A Model of Stress Change under the First COVID-19 Pandemic among the General Public in Japanese Major Cities and Rural Areas

Round 1

Reviewer 1 Report

In the manuscript, the authors present the results of a study. The aim of the study was to analyse the relation between the COVID-19-related stress and socio-demographic variables in different cities in Japan (Tokyo, Osaka and Nagano). Despite the fact that the paper itself is very interesting and raises a current issue, it requires introducing many major changes, both content-related and editorial.

1. No full affiliation of the authors of the study.

Introduction

2. On the basis of four reference titles, the authors put forward the thesis that research on the level of COVID-19-related stress mainly concerned Chinese healthcare professionals (line: 31-32). There are many works assessing the level of stress created by authors from all over the world. This requires improvement. I suggest conducting a new literature search.
3. I would like to receive a broader justification as to why the authors have adopted such a research objective. The reader would like to know why the study conducted in such a study sample is so crucial.

Materials and methods

4. In my opinion, point 2.1 should be entitled 'Study Design and Participants' and should thoroughly describe how to obtain a study sample. There is no information on how the respondents were recruited. Which portal was used to place the survey on? Could anyone participate in the study?
5. I suggest combining point 2.2. “Exclusion Standard” with point 2.1.
6. Did the respondents give their consent to participate in the study? How did they do it? Was the objective of the study presented to the participants? In what way? If the respondents did not give their consent to participate in the study, what happened then?
7. In point 2.4.1, the authors of the paper write: „According to a literature review…” (line 69). What kind of literature review? There are no quotations. Then, the authors mention about the consultations carried out with some experts. Who were these experts? How were they recruited? The entire point 2.4.1. is not clear at all. Improve this section so that the potential reader clearly knows what this part of the work is all about.
8. How did the authors perceive the pre-pandemic period and the period during the pandemic, before and during the Covid-19 lockdown?
9. In point 2.4.2, the authors of the work describe the Brief Job Stress Questionnaire of Japanese Ministry of Health. The research tool is not thoroughly described. While looking through the literature related to a given tool, I found out that it is used to assess the work-related stress. Due to this fact, the title of the work, the aim of the work and the content of the introduction should be changed as the tool is not about life-related stress but work-related stress. It is very important that the content of the work is consistent with the methodological basis of the study. What was the Cronbach's alpha score for this tool in the study group?

Results

10. In point 3.1, I suggest presenting the most important characteristics of the study group in a very short manner. Other characteristics of the group should be indicated in a table.
11. The authors of the work conclude that “Compared to the situation before the lockdown due to COVID-19, stress was increased in residents (71.5% of respondents), unchanged in 82 residents (7.3% of respondents), and decreased in 240 residents (21.2% of respondents)”. What were the average results for the individual subgroups, separated by the authors?
12. Were the correlations described in point 3.3. statistically significant? There is no information in this regard.
13. Table No 1 requires improvement. There is no need to provide an explanation for the abbreviations in the title. They should be presented below the table. I have no idea what the results in the p-Value column mean, for instance: 3.65E-05, 1.13E-05 etc. The aforesaid table needs to be adapted to the requirements of the magazine according to the editorial format. No post-hoc analysis? This table is not understandable.
14. I do not understand the way the results in point 3.5. are presented. The whole section needs to be reworded. The authors of the study do not present the results obtained for scientific articles in a standard way.

Discussion

15. The discussion itself is of quite poor quality. This needs to be elaborated once again. I suggest applying the following scheme: starting with the most important results of the study, then comparison of the results of own research with results obtained in other countries available in world literature, and ending up with explanation of the potential mechanisms affecting the obtained own results. Everything needs to be improved.

Conclusion

16. The conclusions are so long that reading becomes tiresome. Please rewrite the conclusions, 2-3 sentences are enough. The conclusions should result from the studies carried out.

Summary

The study presented for review is of poor quality. The work has a great number of methodological and editorial errors. Taking the aforementioned into consideration, the study requires a number of changes before being published in a journal. I think that, in the current form, the paper should not be qualified for printing.

Author Response

Dear Reviewers 1

Thank you very much for reviewing our manuscript and offering valuable advice. We have addressed your comments with point-by-point responses and revised the manuscript accordingly.

Reply to reviewer 1 comments

1. No full affiliation of the authors of the study.

Answer. We have added the full affiliation on page 1, lines 6 to 9.

Introduction

2. On the basis of four reference titles, the authors put forward the thesis that research on the level of COVID-19-related stress mainly concerned Chinese healthcare professionals (line: 31-32). There are many works assessing the level of stress created by authors from all over the world. This requires improvement. I suggest conducting a new literature search.

