Adolescent mothers and their children affected by HIV—An exploration of maternal mental health, and child cognitive development

Kathryn J. Steventon Roberts; Colette Smith; Lucie Cluver; Elona Toska; Janina Jochim; Camille Wittesaele; Marguerite Marlow; Lorraine Sherr

doi:10.1371/journal.pone.0275805

Peer Review History

Original SubmissionDecember 23, 2021
4 Aug 2022 Decision Letter - Forough Mortazavi, Editor PONE-D-21-40432Adolescent mothers and their children affected by HIV – an exploration of maternal mental health, and child cognitive developmentPLOS ONE Dear Dr. Roberts, 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 Sep 18 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, Forough Mortazavi 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. Please amend your current ethics statement to address the following concerns: a) Did participants provide their written or verbal informed consent to participate in this study? b) If consent was verbal, please explain i) why written consent was not obtained, ii) how you documented participant consent, and iii) whether the ethics committees/IRB approved this consent procedure. 3. 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 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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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: 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 ****** 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: There is currently a lack of evidence exploring the impacts of maternal mental health on the development of children born to adolescent mothers overall and by HIV status. This study provides information on a specific population and topic that is currently missing from the literature. It should be published given the lack of evidence, but I do have some smaller comments to potentially improve the paper. Can you provide more of a rationale for the hypothesis of why relationships between mental health/HIV status and child development would be different by age? What are these mechanisms? This would help to give a sense of if interventions need to be targeted for young women or could address these issues despite age. What is the generalizability of this sample? Please provide more detail on if these scales have been validated in this population. Did you consider how to account for time since HIV diagnosis or ART status as those might affect the relationship between HIV status and child development. Also age of the mother when the child was born might be good to consider as 10-19 years is still somewhat of a spectrum. The authors adjust for quite a few covariates and some of them could mediate these relationships which may attenuate associations and make it difficult to identify the total effect of each factor. https://academic.oup.com/aje/article/177/4/292/147738 What happened to participants who had a mental health diagnosis. Were they referred to care? The percentage with suicidality is very high. Is there reasonable or is there a potential explanation for this? It seems as though some of these women may have postnatal depression given that this is cross-sectional data and the timing of when children were born. Is it necessary to consider this? How may this change some of these associations compared to adolescent depression? ****** 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 ******** [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. https://doi.org/10.1371/journal.pone.0275805.r001
Revision 1
13 Sep 2022 Author Response Dear Editor, Thank you to your and the referees for taking the time to review our manuscript titles “Adolescent mothers and their children affected by HIV – an exploration of maternal mental health, and child cognitive development”. We have now addressed all of the referee comments. Please see our responses below. Thank you again for your consideration. We look forward to working with you further and to hearing from you in the near future. Yours sincerely, Kathryn Steventon Roberts For and on behalf of the authors 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 The manuscript has been checked in accordance with these guidelines. 2. Please amend your current ethics statement to address the following concerns: a) Did participants provide their written or verbal informed consent to participate in this study? b) If consent was verbal, please explain i) why written consent was not obtained, ii) how you documented participant consent, and iii) whether the ethics committees/IRB approved this consent procedure. The below statement has now been added to the ethics statement for clarity. “Written informed voluntary consent was obtained from all participants, and in the instance when an adolescent was under 18 years of age, written consent was also obtained from their adult caregivers. Additional written consent was obtained from the primary caregiver of the infant if adolescent mothers identified that they were not the main caregiver of their child” 3. 