Predictors of Anxiety in the COVID-19 Pandemic from a Global Perspective: Data from 23 Countries

Round 1

Reviewer 1 Report

Interesting cross-national study. Please see comments below.

Abstract: Instead of “everyday’s lifestyle.” Do you mean everyone’s lifestyle or everyday life? “people sharing a home with someone else had higher level of anxiety either” do you mean -people sharing a home with someone else also  had higher level of anxiety ? “Scores of the GAD-7and SAI varied across countries, with the maximum reported for Brazil, Iraq, Canada, USA, and Italy.” Maximum what? Difference pre-post pandemic? Highest anxiety scores? Please clarify. What is “power distance”? looseness/tightness of what? Covid-19 restrictions?

Please check throughout paper for correct English grammar/usage and clarity, as there are multiple English usage issues throughout paper.

Intro: Covid restrictions in some countries such as the U.S. were very different state by state. Canadian restrictions were regional. Saying that there was lockdown, etc..may only apply to part of the country

2.3 says- “ Participants who met above mentioned inclusion criterion were eligible to participate” No inclusion/exclusion criteria were presented (but should be). You mention recruitment in an academic setting and social media. Please expand. Was this a convenience sample?

2.4.1 have Generalized Anxiety Disorder Scale (GAD-7)[41] and the State Anxiety Inventory (SAI) been assessed for cross-cultural accuracy? If so, please describe. If not please address.

Please address how can you attribute GAD outcomes to Covid-19 rather than a pre-existing anxiety disorder.

2.5 Should clarify that the Infectious Disease Vulnerability Index is a country level index of vulnerability

4.1 Sample size differential between men and women in many countries make within-country sex comparisons difficult. these small sample sizes and sex sample differentials need to be addressed

Figure1. GAD-7 high anxiety level bars cut off Figure 2. Black bar cuts off GAD chart at bottom-not readable figure 3, 5 and 5 GAD chart looks like it was cut off on right hand side. It looks like all the GAD-7 figures in the paper have part of them cut out. Please review all charts.

4.3 You say as the age of the respondent increases the level of anxiety decreases. Should verbally describe the age distribution of the sample.

Discussion:  Why would East Asian populations be more genetically susceptible to anxiety as suggested in the discussion?

Limitations should discuss that countries Covid response policies (not measured) could contribute to anxiety as could Covid rates/Covid mortality rates (not included in the model).

Author Response

Dear reviewer,

Many thanks for your caring of our manuscript.

Changes in the new version of abstract and manuscript are presented in red.

Below are our responds to comments of review, point by point. We do hope that you will find this version, and responses satisfactory. 

Interesting cross-national study. Please see comments below.

Abstract: Instead of “everyday’s lifestyle.” Do you mean everyone’s lifestyle or everyday life? “people sharing a home with someone else had higher level of anxiety either” do you mean -people sharing a home with someone else also  had higher level of anxiety ? “Scores of the GAD-7and SAI varied across countries, with the maximum reported for Brazil, Iraq, Canada, USA, and Italy.” Maximum what? Difference pre-post pandemic? Highest anxiety scores? Please clarify.

Thanks. Corrected.

What is “power distance”? looseness/tightness of what? Covid-19 restrictions?

Thanks. These definitions are given in the Methodology section. The size of the resume does not allow to describe them here.

Please check throughout paper for correct English grammar/usage and clarity, as there are multiple English usage issues throughout paper.

Corrected by native speaker co-authors.

Intro: Covid restrictions in some countries such as the U.S. were very different state by state. Canadian restrictions were regional. Saying that there was lockdown, etc..may only apply to part of the country

Thanks. Corrected in p. 3 and p. 7. We based on the answers of the respondents themselves.

2.3 says- “ Participants who met above mentioned inclusion criterion were eligible to participate” No inclusion/exclusion criteria were presented (but should be). You mention recruitment in an academic setting and social media. Please expand. Was this a convenience sample?

Thanks. Corrected in p. 7.

2.4.1 have Generalized Anxiety Disorder Scale (GAD-7)[41] and the State Anxiety Inventory (SAI) been assessed for cross-cultural accuracy? If so, please describe. If not please address.

We used approved version of questionaries in different languages. Corrected 2.4.1.

Please address how can you attribute GAD outcomes to Covid-19 rather than a pre-existing anxiety disorder.

Many thanks. This is a good question. In this study we are using two instruments, GAD and SAI. GAD has been frequently use to estimate depression, and have been frequently used for clinical purposes, the second questionnaire, SAI, has been developed to assess spontaneity and anxiety in normal samples. In current study we demonstrated that individual ratings on both inventory were in high correlation. We do not include respondent who were predisposed for depression and got any previous treatments (added p.7). 

2.5 Should clarify that the Infectious Disease Vulnerability Index is a country level index of vulnerability

Thanks. Corrected in p. 9.

4.1 Sample size differential between men and women in many countries make within-country sex comparisons difficult. these small sample sizes and sex sample differentials need to be addressed

Thanks. We have indicated this limitation in the Limitation section (see corrected in p.21-22). In addition, we used Hedges' correction Effect size, which is an alternative measure of effect size where there are different sample sizes (see corrected Table 1.)

Figure1. GAD-7 high anxiety level bars cut off Figure 2. Black bar cuts off GAD chart at bottom-not readable figure 3, 5 and 5 GAD chart looks like it was cut off on right hand side. It looks like all the GAD-7 figures in the paper have part of them cut out. Please review all charts.

Sorry, but in my version of manuscript all is ok. May be something wrong during download?...

4.3 You say as the age of the respondent increases the level of anxiety decreases. Should verbally describe the age distribution of the sample.

Thanks. Described in p. 6 (2.2. Participants)

Discussion:  Why would East Asian populations be more genetically susceptible to anxiety as suggested in the discussion?

Thanks. This is opinion of Chiao and Blizinsky (2010), which we only refer. Corrected in p. 21.

Limitations should discuss that countries Covid response policies (not measured) could contribute to anxiety as could Covid rates/Covid mortality rates (not included in the model).

Thanks. Added in p. 22.

Author Response File: Author Response.pdf

Reviewer 2 Report

The work is interesting. The aim and statistics are clearly presented.

Author Response

Thank you very much for your assess of our manuscript.

Reviewer 3 Report

Dear Author,

the work is very interesting, it does not need major changes:

-Introduction section needs to be improved;

-Please use key words according to MeSH (Medical Subject Headings);

-in conclusion section please specify future perspective of this study

Thanks

Author Response

Dear reviewer,

Many thanks for your caring of our manuscript.

Changes in the new version of manuscript are presented in red.

Dear Author,

the work is very interesting, it does not need major changes:

-Introduction section needs to be improved;

Introduction improved, many parts corrected and added new parts.

-Please use key words according to MeSH (Medical Subject Headings);

Thanks. Changed p. 3.

-in conclusion section please specify future perspective of this study

Thanks. Added in p. 22.