Dear Dr. Adjorlolo,

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.

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Paweł Larionow, Ph.D.

Academic Editor

PLOS ONE

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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

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

Reviewer #1: Yes

Reviewer #2: Yes

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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

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: 1. It is recommended that the discussion section further address cultural differences in the experience of stigma and mental health.

2. It is also suggested that measurement invariance across subgroups (e.g., age or gender) be examined to enhance the generalizability of the findings.

3. Concurrent validity with clinical measures is also recommended for future studies.

4. Overall, this manuscript represents an excellent example of instrument validation in a distinct cultural context and could serve as a valuable regional reference.

Reviewer #2: REVIEW REPORT: Factorial structure of the Patient Health Questionnaire -9(PHQ-9) Generalized Anxiety Disorder-7(GAD-7) and Berger HIV Stigma Scale-Short Form (HSS-SF) among Adolescents living with HIV in Ghana

The paper is a quantitative study entitled ‘Factorial structure of the Patient Health Questionnaire -9(PHQ-9) Generalized Anxiety Disorder-7(GAD-7) and Berger HIV Stigma Scale-Short Form (HSS-SF) among Adolescents living with HIV in Ghana ‘This title is a bit too long. It would be better if the authors avoided abbreviations in the title but have them in the main text.

Abstract

The abstract is well detailed and addresses the main research question. The study addressed one main objective namely; the factor structure, internal consistency, and correlations of the PHQ-9, GAD-7, and HSS-SF among ALHIV in Ghana. This is well captured in the abstract.

Introduction

The introduction and background information are nicely detailed and has clearly identified the gap in the usage of the 3 tools.

Materials and Methods

The study design, setting, exclusion and inclusion criteria are well explained but the sampling procedure is unclear. In line 174-175, the authors should state, out of the total percentage of the required population what percentage was 63 for Atua, 16 for Akuse and 26 for Asesewa. Being a quantitative study it is important to explain how the sample size was arrived at. The scope of the study is well provided and the presentation is consistent throughout the manuscript.

Data collection procedure

This section is detailed and well written.

Data analysis and Results

• The findings that the study produces are very critical but have no implications, and they only need one or two sentences to bring out the implication of each finding so that the study remains in context.

• The manuscript is well written with key subtopics availed. The authors however need to be more analytical in data presentation. The results are presented and not interpreted at all. Making it difficult to make exact meaning. It is always good practice to interpret all findings, this makes it easy to come up with the implications of the findings. The manuscript would be more useful to a broader readership if the authors moved from just providing results to interpreting them and giving the implication as well.

• I tend to think that the authors oversimplified the findings thus inhibiting the deeper message that the subject under study could provide.

• All results presented in tables need some write up to explain the figures rather than simply putting the table and leaving them that way. All tables must have some explanation.

Discussion

On the PHQ-9 the authors propose that it would be beneficial to explore the affective/ cognitive and somatic domains separately (Line 347). How about separating cognitive and affective domains or why do the authors think that cognitive and affective should be studied together in the case of Ghana. Generally, the discussion is good but as a wrap up what was the most common finding of this study and what research gap does it fill? Or what new information came from this study? The discussion section should be improved by linking the study findings to earlier works on the subject area and explaining how the current study complements previous ones.

Limitations

What about the sociocultural influences on the responses of the adolescents? Don’t you think this is a limitation?

Conclusion

The conclusion is good except line 401-402-what did HSS-SF demonstrate? It would be nice to state the findings before indicating that they are not sufficient and acceptable.

References

Well done, only needs uniformity. Choose one style of referencing and use it – do not mix.

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Reviewer #1: No

Reviewer #2: No

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Dear Dr. Adjorlolo,

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.

==============================

M , SD

==============================

Please submit your revised manuscript by Jun 26 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'.
• 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 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,

Paweł Larionow, Ph.D.

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.

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[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

Factorial Structure of the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Berger HIV Stigma Scale-Short Form among Adolescents Living with HIV in Ghana.

PONE-D-25-17680R2

Dear Dr. Adjorlolo,

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,

Paweł Larionow, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: