Effects of childhood trauma on mental health outcomes, suicide risk factors and stress appraisals in adulthood

Leizhi Wang; Chris Keyworth; Daryl B. O'Connor

doi:10.1371/journal.pone.0326120

Peer Review History

Original SubmissionMarch 7, 2025
7 Mar 2025 Author Response https://doi.org/10.1371/journal.pone.0326120.r001
16 Apr 2025 Decision Letter - Marianna Mazza, Editor Dear Dr. WANG, 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 May 31 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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Additional Editor Comments (if provided): [Note: HTML markup is below. 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: The manuscript was clearly written and well presented. the analyses was rigorous and adequate and the results was well presented. The study provides robust insight into the impact of childhood trauma on mental outcomes, suicidal risks and stress in later life. Question for the authors: What informed the choice of one week between session 1 and session 2? Reviewer #2: Abstract Lines 33–37 "The current study sought to: (1) investigate whether childhood trauma was associated to mental health outcomes (depression, anxiety), suicide risk factors (defeat, entrapment), and stress related outcomes (stress appraisal, perceived stress) in adulthood and (2) explore the indirect effects of childhood trauma on mental health outcomes and suicide risk factors through stress appraisal and perceived stress." Clearly defines two aims. Suggested revision for conciseness and grammar: "...associated with mental health outcomes..." (Correct "associated to" → "associated with") Line 38–41 "273 participants were recruited to online prospective study that consist of two sessions with one week interval. In session 1, the childhood trauma questionnaire was completed. In session 2, participants completed measures the level of depression, anxiety, defeat, entrapment, stress appraisal and perceived stress over the preceding week." Needs grammatical fixes: "to an online prospective study" "that consisted of two sessions" "participants completed measures assessing the level of..." Introduction Summary of Strengths �Well-organized and thorough. �Cites foundational and recent literature. �Clearly identifies research gaps. �Introduces relevant theories (IMV model, transactional model). �Logical flow from general to specific. Areas for Improvement Line Issue Suggestion 94 Wordiness Reword to improve clarity: "how individuals appraise daily stressors" 101 Diction Replace "quotidian" with "everyday" unless required by journal style 136 Grammar "remain" → "remained" 140–146 Readability Consider using bullet points or shorter sentences to list the study aims METHOD Strengths Summary �Clear structure and well-defined procedure. �Ethical and transparent throughout. �Inclusion/exclusion criteria and compensation are well explained. �Pre-registration and REC approval enhance scientific credibility. Suggestions Summary Line Issue Suggestion 149 Formality Replace "&" with “and” in subheading. 153 Clarity Consider simplifying "lifetime history of suicide-related behaviours". Discussion Overall Strengths �Well-organized and comprehensive. �Strong alignment with theoretical frameworks (e.g., IMV model, transactional stress model). �Integrates prior studies effectively. �Addresses both direct and indirect effects with nuance. Areas for Improvement Line Issue Suggested Revision 340 Placement of statistical control variables Move “controlling for age and sex” to methods/results 347 Grammar “Findings from current study are consistent...” 351 Phrasing “associated to” → “associated with” 357 Awkward phrasing “Worthy noticing” → “worth noting” 364 Diction “happened in early life” → “experienced in early life” 375 Typo “stres” → “stress” 386 Grammar “shown” → “showed” 394 Verb form “investigate” → “investigating” 396 Subject-verb agreement “have long term effect” → “has long-term effects” Implications Overall Strengths �Effectively links findings to real-world clinical applications. �Clearly grounded in evidence-based therapy, especially CBT. �Highlights mechanisms (stress appraisal) that can be targeted in intervention. Suggested Revisions Summary Line Issue Suggested Fix 398 Redundancy “may have implications for potential interventions” → simplify 399–400 Grammar “target at stress appraisals” → “targeting stress appraisals” 403 Awkward phrasing “life events' outcomes” → “outcomes of life events” 405 Vague reference Specify “this” more clearly 410 Citation clarity Integrate citation into sentence more smoothly 413 Grammar “core of CBT on” → “core focus of CBT is on” Overall Strengths Clear acknowledgment of sample and design limitations. Well-structured recommendations for future research. Highlights mediating mechanisms and theoretical contributions. Suggestions are realistic, thoughtful, and grounded in current trends (e.g., diary methods, thematic analysis). Suggested Revisions Summary Line Issue Suggested Fix 420 Missing article “current sample” → “the current sample” 421 Clarity Rephrase to clarify screening and inclusion 429 Typo Remove duplicate “the” 437 Grammar/clarity “information on undergoing treatment” → “participants’ treatment status” 445 Repetition Combine/simplify stress appraisal discussion ****** 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: Yes: Yetunde Adeniyi Reviewer #2: Yes: Dr. Kwabena Acheampong ******** [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 Attachments Attachment Submitted filename: Reviewer.docx https://doi.org/10.1371/journal.pone.0326120.r002
