PONE-D-22-05826THE MAGNITUDE OF MENTAL DISTRESS AND ASSOCIATED FACTORS AMONG A SCHOOL OF MEDICINE AND COLLEGE OF HEALTH SCIENCES STUDENTS AT DEBRE MARKOS UNIVERSITY, 2021PLOS ONE

Dear Dr. Tsegaye,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Kind regards,

Matias Noll, Ph.D

Academic Editor

PLOS ONE

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"The author(s) received no specific funding for this work."

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

"First of all, we would like to thank Wolkite University for financial support.

Our heartfelt gratitude also goes to, Debre Markos University college of medicine and health science undergraduate students who participate in the study

We would also give our appreciation to data collectors and supervisors for their endeavor."

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

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: Yes

Reviewer #3: Partly

Reviewer #4: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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: No

Reviewer #3: Yes

Reviewer #4: Yes

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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: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: Yes

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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: Abstract:

• Introduction is too long; it should be short. The instrument used to assess mental distress in this study should be

mentioned.

• Key words: There were only three keywords, which may be increased.

Introdcution:

• At the end of the introduction, state the purpose of the study.

Methods:

• Line-144: "Study participants were not excluded from this study." This is not an exclusion criteria.

• Line-146: Earlier, no objectives were mentioned.

• Line 162-163: There is no need to mention the figure title if there is no figure at this point.

• Line 181: In the definition, what type of "specified substance" should be mentioned?

• Line 222: The reference/Id number of the ethical approval should be given.

Results:

• Line 238: There is no need to include 'North West Ethopia' in the Tables title.

• Table 1 shows no consistency in the variables and categories. They need to be rearranged (e.g against the age group

in the variable column, the religion of the students was mentoned in the category column.

• Table-1 is too long

• Line 243-244: ‘Nearly three fourth of the students ……. have interest to their department’ This sentence is

perplexing because of the words ‘with their choice ' and ‘have interest '.

• Line 257-258: There is no need to mention figure title without a figure.

• All the figures are mentioned as Figure No-1.

Discussion:

• Line 303-304: ‘similar study subjects in similar setting, Ethiopia.’ is unclear.

• Line 319-320: ‘health science education environment is more of stressful’ is unclear, need explanation.

• There are some more explanations that are not supported by other studies or the findings of this study.

Conclusion:

• The last paragraph (372–375), not supported by the findings of this study, should be removed from conclusion

References:

• Many of the references are not properly written, and page numbers are missing.

Opinion

• Overall, the manuscript requires improvements in the English language, including grammar.

• The manuscript requires major revisions.

Reviewer #2: 1. What are the exclusion criteria of the study? It has to be written clearly

2. There was merging of variables in table 1 see the rows at Educational status of the mother

3. Spacing problems for instance table 1 and the next paragraph and below table 2

4. Inappropriate or unimportant part in table 3 column 2 part, please check and correct

5. The letters and numbers in figures1 has to be given a key

6. The fonts in the figures must be similar with the main text

Reviewer #3: Authors have work to improve the quality of this study. The discussion part require some improvement. it follows the same fashion just by comparing the findings and then saying lower and higher than this and that. more over some the conclusions and recommendations are not based on the result example; proper time management and the one recommended for the University clinic workers. Overall the current form of manuscript can be suitable for this reputed journal i.e., Plos One with some improvement.

Reviewer #4: The manuscript reported the magnitude of mental distress and associated factors among a school of medicine and college of health sciences students at a university, which is an important topic

The manuscript was clear, generally well-written, structures and organized.

The Introduction provided a comprehensive background. However, grammatical and spelling mistakes presents. I advise to review the whole manuscripts for this particular point.

The methods section was specific. Details that supports the reproducibility of the research is presented very-well. The following was a concern:

-Why only undergraduate students were included? To me, post graduate might exhibit distress as well and might be sometime more than undergraduates as they could have families, work or other commitments. Any explanation?

- I don’t see there is a need for figure 1

The results section is thorough, well-subdivided and appropriately supported by data analyses.

- Please remove Muslim and protestant from age category and mention them as standalone variable- religion.

- I cannot read under “Educational status of the mother” in page 12; I believe there is missing variables which correspond to the mentioned categories, please review.

- Please re-order figures, all are 1? As a reader couldn’t correlate them easily.

- NO need for level of social support; can be written in text only.

- The last figure can be easily demonstrated in a pie chart

- Proper formatting is needed.

