Peer Review History
Original SubmissionJuly 27, 2021 |
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PONE-D-21-24391The health impacts of a 4-month long community-wide COVID-19 lockdown: Findings from a prospective longitudinal study in the state of Victoria, Australia.PLOS ONE Dear Dr. Griffiths, 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. I ask that you first - that is, prior to attempting revisions - please review the comment provided by Reviewer 5 regarding a similarly titled paper. As the Reviewer notes, this may well be a preprint or conference paper. Could you please first review this comment and provide in correspondence with me a response to that query. Following resolution of that query, please consider submitting revisions in line with those outlined by reviewers 2, 3 and 4 in whole. Please consider the revisions and comments specified by those reviewers in light of each other - and make a holistic response to them at appropriate moments. Reviewer 1 and reviewer 5 provide more substantial critique of the paper and its methods. Please review these comments and respond to each point raised in a neatly set out table (with verbatim extract of the relevant reviewer comment) appended in a separate document (your rebuttal letter) with a brief comment against each query raised with reference to the areas (or main areas) where you have made edits in response. Please also ensure that any edits to the manuscript are provided in mark up for review. I note that some of the comments made by Reviewer 1 and 5 may well be similar in nature - so please respond in line line of the table to both. Whilst Reviewer 5 has recommended a rejection, given the commentary by other reviewers and my own views, I believe an opportunity to make revisions to the manuscript is warranted. Please submit your revised manuscript by Nov 25 2021 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:
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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. 6. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [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: Partly Reviewer #2: Partly Reviewer #3: Partly Reviewer #4: Yes Reviewer #5: No ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes Reviewer #3: I Don't Know Reviewer #4: I Don't Know Reviewer #5: No ********** 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: No Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: No ********** 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 Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: 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: Summary: This paper summarized a survey to find the association of lockdown with psychological distress in Victorian community in Australia. N=898 subjects who finished the survey in all time points was included in the study. The paper contributes to understanding people’s psychological distress influenced by the lockdown policy, but recovered after the lockdown. This paper is practical and meaningful. The topic of this study is interesting. It helped us to understand how the lockdown policy’s influence on people’s mental health. The survey monitored people’s status longitudinally across the time points. This paper was well written and structured logically. It clearly introduce the background and findings in the discussion. Concerns: There are quite a few concerns on methods and analysis and unclear points in this paper. There are some major issues: 1. The data collection background was not clearly explained. The survey Reponses were from the working age group, so the population is the entire working-age group in corresponding areas/community, but what is the population of the study subjects? What is the exact definition of working-age group? From the supplementary table S1, the retention group N=898 contains subjects with age 65 and more. So, more clarification and discussion are necessary. 2. How was the survey sample size decided? There is no power analysis discussion in the paper. What is the power or effect size from the current sample? 3. The data collection process was confusing. How the survey participants were recruited? Randomly selection? Volunteer response? Response rate? More explanation is needed. 4. There is only a rough descriptive table between sample and subjects excluded from the study. But, there is no descriptive tables to compare exposure group (N=305) and Comparison group (N=593) on age, gender, etc. it is concern that if there were unbalance between these two groups. 5. From table S2, the descriptive table between Retention group and attribution group (excluded subjects), it seems the retention group is mainly telephone interview (80%), and attribution group were more taking online survey (60%). I think there is bias. Revision and More discussion is needed 6. In terms of the main finding, for example the figure of mental health, the conference intervals are needed to show the variation of each group across different time points (before, lockdown and After). What is the effect size of this differences claimed in the paper? 7. Also, sensitivity analysis needs to be added to show the robustness of the finding. Reviewer #2: Thank you for the opportunity to review such a beautifully written paper on a topic of great national importance. I would recommend acceptance if one issue can be remedied. The study evaluates mental health at different time points and finds no lasting effects from the lockdown. To reach this conclusion it used the Kessler 6 scale and the mental component of the SF-12. My concern is that the scales used may not capture the full range of mental health impacts of lockdown. For instance, this range includes disorders that have a complicated aetiology, such as post-traumatic stress disorder (PTSD), where symptoms may emerge over time. In fact, in the literature on disaster response suggests there may be a 'honeymoon phase' characterised by increased community cohesion in the immediate aftermath of a mass trauma event (see e.g. DeWolfe, 2000, p.5). Post-traumatic stress is one of the most likely sequelae of the crisis, yet I can find no research on the validity of the SF-12 or the K-6 for discerning PTSD symptoms in a study population. I would request the manuscript be amended to account for these limitations. It would be more accurate to say, hewing closer to the wording of the scales themselves, that day-to-day stress and distress returned to pre-lockdown levels, but impacts on the longer-term mental health of participants cannot be assessed using the methodology adopted in the study. ---- DeWolfe 2000 https://www.hsdl.org/?view&did=4017 accessed 13 Sept 2021. Reviewer #3: Your paper is both timely and adds to our knowledge of the impact of lockdowns on the mental health of the population. I believe your paper could be strengthened with more detail - at the moment, yes it substantiates the fact that people in lockdown in Victoria suffered from worse mental health, but we don't know much about the nuances therein. I note that you have not analysed the experiences of your subjects based on whether they are Aboriginal or Torres Strait Islanders or from CALD backgrounds, or for example where they lived specifically, and even though you note that you looked a gender, you did not discuss any differences in detail. Reviewer #4: This well-written and timely paper investigates the short- and long-term negative effects of lockdown in the State of Victoria, Australia. The authors found that the Victorian lockdown led to increased psychological distress during the lockdown, but these effects resolved after restrictions are lifted. The study raises important points regarding the negative effects during and following lockdowns and contributes to existing works on this important topic. However, the persistence of the negative health effects needed to be evaluated more carefully. Only showing that negative mental health consequences resolve over time is too simplistic. Since the Covid-19 pandemic began, we have learned that lockdown and social isolation measures have different effects for different populations. Some communities are more vulnerable than others. For example, disadvantaged low-income communities and people with mental health and addiction problems are more susceptible to negative impacts from interventions such as lockdowns. It would be useful for the author to provide information about the impacts of these measures on vulnerable individuals during and following lockdowns. If the authors don’t have the data regarding the effects on these populations, they should acknowledge and discuss this limitation. The same applies to the discussion around the Australian government’s efforts to mitigate the harm caused by public health measures against Covid-19. Discussion is needed on the strategies for mitigating the negative psychological consequences of lockdown specifically for populations more susceptible to public health measures. Can the author also discuss strategies to assist vulnerable communities during lockdowns and relate these to the situation in Victoria? Last, there would be value in the author adding a paragraph comparing their findings to similar studies conducted in other countries (e.g., the short-/long-term negative effects of lockdowns) and discuss variation in outcomes (if such exists). Reviewer #5: Comments to Author: Ms. Ref. No. PONE-D-21-24391 Title: The health impacts of a 4-month long community-wide COVID-19 lockdown: Findings from a prospective longitudinal study in the state of Victoria, Australia. • Overall objective and the extent to which this was achieved: This paper attempts to address a very important and, to date, a sparsely researched topic: When lockdown ceases, to what extent do the established negative health effects of lockdown persist and what is the speed of recovery of individuals and communities to these negative effects? The authors state that they took advantage of a natural experiment where, contemporaneously, there was a comparison group outside the lockdown area in Victoria, Australia. Their stated aim was to examine (lines 83-87): 1. the impact on mental and physical health of the extended lockdown. 2. the impact of the extended lockdown on established determinants of health: unemployment, social interaction, and finances. 3. Effects persisting after lockdown was lifted. Of these three aims, the literature is flooded with the impact of lockdowns on health, mental, physical, and psychological. This is also mentioned in their introduction. However, it is the third aspect that is under-researched as again, they explain (lines 70 -73) even before the three objectives are listed. Main takeaway: Unfortunately, it is in this third objective that the paper falls short. In their conclusion, they mainly talk about the negative impact of the extended lockdown (not new ground) and the mitigating effect of employment and social interactions which also has been shown. They end by saying “longer-term follow-up is required to identify any persistent health effects of community lockdowns.” They actually could have done this had they exploited the 2 months of post-lockdown data. But that was not done. • Clarification needed: The paper seems remarkably similar to this already published: Griffiths, D., Sheehan, L., Vreden, C.V., Petrie, D., Sim, M. and Collie, A., 2021. 1360 Health impacts of a 4 month community-wide lockdown: a prospective longitudinal study in Victoria, Australia. International Journal of Epidemiology, 50(Supplement_1), pp.dyab168-240. Though this appears in Google Scholar, do I assume that this is just the publication of an abstract of a conference presentation? I was unable to get hold of this paper. The authors can clarify. • The Model: 1. I failed to find out what is the model that they are estimating. Lines 170 to 189 give a general description of what was done. The exact specification of the model/models needs to be spelled out, and the control variables indicated. This is the heart of the paper and a general description does not provide the information needed to assess the underpinnings of the analysis 2. In the estimation, they also need to add a fixed time effect. • Variables: 3. What were all the variables and how were they defined and measured? For instance, I could find no definition of the two key variables they have used and even shown graphs with them: psychological distress and mental health. 4. Of the variables they have discussed, I have the following comments: i) Financial stress is important to capture. However, the authors have taken only one out of the 3 indicators that the GSS Summary Results for Australia have considered. The GSS considers three elements: a. A cash flow problem in the last year in terms of either inability to pay bills on time or having to get help to pay. b. The ability to raise $2000 within a week for something important. c. Taking a dissaving action such as “drawing on savings, increasing a credit card balance by $1,000 or more and taking out a personal loan”. Please see Graph 2 in https://www.abs.gov.au/statistics/people/people-and-communities/general-social-survey-summary-results-australia/2014. It can be seen that of all the 3 stressors, cash flow and dissaving have higher percentages in general than the ability to raise $2000 dollars. In fact, it is the unemployed that have the most problems. The authors need to justify why the other two were not considered and why focusing on the selected item was appropriate. ii) I do not understand how, (if the responses to that one question was taken as “yes” or “no” or “don’t know”), financial stress could be measured (for each person) on a 1 to 10 scale. Is this an overall (average) measure for the county? This needs clarification. 5. Social Interaction – two binary measures are taken: Was any time spent with anyone not a household member and Whether contact was made with 7 or fewer people via speech, phone or online communication. The original 35 item Duke Social Support Index was abbreviated to a 23-item index and also to a 11-item index for use on elderly patients who may get exhausted by the use of the longer questionnaire. However, studies have generally used either the 23 item or the 11 item DSSI. Usually these have been for older people. In this paper (not confined only to the elderly), only two items have been picked and the justification of these two items has not been given. In other words, why would we believe in the validity of a 2-item DSSI? The authors need to justify and discuss this. 6. What is the need for the variable “engagement in work” since “employment” at time of survey is also included? Is there any extra information being captured? • Other comments regarding results: Turning to the results with regard to the stated objectives: 7. The negative health findings (they focus on psychological distress and mental health --- again, how were these measured?) during lockdown for both exposed and comparison group is in line with findings elsewhere in the COVID literature and so do not break new ground. • Unobserved heterogeneities as the two groups do not appear similar 8. During the lockdown period the mental health of the comparison group actually improved significantly from pre-lockdown. There is no further exploration of this counter-intuitive result. However, this pattern did not show up in the exposure group thus leading one to suspect that there are other factors at play or unobserved heterogeneities that have not been captured and which may, thus, invalidate this “natural experiment”. 9. Right now, looking at the mental health and psychological graphs, it can be seen that the two groups did not begin at the same level. Are these differences statistically significant? This is important as otherwise, this further shows that the two groups were quite different to begin with (another reason to suspect other unaccounted for factors at play). 