health interventions tailored to disadvantaged communities would make the abstract more impactful.

2. Introduction

• To strengthen the relevance, consider providing a brief overview of the unique characteristics of the PPR communities (e.g., socio-economic constraints, limited access to mental health resources). This would contextualize the challenges faced by adolescents in these settings and reinforce the importance of the study.

• While the authors have referenced international studies on adolescent coping and help-seeking, the literature review could benefit from further discussion of any regional or cultural factors specific to Southeast Asia or Malaysia, which might influence coping strategies and help-seeking behaviors. This would provide additional context for the study’s relevance

• Consider explicitly stating the research question or hypothesis at the end of the introduction. This would give readers a clear understanding of the study’s focus and objectives.

3. Methods

• A more detailed explanation of the coding and analysis process would improve transparency. Specifically, it would be beneficial to describe how coding was conducted (e.g., use of software, independent coding by multiple researchers) and how disagreements were resolved to ensure inter-coder reliability.

• Additionally, mentioning whether the researchers used any form of reflexivity to

minimize bias would strengthen the methodological robustness.

4. Results

• Including some quantitative data, such as the proportion of participants endorsing each coping strategy or barrier, would provide additional context and help quantify the prevalence of specific behaviors.

• Furthermore, a summary table outlining each theme with supporting quotes could enhance the visual presentation of the findings, making the results more accessible to readers.

5. Discussion

• The authors could further expand on how their findings might influence specific public health or educational policies, especially in low-resource settings, and suggest avenues for future research

6. Conclusion

• A brief statement highlighting the potential for community-based mental health programs tailored to the PPR context would provide a forward-looking end to the paper, emphasizing actionable insights that policymakers and practitioners can take from this research.

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Reviewer #1: No

Reviewer #3: Yes:  Martina Mchenga

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PONE-D-23-42611R2Noteworthy trends in maladaptive coping strategies and hindrances to help-seeking behaviour among adolescents living in Malaysia's People’s Housing Project (PPR) during the COVID-19 pandemic: a qualitative studyPLOS ONE

Dear Dr. Subramaniam,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

These are revisions from me the Academic Editor. I see that you have answered all the queries of the last Reviewer, however, the underlisted remain before the paper can be acepted. They are editing tasks and I encourage you to work on them. Thank you.

REVISIONS AUTHOR NEEDS TO WORK ON—MOSTLY  EDITING

FOR THE REVISED SECTIONS

P. 2, line 68: This findings study emphasize the need for

p. 5, Line 144: Additionally, in the context of Asian nations and low and middle income countries, 144 cultural factors such as stigma surrounding mental health issue ( 16), familial support systems 145 (17) and awareness of mental health (18) may further shape adolescents’ coping strategies 146 and help-seeking behaviours. Addressing these cultural significance is critical to 147 understanding and effectively intervening in mental health challenges faces by this 148 population. 149 150 Hence, th

P. 8, line 245: coding framework. Within these discussions, the research team also identified and incorporated (YOU OMITTED ‘THE’)

FOR THE ORIGINAL SECTIONS THAT WERE NOT REVISED

P. 22, line 612: provide objective outcomes which can further limits the generalizability of current findings (SHOULD BE ‘LIMIT’)

P. 22, line 617: Secondly, the presence of the researcher and counsellor during the (OMISSION HERE) may affect

P. 22, line 618: participants’ responses which may leading to biased results (SOMETHING IS NOT RIGHT WITH ‘MAY LEADING’….

Please submit your revised manuscript by Feb 17 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Adobea Yaa Owusu, MA, PhD, MPH

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

None

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Reviewers' comments:

NONE

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Noteworthy trends in maladaptive coping strategies and hindrances to help-seeking behaviour among adolescents living in Malaysia's People’s Housing Project (PPR) during the COVID-19 pandemic: a qualitative study

PONE-D-23-42611R3

Dear Dr. Subramaniam,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Adobea Yaa Owusu, MA, PhD, MPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

None

Reviewers' comments:

None