From Anxiety to Hopelessness: Examining Influential Psychological Processes Affecting Mental Health Status of Spanish Nurses During the COVID-19 Pandemic

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Although this topic is of interest to the readers, the manuscript needs significant restructuring to be considered for a second revision. Here are my comments:

1. Please rephrase the title of the article to read: "From anxiety to hopelessness: Examining influential psychological processes affecting mental health status of Spanish nurses during the COVID-19 pandemic

2. The current structure of the abstract needs to be revised. Several grammatical errors were detected (run-ons, misspelled words). Please make sure to make those corrections.

3. Line 45, please remove "the" from "on the one hand".

4. delete line 49 since the purpose should be stated at the end of the introduction.

5. In line 100, please make sure to format the references adequately.

6. Line 108-113 should be part of the purpose of the study at the end of the introduction. Please remove and merge with the last paragraph.

7. The introduction is in need of major re-structuring. Currently, it is too long and should be shortened to focus on the major variables addressed in the study. 

8. In the design section of the manuscript, the number of COVID-19 cases is displayed as decimals which is confusing. Please make sure to replace points with commas.

9. Was IRB approval received for this study? Please indicate this in your methods section.

10. What about years of experience and its significant effect on hopelessness? Was this also reported in other studies? Is this finding related to the shortage in nurses being reported in Spain? Please elaborate on this point in this discussion.

 

 

Comments on the Quality of English Language

Grammatical errors are apparent throughout the manuscript. English structure is very weak.

Author Response

1. Please rephrase the title of the article to read: "From anxiety to hopelessness: Examining influential psychological processes affecting mental health status of Spanish nurses during the COVID-19 pandemic

The title has been changed as advised by the reviewer.

2. The current structure of the abstract needs to be revised. Several grammatical errors were detected (run-ons, misspelled words). Please make sure to make those corrections.

The manuscript has been reviewed by a professional to check for grammatical errors and misspellings.

3. Line 45, please remove "the" from "on the one hand".

This has been corrected.

4. delete line 49 since the purpose should be stated at the end of the introduction.

Line 49 has been deleted.

5. In line 100, please make sure to format the references adequately.

The references have been adequately formatted.

6. Line 108-113 should be part of the purpose of the study at the end of the introduction. Please remove and merge with the last paragraph.

Lines 108-113 have been deleted and inserted at the end of the introduction.

7. The introduction is in need of major re-structuring. Currently, it is too long and should be shortened to focus on the major variables addressed in the study.

Changes made in the introduction:

Length reduction: Redundant details and repetitive examples about concepts already known in the literature such as “hopelessness” and “helplessness” were eliminated, keeping the core information and arguments relevant to the study.

Content restructuring: Sections that talked about the same thing, such as the relationship between anxiety, emotional exhaustion, and hopelessness, were consolidated.

The background paragraphs were grouped around the main variables of the study (anxiety, emotional exhaustion and cognitive fusion), emphasizing their role in the hypothesis and in the structure of the model.

 

8. In the design section of the manuscript, the number of COVID-19 cases is displayed as decimals which is confusing. Please make sure to replace points with commas.

The numbers have been changed to be correctly displayed now.

9. Was IRB approval received for this study? Please indicate this in your methods section.

A section including ethical considerations and number of IRB has been added.

10. What about years of experience and its significant effect on hopelessness? Was this also reported in other studies? Is this finding related to the shortage in nurses being reported in Spain? Please elaborate on this point in this discussion.

We sincerely thank the reviewer for their valuable suggestion regarding the relationship between years of experience and their significant effect on hopelessness, as well as their potential connection to the nursing shortage in Spain. In response, we have incorporated a paragraph into the discussion that elaborates on this point. The added paragraph emphasizes how professional nursing experience contributes to coping strategies that mitigate the psychological impact of stressful work events, as supported by existing literature. Furthermore, it addresses the particular case of Spain, where the shortage of nurses and the aging workforce have created a more demanding environment for younger and less experienced nurses, potentially amplifying their levels of hopelessness. We believe this addition strengthens the discussion and provides greater context to the findings.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript “From anxiety to hopelessness in nurses. A prospective study on influential psychological processes in the context of the COVID-19 pandemic” evaluates a model that explores psychological processes leading to hopelessness in Spanish nurses two years after experiencing the stress of working during the COVID-19 pandemic.

The authors introduced a novelty element by evaluating over time the effects of COVID-19 on the interactions concerning anxiety, hopelessness, cognitive fusion and emotional exhaustion. Prospective studies can better establish causal relationships between predictors and outcomes by collecting data at multiple time points, reducing the risk of retrospective bias.

A two-year prospective study like this one is significant in understanding the prolonged impact of initial stressors on mental health during the COVID-19 pandemic.

This model reports that anxiety impacts both cognitive fusion and emotional exhaustion, with emotional exhaustion emerging as a key factor associated with hopelessness. It is recommended that these psychological factors be explained better (maybe as a short explanation of Figure 1 for a better understanding of the terms).  line 253

Despite its limitations, this study can become a valuable guide for protecting nurses' psycho-emotional health and serves as an awareness-raising element regarding the long-term effects of pandemic-related stress on medical staff. The study design is appropriate for testing the hypothesis and has relevant references.

Authors are advised to review the manuscript carefully and consider checking for redundant sentences for easy reading.

Author Response

This model reports that anxiety impacts both cognitive fusion and emotional exhaustion, with emotional exhaustion emerging as a key factor associated with hopelessness. It is recommended that these psychological factors be explained better (maybe as a short explanation of Figure 1 for a better understanding of the terms).  line 253

The manuscript has been revised and we tried to better explain figure 1 so the reader can fully understand its significance.

Authors are advised to review the manuscript carefully and consider checking for redundant sentences for easy reading.

The manuscript has been reviewed by a professional to check for grammatical errors and misspellings and redundant sentences.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

 

1. In line 108, there is a typo at the beginning of the sentence. Additionally, as mentioned previously in my comments, the purpose of the paper should be stated at the end of the introduction. However, it was stated twice, in line 108 and at the end of the introduction, rendering it confusing to the reader.

2. The abstract is not coherent grammatically. Please adjust the way the abstract is structured.

Comments on the Quality of English Language

English should be checked across the manuscript, specifically for the abstract and introduction sections.

Author Response

1. In line 108, there is a typo at the beginning of the sentence. Additionally, as mentioned previously in my comments, the purpose of the paper should be stated at the end of the introduction. However, it was stated twice, in line 108 and at the end of the introduction, rendering it confusing to the reader.

Line 108 has been corrected, we also eliminated the purpose of the paper from this paragraph and now appears only at the end of the introduction.

1. The abstract is not coherent grammatically. Please adjust the way the abstract is structured.

The abstract has been further reviewed by a proffesional, as well as the remaining of the text

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have revised the manuscript, improving its current form and it has the potential to become an important contribution to the field.

Author Response

Thanks for your review and tips to improve our research even more.