The influence of social support, physical activity, general psychological distress, and demographic characteristics on self-reported health status among women in Iran

Badriyeh Karami; Shahab Rezaeian; Ebrahim Shakiba; Amirhossien Naghibzadeh; Abbas Mohammad Karimi Mazhin; Masoumeh Malek; Hadi Darvishigilan

doi:10.1371/journal.pone.0343015

Peer Review History

Original SubmissionSeptember 14, 2025
9 Oct 2025 Decision Letter - Zahra Lorigooini, Editor Dear Dr. Darvishigilan, 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: After reviewing the editorial, I found that the study topic is relevant; however, several important issues need to be addressed before further consideration. Foremost, although an ethics code (IR.KUMS.REC.1403.078) is provided, there is no IRCT registration number. Please clarify it. Next, the statistical analysis needs to be revised and clarified. The logistic regression model lacks information on variable selection, control for confounders, assumption testing (normality, multiple collinearity), and goodness-of-fit assessment. Confidence intervals for several odds ratios are missing, and the SRH duality needs to be justified. 3rd, please confirm obviously that the study population and dataset are completely independent of the population used in your previously published article in Scientific Reports (2025; DOI: 10.1038/s41598-024-79835-9) Lastly, the manuscript requires significant improvements in language and formatting, including the correction of grammatical errors, consistent verb tense usage, and proper reference formatting. Please review the manuscript in its entirety and provide a detailed and point-by-point response. The revised version will be reevaluated for compliance with PLOS ONE's guidelines to be processed by reviewers. Please submit your revised manuscript by Nov 23 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 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, Zahra Lorigooini Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. 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. 3. 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 move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [Note: HTML markup is below. Please do not edit.] 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.0343015.r001
Revision 1
15 Oct 2025 Author Response Dear editorial board of Journal of Plos One Thanks for providing the comments of the respectful reviewer to us. We tried to revise the manuscript, titled “The Influence of Social Support, Physical Activity, psychological problems, and Demographic Characteristics on Self-Reported Health Status among Women” based on the comments and respond it in the following table. Revisions has been shown as highlight in the manuscript. Hope the revisions are satisfactory now. However, we welcome any further constructive comments if required. Dr. Hadi Darvishigilan Corresponding author Comments Response 1. Foremost, although an ethics code (IR.KUMS.REC.1403.078) is provided, there is no IRCT registration number. Please clarify it. Thank you for your comments. This study is not a clinical trial study, so it does not have an IRCT code. This study is the result of a research project conducted with code 4030146 from Kermanshah University of Medical Sciences. 2. The statistical analysis needs to be revised and clarified. The logistic regression model lacks information on variable selection, control for confounders, assumption testing (normality, multiple collinearity), and goodness-of-fit assessment. Confidence intervals for several odds ratios are missing, and the SRH duality needs to be justified. We appreciate your valuable comments. The section on Statistical analysis has been thoroughly revised to provide greater clarity and methodological transparency. 3. Please confirm obviously that the study population and dataset are completely independent of the population used in your previously published article in Scientific Reports (2025; DOI: 10.1038/s41598-024-79835-9) The mentioned study (DOI: 10.1038/s41598-024-79835-9) is the result of a research project with the code 4020003, which was conducted in early 2023 with the participation of 495 people aged 18 to 75 (men and women). This is while the submitted manuscript is the result of another research project with the code 4030146, which was conducted in 2024. The participants were 350 women aged 18 to 75, and the data from this study is completely independent of the study published in the journal Scientific Reports. 4. Lastly, the manuscript requires significant improvements in language and formatting, including the correction of grammatical errors, consistent verb tense usage, and proper reference formatting. The manuscript was improved in language and formatting. Attachments Attachment Submitted filename: Editors Comments Response..docx https://doi.org/10.1371/journal.pone.0343015.r002
5 Dec 2025 Decision Letter - Zahra Lorigooini, Editor Dear Dr. Darvishigilan, 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 Jan 19 2026 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 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, Zahra Lorigooini Academic Editor PLOS One Journal Requirements: 1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed Reviewer #2: (No Response) Reviewer #3: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** Reviewer #1: To the Editor PLOS ONE Dear Editor, Thank you very much for inviting me to read the paper titled, " The Influence of Social Support, Physical Activity, psychological problems, and Demographic Characteristics on Self-Reported Health Status among Women". Overall, as a reader of the paper, I felt that the paper is very well written and have important content for professionals in the relevant fields. Congratulations to the authors for their wonderful work. Reviewer #2: General Comments: - The topic is very interesting and relevant to contemporary