Factors Associated with COVID-19-Related Stress among Female Primary Caregivers in Vulnerable Families in South Africa
Round 1
Reviewer 1 Report
“This study aimed to predict family-related stressors emanating from the COVID-19 pandemic from the perspective of female caregivers in a metropolitan area of South Africa”. A cross-sectional survey was completed by 275 caregivers from Oct. 2021 to Feb. 2022. Results. Approximately ½ of the respondents reported stress levels above average related to children/partner issues or financial issues. Above stress level related to children/partner were associated with fear of COVID-19, feeling depressed, COVID-19’s impact on daily life, lower education level, being in a relationship and living together and perceiving increased domestic violence in the community. Above stress related to finances was associated with age, impact of COVID in daily life, being in a relationship and living together, running out of food in the last 30 days.
There are several strengths in the study: exploring the impact of COVID-19 in the stress level of a large sample of vulnerable families in South Africa, in the context of other socio-ecological factors. The review of the relevant literature is sound. The results are compelling and suggestive of the need for further exploration of these relationships to further examine these relationships to determine causality.
Aside from some methodological queries and concerns, my major concern is the interpretation of the findings. It is well known that cross-sectional studies are considered informative and somewhat preliminary to more specific controlled studies in which some variables could be controlled or examined longitudinally.
Below I list a number of issues that may need to be considered prior to publishing this work.
1. Title of the article. I am not sure the title reflects the findings of the study.
2. Data Collection. It is unclear if the fieldworkers administrated the measures by reading each item or conducting an interview in which the items were embedded. Please be more specific about how the data were collected. Also, who scored the questionnaires? How was the data derived from the questionnaires? This is an important issue to address regarding the potential of bias in the data collection.
3. Fear of COVID-19 scale. More information is needed regarding this scale. Since it is a fairly new scale, with only 7 items, old items should be listed in a table, along with the 17 items of the COVID-19 Family stressor scale. In addition, regarding the fear of COVID-19 scale, more information about its psychometric properties is needed. The total mean, average, and standard deviation of fear of COVID should be provided and how the above average and below average was determined.
4. Analyses. It is said that ‘univariate analysis was run’…between a large number of variables that included demographic, fear (I assume is fear of COVID-19, since for the second groups of univariate analysis [ses?]) feeling depressed (where is this coming from?), etc., etc. on financial stress. The same was said for stress from children/partner. There is no justification as to how these factors were selected for analysis. Conducting many univariate analyses is inappropriate, unless they are preliminary for selecting variables to be included in multiple regression analysis to predict (as is expected by the aims of the study) relationships with stress. The use OR and ps should be stated in the analysis section. As well as the use of x2.
5. Results. A reorganization of the results is recommended, starting with a description of the socio-demographic variables. Then a descriptive statistic section of the results from the two measures should follow, including information about Fear of COVID-19 results. Then description of the correlations. Please see above my comments regarding univariate analyses.
6. Tables 1 and 2 should be combined.
7. Discussion. A reorganization of the discussion, starting with what the study aimed to do, what was done and what was found. The authors need to keep very clearly in mind the nature of the study cross-sectional with one cohort only when discussing the results. While the results can be suggestive of some changes in the social and health system in South Africa, it is equally important to specify that further research is needed to determine more specific and causal inferences from the findings.
8. The same can be said about the conclusions.
9. In the abstract, there is the same problem of interpretation of the data.
10. Finally, a careful reading of the manuscript is need to catch omissions (fear of COVID, page 3, line 123), inconsistencies (CoFaSS vs CoFASS, page 3, lines 106 and 110); repetitions (part of, page 2, line 80) and a number of typos.
Author Response
Dear Reviewer
Thank you for your valuable comments. My response is in the attached document.
Kind regards
Michelle Engelbrecht
Author Response File: 
Author Response.pdf
Reviewer 2 Report
A very well-written and clearly argued analysis of the COVID-19 impacts for South African families. Some suggestions:
• The author may wish to capture some more of the staggering COVID-19 repercussions on young learners in their introduction/discussion. i.e., limited opportunities for social interaction, decreased motivation, longer-term psychosocial or developmental issues which may affect learning inequalities between different income households (https://doi.org/10.3390/su14159699, https://doi.org/10.1177/2347631120983481, https://doi.org/10.1007/s11125-020-09486-x)
• The author may need to define what depression means in this study. Could that be the clinical definition of depression as a mood disorder? And if so, how is it ensured that respondents have the same understanding of depression?
Author Response
Dear Reviewer
Thank you for your valuable comments. My response is in the attached document.
Kind regards
Michelle Engelbrecht
Author Response File: Author Response.pdf