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. Reference list has been checked. Comments to the Author: 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: There is currently a lack of evidence exploring the impacts of maternal mental health on the development of children born to adolescent mothers overall and by HIV status. This study provides information on a specific population and topic that is currently missing from the literature. It should be published given the lack of evidence, but I do have some smaller comments to potentially improve the paper. Thank you for your comments. Can you provide more of a rationale for the hypothesis of why relationships between mental health/HIV status and child development would be different by age? This would help to give a sense of if interventions need to be targeted for young women or could address these issues despite age. Thank you for this comment, further justification has now been added to the introduction of the manuscript What is the generalizability of this sample? Details on generalisability have now been added to the discussion section of the manuscript. “Nevertheless, these findings provide insight into the needs of adolescent mothers and their children and are likely generalisable to this population within the Eastern Cape, broader South Africa, and populations experiencing similar challenges in sub-Saharan Africa.” Please provide more detail on if these scales have been validated in this population. Thank you for this comment. Details on validation and previous use of measures in similar populations have been added throughout the measures section. Did you consider how to account for time since HIV diagnosis or ART status as those might affect the relationship between HIV status and child development. Also age of the mother when the child was born might be good to consider as 10-19 years is still somewhat of a spectrum. Thank you for these comments. Age of HIV diagnosis may have an impact however this detail was not available for all participants within the dataset. Therefore, the decision was made for this exploratory first step within the investigation of the relationship between these factors to focus on living with HIV vs. not living with HIV. In terms of maternal age, the decision was made apriori to focus on adolescent mothers as a whole population as stratification may result in unclear recommendations for intervention. We do however, adjust for maternal age within the multivariable models within the paper which would account for any differences in maternal age in the final models, and thus in the final recommendations from this paper. The authors adjust for quite a few covariates and some of them could mediate these relationships which may attenuate associations and make it difficult to identify the total effect of each factor. https://academic.oup.com/aje/article/177/4/292/147738 Thank you for your comment. The number of covariates was deemed appropriate by the writing team given the number of participants in the sample. Covariates were not included in the table so not to complicate the main findings from there analyses. Please see the full table below. Variables included as covariates were also included within sensitivity analyses exploring the relationship between each factor and child cognitive development. As seen in table 6 maternal education and child age and maternal education attainment were also found to be associated with child cognitive development. These factors are discussed in both the results and discussion section of the manuscript. What happened to participants who had a mental health diagnosis. Were they referred to care? If participants responded in the affirmative to any of the of the 5 suicidality items within the questionnaire, they were immediately referred to the appropriate services at the time of interview. A comment to this effect has been added to the methodology section of the manuscript. The percentage with suicidality is very high. Is there reasonable or is there a potential explanation for this? Thank you for your comment. These high rates of suicidality, particularly among adolescent mothers who are living with HIV may seemingly reflect the myriad of challenges and the need for support among this group. This detail has now been added to the discussion of this manuscript. It seems as though some of these women may have postnatal depression given that this is cross-sectional data and the timing of when children were born. Is it necessary to consider this? How may this change some of these associations compared to adolescent depression? Thank you for your comment. These analyses aimed to explore a broad array of mental health symptoms. Given the lack of data on this population and the exploratory nature of these works we did not disaggregate between the postpartum period and beyond the postpartum period to ensure that coverage of the whole population was provided. This however would be an interesting concept for future analyses. Given this, detailing the needs for such works has been added to the limitations section of the manuscript. https://doi.org/10.1371/journal.pone.0275805.r002
26 Sep 2022 Decision Letter - Forough Mortazavi, Editor Adolescent mothers and their children affected by HIV – an exploration of maternal mental health, and child cognitive development PONE-D-21-40432R1 Dear Dr. Steventon Roberts, 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, Forough Mortazavi Academic Editor PLOS ONE Additional Editor Comments (optional): 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 ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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 ****** 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 authors have addressed my comments and the manuscript is well written. I have no further comments. ****** 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 ******** https://doi.org/10.1371/journal.pone.0275805.r003
Formally Accepted
11 Oct 2022 Acceptance Letter - Forough Mortazavi, Editor PONE-D-21-40432R1 Adolescent mothers and their children affected by HIV – an exploration of maternal mental health, and child cognitive development Dear Dr. Steventon Roberts: 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. Forough Mortazavi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0275805.r004

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 .