Peer Review History

Original SubmissionMay 18, 2020
Decision Letter - Ethan Morgan, Editor

PONE-D-20-14823

The longitudinal impact of employment, retirement and disability status on depressive symptoms in HIV-positive men in the Multicenter AIDS Cohort Study

PLOS ONE

Dear Dr. Ware,

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.

From my own reading of the manuscript, I agree with the reviewers comments (below). Please carefully consider each of the comments and incorporate as appropriate. I look forward to receiving your revision soon.

Please submit your revised manuscript by Sep 20 2020 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.

Please include the following items when submitting your revised manuscript:

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

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Ethan Morgan

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. Thank you for stating the following in the Funding Section of your manuscript:

"The MACS is primarily funded by the National 342 Institute of Allergy and Infectious

Diseases, with additional co-funding from the National Cancer Institute, the National Institute on

Drug Abuse, and the National Institute of Mental Health. Targeted supplemental funding for

specific projects was also provided by the National Heart, Lung, and Blood Institute and the

National Institute on Deafness and Communication Disorders. MACS data collection is also

supported by grant UL1-TR000424 (Johns Hopkins University Institute for Clinical and

Translational Research) from the National Center for Advancing Translational Sciences, a

component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

This research was supported by the NIH via interagency agreement with the National Institute of

Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health

and Human Development, and other NIH Cooperative Agreements (U01-HD-32632):

Disclaimer: The contents of this publication are solely the responsibility of the authors and do

not represent the official views of the Johns Hopkins Institute for Clinical and Translational

Research, National Center for Advancing Translational Sciences, NIH, the Department of Health

and Human Services, or the US government."

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

"The authors received no specific funding for this work."

3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions.

In your revised cover letter, please address the following prompts:

a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories.

We will update your Data Availability statement on your behalf to reflect the information you provide.

[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?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

**********

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 requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Overall, this study utilizes a well-known and conducted research cohort, yet still manages to assess a novel question that will contribute to current literature. This is a very good paper with well-written and thought out analyses and results. The discussion is well developed and appropriately follows the findings. I only had a few suggestions below for the authors to consider.

1. I would suggest removing retirement findings from the results as they are non-significant, or at least moving it to the end of the paragraph after the significant findings.

2. Any hypothesis as to why those 60-69 had reduced odds of depression risk?

3. I would suggest including N’s for the models in each of table 2, 3, and 4

Reviewer #2: I commend the authors for seeking to look at healthy aging and employment among men living with HIV. This is a robust data set and provides ample opportunity to examine changes in labor engagement and mental health across the lifespan. I believe this manuscript has potential to make an important contribution and I have outlined suggested revisions and concerns below.

Comments:

1. The paragraph in the introduction on benefits/risks of retirement feels a bit disjointed. Revisiting this paragraph to clarify the primary point with better flow between supporting (or conflicting) studies would make it clearer why studying retirement specifically is important.

2. In line 75, participants are referred to as HIV-positive men. Elsewhere the preferred person-first language “People living with HIV” is used. Here, I suggest changing the language to “men living with HIV” in this sentence. People first, non-stigmatizing language should be used throughout. HIV-positive status can be changed to HIV status. HIV positive participants can be changed to participants living with HIV.

3. Social support is identified as a covariate but it isn’t explained why this construct would be important to include in the methods or introduction but it is mentioned briefly in the discussion. I suggest making it more clear why this is included and potentially discussing it’s link as an implied mechanism for linking mental health and labor engagement.

4. More detail about the depression measure would be helpful. How could a participant achieve a score of 16 to exceed the clinical threshold? For a reader to know this, the scoring on individual items should be reported. For example, on the CESD items are typically rated by frequency ranging from 0 to 3.

5. How many participants required imputation for missing employment status? Were any sensitivity checks completed to see if the imputation approach to missingness changed results? Similarly, why was this approach used for employment but not disability and retirement?

6. How was the index visit chosen and what does this mean?

7. The authors make the point (without citation) that the link between labor related determinants and depression is expected to be lagged, however, it is unclear why a 2 year lag was chosen. At the aggregate level it appears justified that average sample levels of depression may lag behind major labor market shifts quite slowly but it’s less clear why unemployment would take two years to impact mental health, particularly if in that two years employment status changes again. Because conclusions are drawn about implied causality, it is important to justify this time lag. There may be a number of confounding events or factors in that two year window that could also contribute to mental health.