Answer.　A new research review has been carried out and the results added to page1 line 38 to page2 line 51, and Page15 line 340 to Page 17 line 430.

3. I would like to receive a broader justification as to why the authors have adopted such a research objective. The reader would like to know why the study conducted in such a study sample is so crucial.

Answer.　In light of the findings of the new review, we have added an explanation of the purpose of our study and the significance of the subject on Page2 lines 51 to 56.

Materials and methods

4. In my opinion, point 2.1 should be entitled 'Study Design and Participants' and should thoroughly describe how to obtain a study sample. There is no information on how the respondents were recruited. Which portal was used to place the survey on? Could anyone participate in the study?

Answer. The name of the subsection has been changed to 'Study Design and Participants' according to your suggestion. Regarding the method of recruiting respondents, the following text was added.

“Page3 lines 69 to 79: Sampling targets were mainly residents of Tokyo, Osaka, Nagano of Japan were selected for the survey. We asked Asmark Inc. to continue requesting responses from the three main data collection target three regions until the target of each region of 300 people was reached, where the questionnaire responses were forwarded.  Asmark inc. has 16 million registered users and specializes in providing market research services in accordance with the international standard JIS Y20252 (ISO 20252).  As of 28 July 2020, a total of 1,707 people had answered the web survey questionnaire. Incomplete responses and responses in which all items related to the target variable, the amount of stress change, was entered with the same value were excluded. “ 

Page 3 lines 85 to 88: Informed consent, including permission to publish the study results, was obtained by clicking on the consent button at the beginning of the questionnaire. Those who did not consent or who stopped answering during the survey were free to quit the survey.

5. I suggest combining point 2.2. “Exclusion Standard” with point 2.1.

Answer.　As you pointed out, we combined points 2.2. And points 2.1. on page 3 lines 69 to 82.

6. Did the respondents give their consent to participate in the study? How did they do it? Was the objective of the study presented to the participants? In what way? If the respondents did not give their consent to participate in the study, what happened then?

Answer. Respondents read the purpose of the questionnaire and conducted a web questionnaire in which only those who clicked the consent button could answer. Those who did not consent or who stopped answering during the survey were free to quit the survey. We added that on page 3 lines 85 to 88.

7. In point 2.4.1, the authors of the paper write: „According to a literature review…” (line 69). What kind of literature review? There are no quotations. Then, the authors mention about the consultations carried out with some experts. Who were these experts? How were they recruited? The entire point 2.4.1. is not clear at all. Improve this section so that the potential reader clearly knows what this part of the work is all about.

Answer. The literature review meant investigating ways of measuring stress. Expertise also meant consultation with co-authors. Due to poor wording, the relevant section has been completely revised on page 3 lines 85 to 88.

8. How did the authors perceive the pre-pandemic period and the period during the pandemic, before and during the Covid-19 lockdown?

Answer. In Japan, the state of emergency declared by the government lasted from April to the end of June. We defined that period as the period during the pandemic and the period before as the period before the self-restraint. It is thought that respondents considered the period from autumn 2019 to January, February, and March 2020 to be pre-pandemic when they answered the questionnaire. We added that on page 3 lines 98 to 101.

9. In point 2.4.2, the authors of the work describe the Brief Job Stress Questionnaire of Japanese Ministry of Health. The research tool is not thoroughly described. While looking through the literature related to a given tool, I found out that it is used to assess the work-related stress. Due to this fact, the title of the work, the aim of the work and the content of the introduction should be changed as the tool is not about life-related stress but work-related stress. It is very important that the content of the work is consistent with the methodological basis of the study. What was Cronbach's alpha score for this tool in the study group?

Answer. We have added an explanation of this stress questionnaire and its Cronbach's value of 0.8 on page 3 lines 96 to 98. In addition, we added the Cronbach's value used in our study was 0.955 on page 4 lines 129 to 130.

10 Results

10.In point 3.1, I suggest presenting the most important characteristics of the study group in a very short manner. Other characteristics of the group should be indicated in a table.

Answer. In order to present the most important features of the research group in a very concise way, we have added new figures 2 and 3. The description has been added on page 5 lines 146 to 148.

11.The authors of the work conclude that “Compared to the situation before the lockdown due to COVID-19, stress was increased in residents (71.5% of respondents), unchanged in 82 residents (7.3% of respondents), and decreased in 240 residents (21.2% of respondents)”. What were the average results for the individual subgroups, separated by the authors?

