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. 2021 Feb 2;16(2):e0245751. doi: 10.1371/journal.pone.0245751

Psychosocial impacts of COVID-19 in the Guinean population. An online cross-sectional survey

Almamy Amara Touré 1,2,*, Lansana Mady Camara 2,#, Aboubacar Sidiki Magassouba 3,#, Abdoulaye Doumbouya 1,#, Gnoume Camara 3,‡, Alsény Yarie Camara 1, Gaspard Loua 4,‡, Diao Cissé 3,‡, Mohamed Sylla 1,‡, Alpha Oumar Bereté 1,‡, Abdoul Habib Beavogui 1,5,#
Editor: Akihiro Nishi6
PMCID: PMC7853443  PMID: 33529216

Abstract

Guinea, like many other African countries, has been facing an unprecedented COVID-19 outbreak, since March 2020. In April 2020, Guinean National agency for health security recorded 1351 confirmed cases of COVID-19, including 313 recoveries and 07 deaths. To address this health crisis, some drastic measures were implemented to prevent the spread of COVID-19. Those measures might potentially cause some psychological problems among Guineans. Thus, we conducted this study to assess the psychosocial impacts of COVID-19 in the Guinean population. We carried out an online cross-sectional survey among internet users in Guinea. A free e-survey platform was used, and questionnaires were sent to internet users. The study ran from May 1 through May 10 2020. Participation in the study was voluntary. Data collection was based on sociodemographic information and self-reported questionnaires: Impact of Event Scale-Revised (IES-R) for stress evaluation, Penn state worry questionnaire (PSWQ), and an adapted Social Psychological Measurements of COVID-19. A total of 280 participants took part in the study; responses from 5 participants were deleted because of incompleteness. The average age of participants was 28.9 [95% CI: 28.1;29.6]. Most of participants were male 65.5% [95% CI: 59.5%;71.1%]. Unemployed participants stood for 48.7% [95% CI: 42.7%;54.8%]. IES-R scale for stress evaluation yielded the following findings: 19.6% (mild), 5.23% (moderate) and 9.15% (severe); 82.8% and 17.2% of participants had respectively reported low and moderate worry. No significant statistical association was found between sociodemographic variables and traumatic events (IES-R and PSWQ). However, 82% of our participants had to cope with the negative impacts of COVID-19. Although there were few cases of traumatic events, negative impacts of COVID-19 on study participants deserve to be underlined. So, further investigations are necessary to identify and disentangle specific psychosocial problems in different Guinean socio-cultural contexts.

Introduction

Coronavirus disease 2019 (known as "COVID-19") started in December 2019 in China and has been spreading worldwide with its unparalleled consequences in the recent history of humanity. In the wake of this overwhelming situation, the World Health Organization (WHO) declared the outbreak of COVID-19 as a Public Health Emergency of International Concern and could be characterized as a pandemic [1]. Since then, the number of cases and deaths due to COVID-19 has been ever-increasing, thereby threatening global health. According to the WHO report, globally, 7 410 510 cases of coronavirus has been confirmed with 418 294 deaths toll. African countries have reported 155 762 cases with 3 700 deaths toll [2]. Guinea, like other African countries, has been facing COVID-19 outbreak since March 2020. As of April 28, Guinean National Agency for Health Security recorded 1351 confirmed cases of COVID-19, including 313 recoveries and 07 deaths [3].

The first measures taken by the Guinean authorities were as follows: declaration of the state of health emergency, closure of schools and places of worship (mosques and churches), reduction in the number of passengers in public transportation, ban on the gathering of more than 20 people, obligation to wear masks in public places, and the respect of social distancing. In addition to these stringent measures, Conakry Capital city (deemed as outbreak hotspot) was isolated from the other cities with limited access. Those measures have been reinforced by massive sensitization, the sharing of sanitary kits, and the establishment of a curfew. Moreover, to mitigate the socio-economic impact of coronavirus, the Guinean Government announced a response plan against the pandemic by focusing on support for health and social management.

The aforementioned restrictive measures could potentially have some impacts on the Guinean population, for this is their first time facing such a colossal health crisis. For instance, religious communities could never imagine the closure of places of worship, for, during the 2014 Ebola virus disease outbreak, they never experienced these kinds of restrictive measures. Therefore, this may arguably lead to social and psychological crisis. Since drastic regulations were implemented, it could stem multiple responses from the population according to their features. One of the common reactions to the pandemic is the fear of its psychological impacts [4–7]. Psychological impacts may vary according to the sociodemographic characteristics. A study done in China found that COVID-19 Peritraumatic Distress Index (CPDI) had been associated with gender, age, education, occupation and region [8]. WHO has also mentioned that one of the possible outcomes of COVID-19 pandemic is generating stress and anxiety among people [1].