8. The authors refer to both within and between subjects differences in the methods, however, no within subjects analysis was conducted. The repeated measures statement in SAS typically uses subject ID to indicate within the model that some data points belong to the same participant and are thus non-independent. Repeated measures from multiple subjects do provide more robust data however it appears only between subjects results are reported in this study. Some clarification would help to make it clear that the results are between-subjects only.

9. It should be stated in text that retirement was not associated with odds of depression risk. The confidence band include 1.0 and the p-value is far from the alpha = .05 significance or even p = .10 marginal significance. Likewise in the discussion it is inappropriate to draw conclusions that retirement is associated with better mental health. This is not supported by the study results.

10. How might retirement status be confounded with age? Perhaps a different study design would be more appropriate for examining the impact of retirement. That is, younger individuals are highly unlikely to retire thus providing little variance in retirement data earlier in life. A within-person analysis would better answer the question whether an individual’s mental health is different when they retire. The introduction appeared to frame the paper, in part, around aging and retirement but the methods didn’t really focus on this age group or life transition. I do agree with authors that understanding how retirement is related to health is important in the aging cohort of men living with HIV, but don’t feel this paper really provides much insight into that process.

Editorial notes:

There are some minor editorial changes needed to ensure the same and correct tense is used across sections (for example, hypotheses should be in past tense).

**********

6. PLOS authors have the option to publish the peer review history of their article (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.

Revision 1

Response to Reviewer #1:

Thank you for your review of our paper. We have answered each of your points below. Additionally, we performed missing value imputation for disability and retirement status. All models (employment, disability, and retirement) has been re-analyzed. Therefore, results vary slightly from the initial manuscript.

Reviewer # 1 Comment

I would suggest removing retirement findings from the results as they are non-significant, or at least moving it to the end of the paragraph after the significant findings.

Author Response

Thank you for your comment. I moved the non-significant result of retirement to the end of the other significant findings as suggested.

Reviewer # 1 Comment

Any hypothesis as to why those 60-69 had reduced odds of depression risk?

Author Response

I performed missing value imputation for retirement and disability variables. The models for employment, disability and retirement were then re-ran. Those 60-69 no longer have a statistically significant decreased odds of depression risk in all three models.

Reviewer # 1 Comment

I would suggest including N’s for the models in each of table 2, 3, and 4

Author Response

I added the participant N and visit level N into Tables 2, 3 and 4 as suggested.

Response to Reviewer #2:

Thank you for your review of our paper. We have answered each of your points below. Additionally, we performed missing value imputation for disability and retirement status. All models (employment, disability, and retirement) has been re-analyzed. Therefore, results vary slightly from the initial manuscript.

Reviewer # 2 Comment

The paragraph in the introduction on benefits/risks of retirement feels a bit disjointed. Revisiting this paragraph to clarify the primary point with better flow between supporting (or conflicting) studies would make it clearer why studying retirement specifically is important.

Author Response

Thank you for your comment. I made changes to the paragraph introducing retirement for clarity (see lines 59-67) as suggested.

Reviewer # 2 Comment

In line 75, participants are referred to as HIV-positive men. Elsewhere the preferred person-first language “People living with HIV” is used. Here, I suggest changing the language to “men living with HIV” in this sentence. People first, non-stigmatizing language should be used throughout. HIV-positive status can be changed to HIV status. HIV positive participants can be changed to participants living with HIV.

Author Response

As suggested, we used person first language throughout the manuscript.

Reviewer # 2 Comment

Social support is identified as a covariate but it isn’t explained why this construct would be important to include in the methods or introduction but it is mentioned briefly in the discussion. I suggest making it more clear why this is included and potentially discussing it’s link as an implied mechanism for linking mental health and labor engagement.

Author Response

Friedman et al assessed social support in this sample of men. They found that higher social support was associated with lower levels of negative psychosocial health outcomes (which includes depression). This has been added to the manuscript to make it clear on why we chose to include it as a covariate in the models (see lines 118 to 121).

Reviewer # 2 Comment

More detail about the depression measure would be helpful. How could a participant achieve a score of 16 to exceed the clinical threshold? For a reader to know this, the scoring on individual items should be reported. For example, on the CESD items are typically rated by frequency ranging from 0 to 3

Author Response

As suggested, I added the value range for the responses and the minimum and maximum scores (See lines 124-127).

