Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The article complies with the standards on clarity, methodology, and result presentation. The issue of the degradation of ecosystems and the mental health of healthcare professionals is covered in detail. 

I would suggest going over the conclusions section again. I believe it would be wise to add to the idea that the results support the need to promote mental health, hope, and the ability to adapt of the demonstration. Why? Given that the study's goal is to characterize and investigate the relationship between hope, resilient behavior, and mental health among Portuguese healthcare professionals, it would be appropriate for the conclusions to explain to the reader what those characteristics were detected as well as how these relate to hope, resilient behavior, and mental health among Portuguese healthcare professionals, given that the study's goal is to characterize and investigate the relationship between these factors and mental health among these professionals.

Author Response

Dear Reviewer 1,

Thank you very much for the careful analysis of our manuscript, your feedback and the opportunity to improve the manuscript.

We absolutely agree with your suggestion, so we added a paragraph at the beginning of the Conclusions. We would appreciate your feedback on it.

Best regards,

Authors

Reviewer 2 Report

Comments and Suggestions for Authors

Review report on “Risks of ecosystems’ degradation……”

 

1.     This study is poorly designed, and the authors.  The biggest problem is that the study has no comparison group. So, how do you know the associations between the variables you found in the study were indeed driven by the fact that the participants are healthcare professionals? Or, these associations exist among most people, even non-healthcare professionals?  If these associations apply to other people, why focus on healthcare professionals, then? Without a suitable comparison group, you can't answer this question. So, the study would have to be redesigned and redone to yield useful information. 

 

2.    The paper needs to be restructured. In particular, the Introduction is way too elaborate. A typical Introduction has 4-5 paragraphs at most. It’s also VERY strange that the Introduction even has subsections (1.1., 1.2.,.., etc.). Come on, it is supposed to be an “Introduction”! You should have put that lengthy narrative review as the “theoretical background” or simply the “literature review” of the presented study!

 

3.       Why was Portugal selected as the target of the study? Is there anything about this country that makes it particularly useful for this study? Should explain.

 

4.     It’s NOT clear how the sample was collected. Is it representative of any underlying population? How the data were collected? Were there refusals? What was the refusal rate? How did you deal with refusals? Any replacements? None discussed.

 

5.       It’s strange that a 4-point scale was used. Usually, a 5 or 7-point scale is used. So, the results are hard to compare with other studies. 

 6. Why not include socio-demographic variables in the analysis and run some regressions?

 

 

Comments on the Quality of English Language

Too elaborate. It should be made more concise and focused.

Author Response

Dear Reviewer 2,

Thank you for the analysis of our manuscript, your feedback and the opportunity to improve the manuscript.

To simplify, we present the results of the reflections inspired by every comment you shared with us bellow each one.

1.     This study is poorly designed, and the authors.  The biggest problem is that the study has no comparison group. So, how do you know the associations between the variables you found in the study were indeed driven by the fact that the participants are healthcare professionals? Or, these associations exist among most people, even non-healthcare professionals?  If these associations apply to other people, why focus on healthcare professionals, then? Without a suitable comparison group, you can't answer this question. So, the study would have to be redesigned and redone to yield useful information. 

ANSWER: We would appreciate to know the end of the first sentence: “and the authors.” so we could address it.

Even though we recognize the relevance of comparative studies, we consider they are not compulsory. We never intended for readers to conclude the associations were driven by the sample’s profession. In fact, in the beginning of the abstract we mention that “affect their mental health. Research suggests that hope and resilience can play an important role in this scenario, since they are related to/predict mental health in highly heterogeneous samples (considering geography, age, profession, health, etc.).”

The relevance to focus on healthcare professionals derives from the current literature stressing these professionals deal with major mental health challenges and there is an urgency in identifying effective interventions to prevent mental health disorders in these professionals.

2.    The paper needs to be restructured. In particular, the Introduction is way too elaborate. A typical Introduction has 4-5 paragraphs at most. It’s also VERY strange that the Introduction even has subsections (1.1., 1.2.,.., etc.). Come on, it is supposed to be an “Introduction”! You should have put that lengthy narrative review as the “theoretical background” or simply the “literature review” of the presented study!

ANSWER: Since the journal is relevant for researcher and practitioners from different fields, we considered it necessary to thoroughly base our study to be fully understandable to readers with very different backgrounds.

In Human and Social Sciences, for instance, 4-5 paragraphs would be a very atypical Introduction, making it relevant for several relevant journals to publish Introductions with subsections.

If for Reviewer 2 and Editor the solution is to ignore the journal’s structure and give another name to the first part of the manuscript, we will gladly do so. We would like confirmation, though, considering the content of the journal’s “Instructions for Authors”.

3.       Why was Portugal selected as the target of the study? Is there anything about this country that makes it particularly useful for this study? Should explain.

ANSWER: The contry was selected because all the researchers of the team are Portuguese and work in Portugal and, to the best of our knowledge, Portuguese healthcare professionals do not have any characteristic that renders research with them useless for research and intervention that can be undertaken with other countries’ samples.