Revision 1
20 May 2025 Author Response Dear Dr Acheampong, Thank you for the feedback on the above paper and for the opportunity to submit a revision for further consideration. We have responded to all of the suggestions and we feel that the manuscript is now substantially improved. We hope that you will agree that we have been able to satisfactorily address the comments or provide justification where an alternative approach is taken and that you feel the manuscript is suitable for publication in PLOS ONE. Of course, we are very happy to respond to any further comments. The details of how we have addressed the specific issues raised are below and highlighted in yellow in the manuscript. PONE-D-25-11717 Reviewer #1: The manuscript was clearly written and well presented. the analyses was rigorous and adequate and the results was well presented. The study provides robust insight into the impact of childhood trauma on mental outcomes, suicidal risks and stress in later life RESPONSE: We thank the reviewer for this positive comments. Reviewer #2 Question for the authors: What informed the choice of one week between session 1 and session 2? RESPONSE: Thanks for your question. We adopted a 1-week prospective design because we wanted to ensure that our assessment of childhood trauma was separated in time from the outcomes variables to help ensure completion of this measure did not contaminate the completion of the other measures as well as allowing us to more robustly test our predictions. One week was chosen specifically because we wanted to reduce the length of time commitment involved in taking part in the study, as our previous experience has indicated that having 7 days between timepoints helps to reduce drop-out. Abstract Lines 33–37 "The current study sought to: (1) investigate whether childhood trauma was associated to mental health outcomes (depression, anxiety), suicide risk factors (defeat, entrapment), and stress related outcomes (stress appraisal, perceived stress) in adulthood and (2) explore the indirect effects of childhood trauma on mental health outcomes and suicide risk factors through stress appraisal and perceived stress." Clearly defines two aims. Suggested revision for conciseness and grammar: "...associated with mental health outcomes..." (Correct "associated to" → "associated with") RESPONSE: As suggested, we have revised the aim to improve conciseness and grammar. Please refer to p. 3. Line 38–41 "273 participants were recruited to online prospective study that consist of two sessions with one week interval. In session 1, the childhood trauma questionnaire was completed. In session 2, participants completed measures the level of depression, anxiety, defeat, entrapment, stress appraisal and perceived stress over the preceding week." Needs grammatical fixes: "to an online prospective study" "that consisted of two sessions" "participants completed measures assessing the level of..." RESPONSE: Thank you very much for pointing this out. We have corrected the grammatical errors mentioned above (see p. 3). Introduction Summary of Strengths � Well-organized and thorough. � Cites foundational and recent literature. � Clearly identifies research gaps. � Introduces relevant theories (IMV model, transactional model). � Logical flow from general to specific. RESPONSE: Thank you for your positive comments. Areas for Improvement Line Issue Suggestion 94 Wordiness Reword to improve clarity: "how individuals appraise daily stressors" 101 Diction Replace "quotidian" with "everyday" unless required by journal style 136 Grammar "remain" → "remained" 140–146 Readability Consider using bullet points or shorter sentences to list the study aims RESPONSE: Thank you very much for your suggestions. We have corrected the grammatical issues you identified, replaced “quotidian” with “everyday” in line 101, and rewritten lines 94 and 140–146 to improve clarity and conciseness. Please see p. 6 & 8. METHOD Strengths Summary � Clear structure and well-defined procedure. � Ethical and transparent throughout. � Inclusion/exclusion criteria and compensation are well explained. � Pre-registration and REC approval enhance scientific credibility. RESPONSE�Thank you for your positive comments. Suggestions Summary Line Issue Suggestion 149 Formality Replace "&" with “and” in subheading. 153 Clarity Consider simplifying "lifetime history of suicide-related behaviours". RESPONSE: Thank you very much for highlighting this issue. We have now addressed the problem—please see p. 9. Discussion Overall Strengths � Well-organized and comprehensive. � Strong alignment with theoretical frameworks (e.g., IMV model, transactional stress model). � Integrates prior studies effectively. � Addresses both direct and indirect effects with nuance. RESPONSE�Thank you for your positive comments. Areas for Improvement Line Issue Suggested Revision 340 Placement of statistical control variables Move “controlling for age and sex” to methods/results 347 Grammar “Findings from current study are consistent...” 351 Phrasing “associated to” → “associated with” 357 Awkward phrasing “Worthy noticing” → “worth noting” 364 Diction “happened in early life” → “experienced in early life” 375 Typo “stres” → “stress” 386 Grammar “shown” → “showed” 394 Verb form “investigate” → “investigating” 396 Subject-verb agreement “have long term effect” → “has long-term effects” RESPONSE: Thank you very much for highlighting theseareas for improvement. We have implemented all the suggested changes. Please see p. 21-24. Implications Overall Strengths � Effectively links findings to real-world clinical applications. � Clearly grounded in evidence-based therapy, especially CBT. � Highlights mechanisms (stress appraisal) that can be targeted in intervention. RESPONSE�Thank you for your positive comments. Suggested Revisions Summary Line Issue Suggested Fix 398 Redundancy “may have implications for potential interventions” → simplify 399–400 Grammar “target at stress appraisals” → “targeting stress appraisals” 403 Awkward phrasing “life events' outcomes” → “outcomes of life events” 405 Vague reference Specify “this” more clearly 410 Citation clarity Integrate citation into sentence more smoothly 413 Grammar “core of CBT on” → “core focus of CBT is on” RESPONSE: Thank you for your helpful suggestions. We have corrected the grammatical errors and awkward phrasing you identified. The section on CBT (lines 412–416) has been rewritten to integrate the citations more smoothly, and the wording at lines 401 and 408 has been revised for greater clarity. Please refer to p. 24 for the detailed changes. Overall Strengths Clear acknowledgment of sample and design limitations. Well-structured recommendations for future research. Highlights mediating mechanisms and theoretical contributions. Suggestions are realistic, thoughtful, and grounded in current trends (e.g., diary methods, thematic analysis). RESPONSE�Thank you for your positive comments. Suggested Revisions Summary Line Issue Suggested Fix 420 Missing article “current sample” → “the current sample” 421 Clarity Rephrase to clarify screening and inclusion 429 Typo Remove duplicate “the” 437 Grammar/clarity “information on undergoing treatment” → “participants’ treatment status” 445 Repetition Combine/simplify stress appraisal discussion RESPONSE: Thank you very much for your suggestions. We have corrected the grammatical and spelling errors you noted, including missing articles and typographical mistakes. In addition, we have rephrased the discussion of limitations concerning the screening and inclusion criteria (lines 423–427) to improve clarity. Finally, we have revised the summary of the stress-appraisal findings (lines 444–447) to make it more concise and straightforward. Please see pp. 25–26. Overall Remarks This article provides a thoughtful and empirically grounded exploration of the long-term psychological consequences of childhood trauma, with a particular focus on how stress appraisal and perceived stress mediate its effects on mental health and suicide risk factors. The study is timely, well-structured, and contributes meaningfully to the growing body of literature examining the cognitive and affective mechanisms linking early adversity to adult psychopathology. The use of a two-session prospective design, inclusion of validated psychometric tools, and attention to both direct and indirect pathways of influence (e.g., via perceived stress and stress appraisals) are notable strengths. The study’s grounding in theoretical frameworks such as the Integrated Motivational-Volitional (IMV) model further strengthens its relevance and interpretative depth. RESPONSE: Thank you so much for your positive comments. However, several methodological limitations reduce the generalizability of the findings. Notably, the lack of clinical screening for participants introduces the risk of confounding due to varying mental health statuses. Moreover, the cross-sectional nature of the stress appraisal measurement limits causal inferences, though the authors commendably suggest future longitudinal and ecological designs. RESPONSE: Thank you for your thoughtful comments. As you have noted—and as we detail in the study’s limitations—this research does have certain constraints. These limitations are explicitly acknowledged and discussed in the Discussion section. We believe they do not materially weaken the findings and will instead contribute meaningfully to the existing literature and prompt further research in this area. The discussion and implications are particularly strong, connecting empirical results to clinical intervention strategies, especially in the context of cognitive-behavioral therapy (CBT). The emphasis on refining CBT to better address maladaptive stress appraisals presents a promising avenue for intervention development. RESPONSE: Thank you so much for your positive comments. The writing is generally clear, though some grammatical errors and awkward phrasings (e.g., repetition, article use, and sentence clarity) slightly detract from the professional tone. These could be easily corrected with careful proofreading. RESPONSE: Thank you very much for all your suggestions on grammar and phrasing. We have incorporated every comment, and have made additional edits throughout to improve the sentence clarify and grammar. We are confident that the revised manuscript is now substantially improved. Attachments Attachment Submitted filename: Response to Reviewer.docx https://doi.org/10.1371/journal.pone.0326120.r003
25 May 2025 Decision Letter - Marianna Mazza, Editor Effects of childhood trauma on mental health outcomes, suicide risk factors and stress appraisals in adulthood PONE-D-25-11717R1 Dear Dr. WANG, 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, Marianna Mazza Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0326120.r004
Formally Accepted
Acceptance Letter - Marianna Mazza, Editor PONE-D-25-11717R1 PLOS ONE Dear Dr. WANG, 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 Dr. Marianna Mazza Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0326120.r005

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