Reviewer # 2 Comment

How many participants required imputation for missing employment status? Were any sensitivity checks completed to see if the imputation approach to missingness changed results? Similarly, why was this approach used for employment but not disability and retirement?

Author Response

There are 4,417 participant-visits with missing employment, retirement and disability.

Not imputing retirement and disability was an oversight as we were initially focused on employment status. Therefore, we have imputed the missing retirement and disability values. To ensure results did not change due to imputation, we compared the model results from imputed vs non-imputed data for each of the primary outcomes: employment, retirement and disability. The estimates for the primary predictors was less than 0.001. Therefore, we can confidently state that imputing missing values did not change our results.

Reviewer # 2 Comment

How was the index visit chosen and what does this mean?

Author Response

Index visit is the first visit in our retroactive observation of employment, disability, retirement status and depressive symptoms.

We chose the index visit of October 1997 because it was the peak of the HAART initiation within the MACS.

Many persons living with HIV were unable to work due to disease progression. By looking at the time periods in which potent HAART was introduced, we can assess how employment trends as PLWH become healthier and possibly re-enter the workforce.

Reviewer # 2 Comment

The authors make the point (without citation) that the link between labor related determinants and depression is expected to be lagged, however, it is unclear why a 2 year lag was chosen. At the aggregate level it appears justified that average sample levels of depression may lag behind major labor market shifts quite slowly but it’s less clear why unemployment would take two years to impact mental health, particularly if in that two years employment status changes again. Because conclusions are drawn about implied causality, it is important to justify this time lag. There may be a number of confounding events or factors in that two year window that could also contribute to mental health.

Author Response

Segel-Karpas et al used a 2-year lag on employment status and depressive symptom and decided to use a similar approach. Lines 85 to 90 explains our reasoning for the 2-year lag.

“We decided to conduct time-lagged analyses to allow for the potential effects of employment, disability, and retirement on health outcomes to become salient during the observation period, and we also wanted to consider the potential adaptation to the experience of retirement or disability”.

Reviewer # 2 Comment

The authors refer to both within and between subjects differences in the methods, however, no within subjects analysis was conducted. The repeated measures statement in SAS typically uses subject ID to indicate within the model that some data points belong to the same participant and are thus non-independent. Repeated measures from multiple subjects do provide more robust data however it appears only between subjects results are reported in this study. Some clarification would help to make it clear that the results are between-subjects only.

Author Response

We adjusted for between and within subject variances in our models. We did not report within subject differences. We will make it clear in the methods that only between subject results are reported (see line 160).

Reviewer # 2 Comment

It should be stated in text that retirement was not associated with odds of depression risk. The confidence band include 1.0 and the p-value is far from the alpha = .05 significance or even p = .10 marginal significance. Likewise in the discussion it is inappropriate to draw conclusions that retirement is associated with better mental health. This is not supported by the study results.

Author Response

We have made the change to reflect that retirement was not associated with the risk of depressive symptoms.

Reviewer # 2 Comment

How might retirement status be confounded with age? Perhaps a different study design would be more appropriate for examining the impact of retirement. That is, younger individuals are highly unlikely to retire thus providing little variance in retirement data earlier in life. A within-person analysis would better answer the question whether an individual’s mental health is different when they retire. The introduction appeared to frame the paper, in part, around aging and retirement but the methods didn’t really focus on this age group or life transition. I do agree with authors that understanding how retirement is related to health is important in the aging cohort of men living with HIV, but don’t feel this paper really provides much insight into that process.

Author Response

This is a repeated measures analysis so we adjust for with-in person variance of the predictor variables over time. That said, not all men started at the same age—so we adjusted for age for retirement (for example, to account for early vs. late retirement).

Attachments
Attachment
Submitted filename: Response to Reviewers.pdf
Decision Letter - Ethan Morgan, Editor

The longitudinal impact of employment, retirement and disability status on depressive symptoms among men living with HIV in the Multicenter AIDS Cohort Study

PONE-D-20-14823R1

Dear Dr. Ware,

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 for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, 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,

Ethan Morgan

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Formally Accepted
Acceptance Letter - Ethan Morgan, Editor

PONE-D-20-14823R1

The longitudinal impact of employment, retirement and disability status on depressive symptoms among men living with HIV in the Multicenter AIDS Cohort Study

Dear Dr. Ware:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

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 plosone@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. Ethan Morgan

Academic Editor

PLOS ONE

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 .