PONE-D-24-07224Prevalence and associated factors of depression among adult refugees in East Africa: A protocol for systematic review and meta-analysisPLOS ONE

Dear Dr. Shibeshi,

I sincerely appreciate you submitting your important manuscript to PLOS One. It was a pleasure reading and learning about your work and finding scholarly merit and practical relevance in it. However, I believe it will benefit from improved quality and readability, taking into consideration the reviewers' suggestions and concerns before being accepted for publication in this journal. Please carefully review and respond to the reviewer's feedback for our further consideration and decision. 

Please submit your revised manuscript by Jan 06 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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We look forward to receiving your revised manuscript.

Kind regards,

Sharada P Wasti, MSc, PhD

Academic Editor

PLOS ONE

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2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed:

- https://pubmed.ncbi.nlm.nih.gov/37181276/

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

3. When completing the data availability statement of the submission form, you indicated that you will make your data available on acceptance. We strongly recommend all authors decide on a data sharing plan before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire data will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process.

4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 #2: 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 #2: No

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 and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Comments to the Authors;

Thank you for the opportunity to review the manuscript titled “Prevalence and associated factors of depression among 1 adult refugees in East Africa: A protocol for systematic review and meta-analysis.”

Overall,

Depression is a significant issue among adult refugees in Africa, as they often face a multitude of stressors and hardships that can contribute to the development of mental health concerns. Refugees are often forced to flee their homes due to violence, persecution, or other traumatic events, which can lead to feelings of helplessness, fear, and loss. However, mental health services for refugees in East Africa are often limited, leading many to suffer in silence without adequate support or treatment.

It is crucial for organizations, governments, and healthcare providers to prioritize mental health support for refugees in Africa, as addressing depression and other mental health concerns can improve their overall well-being and help them to better cope with the challenges they face. Providing access to mental health services, psychosocial support, and community resources can help refugees to heal from their trauma and build resilience as they navigate their new lives.

I hope there are chances to more strengthen this manuscript. Here are the comments to be addressed by the authors.

1. Abstract

- Line 19, say the aim of this study is to……

- write as Materials and Methods through the manuscript

- Please replace the word reviewers by researchers through manuscript.

- Line 32-33 the statement, for determinants of depression an effect size with a 95% confidence interval will be analyzed. Say will be reported.

2. Introduction

- From Line 49-56 the idea in the paragraph needs the appropriate citation and should be cited?

- Please cite the idea from Line 103-105?

- The paragraph from line 108-115 looks unclear and please modify the paragraph as such in accordance to the rationale for this study,or remove it?

- The last paragraph of the introduction looks ambiguous, please modify the last paragraph of the introduction by incorporating the research gaps, and aim of this systematic review and meta analysis?

-Please modify the objective of this study as general and specific forms? Note that your research question shuld be inline with your specific objective.

- Please modify the second specific objective by

Summarizing associated factors and their effect size among adult refugees in East Africa.

3. Materials and Methods

- Well written

-Please modify the Materials and Methods section as:

This systematic review and meta analysis will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA-P) statement. The protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO registration number: CRD42024496728. The PRISMA flow chart for reporting systematic review and meta-analysis is presented in figure 1.

-In the eligibility criteria, the best way to organize the search terms for the study is the CoCoPop criteria (condition, context, and population). However, the authors should mention this criteria and modify the inclusion criteria.

-Peasemerge the CoCoPop criteria in the inclusion criteria

- Next to the eligibility criterias please add the subtitle Outcome measeres and describe the autcomes of this systematic review and meta analysis in detail?

-In the search stratagy pease provide the full proposed search stratagy for all proposed databases?

- Subgroup analyses and meta-regressions will be performed to examine sources of heterogeneity. In relation to this study what are the proposed variables for Subgroup analyses and meta-regressions, please mention?

4. Discussion

- Please modify the discussion part as such, containing detailed description of the research question and objectives, the justification for conducting the review, a summary of the existing literature on the topic, and an explanation of the methods that will be used to select and analyze studies for inclusion in the review. Moreover, the discussion section may also discuss any potential limitations or biases in the review process, as well as how the findings of the review will be interpreted and disseminated?

-Modify the strength an and limitation, For instance,

Tthe stetments about publicatuin bias will be performrd by two authors is not the strength,

Also the absence of meta analysis study is not the limitation of this study, please modify accordingly?