10. What accounts for the different trajectories of psychological distress? Again, the two groups appear different. • The graphs 11. The graphs are not easy to understand. i. Since there is no discussion of “health score” in the cases of mental health and psychological distress, one does not know how to interpret the y-axes. The x-axis is not labelled. ii. How were the health scores obtained? iii. As I understand, the first dot is for data collected PRIOR to lockdown. The second dot is the data collected DURING lockdown. The third dot is the data collected POST lockdown. It seems a valuable opportunity to explore the POST lockdown period was not taken by averaging the October to December data. This would have shown the speed of recovery and might have added some new information to the literature. • Precision of estimates and statistical power: 12. Since I am not clear on the models estimated to find the mental and physical effects of a lockdown, I wanted to make sure that if any of the explanatory variables were correlated, that was clearly brought out and the implications mentioned. Employment, social interaction, and financial stress are likely to be highly correlated. Though there are methods to deal with this problem, at least the impact on the precision of the estimates needs to be mentioned. 13. The state of Victoria has 6.68 million people (line 94) accounting for over a quarter of the 6.68 million population of Australia (line 95). I find it worrying that the analysis has only 305 people in Victoria (exposed group) and 593 in the rest of Australia (the comparison group). The sample sizes seem too small for the statistical tests to have much power. At the very least, this should be mentioned. ********** 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 Reviewer #3: No Reviewer #4: No Reviewer #5: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. 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Revision 1 |
PONE-D-21-24391R1The health impacts of a 4-month long community-wide COVID-19 lockdown: Findings from a prospective longitudinal study in the state of Victoria, Australia.PLOS ONE Dear Dr. Griffiths, 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 Apr 28 2022 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:
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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 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 Reviewer #2: (No Response) Reviewer #4: All comments have been addressed ********** 2. 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 Reviewer #4: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #4: Yes ********** 4. 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: No Reviewer #2: Yes Reviewer #4: Yes ********** 5. 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 Reviewer #4: Yes ********** 6. 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: (No Response) Reviewer #2: The authors acknowledge that their methodology does not allow the capture of data on the most relevant possible mental health impact — post-traumatic stress disorder (PTSD). This condition has a clear temporal element: onset of symptoms is often delayed until some time after a traumatising event. There is popular media discussion indicating mental health practitioners and the community itself are reckoning with potentially traumatic effects of lockdown in combination with alarm caused by the pandemic itself (e.g. ABC 2021; Coslett 2021; Sarner 2021; Watson 2021). Yet this paper repeatedly claims to demonstrate that mental health impacts did not persist following the conclusion of lockdown, a conclusion framed by the research questions as posed on lines 83-87 of the manuscript. The authors used instruments (K-6, SF-12) that are not validated for the detection of PTSD. Although they measure symptoms that may accompany PTSD, these symptoms may have taken time to emerge following the cessation of lockdown. The study does not include data from any subsequent time points that could be used to assess whether there have been delayed effects from lockdown. The paper does not acknowledge the limited scope of its exploration of mental health until line 385: ‘Whilst our findings describe a recovery in aspects of mental health such as symptoms of anxiety and psychological distress…’ That rather more circumspect framing should be used throughout the entire paper, instead of referring to ‘mental health’ more generally. REFERENCES ABC 2021 https://www.abc.net.au/radio/melbourne/programs/theconversationhour/the-conversation-hour/13362804 Watson 2021 https://www.abc.net.au/everyday/lockdown-is-harder-than-before-trauma-specialist-explains-why/100252974 Reviewer #4: (No Response) ********** 7. 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 Reviewer #4: 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 2 |
The health impacts of a 4-month long community-wide COVID-19 lockdown: Findings from a prospective longitudinal study in the state of Victoria, Australia. PONE-D-21-24391R2 Dear Dr. Griffiths, 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, Giuseppe Carrà, PhD Academic Editor PLOS ONE |
Formally Accepted |
PONE-D-21-24391R2 The health impacts of a 4-month long community-wide COVID-19 lockdown: Findings from a prospective longitudinal study in the state of Victoria, Australia. Dear Dr. Griffiths: 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. Giuseppe Carrà Academic Editor PLOS ONE |
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