Depression, Acculturative Stress, and Social Connectedness among International University Students in Japan: A Statistical Investigation

Round  1

Reviewer 1 Report

Comments and Suggestions for the authors:

Abstract

Please combine into a single paragraph.

Line 16-17: Is it correct to refer to APU as Japan International University?

Line 31-33: “Among international and domestic students statistically significant positive correlation between depression and acculturative stress, negative associations of social connectedness with depression and acculturative stress were also found. “

This sentence is confusing.

Introduction

Please provide a paragraph that provide a clear connection between the issues being studies and the aim and scope of the Special Issue at the beginning of the paper before jumping in the details. The authors can consider moving to the beginning a part of the last two paragraphs of the Introduction, where explain the objectives and hypotheses of their study.

Line 83-84: “Very high depression prevalence among first-year university students in Japan was reported [26].” Please be more specific.

Line 91-93: “Although these three essential factors (mental health - depression, acculturation - acculturative stress, and social support - social disconnectedness) are related, empirical evidence had not been examined together in previous papers.” This is a strong claim; it is never easy to prove the non-existence of evidence, so either please provide very strong references or rewrite the sentences.

Materials and Methods

The materials and methods have been described thoroughly though there are minor wordings and grammars errors.

Line 124-125: “The diversity of APU gave the study a more general look regardless of origins” This sentence is confusing, please rewrite.

Conclusion and Discussion

The authors have tried to create a dialogue with the extant literature. However, it is still confusing which are their results and which are from the literature especially in the first section. For example, line 336-339: “The depression prevalence of domestic students in APU was also around 30%. From these cases, it can be seen that the depression rate of Japanese college students is close to 30.6% of the prevalence of depression among university students indicated in the systematic review [62].”

The authors can be more concise in listing the results of different studies on the prevalence of depression among international students. The authors should start with their results then create a link to the extant literature rather than listing the results of other studies first.

Line 346-350: This part should be moved to the discussion on the limitations of the study.

The authors should discuss the skewness in the number of males and females participating in this study.

The model (figure 2) should be moved to the end of the Introduction when the authors first introduce their hypotheses.

Regarding the unexpected findings on domestic students, the authors should discuss the Japanese cultural and socio-economic factors because the domestic students here are Japanese.

I find the section on the school’s support and recommendation a bit irrelevant, as this part only describe the steps that the school has taken to prevent mental health issues. The authors should focus on a discussion of the relevant policy implications of their results, meaning given the specific results, what can APU or schools in a similar situation do.

Author Response

Letter of detailed responses to Reviewer 1

Dear Sir/Madam,

Thank you very much for spending a great amount of time and effort you have put in to reviewing our manuscript. Your detailed comments have helped us improve the quality of our paper.

We have addressed your points in our revised version (please see the attached file).

We appreciate the hard work and time that you have spent on this manuscript. Your comments and suggestions have helped us improve the quality of our paper. We hope that the revised paper has met your requirements.

Please accept our sincere thanks for your great contributions to the improvement of higher studies on public health and the overall advancement of sciences in the world.

Shall you have further comments, we look forward to hearing from you.

Best regards,

Author Response File: Author Response.docx

Reviewer 2 Report

This is a cross sectional study on a diverse sample of young adults. They aim to examine the prevalence of depression as well as various predictors (i.e., demographic variables, acculturative stress, social connectedness, and international status). Authors found that demographics predicted depression and that the other variables were correlated. The main strength of this study appears to be the sample, but there are many areas that are lacking. I am primarily concerned with the theoretical framework and approach to the analyses.

Introduction

(1)  Since suicide is purportedly a variable of interest, the intro could use a framework that explains why people consider and complete suicide. I would recommend the Interpersonal Theory of Suicide (see Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner Jr, T. E. (2010). The interpersonal theory of suicide. Psychological review, 117(2), 575.). It will also be important to differentiate between forms of suicide. The IPTS will fit well with their consideration of connectedness/belonging.

(2)  It seems like the authors often conflate factors like acculturative stress, connectedness, and social support. These are all different constructs and social connectedness, in particular, needs to be more well defined.

(3)  Since they indicate that mental health is a serious issue in Japan, it would be helpful to offer some sort of cultural context – how do Japanese people think of and treat mental health.

(4)  Please omit content that is more suitable to the methods and results sections (see lines 92 and 93)

(5)  Since demographic factors are a key part of the analyses, there should be a section in the introduction that discusses the extant literature on the relations between gender/age and depression.

(6)  Although conceptualized within a largely western framework, the authors might consider discussing developmental issues associated with the sample (see Arnett, J. J. (2007). Emerging adulthood: What is it, and what is it good for?. Child development perspectives, 1(2), 68-73.)

Methods

(1)  Was the study anonymous and ethical? Was there any institutional review and/or approval?

(2)  I am not fully convinced that the item "thoughts of being better off dead" really speak to ideation completely. It may be appropriate to call this passive ideation or make an argument for why it is suitable measure for ideation.

Results

(1)  Please include descriptive statistics on the international distribution of countries – this is one of the strengths of the dataset.

(2)  Table 1 appears to have an inaccurate title.

(3)  It is a clear error to include language like “cause” with cross-sectional data that cannot speak to directionality. They can only suggestion association/correlation (see line 209).

(4)  Although a binary logistic regression makes sense for the dichotomous items (i.e., self-harm), a general linear model is more intuitive for the depression measure.

(5)  The authors should run a regression model with the main predictors as well. I would recommend a two-step multiple regression model - 1st with the demographic variables and 2nd with the main predictors (i.e., acculturative stress, social connectedness). They might want to consider higher order models that include moderating effects of factors like social connectedness – if they choose to do this, please include a theoretically based rationale.

(6)  Figure 2 looks like a mediation model and their analysis does not speak to this. I would omit it or examine mediation.

Discussion

(1)  Please omit any coefficients from this section. Feel free to expound on the nature of relationships but leave the actual numbers for only the results section.

General

(1)  There are a number of typos and sentences that are not grammatically correct. There needs to be serious editing.

Author Response

Letter of detailed responses to Reviewer 2

Dear Sir/Madam,

Thank you very much for spending a great amount of time and effort you have put in to reviewing our manuscript. Your detailed comments have helped us improve the quality of our paper.

We have addressed your points in our revised version (please see the attached file).

We appreciate the hard work and time that you have spent on this manuscript. Your comments have helped us improve the quality of our paper. We hope that the revised paper has met your requirements.

Please accept our sincere thanks for your great contributions to the improvement of higher studies on public health and the overall advancement of sciences in the world.

Shall you have further comments, we look forward to hearing from you.

Best regards,

Author Response File: Author Response.docx

Reviewer 3 Report

Overall, this study adds valuable insights to the literature and the study of acculturative stress and depression relating to social exposure and individual experiences. The study design was fair and the response rate was sufficient. The researchers illustrated good data analysis based on the tests presented. 

Several minor errors were identified:

Line 18 said there were 263 participants. Line 126 said it was 268. The table at line 139 when combined domestic and international student population equals 268. Is line 18 a typo?

Please see highlighted sections on the attached for minor corrections.

Comments for author File: Comments.pdf

Author Response

Letter of detailed responses to Reviewer 3

Dear Sir/Madam,

Thank you very much for spending a great amount of time and effort you have put in to reviewing our manuscript. Your detailed comments have helped us improve the quality of our paper.

We have addressed your points in our revised version (please see the attached file).

We appreciate the hard work and time that you have spent on this manuscript. Your comments have helped us improve the quality of our paper. We hope that the revised paper has met your requirements.

Please accept our sincere thanks for your great contributions to the improvement of higher studies on public health and the overall advancement of sciences in the world.

Shall you have further comments, we look forward to hearing from you.

Best regards,

Author Response File: Author Response.docx

Round  2

Reviewer 2 Report

No additional comments at this time.