5. References

- Well written

-Make sure that all cited souces are in their appropriate and supporting ideas.

- General Comments

-The authors should modify the format of this protocol according to the PLOS ONE guideline i.e INTRODUCTION, MATERIALS AND METHODS and DISCUSSION.

- The author should check typo and gramarsin order to increase the quality of the manuscript.

Reviewer #2: Title: Prevalence and associated factors of depression among adult refugees in East Africa: A protocol for systematic review and meta-analysis.

I would like to thank you the editor to give me the opportunity to review this interested protocol which focused on the unusual/refugee settings. I hope the review protocol will help to design strategies for the improvement of the health of refugees particularly in the settings with natural and man-made catastrophes. Here below are some of my comments.

Abstract

Line 23--- I think web of sciences needs institutional subscription to access the advanced search with full features. I was wondering how you could access it.

Line 25---- Google Scholar isn’t databases rather it’s a search engine. Thus, it’s better to write it separately.

In line 30---- “…...The meta-analysis will be conducted using a random-effects model.” How the authors determine the model before heterogeneity assessment?

Line 32----Why the authors prefer Egger’s test rather than Begg’s test? Or Why not both?

Background

The background section is too long. Could the authors make more smart, short and precise background to show the problem for readers in the study area? Most of the ideas are redundant and can be merged. Additionally, the order of paragraphs in this section seems somewhat disorganized (It will be good if the factors come after the prevalence).

Some of the paragraphs are part of methods for example; paragraph 8.

It would be good if the authors include place of the study conducted when they synthesis and compare the previous studies. For example: in line 57 (A recent study in? [10] found…),in line 60, in line 62,…etc.

Line 71----if there is SR and MA of PTSD what will be the contribution/significance of this protocol?

The aim of the study is the prevalence but the authors stated “…understanding how refugees cope with stressors and build resilience can inform impactful mental health interventions and empower individuals”

I can’t find the gap and the significance of the study in the background section.

What is the importance of writing about the ethical issues at the end of the background?

Objective

Line 141 objective is not complete.

Methods

In your PRISMA figure, I don’t recommend to say “reports excluded” because you are still not sure of getting reports in your search.

Line 148—“The reporting 148 flowchart is illustrated in…” is not complete.

In your inclusion criteria in line 153 spelling error “ault” change to “adult”.

In line 157… you already excluded countries out of East Africa in the title. In addition, It’s not clear why the authors exclude the other East African countries such as Eretria, Djibouti, Madagascar...etc.

Line 160---It’s already known in the title (non-refugees are already excluded in the title)

Line 165---Will you use the two mnemonics (CoCoPop and PEO)? If so how and why?

Line 174---As it’s commented in the abstract section “Google Scholar” is not a database rather a search engine.

Publication bias

Line 243---Is there any justification for using the statistical significance p-value 0.10?

Please add risk of bias assessment form

Discussion

Web of sciences is one of the databases that you proposed to use in the abstract whereas contradicted in this section.

It will be good, if the authors merged the similar ideas.

Reviewer #3: Comments to the Authors

The topic “Prevalence and associated factors of depression among adult refugees in East Africa”

is interesting. The manuscript may need to be improved in the following areas:

1) The manuscript repeatedly mentions the study objective, particularly in the Abstract (lines 14-21) and the Introduction (lines 38-50). Concisely restating the objective without repetition will clarify the focus for readers.

2) The introduction mentions the lack of systematic reviews in this area but could further clarify the existing research gap (lines 17-18, 49-50). Expanding on how previous studies are limited such as by geographic scope, lack of consistent diagnostic criteria, or absence of meta-analysis would strengthen the rationale for this review.

3) The inclusion (lines 151-158) and exclusion criteria (lines 159-163) are outlined, but further refinement is suggested. Specifically, explaining the rationale for excluding interventional and qualitative studies would enhance the methodological rigor.

4) The exclusion of EMBASE and Web of Science due to access limitations in Ethiopia (line 252) is a noted limitation, as it may reduce the comprehensiveness of the review. Consider mentioning potential strategies to address this limitation, such as possible collaboration with institutions that have access to these databases.

5) The study emphasis on subgroup analysis is valuable, but more specific examples would add clarity. Identifying potential subgroups, such as geographic regions, gender, or age groups among refugee populations, could enhance the plan’s applicability. The authors briefly address heterogeneity analysis (lines 232-239), but further specifying meta-regression variables for subgroup analysis would justify this methodological choice.

6) The authors intend to use the Joanna Briggs Institute (JBI) checklist for quality assessment (lines 209-216), a commendable approach. However, providing more specific examples for each quality parameter, including definitions for what constitutes high or low quality in this context, would increase transparency. Adding example studies or criteria can enhance the replication potential of this protocol.

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Reviewer #1: Yes: Aragaw Asfaw Hasen

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Comments on protocol on depression among adult refuges.docx

Attachment

Submitted filename: Comments to the Authors PlosOne.docx

PONE-D-24-07224R1Prevalence and associated factors of depression among adult refugees in East Africa: A protocol for systematic review and meta-analysisPLOS ONE

Dear Dr. Shibeshi, 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.

I sincerely appreciate your revision submission of your manuscript as provided by our reviewers to PLOS One. It was a pleasure reading and learning about your work and finding scholarly merit and practical relevance in it. However, I believe it will benefit from improved quality and readability, taking into consideration the following suggestions of both reviewers and the editor to address before being accepted for publication in this journal. Please carefully review and respond for our further consideration and decision. 

​Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Please submit your revised manuscript by Feb 06 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.

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,

Sharada P Wasti, MSc, PhD.

Academic Editor

PLOS ONE

Additional Editor Comments:

Thank you so much for your revision, which you have well addressed to our reviewers suggestions. After carefully reviewing your revised manuscript, I would suggest addressing the following before final approval for the publication in this journal:

a) Could you please keep only review questions and remove lines 85–91 (general objectives and specific objectives), which appear repetitive?

b) Could you edit and make corrections to line 100? Make a section heading: Inclusion and exclusion criteria, and explain your inclusion criteria, i.e., data include from inception to include the month that is missing in line 102, i.e., July 2024?

c) Make clear in lines 106-108 how many countries are in East Africa and accordingly state all countries names in alphabetical order.

d) Lines between 117 and 121 need more clarity, particularly on the “CoCoPop search guide,” which search frameworks need citation to back up this terminology where you can see several other frameworks, i.e., PICO, PCC, PEO, SPICE, SPIDER, and widely used in several systematic review works. So, make this very clear by providing the citation to back up your statement or adopting the widely used framework.

e) In lines 122 to 126, clarify that depression-related factors are secondary results, despite the title implying that both prevalence and associated factors are primary outcomes of this review.

f) Line 127: Keep only the Medline database, which adequately covers PubMed; there is no need to include PubMed with Medline.

g) In line 129, Google Scholar is mentioned as a search resource, which is untrustworthy for systematic review and meta-analysis searches. Replace Google Scholar with the PsycINFO database, which is crucial to your psychological research topic.

h) I would also recommend you keep your search terminologies (Table 1) in the appendix.

[Note: HTML markup is below. Please do not edit.]

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-24-07224R2Prevalence and associated factors of depression among adult refugees in East Africa: A protocol for systematic review and meta-analysisPLOS ONE

Dear Dr. Shibeshi,

Thank you very much for your improved menuscript, which looks to be substantially better; nevertheless, before making a final choice, a few changes and adjustments are necessary to increase the quality of the menuscript:

- Thoroughly review the report, i.e., lines 66 and 91, and edit and maintain the consistency, i.e., line 135 (AHS&AAS) and line 143 (AHS and AAS). So use "and" not "&" in academic writing.

- Line 68 defines first-time use of abbrevation "LGBTQ+"

- Not sure what you intend to state in line 390 is, so thoroughly proofread,

- 26-31 citations are inconsistent and avoid repetition, i.e., 28 and 31,

- Make correction of line 190 after 39 reference full stops,

- Still not corrected and stated the consistency of the use of databases, i.e., line 219 Google Scholar,

- Avoid multiple times defining abbreviations, i.e., line 27, 144, 239 Joanna Briggs Institute (JBI).

Please submit your revised manuscript by 20 January 2025. 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.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• 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,

Sharada P Wasti, Ph.D., MSc

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.

Prevalence and associated factors of depression among adult refugees in East Africa: A protocol for systematic review and meta-analysis

PONE-D-24-07224R3

Dear Abdu Hailu Shibeshi,

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.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter, and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Sharada P Wasti, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you so much for the revised manuscript, which fully addresses all of the comments. I would like to confirm my acceptance for publication in this journal. During proofreading, you must fix the typos on line 130.

Reviewers' comments: