Mapping Developmental Assets in Kosovo’s Youth: Insights into the Internal Cohesion Psychotherapeutic Process for Young People Experiencing Anxiety and Depression: A Qualitative Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The theme presented by the authors is of great importance and relevance not only to the conditions of the sample studied, but also to other groups of adolescents in vulnerable situations. However, the proposals of Positive Youth Development (PYD) and Internal Cohesion Psychotherapy have little empirical support, which should be strengthened by citing other works that have used both proposals. Throughout the text, references 15 and 17 are used both in the introduction and are incessantly referred to in the discussion. 

The description of the sample does not indicate the time in therapeutic sessions to which the participants have been subjected, nor does it indicate their coding, which is recurrently employed in the results. For technical reasons it is important that the authors cite the software used. In the ethical considerations, in addition to citing the committee that validated the study, it is also important to indicate whether informed consent and assent were used (although the consents are indicated in the additional descriptions of the article). Sometimes the textual quotations of what the interviewees say do not have a consistent format (italics). 

 

Several references are used that are more than 10 years old, are they essential or crucial works?

Author Response

Thank you very much for your insightful feedback on our manuscript. We appreciate the opportunity to refine our work based on your comments. We have carefully considered each point and have made corresponding revisions, which are highlighted in the re-submitted file. Your feedback has been invaluable in enhancing the quality and clarity of our research.

2. Questions for General Evaluation

Does the introduction provide sufficient background and include all relevant references?

We acknowledge the reviewer's concern regarding the adequacy of our introduction and background context. In response, we have expanded our literature review to include additional empirical studies that support the relevance and application of Positive Youth Development (PYD) and Internal Cohesion Psychotherapy, specifically addressing the gaps we previously overlooked.

Are all the cited references relevant to the research?

Upon review, we have updated our references to ensure all cited works directly contribute to the research's framework and arguments. This includes a reassessment of older references to confirm their seminal value and relevance to our study's context.

Is the research design appropriate?

We have clarified our research design, including a more detailed explanation of our methodology, participant selection, and data analysis process. Specific attention has been paid to addressing the previously noted omissions regarding the sample description and the duration of therapeutic sessions.

Are the methods adequately described?

To address this point, we have thoroughly revised our methods section to offer clearer insight into the procedures followed during the research. This includes specifying the method used for data analysis, as recommended.

Are the results clearly presented?

We have restructured our results section for better clarity, ensuring that all findings are presented in a manner that directly corresponds to our research questions and hypotheses.

Are the conclusions supported by the results?

In light of the reviewer’s comments, we have reviewed our conclusions to ensure they are fully supported by our results. This involved a deeper analysis of the data and a more careful integration of our findings with the broader discourse on the topic.

3. Point-by-point response to Comments and Suggestions for Authors

Comments 1:

The reviewer expressed concerns regarding the lack of empirical support for PYD and Internal Cohesion Psychotherapy, highlighting the overreliance on references 15 and 17.

Response 1:

Thank you for this crucial observation. We have broadened our literature review to include a more diverse range of studies that provide empirical support for PYD and Internal Cohesion Psychotherapy. This includes newer studies that we previously overlooked. The revised manuscript now presents a balanced view, reducing the emphasis on references 15 and 17, however due to the importance of the study and the lack of evidence in this field, we have to keep these references to our study to ensure that we are addressing the dimensions of ICP correctly and appropriately.

Comments 2:

The description of the sample and ethical considerations were found lacking in detail, particularly regarding the coding of participants and the format of interviewee quotations.

Response 2:

We appreciate your attention to these details. The manuscript has been updated to include a comprehensive description of the sample, including the coding methodology and the duration of therapeutic sessions. We have also standardized the formatting of interview quotations to ensure consistency throughout the text. Additionally, the ethical considerations section has been expanded to explicitly mention the committee's approval and the use of informed consent and assent.

4. Response to Comments on the Quality of English Language

Point 1:

Not applicable as the comment was not provided, but we have proactively revised the manuscript to ensure the language is clear, concise, and free of errors.

5. Additional clarifications

We would like to note that while several references are more than 10 years old, they are considered seminal works in our field of study. Their inclusion is crucial for providing a comprehensive understanding of the theoretical foundations and empirical evidence supporting our research. We have, however, ensured to complement these with recent studies to reflect current developments in the field.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The evaluated article is correct and valid in its structure, references, introduction, objectives, methodological procedures and discussion of results as well as in the conclusions, limitations and future lines of research.

The interview is used as a qualitative tool (after translating into the Albanian language as it is the mother tongue of the sample population). It is recognized that it works with a small sample but this is due to the circumstances of selection of the study population (having undergone previous psychotherapy sessions).

Youth mental status is investigated, focusing on symptoms of anxiety and depression among young people in Kosovo. It is framed in Positive Youth Development (PYD) and explores its integration with Internal Cohesion Psychotherapy (PIC) to analyze youth mental health challenges.

The positive impact of PCI on nine mental health outcomes is demonstrated. And thematic analysis of participants' narratives reveals six key themes, showing the transformative nature of ICP, the critical role of supportive social networks, values and beliefs, reflections on personal growth, and the widespread impact of relationship therapy. The life stories of the participants highlight the great influence of ICP on personal growth, social relationships and mental health. Internal and external assets are observed (growth, motivation and commitment to learning, positive values; security, service to others, respectively), highlighting the role of social networks, values, beliefs and cultural competence. It helps to understand the factors that influence young people in Kosovo. It concludes that the integration of the PYD and the ICP is a powerful synergy to address the challenges of youth mental health.

Author Response

Dear Reviewer,

Thank you for your insightful review and the positive evaluation of our manuscript. Your recognition of our work's structure, methodology, and thematic analysis, particularly in the context of youth mental health in Kosovo, is greatly appreciated.

We acknowledge and are grateful for your understanding of the challenges we faced, including working with a small sample size and the necessity of translating interviews into Albanian to ensure cultural and linguistic relevance.

Your summary and affirmation of the significant impact of Internal Cohesion Psychotherapy (ICP) within the Positive Youth Development (PYD) framework on mental health outcomes in our study are encouraging. It underscores the importance of our findings and the potential for PYD and ICP integration to address youth mental health challenges effectively.

We are motivated by your feedback and look forward to advancing this area of research, informed by your insights.

 

Reviewer 3 Report

Comments and Suggestions for Authors

I would have liked to see more theoretical integration of concepts of the therapies into a coherent whole.  Many psychological reports tend to focus almost exclusively on the internal processes and it was good to see the explicit inclusion of the social context and resources as relevant factors.  These unfortunately are claimed to be important, but the causation and framework for integration is not explained well.  From a Sociological stand point a lot of this can go back to Durkheim's Mechanical and Organic Solidarity and the role they play in both social and individual lives.  In many ways Mechanical Solidarity based on shared emotions/experiences and meanings serves as the core of the self for everyone, and is the core to a sense of community.  Becoming aware of this and how it shapes who you are, seems in many ways to be the essence of ICP and why it can stabilize the person as it places them as an individual within a supportive community of personal ties and shared meanings.  These primary ties are essential to the sense of self and identity.  At the same time in modern complex societies we characterize society as mainly Organic Solidarity based on our specialties and differences that create mutual dependencies and instrumental relationships as secondary ties.  While these are necessary, they do not engage the emotions and sense of well being and can lead to anomie and sense of being lost or isolated even within a group.  When we talk about the malaise of mass society, this is likely the chief cause of this.  What it seems the two programs do is to integrate these two aspects for the clients, with the ICP providing a clearer recognition of the value and stability of their Mechanical Solidarity ties and emotional wellspring, and the PYD provides the framework of integration in a functional way to the diversity and instrumental relationships necessary to modern life.  Seeing the two programs as promoting integration of the facets of each person's life is I believe the theoretical key and should be explored more explicitly and thoroughly in the discussion.

Author Response

The manuscript is reviewed and adressed the comments accordingly. Please see the attachment.

We sincerely appreciate your comprehensive review and the valuable insights provided. Your feedback has guided significant improvements in our manuscript. The detailed responses to your comments and the revisions made are outlined below. We have highlighted these changes in the re-submitted file to facilitate your review.

2. Questions for General Evaluation

- Does the introduction provide sufficient background and include all relevant references? 

 We have enriched our introduction with a more thorough discussion on the theoretical frameworks, including Durkheim's theories on Mechanical and Organic Solidarity, to better contextualize our research within the broader sociological discourse.