We consider all countries/populations are equally “useful”, non-discriminating between countries with more or less strong research/publication presence.

4.     It’s NOT clear how the sample was collected. Is it representative of any underlying population? How the data were collected? Were there refusals? What was the refusal rate? How did you deal with refusals? Any replacements? None discussed.

 ANSWER: In section 2.3. Procedure, we described how the sample and data were collected (in brief: non-probabilistic by the snowball technique sampling; data was collected online, by sharing a questionnaire through Google Forms). Therefore, it is not a representative sample and it is not possible to consider the refusal concept in this data collection procedure.

5.       It’s strange that a 4-point scale was used. Usually, a 5 or 7-point scale is used. So, the results are hard to compare with other studies. 

 ANSWER: Even though aware of the debate regarding the ideal number of points on a Likert scale, to render our results comparable to those published (and for methodological and ethical reasons), we did not change the scales of the instruments used, previously and internationally tested.

 6. Why not include socio-demographic variables in the analysis and run some regressions?

 ANSWER: We did not do that because our objectives were based on previous relevant research and the regressions with socio-demographic variables were not considered by us at the same level of novelty or relevance. Nevertheless, we are more than willing to identify that as a limitation of our study and would appreciate if Reviewer 2 could indicate which variables s/he considers worth mentioning.

 

Comments on the Quality of English Language

Too elaborate. It should be made more concise and focused.

ANSWER: A review was undertaken to improve the quality of the text.

Best regards,

Authors

Reviewer 3 Report

Comments and Suggestions for Authors

Dear authors,

thank you very much for the opportunity to read your manuscript. It is an interesting approach to the problems arising from the mental health of health professionals and their capacity for resilience and hope. In my opinion, it is necessary to review the STROBE guide to improve research reporting

Title: Correct.

Keywords: I propose some improvements to adjust to MeSH terms. For health care professionals ("Health Personnel" is the correct MeSH) and for resilient coping (the MeSH "Resilience, Psychological"). "Sustainability's factors related to health" and "ecosystems’s degradation risks" are not MeSH terms, however, it is up to the editor to decide whether it is appropriate to use this term as a keyword.

Abstract: Include the study design.

Introduction: In my opinion, the introduction is very extensive, but I understand that the theoretical framework requires a broad approach to the issues studied. The introduction concludes by describing the research objectives.

Materials and Methods: The first subheading should be the research design. Participants: should include several important aspects in addition to the inclusion criteria, such as exclusion criteria and type of sampling. In addition, it would be interesting if an estimate of the sample size had been calculated based on the expected proportion of the population according to the standard deviation obtained (in the same context or other contexts in which the same instrument has been used) in previous similar studies, as well as the desired precision and the required replacement rate.

It should explain in more detail the setting, but should not provide in the methods section the results of the sample obtained and characteristics of the individuals (age, sex, profession...); this information should be transferred to the results (the first results should be the sociodemographic characteristics of the sample).

In relation to the internal consistency properties of the GHQ-28 instrument, you should not include this information in a table (it does not provide relevant information to constitute a table). It is sufficient to describe in the text this information on the Crombach for the total scale and the dimensions in the background. The internal consistency results of the present study should be reported in the results section and the subsequent discussion should address the necessary aspects in this regard.

 

In section 2.3 procedure, the design is described, but as I mentioned earlier, this paragraph should be moved to the beginning of Materials and Methods; the same goes for the sample.

The ethical aspects should be in a specific section, typically at the end of the methodology.

For the bivariate analyses, only Pearson correlations have been conducted (it is understood that parametric tests were used based on the normality of the data, but this is not explained in the method) with continuous variables. Have bivariate analyses between groups with Student's t-test or Mann-Whitney U test (according to normality) not been conducted?

The results should be presented in an orderly manner, first characteristics of the sample (see previous comment), then descriptive results, and finally bivariate and multivariate inferential results.

In Table 2, results from other studies should not be included; only the results achieved in this research should be described. Results from other studies will be discussed in the discussion section.

The correlation results could be presented in a table. This would enhance their comprehension.

Discussion: Include the aspects mentioned above.

The conclusions must respond to the objectives of the research. Do not use references in this section.

References: review and correctly include the style and links or DOI to the primary source where appropriate

Author Response

Dear Reviewer 3,

Thank you very much for the carefull analysis of our manuscript, your feedback and the opportunity to improve the manuscript.

To simplify, we present the results of the reflections inspired by every comment you shared with us bellow each one.

We would appreciate your feedback on it.

Best regards,

Authors

Dear authors,

thank you very much for the opportunity to read your manuscript. It is an interesting approach to the problems arising from the mental health of health professionals and their capacity for resilience and hope. In my opinion, it is necessary to review the STROBE guide to improve research reporting.

We reviewed the manuscript considering the STROBE guide.

Title: Correct.

Keywords: I propose some improvements to adjust to MeSH terms. For health care professionals ("Health Personnel" is the correct MeSH) and for resilient coping (the MeSH "Resilience, Psychological"). "Sustainability's factors related to health" and "ecosystems’s degradation risks" are not MeSH terms, however, it is up to the editor to decide whether it is appropriate to use this term as a keyword.

We substituted the terms you indicated and look forward to the Editors’ feedback.

Abstract: Include the study design.

We added retrospective, analytical observational, and descriptive and correlational research design to the “cross-sectional study” previously indicated in the abstract.

Introduction: In my opinion, the introduction is very extensive, but I understand that the theoretical framework requires a broad approach to the issues studied. The introduction concludes by describing the research objectives.

Materials and Methods: The first subheading should be the research design.

We added:

2.1. Research design

Considering its aims, the present study used a retrospective, analytical observational, cross-sectional, descriptive and correlational research design..

And adjusted the numering of the subsequent sections.

Participants: should include several important aspects in addition to the inclusion criteria, such as exclusion criteria and type of sampling. In addition, it would be interesting if an estimate of the sample size had been calculated based on the expected proportion of the population according to the standard deviation obtained (in the same context or other contexts in which the same instrument has been used) in previous similar studies, as well as the desired precision and the required replacement rate.

We added:

Exclusion criteria were: at the time of participation, not working as an healthcare professional, not working in Portugal, being a minor, and not giving informed consent to participate.

The sentence that follows was moved from Procedure to Participants:

The sampling was non-probabilistic by the snowball technique with healthcare professionals from Portugal.

Due to difficulties in obtaining the population numbers, an estimate of the sample size was not calculated.

It should explain in more detail the setting, but should not provide in the methods section the results of the sample obtained and characteristics of the individuals (age, sex, profession...); this information should be transferred to the results (the first results should be the sociodemographic characteristics of the sample).

The sociodemographic characterization of the sample were moved to the begining of the Results section (3.1. Sociodemographic characteristics of the sample).

We did not explain in more detail the setting since data was collected via Google Forms. If further instructions are presented, we will gladly comply.

In relation to the internal consistency properties of the GHQ-28 instrument, you should not include this information in a table (it does not provide relevant information to constitute a table). It is sufficient to describe in the text this information on the Crombach for the total scale and the dimensions in the background. The internal consistency results of the present study should be reported in the results section and the subsequent discussion should address the necessary aspects in this regard.

 We consider it is easier for readers to see the present and previous Portuguese Cronbach alfas in a table, in the Method section, as is typical in our field of studies. Neverthless, if it is considered important, we will, of course, change it.

In section 2.3 procedure, the design is described, but as I mentioned earlier, this paragraph should be moved to the beginning of Materials and Methods; the same goes for the sample.

The manuscript was altered accordingly.

The ethical aspects should be in a specific section, typically at the end of the methodology.

We added a section: 2.5. Ethical aspects

For the bivariate analyses, only Pearson correlations have been conducted (it is understood that parametric tests were used based on the normality of the data, but this is not explained in the method) with continuous variables. Have bivariate analyses between groups with Student's t-test or Mann-Whitney U test (according to normality) not been conducted?

No, they haven’t.

The information regarding normality was added.

The results should be presented in an orderly manner, first characteristics of the sample (see previous comment), then descriptive results, and finally bivariate and multivariate inferential results.

The results now follow that structure, begining with the sub-section regarding the characteristics of the sample, with the two subsequent sections in the mentioned order (even though its names focus not on the type of analysis, but on the psychological content/study aims).

In Table 2, results from other studies should not be included; only the results achieved in this research should be described. Results from other studies will be discussed in the discussion section.

Since Sustainability does not have strict formatting requirements, we ask to maintain the initial structure, baring in mind that the present study results are clearly identified and no confusion can be made by the reader between present and previous results. Our option intended to present and improve the comprehension of our results, since in the Discussion such comparison cannot be fully explored.

The correlation results could be presented in a table. This would enhance their comprehension.

We consider that a table for the correlation results would unnecessarily take up too much space, that is why we did not opt for that solution. If necessary, we will change it, of course.

Discussion: Include the aspects mentioned above.

Please, see comment above.

The conclusions must respond to the objectives of the research. Do not use references in this section.

The altered the beginning on the Conclusions, accordingly.

We deleted all references with the exception of Müller et al. (2023), not to risk plagiarism in the use of their terminology.

References: review and correctly include the style and links or DOI to the primary source where appropriate.

We did and we will make a final revision before the final version of the manuscript is reached.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors apparently refused to address the concerns I raised by simply "arguing away" those concerns. So, most of the concerns still remain. And in some cases, they even argue that their limitations are, in fact, advantages. I request that the authors address those comments seriously (if your paper is so perfect, why do you need peer review? Now that at least one of the peers found serious problems in your paper. Shouldn't you address those?). 

Comments on the Quality of English Language

Only when the paper has been substantially revised will this be appropriate.

Author Response

As recomended:

"Please submit your manuscript (you dont need to make any changes) to the system as soon as possible that we can continue processing".

Author Response File: Author Response.docx