women’s health issues. The authors aimed to assess how social support, physical activity, mental health, and sociodemographic characteristics among women affect their self-perceived health status. For this goal, the authors used appropriate tools. - Self-reported health is a crucial data source for healthcare providers, researchers, and decision-makers. - We suggest specifying the context of the study in the title and abstract (in Iran). - We recommend using the STROBE checklist for observational studies to report the study. Specific comments: Introduction Overall, the introduction is well written and clear. The authors described the relevance of the topic. However, the existence of 5 concepts (4 exposures and 1 outcome) in the study may make things hard to assimilate. Therefore, please specify why the authors chose to assess these four exposures in relation to self-reported health. Line 99-101: The idea expression is complex to understand. Please avoid using too many linking adverbs consecutively (additionally, consequently, etc.) Line 109: Provide a reference to research conducted that reveals that studies concerning the factors associated with SRH in Iran are quite scarce. Methods I don't agree with the methods’ section structure. We recommend using the STROBE checklist for observational studies to report on the study, especially the methods section. Line 116: The research should have one design, descriptive or analytic. In this case, the study is an analytic cross-sectional. The authors could simply write “cross-sectional study”. Line 129: The authors should report the minimal sample size is 348, and report 350 in the results section. Line 145: women included in this were aged 18 to 75 years. I can see a huge difference in age in this population, and I wonder if a 75-year-old woman can recall her daily life habits for physical activity, or if she can do physical activity. I think that this age interval is so large that it can affect the study result because of the difference in age characteristics. -Are pregnant women included in the study? Pregnant women have a specific need for social support and adaptive physical activity. This should be specified in the inclusion and exclusion criteria. Line 152: Using two different data collection strategies (questionnaire for participants and interview for others) in the study creates information bias. How did the authors manage this? Line 174: DASS is a measurement tool for mental health status. “Mental health” is more appropriate than “psychological disorders.” Line 211-213: I do not agree with the authors to perform binary logistic regression should be performed because OR is applicable for case-control studies. However, linear logistic regression is correct and suitable for this study. We recommend performing a multivariable linear regression analysis or at least providing a reliable argumentation regarding the choice of logistic regression. Results As mentioned above, I think that the age interval (18 to 75 years) is too large, which can affect the study results due to the difference in age characteristics (developmental patterns are different in each age category). The authors would rather present the data according to age groups (young and adult women (18 to 40 years, middle adulthood women 41 to 65 years, and old women aged more than 65 years). Discussion Discussion is missing limitations of the study and its implications for practice Reviewer #3: References used in the manuscript are outdated. I recommend updating the literature with more recent studies(3-5 years) ****** 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: Yes: Dr Maha Dardouri Reviewer #3: Yes: mobin ebrahimain ******** [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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. https://doi.org/10.1371/journal.pone.0343015.r003
Revision 2
23 Dec 2025 Author Response Dear editorial board of Journal of Plos One Thanks for providing the comments of the respectful reviewer to us. We tried to revise the manuscript, titled “The Influence of Social Support, Physical Activity, General Psychological Distress, and Demographic Characteristics on Self-Reported Health Status among Women in Iran” based on the comments and respond it in the following table. Revisions has been shown as highlight in the manuscript. Hope the revisions are satisfactory now. However, we welcome any further constructive comments if required. Dr. Hadi Darvishigilan Corresponding author Comments Response Reviewer 1 1. Overall, as a reader of the paper, I felt that the paper is very well written and have important content for professionals in the relevant fields. Congratulations to the authors for their wonderful work. Many thanks for your attention and times. Reviewer 2 1. We suggest specifying the context of the study in the title and abstract (in Iran). Many thanks for your comments. It was conducted. Page 1, line 2 and Page 2, line 41. Introduction 1. Overall, the introduction is well written and clear. The authors described the relevance of the topic. However, the existence of 5 concepts (4 exposures and 1 outcome) in the study may make things hard to assimilate. Therefore, please specify why the authors chose to assess these four exposures in relation to self-reported health. Many thanks for your comments. Explanations for the reason for choosing four exposures in relation to self-reported health were added to the end of the introduction. Page 4, lines 106-109 and Page 5, lines 110-112. 2. Line 99-101: The idea expression is complex to understand. Please avoid using too many linking adverbs consecutively (additionally, consequently, etc.) Many thanks for your comments. It was revised. Page 4, lines 96-101. 