Body image, obesity, and sexual coercion: Impacts on depression among students at a Nigerian university

Oluwasegun Akinyemi; Olajumoke Kemi Ekundayo; Mojisola Fasokun; Fadeke Ogunyankin; Oghenekaro Samuel Ifoto; Oluwaferanmi Deborah Alatise; Oluebubechukwu Eze; Muyiwa Sunday Okusami; Kakra Hughes; Miriam Michael; Akinola Akinmade

doi:10.1371/journal.pone.0319308

Peer Review History

Original SubmissionJanuary 30, 2025
30 Jan 2025 Author Response https://doi.org/10.1371/journal.pone.0319308.r001
27 Mar 2025 Decision Letter - Patrick Okonta, Editor Dear Dr. Eze, 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. ACADEMIC EDITOR: Thank you for submitting your manuscript to the Plos One journal for review and possible publication. Kindly respond to the comments of the 2 reviewers. Furthermore address this points also. 1. This is a quantitative cross sectional study. The authors stated in the methodology as follows, " Participants were selected using stratified random sampling, with strata defined by academic year and faculty. This approach ensued a proportional representation of the students from different academic levels and discipline". In furtherance to this statement, I would like the authors to demonstrate this by adding this characteristics of the sample in the Table 1 showing baseline characteristics of study population. 2. Since the study topic is quite sensitive, the authors should provide further details on a) How and where the participants where recruited b) How the filled questionnaires were collected to ensure confidentiality and anonymity. Please submit your revised manuscript by May 11 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. 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'. 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Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: This study presents valuable contributions to the literature. It offers important new findings on body image, obesity, sexual cohesion, and depression among Nigerian university students. The research is novel. With the suggested revisions, I believe this manuscript is a significant addition to the field. My comments: Introduction: “These challenges are particularly relevant in university settings, where social comparison and peer influence are prevalent.” -it may be good to include citations and evidence of the extent and effect of this peer influence in university if possible Introduction: “In university populations, the prevalence of IPV is substantial, and its psychological and academic consequences are profound” -please include the reported prevalence of IPV in the literature Methods: “The study was conducted over a one-month period from September 20, 2024, to October 21, 2024, at Afe Babalola University, a private university in Nigeria” -Nigeria is a large capture area, it should be noted by the authors which region the school is situated in Nigeria, and other demographic characteristics such as whether the school is situated in an rural/urban setting, etc Methods: “Data Collection: Data was collected using a structured, self-administered questionnaire. The questionnaire consisted of validated scales to measure the primary outcomes and explanatory variables:” -in this section, please include for each how the scales were scored, what higher scores represent, the number of questions in each scale, and some examples questions. Cronbach’s alpha should also be included if possible. For instance: “Depression: Assessed using the Patient Health Questionnaire-9 (PHQ-9), a widely used tool for measuring depressive symptoms. The PHQ-9 consists of nine items, each scored on a 4-point Likert scale ranging from 0 ("Not at all") to 3 ("Nearly every day"). Total scores range from 0 to 27, with higher scores indicating greater severity of depressive symptoms. Example item: "Over the last two weeks, how often have you felt little interest or pleasure in doing things?"” Methods: “Confounding Variables: The following variables were included as potential confounders in the analysis:” -please go into more detail in how exactly these were defined and used as confounders in the analysis Results: “Academic performance, measured by CGPA” -please expand and then add abbreviations in brackets Results: “Students with low body image concerns also (the reference group) reported an adjusted incidence of depression of 26.4% (Coef. = 0.2642, 95% CI: 0.2045–0.3239, p” -It is unclear what the brackets “(the reference group)” is supposed to reflect. I think it may be placed in the wrong position in the sentence Methods -there does not appear to be data reported on how many questionnaires were sent out and what percent of those, or how many, were completed. This information must be included and should be at the start of the methods section where demographic characteristics are described. Reviewer #2: This is an interesting article exploring a grossly understudied subject in Nigeria. 1. As the authors pointed out, this study was carried out in one university though the title may suggest otherwise. First impression from reading the title would be that several institutions were sampled. I would suggest that the title be edited to reflect that the study was done in ONE Nigerian University 2. The tables are clear and easy to read. I would have suggested that some tables be merged but I worry that it doing so could detract from the clarity of your message. 3. The university in this study is a private institution and the generalizability of the results to both private and public institutions in Nigeria could be challenged given the probabilty of differing socioeconomic variables though it is helpful that some of these were noted as confounders. However, this study does an excellent job of generating awareness of psychosocial determinants of mental health in the student population of LMICs like Nigeria with a large population of young people. Overall, I would say this is a very useful scholarly publication and look forward to reading more of these articles in future. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No Reviewer #2: No ******** [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. https://doi.org/10.1371/journal.pone.0319308.r002
Revision 1
4 May 2025 Author Response Response to Academic Editor – Manuscript ID: PONE-D-25-05094 Title: Body Image, Obesity, and Sexual Cohesion: Impacts on Depression among Nigerian University Students Dear Academic Editor, We sincerely thank you for your valuable feedback and for the opportunity to revise our manuscript. Below, we provide detailed responses to your comments and describe the corresponding revisions made to the manuscript. Editorial Comments: 1. Comment: "The authors stated in the methodology as follows, 'Participants were selected using stratified random sampling, with strata defined by academic year and faculty. This approach ensured a proportional representation of the students from different academic levels and discipline.' In furtherance to this statement, I would like the authors to demonstrate this by adding this characteristic of the sample in Table 1 showing baseline characteristics of study population." Response: We appreciate this suggestion. We have included two tables as supplementary files reflecting the stratification by academic year and faculty. This addition demonstrates the proportional representation across different academic levels and disciplines, as described in our methodology. The added tables provides a more comprehensive overview of the baseline characteristics of our study population. 2. Comment: "Since the study topic is quite sensitive, the authors should provide further details on: a) How and where the participants were recruited b) How the filled questionnaires were collected to ensure confidentiality and anonymity." Response: Thank you for highlighting the need for further clarity regarding participant recruitment and data collection procedures. We have expanded the 'Study Setting and Population' and 'Data Collection' sections of the Methodology to address these points: a) Recruitment Process: We have clarified that participants were recruited through announcements made in lecture halls, student email lists, and campus notice boards. Recruitment was conducted in collaboration with faculty representatives to ensure voluntary participation across all strata. b) Collection of Questionnaires: We have specified that completed questionnaires were deposited anonymously into sealed drop boxes placed at designated locations within the university (e.g., faculty offices and the student affairs building). This process was designed to maintain confidentiality and anonymity. Additionally, research assistants were available to guide participants but were not present during questionnaire completion to further ensure privacy. Reviewer #1: “This study presents valuable contributions... With the suggested revisions, I believe this manuscript is a significant addition to the field.” We are grateful for your encouraging comments and insightful suggestions. Please find our detailed responses below: 1. Introduction – Peer Influence Citation: “...include citations and evidence of the extent and effect of this peer influence in university if possible.” Response: We have added relevant citations to support the statement regarding peer influence and social comparison in university settings. The revised sentence now reads: “These challenges are particularly relevant in university settings, where social comparison and peer influence significantly impact students' body image and mental health, with studies reporting that peer pressure and appearance-based comparisons are strongly linked to body dissatisfaction and depressive symptoms among students(21, 22).” 2. Introduction – Prevalence of IPV: “...please include the reported prevalence of IPV in the literature.” Response: We have incorporated data on IPV prevalence within university populations. The sentence now states: “In university populations, the prevalence of IPV ranges from 20% to 30%, with profound psychological and academic consequences, particularly among female students(23-27).” 3. Methods – Specify University Region and Setting: “...note which region the school is situated in Nigeria, and whether it is a rural/urban setting.” Response: We have clarified that Afe Babalola University is located in Ado-Ekiti, Southwestern Nigeria, and is situated in an urban setting. This information has been added to the Study Setting and Population section. 4. Methods – Details on Scales Used: “...include how the scales were scored, number of items, example questions, and Cronbach’s alpha.” Response: We have expanded the Data Collection section to include detailed descriptions of each scale, including scoring systems, number of items, example questions, and Cronbach’s alpha where available. For example: “Depression: Assessed using the Patient Health Questionnaire-9 (PHQ-9)(39), consisting of 9 items scored on a 4-point Likert scale (0 = "Not at all" to 3 = "Nearly every day"). Total scores range from 0 to 27, with higher scores indicating greater depressive severity. Example item: “Over the last two weeks, how often have you felt little interest or pleasure in doing things?” (Cronbach’s alpha = 0.85).’” Similar details were added for all other scales. 5. Methods – Confounding Variables Definition: “...go into more detail on how these were defined and used as confounders.” Response: We have provided detailed definitions for each confounding variable and clarified that they were incorporated into the inverse probability weighting (IPW) models to adjust for potential biases. 6. Results – Clarify CGPA: “...expand and then add abbreviations in brackets.” Response: We revised the sentence to read: “Academic performance, measured by Cumulative Grade Point Average (CGPA), was...” 7. Results – Clarify ‘Reference Group’ Placement: “It is unclear what the brackets ‘(the reference group)’ is supposed to reflect.” Response: Thank you for pointing this out. We have repositioned the phrase for clarity. The revised sentence now reads: “Students with low body image concerns (reference group) reported an adjusted incidence of depression of 26.4%...” 8. Methods – Report Response Rate: “...include how many questionnaires were sent out and what percent were completed.” Response: We have added this information at the beginning of the Methods section: “A total of 550 questionnaires were distributed, and 501 were completed and returned, yielding a response rate of 91.1%.” Reviewer #2: “This is an interesting article exploring a grossly understudied subject in Nigeria...” We appreciate your positive feedback and thoughtful comments. Please find our responses below: 1. Title Clarification: “...suggest that the title be edited to reflect that the study was done in ONE Nigerian University.” Response: We agree and have revised the title to: “Body Image, Obesity, and Sexual Cohesion: Impacts on Depression among Students at a Nigerian University” This reflects the single-institution focus more accurately. 2. Tables – Comment on Clarity: “I would have suggested that some tables be merged but... clarity of your message.” Response: We appreciate your acknowledgment of the clarity of the tables. We have opted to retain the current table structure to preserve readability and ensure that each psychosocial factor is distinctly presented. 3. Generalizability Concern: “...the generalizability of the results to both private and public institutions...” Response: We have addressed this in the Limitations section by explicitly noting that the findings are based on data from a private university and may not fully represent public university settings due to potential socioeconomic differences. However, we also emphasized the value of this study in generating awareness and serving as a foundation for future multi-institutional research. We thank both reviewers again for their valuable insights, which have greatly improved the quality of our manuscript. Attachments Attachment Submitted filename: Response to Reviewers1.docx https://doi.org/10.1371/journal.pone.0319308.r003
20 May 2025 Decision Letter - Patrick Okonta, Editor Body Image, Obesity, and Sexual Cohesion: Impacts on Depression among Students at a Nigerian University. PONE-D-25-05094R1 Dear Dr. Eze, 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. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. 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, Patrick Ifeanyi Okonta, MBBCh, MPH, FWACS, FMCOG, MD, DRH Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: (No Response) ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No ******** https://doi.org/10.1371/journal.pone.0319308.r004
Formally Accepted
Acceptance Letter - Patrick Okonta, Editor PONE-D-25-05094R1 PLOS ONE Dear Dr. Eze, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Patrick Ifeanyi Okonta Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0319308.r005

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