Answer.  The amount of stress change in each subgroup is shown on page 6 lines 172 to 175. " Stress change average in these three subgroups was as follows. Stress change average in the group with increased stress: 3.535±0.441. Stress change average in the group with no change in stress: 3±0. Stress change average in the group with decreased stress: 2.426±0.546."

12.Were the correlations described in point 3.3. statistically significant? There is no information in this regard.

Answer. We have created a new table1 to show which of all the explanatory variables are significantly correlated with the target variable. The explanation has been added on page6 line 183 to 191.

13. Table No 1 requires improvement. There is no need to provide an explanation for the abbreviations in the title. They should be presented below the table. I have no idea what the results in the p-Value column mean, for instance: 3.65E-05, 1.13E-05 etc. The aforesaid table needs to be adapted to the requirements of the magazine according to the editorial format. No post-hoc analysis? This table is not understandable.

Answer. 3.65E-05 means 3.65 × 10^-5 (10 minus fifth) and 1.13E-05 means 1.13 × 10^-5 (10 minus fifth).　These very small p-values have been re-stated as "p<0.001" on Table1,2,3.

Table 1 was very difficult to understand, with a mixture of correlation analysis and analysis of significant differences in the target variable for each question answer (analysis of variance, t-test), in accordance with the Chinese paper that referred to the description of the analysis results.
The revised results of the correlation analysis are shown in Table 1, and the test of the difference in the amount of stress change for each question-answer of the objective variable that is significant for the objective variable is separated in Table 2.

14. I do not understand the way the results in point 3.5. are presented. The whole section needs to be reworded. The authors of the study do not present the results obtained for scientific articles in a standard way.

Answer. We have re-tested and reworked all three tables to show that we have done a step-by-step analysis in the whole section. 

Table 1. Correlation analysis between the amount of stress change and all explanatory variables,

Table 2. consideration of the amount of stress change for each significant explanatory variable,

Table 3. Multiple‐factor analysis of the amount of change of stress in the first COVID-19 pandemic.

15. Discussion

The discussion itself is of quite poor quality. This needs to be elaborated once again. I suggest applying the following scheme: starting with the most important results of the study, then comparison of the results of own research with results obtained in other countries available in world literature, and ending up with explanation of the potential mechanisms affecting the obtained own results. Everything needs to be improved.

Answer.  As you pointed out, we started with 1. the most important research results, 2. comparisons with previous research results, and 3. Finally, we added the possibility of application and use on page 12 lines 239 to 259.

Conclusion

16. The conclusions are so long that reading becomes tiresome. Please rewrite the conclusions, 2-3 sentences are enough. The conclusions should result from the studies carried out.

Answer.  We have re-written the conclusion completely in accordance with your suggestion on page 13 lines 269 to 274.

17. Summary

The study presented for review is of poor quality. The work has a great number of methodological and editorial errors. Taking the aforementioned into consideration, the study requires a number of changes before being published in a journal. I think that, in the current form, the paper should not be qualified for printing.

Answer. In the short time we had, we did our best to improve on the points you raised.

Again, thank you for giving us the opportunity to strengthen our manuscript with your valuable comments and queries. We have worked hard to incorporate your feedback and hope that these revisions persuade you to accept our submission.

Reviewer 2 Report

NOTES TO THE AUTHOR(S)

The topic is intriguing and could potentially make theoretical contributions. However, it needs a considerable amount of work to be publishable. Some areas need clarification as noted below:

- I would suggest that the abstract in question would benefit from some form of framing of the context of the study, by which I mean the history of the problem and the results already formulated that are relevant to it. This would allow a better understanding of the importance of the topic.

Introduction

- The paper do not cites an appropriate range of literature sources. Further, there is no clear distinction between manuscript sections in terms of the content they report. First, I suggest dividing the section "Introduction" into three components, respectively introduction (explain the general argument of the paper, without going into specific details) background (situate the study concepts within the context of extant sustainability knowledge, discuss the international relevance of the concepts) and purpose, creating greater clarity in the analysis of the reader. The authors should revisit the text and, if wishing to retain the structure of the argument, at least explain clearly in the introduction how the argument proceeds and which are the steps they taken in answering the research question.

- The manuscript could include a stronger argument for studying the variables of interest. Authors did not include comprehensive theoretical model that describe and explain relations of all used theoretical concepts. I suggest an illustration/diagram for a better analysis.

Methods
- The Brief Job Stress Questionnaire of the Japanese Ministry of Health, Labour and Welfare, was it previously validated? If yes, who validated it? The presentation of certain metric properties in relation to reliability and validity is justified.

- There is little explanation as to why you analyse your data in the way that you do, or why your methods are appropriate (statistical procedures).

- Is it necessary to clarify the method employed? More precision is necessary regarding the sampling strategy and access to the target population. Were inclusion/exclusion criteria used?

- There is no mention of the sample size that was targeted and obtained to meet the sample size requirements for psychometric analysis, i.e. Bartlett´s test of sphericity? KMO?

- Pg2, line 69 - What bibliographic references were used to determine the questions that make up the questionnaire?

Results
- I consider it essential to include a table relative to the socio-demographical data obtained, as well as the descriptive statistics, in order to appropriately characterize the population being studied.
- A better visual structure of tables (boldface variables with statistical significance) would improve the readability.

Discussion
- In the discussion section, there is a complete absence of the empirical implications of the study, besides which the theoretical implications should have been approached in greater depth;

- Identify recommendations for practice/research/education/management as appropriate, and consistent with limitations, in order to more fully allow readers to understand the extent to which the authors were able to answer the research questions and to grasp the limitations of this study.

CHECKLIST FOR STYLE

The manuscript will serve a broad audience of students, researchers, and practitioners, however the manuscript needs to be carefully and attentively proofread, because some sentences are awkwardly constructed, punctuation is deficient, and therefore reading is occasionally difficult to follow.

Author Response

Dear Reviewers 2

Thank you very much for reviewing our manuscript and offering valuable advice. We have addressed your comments with point-by-point responses and revised the manuscript accordingly.

1.The topic is intriguing and could potentially make theoretical contributions. However, it needs a considerable amount of work to be publishable. Some areas need clarification as noted below:

Answer. Thank you for your interest in this topic. We have made corrections to your suggestions as much as possible.

2.- I would suggest that the abstract in question would benefit from some form of framing of the context of the study, by which I mean the history of the problem and the results already formulated that are relevant to it. This would allow a better understanding of the importance of the topic.

Answer. Following your suggestion, we have framed the results of previous studies and contrasted the position of the theme of this study on page 1 lines 11 to 14.

“The investigation of stress related to COVID-19 has been dominated by cases of healthcare workers, students, patients, and the stress grasping during first COVID-19 pandemic. This study examined the relationship between the amount of stress change comparing before and after COVID-19 pandemic and demographics (age, sex, occupation, etc.) in residents of a large city and a rural area of Japan. “

3.Introduction

- The paper do not cites an appropriate range of literature sources. Further, there is no clear distinction between manuscript sections in terms of the content they report. First, I suggest dividing the section "Introduction" into three components, respectively introduction (explain the general argument of the paper, without going into specific details) background (situate the study concepts within the context of extant sustainability knowledge, discuss the international relevance of the concepts) and purpose, creating greater clarity in the analysis of the reader. The authors should revisit the text and, if wishing to retain the structure of the argument, at least explain clearly in the introduction how the argument proceeds and which are the steps they taken in answering the research question.

Answer.  A new review of the latest research was conducted, as well as the positioning of this study within these existing research findings. This new review has been carried out and the results added to page1 line 37 to page2 line 51, and Page15 line 340 to Page 17 line 430.

4.- The manuscript could include a stronger argument for studying the variables of interest. Authors did not include comprehensive theoretical model that describe and explain relations of all used theoretical concepts. I suggest an illustration/diagram for a better analysis.

Answer.  A diagram conceptually showing the theoretical model of this study compared to the theoretical model of previous studies has been added as figure 1.
In addition, we explained the all-comprehensive theoretical model of our study on page 4 lines 132 to 135.
"In this paper, in order to examine the relationship between the amount of stress change and 36 explanatory variables, the following three steps were used: 1. correlation analysis, 2. consideration of the amount of stress change for each significant explanatory variable, and 3. explanatory modeling of the overall amount of stress change."

5.Methods

- The Brief Job Stress Questionnaire of the Japanese Ministry of Health, Labour and Welfare, was it previously validated? If yes, who validated it? The presentation of certain metric properties in relation to reliability and validity is justified.

Answer.  The Ministry of Health, Labor, and Welfare's simple job stress questionnaire has proven stress check items in over 10,000 people. In addition, in accordance with the suggestion of reviewer 1, we calculated the reliability coefficient Cronbach's alpha of the original simple job stress questionnaire and the reliability coefficient Cronbach's alpha of the index of this study, which was created so that the index could be answered in comparison with the index before CODIV-19, and described them in the text on page 3 line 96 to 98, page 4 line 129 to 130.

6.- There is little explanation as to why you analyse your data in the way that you do, or why your methods are appropriate (statistical procedures).

Answer.  In addition to clarifying the relationship between the statistical methods implemented and the results of each analysis on page 4 lines 132 to 135, the resulting tables have been revised to correspond to the organization in Table 1,2,3.

7.- Is it necessary to clarify the method employed? More precision is necessary regarding the sampling strategy and access to the target population. Were inclusion/exclusion criteria used?

Answer.  In accordance with you and reviewer 1's suggestions, we have re-described the sampling strategy, access to the target population, and inclusion/exclusion criteria more precisely on page 3 lines 69 to 76.
”2.1. Study Design and participants
Sampling targets were mainly residents of Tokyo, Osaka, Nagano of Japan were selected for the survey. We asked Asmark Inc. to continue requesting responses from the three main data collection target three regions until the target of each region 300 people was reached, where the questionnaire responses were forwarded. Asmark inc. has 16 million registered users and specialises in providing market research services in accordance with the international standard JIS Y20252 (ISO 20252). As of 28 July 2020, a total of 1,707 people had answered the web survey questionnaire. ”

8.- There is no mention of the sample size that was targeted and obtained to meet the sample size requirements for psychometric analysis, i.e. Bartlett´s test of sphericity? KMO?

Answer.  Added the following description of the sample size requirement on page3 lines 79 to 82. “ The sample size was more than 16 times the number of survey items (62). The number of questions for the objective variable of this study, stress change (mean value) (26), and explanatory variables (36) totaled 62. The sample size of related studies that include multiple population attributes is also generally around 1000 people.”

9.- Pg2, line 69 - What bibliographic references were used to determine the questions that make up the questionnaire?

Answer.  The main literature review meant investigating ways of measuring stress. Expertise also meant consultation with co-authors. Due to poor wording, the relevant section has been completely revised on page 3 lines 91 to 98.

10.Results

- I consider it essential to include a table relative to the socio-demographical data obtained, as well as the descriptive statistics, in order to appropriately characterize the population being studied.

- A better visual structure of tables (boldface variables with statistical significance) would improve the readability.

Answer.  For all of the explanatory variables obtained, we newly added Table 1, which shows the results of correlation analysis with the amount of stress change in the target variable. Also, following your suggestion, we have modified the visual structure of the table (variables in bold with statistical significance).

11. Discussion

- In the discussion section, there is a complete absence of the empirical implications of the study, besides which the theoretical implications should have been approached in greater depth;

Answer.  According to you and reviewer 1 suggestion, we started with 1. the most important research results, 2. comparisons with previous research results, and 3. finally, we added the possibility of application and use on page 12 line 239 to page 13 line 259.

12.- Identify recommendations for practice/research/education/management as appropriate, and consistent with limitations, in order to more fully allow readers to understand the extent to which the authors were able to answer the research questions and to grasp the limitations of this study.

Answer.  We have re-written the conclusion completely in accordance with your suggestion on page 13 lines 269 to 276.

13. CHECKLIST FOR STYLE

The manuscript will serve a broad audience of students, researchers, and practitioners, however the manuscript needs to be carefully and attentively proofread, because some sentences are awkwardly constructed, punctuation is deficient, and therefore reading is occasionally difficult to follow.

Answer.  In the short time we had, we did our best to improve on the points you raised.

Again, thank you for giving us the opportunity to strengthen our manuscript with your valuable comments and queries. We have worked hard to incorporate your feedback and hope that these revisions persuade you to accept our submission.

Round 2

Reviewer 2 Report

I appreciate the authors' effort to revise the manuscript. The clarity of the manuscript is much improved. 

The manuscript will serve a broad audience of students, researchers, and practitioners, however the manuscript still needs to be carefully and attentively proofread by an English-speaker, because many sentences are awkwardly constructed, punctuation and therefore the reading is occasionally difficult to follow.

Author Response

Dear Reviewers 2

Thank you very much for reviewing our manuscript and offering valuable advice. We have addressed your comments and revised the manuscript accordingly.

Reply to reviewer 2 comments

I appreciate the authors' effort to revise the manuscript. The clarity of the manuscript is much improved.
Answer. Thank you very much for your kind reply.

The manuscript will serve a broad audience of students, researchers, and practitioners, however, the manuscript still needs to be carefully and attentively proofread by an English-speaker, because many sentences are awkwardly constructed, punctuation and therefore the reading is occasionally difficult to follow.
Answer. Our manuscript was proofread by an English-speaker.

Again, thank you for giving us the opportunity to strengthen our manuscript with your valuable comments and queries. We have worked hard to incorporate your feedback and hope that these revisions persuade you to accept our submission.