3. Line 109: Provide a reference to research conducted that reveals that studies concerning the factors associated with SRH in Iran are quite scarce. Many thanks for your comments. It was conducted. Page 4, lines 106-107. Methods 1. I don't agree with the methods’ section structure. We recommend using the STROBE checklist for observational studies to report on the study, especially the methods section. Many thanks for your comments. The method's section structure was revised based on the STROBE checklist. 2. Line 116: The research should have one design, descriptive or analytic. In this case, the study is an analytic cross-sectional. The authors could simply write “cross-sectional study”. Many thanks for your comments. It was revised. Page 1, line 2. Page 2 , line 41. 3. Line 129: The authors should report the minimal sample size is 348, and report 350 in the results section. Many thanks for your comments. It was revised. Page 1, line 41 and Page 5, line 116. 4. Line 145: women included in this were aged 18 to 75 years. I can see a huge difference in age in this population, and I wonder if a 75-year-old woman can recall her daily life habits for physical activity, or if she can do physical activity. I think that this age interval is so large that it can affect the study result because of the difference in age characteristics. The fact that the reviewer noted the good variety of age (18-75 years) of participants and the possibility of the differences between the memories of daily habits and physical activity among older women is insightful. The wide age bracket was chosen deliberately to get a rosy image of self-rated health in women within the community. Age was a covariate in crude and adjusted models of logistic regression, and its strong correlation with self-rated health was controlled. We acknowledge that this broad range can bring about heterogeneity and thus the future research can be stratified by organizing participants into smaller age groups in order to offer age specific information. This limitation was added to the limitations section. Page 13, lines 326-330. 5. Are pregnant women included in the study? Pregnant women have a specific need for social support and adaptive physical activity. This should be specified in the inclusion and exclusion criteria. Many thanks for your comments. Pregnant women were not included in this study and were an exclusion criterion. Being pregnant was added to the exclusion criteria in the Methods section. Page 5, line 131. 6. Line 152: Using two different data collection strategies (questionnaire for participants and interview for others) in the study creates information bias. How did the authors manage this? Many thanks for your comments. The data collection method was not very different, and only in cases where participants were unable to complete the questionnaire for any reason, questions were asked by interviewers and then their responses were recorded confidentially. Hence, there is no possibility of bias. More explanation added to the method section. Page 6, lines 134-135. 7. Line 174: DASS is a measurement tool for mental health status. “Mental health” is more appropriate than “psychological disorders.” Many thanks for your comments. Based on the original version of the Depression Anxiety Stress Scales– 21 (DASS-21), this scale is 21-item self-report measure designed to assess the severity of general psychological distress and symptoms related to depression, anxiety, and stress in adults older adolescents (17 years +). So the phrase of “psychological disorders” in the title and other sections was edited. Page 1, lines 1 and page 2, line 39 and page 7, line 173. 8. Line 211-213: I do not agree with the authors to perform binary logistic regression should be performed because OR is applicable for case-control studies. However, linear logistic regression is correct and suitable for this study. We recommend performing a multivariable linear regression analysis or at least providing a reliable argumentation regarding the choice of logistic regression. We sincerely thank the reviewer for this valuable comment regarding the choice of regression model. In our study, the dependent variable (self-rated health) was dichotomized into two categories (poor vs good SRH). For binary outcomes, logistic regression is widely recommended as the appropriate statistical method, since it estimates odds ratios to quantify the association between predictors and the likelihood of poor SRH. This approach is consistent with established statistical guidelines (Hosmer & Lemeshow, Applied Logistic Regression, 3rd edition). Page 19, line 217. Results 1. As mentioned above, I think that the age interval (18 to 75 years) is too large, which can affect the study results due to the difference in age characteristics (developmental patterns are different in each age category). The authors would rather present the data according to age groups (young and adult women (18 to 40 years, middle adulthood women 41 to 65 years, and old women aged more than 65 years). We thank the reviewer for raising this point again. As noted in our response to the previous comment regarding the age variable, all analyses were performed accordingly to control for the confounding effect of age. We added this point as a limitation in our study. Please kindly refer to our earlier response for details. Page 13, lines 326-330. Discussion 1. Discussion is missing limitations of the study and its implications for practice. Many thanks for your comments. The limitation section was added to the end of discussion. Page 13, lines 326-330. Reviewer 3 1. References used in the manuscript are outdated. I recommend updating the literature with more recent studies (3-5 years). Many thanks for your comments. All references were revised and updated as much as possible. Attachments Attachment Submitted filename: Reviewers Comments Response..docx https://doi.org/10.1371/journal.pone.0343015.r004
