How Is the Fear of War Impacting Italian Young Adults’ Mental Health? The Mediating Role of Future Anxiety and Intolerance of Uncertainty
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsDear authors, I appreciate your effort in enriching scientific literature in an important them like this. However, some improvements to the paper are suggested:
Abstract
1.- This phrase "with a significant parallel indirect effect in all three mediation models conducted, acting as risk factors" is confusing what the authors refer with mediation models, please specify.
Introduction:
2.- The phrase: "it can fuel anxiety, stress, and avoidant behavior [41, 42, 43] explored" is confusing mainly by the word: "explored"
Analysis plan:
3.- The hierarchical regression method should be justified, why do not use step wise method or another regression method?
4.- How does and what for all these analyses were performed: "starting from results of correlations, ANOVA, and regressions", it is not clear, please specify
5.- In this phrase: "Model 4 was selected via PROCESS to test the effect of Fear of War on mental health (H3)," it is not clear what the author refer with model 4, this because no previous models (1,2 and 3) were mentioned before in the analysis section.
6.- This phrase is not clear: "and standardized beta and R2 were considered (p < 0.05)." How do these values (standardized beta and R2) were considered?
Results:
7.- The first paragraph of descriptive data (line 253-256) are not clear, this because the range for each scale is not mentioned in the methods section, in addition, I suggest to obtain the average of each instrument instead the sum, and based on these averages to obtain the range of each instrument.
8.- In table 1, I also suggest to use the means (averages) for each instrument instead using the sum, it would be clearer for the reader. By example, in a scleras with 5 questions of 4 likert options, the range of the scale would also be 4 instead 20, and the statistical results with remain the same.
9.- In addition, in table 1 the differences between sexes should be mentioned, with the corresponding statistical probe, as this is one objetive of the study.
10.- Table 3: It is recommended to mention the significance of acronyms at table foot
11.- Lines 308-311 "The total amount of.....stress": The findings presented do not correspond to any figure or table, please refer to the corresponding one.
12.- The results of the next paragraph (lines 312-324) are neither presented in a table or figure, in addition the initials: "i.e." (line 315), are not clear in that context, please specify.
13.- The word "target" in line 399 is not clear
14.- Line 416, the phrase "we aimed to delve deeper into the hypothesis that high levels of Fear of War and its impact on mental health may also depend on media hyperexposure." is not clear how this objective was analyzed, this because media exposure was not analyzed in the study.
15.- Line 474, the phrase that ends with "nuclear Fear of War" is not clear whether it refers to females, please specify.
16.- Line 475, in the phrase: " failure of the female sensitivity for the care and well-being", it seems that is incorrect, this because female are more likely to be more sensitive than men, it is not clear what the authors refers with "failure of the female sensitivity".
Comments on the Quality of English LanguageMinor revisions
Author Response
REVIEWER 2
Dear authors, I appreciate your effort in enriching scientific literature in an important them like this.
- Thank you very much for the positive feedback.
However, some improvements to the paper are suggested:
Abstract
1.- This phrase "with a significant parallel indirect effect in all three mediation models conducted, acting as risk factors" is confusing what the authors refer with mediation models, please specify.
- We have taken the suggestion into consideration and made the requested changes, simplifying the sentence and making it more comprehensible.
Introduction:
2.- The phrase: "it can fuel anxiety, stress, and avoidant behavior [41, 42, 43] explored" is confusing mainly by the word: "explored"
- We made the requested change.
Analysis plan:
3.- The hierarchical regression method should be justified, why do not use step wise method or another regression method?
- We have carefully considered your comment and, in line with what was also requested by reviewer 3, we made changes. In the present study, multiple regression analysis was used as a preliminary analysis to determine whether the hypothesised variables could be included in the mediation models. Therefore, as recommended by reviewer 3, hierarchical regression analyses were replaced by standard multiple regression models.
4.- How does and what for all these analyses were performed: "starting from results of correlations, ANOVA, and regressions", it is not clear, please specify
- We have made the requested change. The reported analyses were used to select the covariates that were added in the mediation models.
5.- In this phrase: "Model 4 was selected via PROCESS to test the effect of Fear of War on mental health (H3)," it is not clear what the author refer with model 4, this because no previous models (1,2 and 3) were mentioned before in the analysis section.
- We have specified what Model 4 of the Process macro for SPSS refers to. In this case, the adoption of other analysis models (Process functions for SPSS), such as model 1 (used for moderation analysis) would not have been in line with the objectives and hypotheses of the study.
6.- This phrase is not clear: "and standardized beta and R2 were considered (p < 0.05)." How do these values (standardized beta and R2) were considered?
- The sentence has been rephrased.
Results:
7.- The first paragraph of descriptive data (line 253-256) are not clear, this because the range for each scale is not mentioned in the methods section, in addition, I suggest to obtain the average of each instrument instead the sum, and based on these averages to obtain the range of each instrument.
- We have taken the suggestion into consideration. We have reported in section 2.2 both the Likert range and the response range for each instrument used in the study. The scoring of each instrument was performed considering the guidelines recommended by the authors in the instrument validation process. We adopted the sum and subsequent mean for the scales that required it and in particular for our dependent variable, DASS-21. As reported in the description of the instrument (section 2.2), the identification of more or less severe Stress, Anxiety and Depression scores requires this specific scoring.
8.- In table 1, I also suggest to use the means (averages) for each instrument instead using the sum, it would be clearer for the reader. By example, in a scleras with 5 questions of 4 likert options, the range of the scale would also be 4 instead 20, and the statistical results with remain the same.
- We have taken the suggestion into consideration. In line with the previous comment we preferred to keep the scoring of the instruments as recommended in the validation processes, especially to ensure a clear understanding of youth psychological distress (our outcome variable). However, we consider your comment pertinent, and we have included both the Likert range and the minimum and maximum response obtained in Table 1.
9.- In addition, in table 1 the differences between sexes should be mentioned, with the corresponding statistical probe, as this is one objetive of the study.
- We have taken the suggestion into consideration and added the difference between sexes in table 1, as also requested by reviewer 3.
10.- Table 3: It is recommended to mention the significance of acronyms at table foot
- We have taken the suggestion into consideration and added the information required.
11.- Lines 308-311 "The total amount of.....stress": The findings presented do not correspond to any figure or table, please refer to the corresponding one.
- We have noticed the error and made the requested change.
12.- The results of the next paragraph (lines 312-324) are neither presented in a table or figure, in addition the initials: "i.e." (line 315), are not clear in that context, please specify.
- We have taken the suggestion into consideration and corrected the paragraph inaccuracy. Furthermore, "i.e." has been replaced with indirect effect, as requested.
13.- The word "target" in line 399 is not clear
- We have taken the suggestion into consideration and made the term “target” clearer.
14.- Line 416, the phrase "we aimed to delve deeper into the hypothesis that high levels of Fear of War and its impact on mental health may also depend on media hyperexposure." is not clear how this objective was analyzed, this because media exposure was not analyzed in the study.
- We find your comment relevant. As also pointed out by reviewer 3, we have edited this sentence to make it clearer. As you noted, hyperexposure is not a finding of ours but emerged in other research. Therefore, this information has been used to interpret our results, opening up new future directions of investigation.
15.- Line 474, the phrase that ends with "nuclear Fear of War" is not clear whether it refers to females, please specify.
- We have noticed the error and made the requested change.
16.- Line 475, in the phrase: " failure of the female sensitivity for the care and well-being", it seems that is incorrect, this because female are more likely to be more sensitive than men, it is not clear what the authors refers with "failure of the female sensitivity".
- We agree with your comment. We have made the indicated section clearer, in line with the research and literature findings in the previous sentence.
The article has been proofread by a certified translator.
Reviewer 2 Report
Comments and Suggestions for AuthorsThis study is a study of Italian youth, showing the mediating effect of intolerance of uncertainty, a known risk factor for depression, stress, and anxiety, as well as factors that young people in particular are more likely to have in general, such as anxiety about the future. While I recognize some significance in examining young adults' perceptions of war and its impact on their mental health when it occurs within the same Europe, I believe the following points require further mention.
#1 Methods: The method of recruiting participants is a bit confusing. Are you meaning that the online survey was not outsourced to a professional research service, but rather that the researchers created a response form and targeted those who accessed it through the researchers' social media pages? In what way did you sample only young people? The sample size seems somewhat small for an Internet survey. I think a little more detail is needed regarding these procedures.
#2 Results: Why was ANOVA used to analyze the difference between gender and each psychological scale? Normally, when comparing the difference between two groups, such as gender, a t-test would be used. Also, although the gender difference of the psychological scale is described after correlation, I think it is able to present this result in the paragraph before correlation by adding the significance level and effect size in Table 1.
#3 Results: I am not quite sure why you are using hierarchical regression analysis in results 3.3. The advantage of hierarchical multiple regression analysis is that by conducting the regression analysis in several steps, one can see if there is any change in the explanatory power of the variable. If the reason for this analysis is to determine whether to include it in the mediation model, a simple multiple regression analysis would be sufficient.
#4 Discussion: You mention hyperexposure to media on P20, L416, have you examined what media young adults with a strong fear of war in this study use most often or how often they use it? If so, this needs to be indicated in the results. It is possible that exposure to negative information about war is strongly associated with these fears, as intolerance of uncertainty is known to lead to excessive information seeking as a safety-checking behavior.
#5 What measures do the authors believe are necessary to address the apparent influence of intolerance of uncertainty and future anxiety on depression, anxiety, and stress? In particular, the authors' ideas on the population approach should be included in the discussion.
Author Response
REVIEWER 3
This study is a study of Italian youth, showing the mediating effect of intolerance of uncertainty, a known risk factor for depression, stress, and anxiety, as well as factors that young people in particular are more likely to have in general, such as anxiety about the future. While I recognize some significance in examining young adults' perceptions of war and its impact on their mental health when it occurs within the same Europe, I believe the following points require further mention.
- Thank you for the feedback.
#1 Methods: The method of recruiting participants is a bit confusing. Are you meaning that the online survey was not outsourced to a professional research service, but rather that the researchers created a response form and targeted those who accessed it through the researchers' social media pages? In what way did you sample only young people? The sample size seems somewhat small for an Internet survey. I think a little more detail is needed regarding these procedures.
- We find your comment very pertinent and have enriched paragraph 2.1 with the requested information. We apologize for the error, but the sampling period was actually shorter than originally marked. We have included the different steps of the sampling process, the inclusion and exclusion criteria considered as well as the a priori sample power analysis that preceded and guided the sampling.
#2 Results: Why was ANOVA used to analyze the difference between gender and each psychological scale? Normally, when comparing the difference between two groups, such as gender, a t-test would be used. Also, although the gender difference of the psychological scale is described after correlation, I think it is able to present this result in the paragraph before correlation by adding the significance level and effect size in Table 1.
- We have noticed the error and made the requested change. It is indeed statistically more correct to report the results of the t-test analysis, thank you for the suggestion. As also requested by reviewer 2, we have included these results with p value and effect size in Table 1.
#3 Results: I am not quite sure why you are using hierarchical regression analysis in results 3.3. The advantage of hierarchical multiple regression analysis is that by conducting the regression analysis in several steps, one can see if there is any change in the explanatory power of the variable. If the reason for this analysis is to determine whether to include it in the mediation model, a simple multiple regression analysis would be sufficient.
- We have carefully considered your comment. In fact, since regression in this case is a preliminary analysis to highlight which variables to include in the mediation models, we considered it correct to report the results of standard multiple regression models (section 3.3), as suggested also by reviewer 2.
#4 Discussion: You mention hyperexposure to media on P20, L416, have you examined what media young adults with a strong fear of war in this study use most often or how often they use it? If so, this needs to be indicated in the results. It is possible that exposure to negative information about war is strongly associated with these fears, as intolerance of uncertainty is known to lead to excessive information seeking as a safety-checking behavior.
- The comment you raise is totally relevant. As also pointed out by reviewer 2, the sentence was ambiguous so we made corrections. We did not detect hyperexposure in our study, a detail investigated in other studies and used to interpret some of our results.
#5 What measures do the authors believe are necessary to address the apparent influence of intolerance of uncertainty and future anxiety on depression, anxiety, and stress? In particular, the authors' ideas on the population approach should be included in the discussion.
- We find this indication very relevant. However, we decided to leave our considerations to the conclusion section for greater argumentative coherence. We have also expanded the section.
The article has been proofread by a certified translator.
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThe authors addressed the suggestions performed
Reviewer 2 Report
Comments and Suggestions for AuthorsI find the authors' responses to my concerns and the revisions to the paper to be adequate.
I salute your valuable work.