Furthermore, many studies emphasized the psychological concerns of COVID-19 among the population [9–18]. Management of psychological effects is essential to prevent unexpected events and mitigate COVID-19 effects among people with health underline conditions and those at high risks of being contaminated by COVID-19. Therefore, the primary objective of this study was to assess the psycho-traumatic impact of COVID-19 in the Guinean population. Specifically, we aimed to:

  • ✓ Measure the prevalence of traumatic events (stress, worry) among the Guinean population,

  • ✓ Spot the sociodemographic factors associated with the trauma caused by COVID 19,

  • ✓ Appreciate population perception regarding the measures implemented by the Government in the battle against COVID 19.

Methodology

We carried out an online cross-sectional survey among literate people (from secondary school to university l). A free online e-survey (https://esurv.org) platform was used to send questionnaires to internet users, and they were encouraged to pass it to one other through social media (Facebook, WhatsApp, messenger) by using snowball sampling. The study population was diverse, and participants came from all sectors of activity in Guinea. However, active internet users were predominant, for our period of study was short. It ran from May 1 to May 10 2020. Participation in the study was voluntary. Participants should have been at least 18 years of age. Institutional approval was obtained from the scientific medical committee of Koffi Anna University in Conakry/Guinea (025/UKAG/P8/2020).

Study tools

Sociodemographic information: Age, gender, marital status, Current residence, job or occupation, levels of education, source (s) of information (s) about COVID-19, time spent at home to avoid contamination.

Penn State Worry Questionnaire (PSWQ): it is a self-administered, 16-items using Likert-type scale designed to measure worry, Possible ranges of the score are 16–80 with the algorithm of total scores: 16–39 = Low Worry, 40–59 = Moderate Worry, and 60–80 = High Worry [19].

Impact of Event Scale-Revised (IES-R): self-report questionnaire, with 22 questions. The score is interpreted as follow: 24–32: Posttraumatic stress disorder (PTSD) as a clinical concern.33-38: This is considered as the best threshold for a probable diagnosis of PTSD; 39 and above as a Severe PTSD [20].

Adapted Social Psychological Measurements of COVID-19: financial impact (difficulties in meeting basic needs such as foods, means of transportation, and healthcare; loss of a job, no financial impact); support (Giving money to support COVID-19 crisis, supporting government initiatives, supporting the idea of more researches on COVID-19 in Guinea, supporting Government restrictive measures, and need of a strong administration); punishment (penalty for non-respect of preventive measure, including wearing masks, social distancing, ban on gathering of more than 20 people, and the curfew) [21].

Survey description

A total of 84 parameters were recorded, and it took about 20 minutes to complete them. Each webpage showed 4–6 questions. Each participant could see a total number of pages equal to 5. Participants were allowed to start the survey and finish it at any time.

Data management and statistical analysis

Duplicated data were carefully handled by blocking the same IP responses. Raw data were extracted in excel format after study completion. Descriptive, statistical analyses were performed for the sociodemographic and all other variables (worry, IES-R). Confidence interval (95%) was built for all variables. We used the chi-square test to identify sociodemographic factors associated with trauma caused by COVID 19. The Likert analysis was used to appreciate population opinions related to the measures implemented by the Guinean government in the fight against COVID 19. We performed all analyses by using R software version 3.6.2. Statistical tests were considered significant when p<0.05.

Results

Description of the sample study

A total of 280 participants took part in this study. Data from 5 five participants were deleted because of a great amount of missing data. The average age of our participants was 28.9 [95% CI: 28.1;29.6]; most of them were male, 65.5% [95% CI: 59.5%;71.1%]; single participants were the most represented. Most of our participants lived in Ratoma district. Unemployed participants stood for 48.7% [95% CI: 42.7%;54.8%]. Most of participants had university level 95.3% [95% CI: 92.1%;97.5%]. Participants having spent more time at home per day due to COVID-19 accounted for 86.2% [95% CI: 81.5%;90.0%] (Table 1).

Table 1. Study sample description.

Variables Frequency % [95% CI] N
Age 275
[18,39] 260 94.5% [91.2%;96.9%]
[40,62] 15 5.45% [3.08%;8.84%]
Gender
Male 180 65.5% [59.5%;71.1%]
Female 95 34.5% [28.9%;40.5%]
Marital Status 275
Married 92 33.5% [27.9%;39.4%]
Single 183 66.5% [60.6%;72.1%]
Residence 275
Dixinn 15 5.45% [3.08%;8.84%]
Kaloum 1 0.36% [0.01%;2.01%]
Matam 3 1.09% [0.23%;3.15%]
Matoto 72 26.2% [21.1%;31.8%]
Others* 35 12.7% [9.03%;17.3%]
Ratoma 149 54.2% [48.1%;60.2%]
Occupation 275
Civil servant 39 14.2% [10.3%;18.9%]
Freelance 57 20.7% [16.1%;26.0%]
Housewife 2 0.73% [0.09%;2.60%]
Private employee 43 15.6% [11.6%;20.5%]
Unemployed 134 48.7% [42.7%;54.8%]
Education 275
High school 5 1.82% [0.59%;4.19%]
College 8 2.91% [1.26%;5.65%]
University 262 95.3% [92.1%;97.5%]
Time spent at home (hours/day) 275
≤ 8 38 13.8% [9.97%;18.5%]
> 8 237 86.2% [81.5%;90.0%]
Legend
N = Total Frequencies
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*Participants from outside Conakry capital city.

