PONE-D-20-15158

Emotional consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study

PLOS ONE

Dear Dr. Ammar,

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PLOS ONE

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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: No

Reviewer #2: No

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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: Yes

Reviewer #2: 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: This is and interesting manuscript and the study topic is very relevant in the current situation. In general, the article is well written and easy to read. The sample number is enough. However, some aspects must be detailed to improve the quality of the article.

GENERAL COMMENTS

The written form of some results could be improved. For example: Statistical symbols letters Could be written in cursive letters or p and r values should be written without “0” before the dot (p = .011). But this depends on the journal. Please check if the results are written correctly according to the journal's criteria

Reading the paper, I understand that the two questionnaires (Short Warwick-Edinburgh Mental Well-being Scale and Short Mood and Feelings Questionnaire) are added to the demographic questions in Table 1. In my opinion, to help other researchers to replicate the study, the complete survey could be attached as a supplementary file. Moreover, this paragraph “The survey included sixty-four questions on health, mental wellbeing, mood, life satisfaction and multidimension lifestyle behaviors (physical activity, diet, social participation, sleep, technology-use, need of psychosocial support).” Suggest that the survey is longer and that only a part of the questionnaire was used in this study.

Regarding the questionnaire, it was translated to “English, German, French, Arabic, Spanish, Portuguese, and Slovenian languages”. This in very interesting as the authors can reach more people and therefore expand the sample. However, the validation process of the different versions has not been explained. On the other hand, the cronbach's alpha values have not been reported. What was the reliability of the questionnaire in this sample?

Results are showed for the total of the sample. However, the survey was sent to different countries and continents which has different isolation conditions when the questionnaire was filled. How might this have affected the results? Would this detail be a possible limitation of the study? Furthermore, cultural differences can be a relevant factor in moods [1].

Another important aspect is the sample distribution which is well balanced in gender but interestingly high educated (Master/doctorate degree 527 (50.3%)). This could generate some bias. Fortunately, the authors have mentioned this in the limitations of the study. Nonetheless, differences by gender has not been reported. In my opinion, it is important to report the existence or not of these differences since the analysis has been carried out men and women together.

MINOR POINTS

Some cites should be revised in the manuscript. For example: “Google’s privacy policy (https://policies.google.com/privacy?hl=en)” or “depression in the respondent.18”.

Authors have use different social networks, although this method has been validated previously [2], how the authors think that this percentage could be affected the sample?

The authors have written the following: “we considered that a score between 7 and13 reflects very low positive mental wellbeing, 14-20 reflects low positive mental wellbeing, 21-27 reflects medium positive mental wellbeing; and 28-35 reflects high positive mental wellbeing.” Why this values or scale? Is there any reference supporting these cut points?

The following discussion paragraph is not supported by the results showed in this study. “The significantly lower total SWEMWBS score and higher total SMFQ score “during” compared to “before” confinement support the negative effects of the current COVID-19 pandemic on mental wellbeing and emotional state in participants from Western Asian, North Africa and Europe.”

Authors interestingly suggest possible solutions to improve health during confinement related to lifestyle and physical activity :“Given that an active lifestyle including physical and social activity is an important modifiable factor for mental health across the lifespan (Rohrer et al. 2005), this intervention should focus on fostering social communication and physical activity (Ammar et al.2020a-c). More references regarding this topic could be added.[3,4]

1. Palinkas, L.A.; Johnson, J.C.; Boster, J.S.; Rakusa-Suszczewski, S.; Klopov, V.P.; Fu, X.Q.; Sachdeva, U. Cross-cultural differences in psychosocial adaptation to isolated and confined environments. Aviation, space, and environmental medicine 2004, 75, 973-980.

2. Browne, K. Snowball sampling: using social networks to research non‐heterosexual women. Int J Soc Res Methodol 2005, 8, 47-60.

3. Xiang, M.; Zhang, Z.; Kuwahara, K. Impact of COVID-19 pandemic on children and adolescents' lifestyle behavior larger than expected. Progress in Cardiovascular Diseases 2020.

4. Brooks, S.K.; Webster, R.K.; Smith, L.E.; Woodland, L.; Wessely, S.; Greenberg, N.; Rubin, G.J. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet 2020.

Reviewer #2: This work is a quality study.

Its main contribution is that it focuses on comparing levels of well-being and distress before and during COVID-19 crisis, which is a novel approach to the study of the phenomenon, since studies have usually focused on how mental health is at the time of assessment during confinement or the health emergency.

It also has another advantage, the participants belong to different continents, with a prominent participation of North Africa. As we know most studies provide data from Asia, Europe, and United States or similar, so this is an advantage as well.

Major issues:

In the description of the SWEMWBS cut-off points, it is indicated that the following points were followed in this study: "In this study, we considered that a

score between 7 and13 reflects very low positive mental wellbeing, 14-20 reflects low positive mental wellbeing, 21-27 reflects medium positive mental wellbeing; and 28-35 reflects high positive mental wellbeing." Unlike the Short Mood and Feelings Questionnaire (SMFQ), where it is stated what the use of the cut-off point is based on, this is not the case. It would be necessary to provide the authors' basis for this classification.

Although the decrease in well-being and distress before and after the crisis is established, later in the discussion and conclusions it is recommended to apply Active

and Healthy Confinement Lifestyle (AHCL), a crisis-oriented interdisciplinary

intervention focused on Weakening of physical and social contacts with the disruption of normal lifestyles. From my point of view this suggestion is not well argued on the basis of the current study. The current study establishes that there is a worsening of mental health and well-being in the world population due to COVID-19, but it does not deepen the knowledge of the factors that explain this worsening, so I see it as very pretentious to recommend a specific intervention in this sense. I would like the authors to review this point and to go deeper into the justification of this issue.

Minor issues:

- On page 16 when describing the effect sizes there is a misprint in “Cohn, 1988.”

"Effect size (Cohen's d) was calculated to determine the magnitude of

the change of the score and was interpreted using the following criteria: 0.2 (small), 0.5 (moderate), and 0.8 (large) (Cohn, 1988). Statistical significance was accepted as α<0.05."

- On page 18, there is a room left in "significantly by 9.4 % during home"

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Reviewer #1: No

Reviewer #2: No

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Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study

PONE-D-20-15158R1

Dear Dr. Ammar,

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.

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Kind regards,

Juan-Carlos Pérez-González, Ph.D.

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

Reviewer #2: 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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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: Yes

Reviewer #2: 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

**********

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: In my opinion the authors have make a good job. The paper now is clearer and more replicable. The method section has been improved and the paper it is very interesting. However, I would make small suggestions which could improve the manuscript:

Authors write the following paragraph: “Reliability of the shortened and/or newly adopted questionnaires was tested by the project steering group through piloting, prior to survey administration. These brief crisis-oriented questionnaires demonstrated high to excellent test-retest reliability coefficients (r = 0.84-0.96).”. This paragraph is confused. It seems that the reliability of the questionnaires was analysed in the pilot study and not with the actual data. Why with the pilot study and not with the used data in this manuscript? If this is the case, authors could analyse the reliability of the used questionnaires if possible. Specially, as the sample could have some bias as they have written in the limitation section. Moreover, why they use the “r” instead “α” to show the reliability coefficient?

Regarding the instrument and all the questionnaires used, it seems that the length of the survey was large which could affect the response rate. In addition, authors have not informed about the response rate. In my opinion it would be interesting to add information about the response rate. If this is not possible because the authors have used the snowball sampling technique, maybe they should add some sentence in the limitations section. In any case, I think the sample, or the number of participants can be representative enough. Adding any reference regarding this aspect could make more robust the method section. The following references could help.

Deutskens E, De Ruyter K, Wetzels M, Oosterveld P. Response rate and response quality of internetbased surveys: An experimental study. Mark Lett. 2004; 15(1): 21-36. https://doi.org/10.1023/B:MARK. 0000021968.86465.00).

Mavletova, A.; Couper, M.P. Mobile web survey design: scrolling versus paging, SMS

versus e-mail invitations. Journal of Survey Statistics and Methodology 2014, 2, 498-

518.

Browne, K. (2005). Snowball sampling: using social networks to research non‐heterosexual women. International journal of social research methodology, 8(1), 47-60.

Lastly authors informed that the total number of questions was: “The survey included sixty-four questions on health, mental wellbeing, mood, life satisfaction and multidimension lifestyle behaviors” in the method section, but this does not match with the “Supporting Information S1 Google form survey.pdf” please revise this aspect.

Reviewer #2: The authors have responded all suggestions and comments by reviewers. The manuscript has improved its quality, so I think the manuscript should be published as it is.

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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: No

Reviewer #2: No