- Are all the cited references relevant to the research? 

  Each reference has been  reviewed for relevance and impact on our study's theoretical foundation and empirical evidence. This has led to the inclusion of additional literature, enhancing the depth and breadth of our research context.

- Is the research design appropriate? 

  The research design has been recognized as appropriate, and we maintain its comprehensive description in the manuscript.

- Are the methods adequately described? 

  We have ensured that our methods section remains clear and detailed, reflecting the procedural integrity of our study.

- Are the results clearly presented? 

  The presentation of our results has been maintained for clarity and direct correlation with our research questions and hypotheses.

- Are the conclusions supported by the results? 

 We have further fortified our conclusions with the results presented, ensuring a robust and unequivocal support from both our empirical findings and the referenced literature.

3. Point-by-point response to Comments and Suggestions for Authors

- Comments 1: 

  The reviewer recommended a deeper theoretical integration of the therapies into a coherent whole, noting the importance of social context and resources, yet pointed out a lack of explanation for causation and framework integration.

  Response 1: 

  We greatly value this observation and agree with the necessity for a more explicit theoretical integration. Accordingly, we have expanded our discussion to explicitly integrate Durkheim's concepts of Mechanical and Organic Solidarity, elucidating their relevance to our study's context and findings. This theoretical framework now serves as a backbone for understanding the synergy between ICP and PYD in addressing youth mental health challenges.

- Comments 2: 

  The reviewer suggested that the integration of PYD and ICP could be seen as a theoretical key to addressing youth mental health challenges and recommended a more thorough exploration of this integration in our discussion.

  Response 2: 

  Acknowledging the critical importance of this perspective, we have significantly revised our discussion section to delve deeper into the theoretical implications of integrating PYD with ICP. This revision elucidates how these programs together foster a balance between Mechanical and Organic Solidarity, promoting a holistic approach to youth mental health.

4. Response to Comments on the Quality of English Language

- Point 1: 

  The reviewer noted no issues with the quality of English language. We have, nevertheless, conducted a thorough review to ensure clarity and readability throughout the manuscript.

5. Additional clarifications

We have addressed every point raised by the reviewer, with a particular focus on enhancing the theoretical grounding of our study through the integration of Durkheim's sociological theories. This not only strengthens our research's foundation but also highlights its contribution to the interdisciplinary understanding of youth mental health interventions.

We thank the reviewer once again for their insightful feedback and hope the revisions made reflect our commitment to contributing valuable research to the field.

 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

THE AUTHORS PRESENT AN EXTENSIVE REVIEW OF THEIR WORK PROPOSAL WITH RESEARCH AND EMPIRICAL DATA. WITHOUT THE EXISTENCE OF HYPOTHESES, IT IS POSSIBLE TO INFER WHICH RESULTS CAN BE OBTAINED DURING THE THERAPEUTIC PROCESS OF YOUNG PEOPLE. THE METHODOLOGICAL PROPOSAL IS CLEAR AND IS PRESENTED THROUGH A PROCESS OF INFORMATION ANALYSIS. THE RESULTS ARE EXTENSIVELY PRESENTED, THESE RESULTS, CATEGORIZED IN DIFFERENT GROUPS, ARE CONSISTENTLY SUPPORTED BY THE STATEMENTS OF THE PARTICIPANTS, ALL OF THEM SIGNIFICANT TO THE POINTS TO BE EMPHASIZED. RESEARCH ETHICS PROCEDURES WERE FOLLOWED, WITH INFORMED CONSENTS FROM THE PARTICIPANTS, AND THE RESULTS WERE REVIEWED BY AN ETHICS COMMITTEE.

THE IMPLICATIONS OF THE RESULTS FOR THE LITERATURE, AND SPECIFICALLY, THE GROUP OF INTEREST IN THE STUDY, ARE EXTENSIVELY DESCRIBED, WITH A PARTICULAR LOCATION OF THE SOCIO-HISTORICAL REASONS TO WHICH THE COVID PANDEMIC CAN BE ATTRIBUTED IN A LARGE PART OF THE RESULTS. IT IS ALSO SUGGESTED TO LOCATE AND CONTINUE WITH A SIMILAR PROPOSAL IN ORDER TO SUPPORT AND STRENGTHEN THE FINDINGS OF THE WORK DONE.