The Discussion section is well-sourced and comprehensive. However, future implications and research are missed.

The Conclusion provide a clear summation and identify the next steps for future research. However, it is lengthy little bit. Try to be more concise

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Reviewer #1: Yes: Sk Akhtar Ahmad

Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

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PONE-D-22-05826R1The magnitude of mental distress and associated factors among a school of medicine and college of health sciences students at Debre Markos university, 2021PLOS ONE

Dear Dr. Tsegaye,

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:

As you will see in the reviews, you have done a nice job with the revision. Reviewer #3 has raised some specific and important revisions to be made.

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

Please submit your revised manuscript by Oct 12 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:

• 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,

Ali A. Weinstein, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

As you will see in the reviews, you have done a nice job with the revision. Reviewer #3 has raised some specific and important revisions to be made.

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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 #3: All comments have been addressed

Reviewer #4: (No Response)

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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 #3: Yes

Reviewer #4: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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 #3: No

Reviewer #4: Yes

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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: The revised objectives can be included in the final paragraph of the introduction. All of the comments have been addressed adequately.

Reviewer #3: 1. General

There are too many editorial problems along the manuscript which include sentence structure, grammatical and spacing errors. There is also inconsistent use of words and phrases.

2. Abstract

• On the introduction section of the abstract, it didn't show why the study conducted

• On page 1 line 36, replace 'conducted' by 'employed'

• On the Methods part of the abstract include the study period and the total sample size.

3. Introduction

• The introduction section of this manuscript lacks coherence. You started by defining the problem then show the effect of mental health distress. The factors came later after the effect. I suggest this flow; 1st define the problem�then come across with associated factors�finally, state the effects of mental health distress.

• Page 5, line 100; don’t use the short for ‘SMCHS’ at its first mention.

4. Methods

• Page 5, line 107; enter the work “design” between the words ‘study’ and ‘was’.

• Page 5, line 109; avoid repetition on the study design.

• Your study area description lacks REFERENCE(S).

• On the exclusion criteria, is ‘March’ among the summer months in Ethiopian context? Because you stated, ‘students on summer break are excluded’

• Page 6, lines 131 & 135; replace ‘Gondar university’ by ‘University of Gondar, Ethiopia’

• On sample size determination, put the formula.

• Did you consider design effect in your sample size determination? In this regard, figure 1 is not clear and needs elaboration. Example: how many students are there for each department per each year? There are also letters like; P, M, N, E, ….., which needs clarification.

5. Results

• Page 7, line 158; remove the last sentence.

• Page 12, lines 231, 235 and 239; figures captions are misplaced. Please revise it for all.

6. Discussion

• The discussion part still needs revision. The finding is well compared with other’s work. However, the way you used to justify discrepancies of your findings with previous works is poor. Justification based on the assessment tool used, sample size difference may not be sound and convincing.

7. Conclusion and recommendation

• What you have recommended for different stakeholders based on the significant associated factors you had.

8. Figure Legend

Figure 2 & 3 are missed and Figure 6 & 7 added which are not cited in the text.

9. References

• The reference part is not written appropriately. Most of the references lack journal name, volume, number and page number (Ref. 1, 3, 5, 9, 10, 15, 20, 21, 26, 32, 33,….). There are also references without year publication. Sometimes CAPITAL letter is used (ref.10). Not only these, consider the other issues too like; use of punctuations.

10. Figures

• Figure 2 & 5 are not visible well, replace with a better visibility.

Reviewer #4: All my previous comments have been addressed. I have no further comments to add. It can be accepted for publications if they have addressed other reviewer's comments. Thanks

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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: Yes: Sk Akhtar Ahmad

Reviewer #3: Yes: Mahmud Ahmednur

Reviewer #4: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

The magnitude of mental distress and associated factors among a school of medicine and college of health sciences students at Debre Markos university, 2021

PONE-D-22-05826R2

Dear Dr. Tsegaye,

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,

Ali A. Weinstein, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments:

Please see the final reviewer comments below. For the final version of the paper, you may want to revise/recheck these.

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 #3: All comments have been addressed

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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 #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: 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 #3: Yes

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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 #3: Yes

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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 #3: Please check the sample size determination farmula. The other thing still on the discussion on page 16, line 292-303, the first three paragraphs are not neccessary. On the references still it needs revision.

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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 #3: Yes: Mahmud Ahmednur Mohammed

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