5 Jan 2026 Decision Letter - Zahra Lorigooini, Editor Dear Dr. Darvishigilan, 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 Feb 19 2026 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 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, Zahra Lorigooini Academic Editor PLOS One Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes Reviewer #3: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: Yes Reviewer #3: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: Yes Reviewer #3: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes Reviewer #3: Yes ****** Reviewer #2: We would like to thank the authors for addressing all comments. The manuscript now is more relevant and suitable for publication. Reviewer #3: As previously noted, it is recommended that the references in this section be updated to primarily include sources published within the last 3–5 years, in order to better reflect the current state of knowledge. ****** 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 #2: Yes: Dr Maha Dardouri Reviewer #3: Yes: Mobin Ebrahimian ******** [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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. https://doi.org/10.1371/journal.pone.0343015.r005
Revision 3
7 Jan 2026 Author Response Dear editorial board of Journal of Plos One Thanks for providing the comments of the respectful reviewer to us. We tried to revise the manuscript, titled “The Influence of Social Support, Physical Activity, General Psychological Distress, and Demographic Characteristics on Self-Reported Health Status among Women in Iran” based on the comments and respond it in the following table. Revisions has been shown as highlight in the manuscript. Hope the revisions are satisfactory now. However, we welcome any further constructive comments if required. Dr. Hadi Darvishigilan Corresponding author Comments to the Author Response 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 Many thanks for your attention and time. Reviewer 2: All comments have been addressed Many thanks for your attention and time. 2. Is the manuscript technically sound, and do the data support the conclusions? Reviewer 1: Yes. Many thanks for your attention and time. Reviewer 2: Partly. Many thanks for your comment. The conclusion section was revised. 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer 1: Yes. Many thanks for your attention and time. Reviewer 2: I Don't Know. Many thanks for your comment. Considering that Dr. Shahab Rezaian (PhD in Epidemiology) has served as a statistical consultant and one of the study authors in various studies and has sufficient skills and expertise in this field, all statistical analysis of the study were performed and rechecked by him. Also, the other authors have sufficient skills and expertise in interpreting and analyzing the results, so there is no concern about the accuracy and precision of the statistical analysis. 4. Have the authors made all data underlying the findings in their manuscript fully available? Reviewer 1: Yes. Many thanks for your attention and time. Reviewer 2: No. Many thanks for your comment. As stated in the manuscript and in the submission system, all underlying study findings are available in the manuscript, and in the event of any ambiguity, the raw data of the study that has been analyzed and analyzed can be provided upon request. 5. Is the manuscript presented in an intelligible fashion and written in Standard English? Reviewer 1: Yes. Many thanks for your attention and time. Reviewer 2: Yes. Many thanks for your attention and time. 6. Review Comments to the Author Reviewer 1: Yes. We would like to thank the authors for addressing all comments. The manuscript now is more relevant and suitable for publication. Many thanks for your attention and time. Reviewer 2: Yes. As previously noted, it is recommended that the references in this section be updated to primarily include sources published within the last 3–5 years, in order to better reflect the current state of knowledge. Thanks for the comment from the respected referee. Older references have been updated. Currently, after updating the references, only references 29 and 31-41 are older, and given that these studies describe the initial design of the questionnaires used in this study in other contexts and their validity and reliability in Iran, it is not possible to update them. Attachments Attachment Submitted filename: Reviewers Comments Response.2ndR.docx https://doi.org/10.1371/journal.pone.0343015.r006
1 Feb 2026 Decision Letter - Zahra Lorigooini, Editor The Influence of Social Support, Physical Activity, General Psychological Distress, and Demographic Characteristics on Self-Reported Health Status among Women in Iran PONE-D-25-48364R3 Dear Dr. Darvishigilan, 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. For questions related to billing, please contact billing support . 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, Zahra Lorigooini Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes Reviewer #3: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: Yes Reviewer #3: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes Reviewer #3: Yes ****** Reviewer #2: All comments have been addressed. We have no other suggestions for the author to address. The manuscript now is suitable for publication. Reviewer #3: The authors have satisfactorily addressed all previous comments. The manuscript is clear, compliant with PLOS policies, and suitable for publication. I recommend acceptance. ****** 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 #2: Yes: Maha Dardouri Reviewer #3: Yes: Mobin Ebrahimian ******** https://doi.org/10.1371/journal.pone.0343015.r007
Formally Accepted
Acceptance Letter - Zahra Lorigooini, Editor PONE-D-25-48364R3 PLOS One Dear Dr. Darvishigilan, 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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 Prof. Zahra Lorigooini Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0343015.r008

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .