Impact of the COVID-19 Pandemic on Mental Health and Lifestyle in Thai Occupational Therapy Students: A Mixed Method Study
and Anuchart Kaunnil 1,*Round 1
Reviewer 1 Report
The impacts of the COVID-19 pandemic led to global reports of hazards to mental health. However, reports regarding lifestyle changes due to the COVID-19 pandemic are lacking.
The authors: (a) Using a convergent mixed methods design, conducted an individual interview with twelve occupational therapy students, and interpreted the results by content analysis. (b) Completed a survey of Sensory Patterns Assessment (SPA) concerning perspectives from occupational therapy students (n=99).
They identified two major themes: (I) adaptive responses were related to patterns of spending time on activities of daily living, rest and sleep, and leisure, during the week; (I) multidimensional challenges were consistent with patterns of spending time on visual, auditory, smell/taste, movement, and meaningful activities.
The participants reported both positive and negative impacts of the COVID-19 pandemic on their lives. Intervention and prevention strategies may be beneficial to address the needs of occupational therapy students. Educators may use the findings of this study to develop teaching techniques that are congruent with students’ lifestyles to prevent negative impacts on mental health and promote academic achievement in the future, as well as general well-being, efficacy, and empowerment of students in the new normal post-COVID-19 pandemic era.
The manuscript is attractive and interesting.
I have some minor suggestions with a pure academic spirit:
1. Insert the conclusions in the abstract
2. Describe figure 1 in details
3. Improve the resolution of the figures
4. The tables do not follow the MDPI standard
5. Insert a paragraph with the limitations
Author Response
Response to Reviewer 1 Comments
We greatly appreciate your thoughtful comments concerning our manuscript entitled " Impact of the COVID-19 pandemic on mental health and lifestyle in Thai Occupational Therapy Students: A mixed method study" (Manuscript ID: ejihpe-1945841). Those comments are all valuable and very helpful for revising and improving our paper. We have studied comments carefully and have made correction which we hope meet with approval. Revised portion are marked in yellow highlighting in the paper.
The main corrections in the paper and the responds to the reviewer’s comments are as flowing:
Point 0: I have some minor suggestions with a pure academic spirit.
Response 0: Thank you very much indeed for your suggestions.
Point 1: Insert the conclusions in the abstract.
Response 1: We are thankful and agreed with your suggestion that now we inserted the conclusion in the abstract on the page 1 in line 29-34.
As an impact of the COVID-19 pandemic, occupational therapy students adapted to new lifestyles and experienced mental health issues related to their studies, families, friends, economics, social climate, and future job opportunities. Educators may use the findings of this study to prevent negative impacts on mental health and promote academic achievement in the future, as well as general well-being, efficacy, and empowerment of students in the new normal post-COVID-19 pandemic era.
Point 2: Describe figure 1 in details
Response 2: We are pleased and thank you very much indeed that you suggest describing Figure 1 in detail. Now we added the detail in manuscript-revision which presents on the page 4 in the Line 170-182.
Point 3: Improve the resolution of the figures.
Response 3: We are thankful and agreed with your suggestion to improve the resolution of all figures.
Point 4: The tables do not follow the MDPI standard
Response 4: Thank you very indeed for the comment, we are already made the tables to be followed the MDPI standard.
Point 5: Insert a paragraph with the limitations
Response 5: We would like to thank you so much for your suggestions about a paragraph with the limitations. Now we are already insert it article 5. Limitation which on the page 17 in the Line 683-695.
Special thanks to you for your good comments. We tried our best to improve the manuscript and made some changes in the manuscript.
We appreciate for reviewers’ warm work earnestly and hope that the correction will meet with approval. Once again, thank you very much indeed for your comments and suggestions.
Best regards,
Anuchart Kaunnil and research team
Reviewer 2 Report
Present manuscript entitled "Impact of the COVID-19 Pandemic on Mental Health and Life- 2 style in Thai Occupational Therapy Students: A Mixed Method 3 Study" addresses a highly topical and relevant issue due to the impact it has had on public health worldwide and to the possible consequences and aftermath that derive from this pandemic health crisis.
Authors tried to investigate the impact of the COVID-19 pandemic on the mental health and lifestyle of occupational therapy students in Thai and although relevant, some fundamental methodological aspects make my decision about this article to reject its publication in this journal.
Sample is not sufficiently described. Sex is wrongly matched with sexual orientation (ie. authors clasiffy students as females, males, lesbian, gay and other LGBTI). No other sociodemographic variable was described. There is no information about this sample, and so, no conclusiones may be drawn of these participants.
Regarding the two themes that were analyzed by the interview data: (1) adaptive responses; and multidimensional challenges (Economic impact; Online activities; Impact on lifestyle and social life impact), results were quite tautological and some conclusions cannot be made from the data obtained (ie. This lifestyle pattern can result in biological 586 clock deviation thus impacting health conditions in the long term).
In sum, my consideration is to reject this paper.
Author Response
Response to Reviewer 2 Comments
We greatly appreciate your thoughtful comments concerning our manuscript entitled "Impact of the COVID-19 pandemic on mental health and lifestyle in Thai Occupational Therapy Students: A mixed method study" (Manuscript ID: ejihpe-1945841). Those comments are all valuable and very helpful for revising and improving our paper. We have studied comments carefully and have made correction which we hope meet with approval. Revised portion are marked in yellow highlighting in the paper.
The main corrections in the paper and the responds to the reviewer’s comments are as flowing:
Present manuscript entitled "Impact of the COVID-19 Pandemic on Mental Health and Life-style in Thai Occupational Therapy Students: A Mixed Methods Study" addresses a highly topical and relevant issue due to the impact it has had on public health worldwide and to the possible consequences and aftermath that derive from this pandemic health crisis.
Point 1: Sample is not sufficiently described. Sex is wrongly matched with sexual orientation (ie. authors classify students as females, males, lesbian, gay and other LGBTI).
Response 1: We are thankful and agreed with your comments and suggestion about the sex that we change to be gender on the page 7 in line 283. Also, we added to present the percent and number of lesbians, gay, bisexual, transgender, and intersex (LGBTI) in the table and detail on the page 8 in line 302-306.
Point 2: No other socio-demographic variable was described.
Response 2: Thank you very much indeed for comments and suggestions. Now we described socio-demographic variable in Qualitative study on the page 7 in the Line 275-278. In terms of Quantitative study, we described on the page 8 in line 302-308.
Point 3: There is no information about this sample, and so, no conclusions may be drawn of these participants.
Response 3: We are thankful and agreed with your comments and suggestion. Now we added information about occupational therapy students on the page 3 in the line 113-140. Moreover, now we inserted the conclusion in the abstract and in the section of conclusion based on the result of occupational therapy participants on the page 1 in line 29-34.
Point 4: Regarding the two themes that were analyzed by the interview data: (1) adaptive responses; and multidimensional challenges (Economic impact; Online activities; Impact on lifestyle and social life impact), results were quite tautological and some conclusions cannot be made from the data obtained (ie. This lifestyle pattern can result in biological clock deviation thus impacting health conditions in the long term).
Response 4: Thank you very indeed for the comment, we are already made it to be clear about our results that is the integration of qualitative and quantitative studies. Now we modified the heading title relevant to the results, which follow.
- Adaptive responses were consistent with areas of occupation and daily activities during the COVID-19 pandemic
- Multidimensional challenges were related to sensory patterns of purposeful and meaningful activities.
We inserted on the page 1 in line 21-23.
Once again, we would like to thank you so much for your mention in the results. Now we made it clear that arrange them point by point, which include integrated themes and survey findings in line 325-576.
- Results
3.1 Adaptive responses were consistent with areas of occupation during the COVID-19 pandemic
- Adaptive Responses (Qualitative study)
- Areas of occupation and daily activities during the COVID-19 pandemic (Quantitative study)
3.2. Multidimensional challenges were related to sensory patterns of purposeful and meaningful activities
- Economic impact
3.2.1 Online learning activities and favorite hobbies were related to visual activities
- Online learning activities and favorite hobbies (Qualitative study)
- Visual activities (Quantitative study)
3.2.2 Impact on lifestyle was related to auditory, smell/taste, and movement activities
- Impact on lifestyle (Qualitative study)
- Auditory, smell/taste, and movement activities (Quantitative study)
3.2.3 Impact on social life was appropriate for meaningful activities
- Impact on social life (Qualitative study)
- meaningful activities (Quantitative study)
Special thanks to you for your good comments. We tried our best to improve the manuscript and made some changes in the manuscript.
We appreciate for reviewers’ warm work earnestly and hope that the correction will meet with approval. Once again, thank you very much indeed for your comments and suggestions.
Best regards,
Anuchart Kaunnil and research team
Reviewer 3 Report
The manuscript looks very interesting; however, there are a couple of quires.
Avoid using "WE" in the entire manuscript using the Authors
The Introduction section is very elaborative, However, the need of the study was not explained well.
Mention the ethical approval No and institute
Self Admisterted questionnaire was tested prior to distribution to the participants
Who all participated in the tool development and please statereliability and validity of the test tool clearly
The figure 1 looks interesting
I suggest using student 1 rather than names
What tool was used for the analysis
There are a couple of confusing statements in the results and try to arrange them point by point
Discussion
Looks very interesting
I also suggest using various Well being scales and their use is reported in the literature
I believe lines 571 and 579 are not required still if the author wants to keep rephrasing the sentences
This content may not necessary rather no additional benefit in the study
Author Response
Response to Reviewer 3 Comments
We greatly appreciate your thoughtful comments concerning our manuscript entitled "Impact of the COVID-19 pandemic on mental health and lifestyle in Thai Occupational Therapy Students: A mixed method study" (Manuscript ID: ejihpe-1945841). Those comments are all valuable and very helpful for revising and improving our paper. We have studied comments carefully and have made correction which we hope meet with approval. Revised portion are marked in yellow highlighting in the paper.
The main corrections in the paper and the responds to the reviewer’s comments are as flowing:
Point 0: The manuscript looks very interesting; however, there are a couple of quires.
Response 0: We are pleased and thank you very much indeed for your comments and suggestion.
Point 1: Avoid using "WE" in the entire manuscript using the Authors.
Response 1: We are thankful and agreed with your mention about “WE” that we changed in our manuscript to “Authors”.
Point 2: The Introduction section is very elaborative; However, the need of the study was not explained well.
Response 2: We would like to thank you very much; we are pleased that you suggested is important point. Now we bridge the gap or problematic issue to connect what we want to study and find out the real situation of COVID-19 impact on occupational therapy students. The explanation of introduction has been inserted on page 3 in the Line 104-140.
Point 3: Mention the ethical approval No and institute.
Response 3: We are thankful and agreed with your comments that now the ethical approval number and institute of this study on the page 4 in line 157-159.
“This research received ethical approval, from the Associated Medical Sciences Research Ethical Committees, Chiang Mai University, code AMSEC-63EX-065.”
Point 4: Self-Administered questionnaire was tested prior to distribution to the participants. Who all participated in the tool development and please state reliability and validity of the test tool clearly.
Response 4: Thank you very indeed for the comments and recommendations. We would like to thank you so much for your mention about tool development with reliability and validity. Now we made it clear that our Thai Sensory Patterns Assessment (TSPA) tool was developed since 2011. In 2020, we develop the Thai’s Sensory Patterns Assessment Tool for Adolescents and Adults. In our previous study, there were 400 participants aged over 15 years in Chiang Mai province, Thailand, which recruited for examining internal consistency, and 40 participants were recruited for testing test-retest reliability. Hence, we added this detail into the manuscript to make readers clear about the TSPA tool for adolescents and adults on the page 5-6 in line 210-232.
Point 6: I suggest using student 1 rather than names.
Response 6: We are thankful and agreed with your comments and suggestion. Now we changed to use student 1-12 rather than names on the page 7 in line 283-284.
Point 7: What tool was used for the analysis.
Response 7: Thank you very indeed for the comments. We added the detail of TSPA tool for adolescents and adults to find sensory patterns for adolescents and adults in two parts: sensory preferences, and sensory arousal. This tool used to find sensory pattern that reflected on visual, auditory, smell/taste, and movement activities that involved in activities of daily living during COVID-19 pandemic on the page 5-6 in line 210-246.
In qualitative analysis, we used content analysis based on Krippendorff (2013) that includes 5 steps that presented on the page 8 in line 285-291.
- The interviews were listened to and thereafter read through several times to obtain a sense of the whole
- The transcribed text was divided into units of meaning, which were condensed and labelled with codes
- The codes were compared, looking for similarities and differences, and then sorted into subcategories and two main categories
- Verified that the coding was congruent with the units of meaning
- The latent content was formulated into an overarching theme
Krippendorff, K. Content analysis: An introduction to its methodology 3rd Edition. Thousand Oaks: SAGE Publications, Inc. 2013.
In quantitative analysis, we used descriptive statistics that showed the frequency (count) and relative frequency (percentage) on the bar chart.
Point 8: There are a couple of confusing statements in the results and try to arrange them point by point
Response 8: We would like to thank you so much for your mention in the results. Now we made it clear that arrange them point by point, which include integrated themes and survey findings in line 325-576.
- Results
3.1 Adaptive responses were consistent with areas of occupation during the COVID-19 pandemic
- Adaptive Responses (Qualitative study)
- Areas of occupation and daily activities during the COVID-19 pandemic (Quantitative study)
3.2. Multidimensional challenges were related to sensory patterns of purposeful and meaningful activities
- Economic impact
3.2.1 Online learning activities and favorite hobbies were related to visual activities
- Online learning activities and favorite hobbies (Qualitative study)
- Visual activities (Quantitative study)
3.2.2 Impact on lifestyle was related to auditory, smell/taste, and movement activities
- Impact on lifestyle (Qualitative study)
- Auditory, smell/taste, and movement activities (Quantitative study)
3.2.3 Impact on social life was appropriate for meaningful activities
- Impact on social life (Qualitative study)
- meaningful activities (Quantitative study)
Point 9: Looks very interesting. I also suggest using various Wellbeing scales and their use is reported in the literature
Response 9: We thank the reviewer for recommendations and suggestions. We added various well-being scales from previous studies into our literature on the page 16-17 in line 659-673.
Point 10: I believe lines 571 and 579 are not required still if the author wants to keep rephrasing the sentences This content may not necessary rather no additional benefit in the study.
Response 10: Thank you very indeed for the comment, we are already made it to be clear by deleting the line that are necessary.
Special thanks to you for your good comments. We tried our best to improve the manuscript and made some changes in the manuscript.
We appreciate for reviewers’ warm work earnestly and hope that the correction will meet with approval. Once again, thank you very much indeed for your comments and suggestions.
Best regards,
Anuchart Kaunnil and research team
Author Response File: 
Author Response.docx
Round 2
Reviewer 2 Report
Some aspects have not been addressed by authors, as per my previous review, so I recommend to make further modifications in order to have it suitable to publication.
I specifically mean the issue of gender (sex) and the reason to have sexual orientation (LGTB) as equivalent as sex (male/female) which it is a concept error which must be modified.
Also, some conclusions are not driven by results, ie. mental health, and so, can not be stated from this work. For example, what kind of variables have been studied in order to talk about mental health?
I have read the modified manuscript, but I do not feel suggestions have really been considered or stated in the authors reply to reviewers.
Author Response
Response to Reviewer 2 Comments
We greatly appreciate your thoughtful comments concerning our manuscript entitled "Impact of the COVID-19 pandemic on mental health and lifestyle in Thai Occupational Therapy Students: A mixed method study" (Manuscript ID: ejihpe-1945841). Those comments are all valuable and very helpful for revising and improving our paper. We have studied comments carefully and have made correction which we hope meet with approval. Revised portions are marked in yellow highlighting in the paper.
The main corrections in the paper and the responds to the reviewer’s comments are as flowing:
Present manuscript entitled "Impact of the COVID-19 Pandemic on Mental Health and Life-style in Thai Occupational Therapy Students: A Mixed Methods Study" addresses a highly topical and relevant issue due to the impact it has had on public health worldwide and to the possible consequences and aftermath that derive from this pandemic health crisis.
Some aspects have not been addressed by authors, as per my previous review, so I recommend making further modifications in order to have it suitable to publication.
Response: We would like to thank you very much indeed for your recommendation again.
Point 1: I specifically mean the issue of gender (sex) and the reason to have sexual orientation (LGTB) as equivalent as sex (male/female) which it is a concept error which must be modified.
Response 1: Thank you very much indeed for comments and suggestions. We don’t have reason to discuss about the issue of LGBTI or sexual orientation related to the impact of COVID-19. So, we have edited the gender to be male and female as reviewer’s concern. Also, we adjust it to present the percent and number of male and female in the table and detail on the page 8 in line 302-303.
Point 2: Also, some conclusions are not driven by results, ie. mental health, and so, can not be stated from this work. For example, what kind of variables have been studied in order to talk about mental health?
Response 2: Again, we are thankful and agreed with your comments and suggestion. We are already made it to be clear about the conclusions that they are driven by the results including mental health variables on page 18-19 in line 697-714.
We appreciate for reviewers’ warm work earnestly and hope that the correction will meet with approval.
Once again, thank you very much indeed for your comments and suggestions.
Best regards,
Anuchart Kaunnil and research team
Author Response File: 
Author Response.pdf
Reviewer 3 Report
The manuscript has been improved.
all the queries had have been answered appropriately
Author Response
Response to Reviewer 3 Comments
We greatly appreciate your thoughtful comments concerning our manuscript entitled "Impact of the COVID-19 pandemic on mental health and lifestyle in Thai Occupational Therapy Students: A mixed method study" (Manuscript ID: ejihpe-1945841). Those comments are all valuable and very helpful for revising and improving our paper. We have studied comments carefully and have made correction which we hope meet with approval. Revised portions are marked in yellow highlighting in the paper.
Point: The manuscript has been improved; all the queries had have been answered appropriately
Response: Thank you very much indeed.
We appreciate for reviewers’ warm work earnestly and hope that the correction will meet with approval. Once again, thank you very much indeed for your comments and suggestions.
Best regards,
Anuchart Kaunnil and research team
Author Response File: Author Response.docx