Prevalence of psychological events

Table 2 shows prevalence of psychological events. More than half of the participants 153 (55.63%%) filled out the Impact of Event Scale–Revised (IES-R) questions and 186 (67.63%) of the participants completed the Penn State Worry Questionnaire (PSWQ). IES-R yielded for the stress evaluation the following findings: mild (19.6%) [95% CI: 13.6%;26.8%], moderate (5.23%) [95% CI: 2.28%;10.0%] and severe (9.15%) [95% CI: 5.09%;14.9%] (severe); while 82.8% [95% CI: 76.6%;87.9%] and 17.2% [95% CI: 12.1%;23.4%] of participants respectively reported low and moderate worry (PSWQ).

Table 2. Psychological impact of COVID-19 pandemic.

Variables Frequency % [CI 95%] N
IES-R 153
Normal 101 66.0% [57.9%;73.5%]
Mild 30 19.6% [13.6%;26.8%]
Moderate 9 5.23% [2.28%;10.0%]
Severe 13 9.15% [5.09%;14.9%]
PSWQ 186
Low worry 154 82.8% [76.6%;87.9%]
Moderate worry 32 17.2% [12.1%;23.4%]
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Participants’ sources of information about COVID-19

Participants were asked to select three sources of information; most of the respondents chose as follows: Facebook, World Health Organization (WHO) website, and other private websites (Fig 1).

Fig 1. Source of COVID-19 information.

Fig 1

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Govpage = Government web page; ANSS = abbreviation in French which means "National Agency for Health Security"; CDC = Centers for Disease Control and Prevention (United States); GovRadio = Government Radio station.

Psychological associated factors

No statistical association was found between sociodemographic variables and traumatic events (IES-R and PSWQ) (Tables 3 and 4).

Table 3. Bivariate analysis Impact of Event Scale-Revised (IES-R) and sociodemographic characteristics.

Normal Mild Moderate Severe p-value
N = 101 N = 30 N = 8 N = 14
Age 0.137
18–39 97 (96.0%) 27 (90.0%) 8 (88.9%) 11 (84.6%)
40–62 4 (3.96%) 3 (10.0%) 1 (11.1%) 2 (15.4%)
Gender 0.578
Male 63 (62.4%) 19 (63.3%) 3 (37.5%) 8 (57.1%)
Female 38 (37.6%) 11 (36.7%) 5 (62.5%) 6 (42.9%)
Marital Status 0.435
Married 36 (35.6%) 13 (43.3%) 1 (12.5%) 6 (42.9%)
Single 65 (64.4%) 17 (56.7%) 7 (87.5%) 8 (57.1%)
Residence
Dixinn 4 (3.96%) 3 (10.0%) 0 (0.00%) 1 (7.14%)
Matoto 29 (28.7%) 8 (26.7%) 6 (75.0%) 4 (28.6%)
Outside Conakry 13 (12.9%) 5 (16.7%) 0 (0.00%) 2 (14.3%)
Ratoma 55 (54.5%) 14 (46.7%) 2 (25.0%) 7 (50.0%)
Occupation
Civil servant 15 (14.9%) 2 (6.67%) 1 (12.5%) 4 (28.6%)
Freelance 17 (16.8%) 5 (16.7%) 0 (0.00%) 4 (28.6%)
Housewife 0 (0.00%) 0 (0.00%) 0 (0.00%) 1 (7.14%)
Private sector employee 20 (19.8%) 7 (23.3%) 3 (37.5%) 1 (7.14%)
Unemployed 49 (48.5%) 16 (53.3%) 4 (50.0%) 4 (28.6%)
Education 0.432
Secondary 3 (2.97%) 0 (0.00%) 0 (0.00%) 0 (0.00%)
College 3 (2.97%) 0 (0.00%) 1 (12.5%) 1 (7.14%)
University 95 (94.1%) 30 (100%) 7 (87.5%) 13 (92.9%)
Time spent at home (hours/day) 0.364
≤8 14 (13.9%) 1 (3.33%) 1 (12.5%) 2 (14.3%)
>8 87 (86.1%) 29 (96.7%) 7 (87.5%) 12 (85.7%)
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p value not computed due to observed values.

Table 4. Bivariate analysis Penn State Worry Questionnaire (PSWQ) and sociodemographic characteristics.

Low worry Moderate worry p-value
N = 154 N = 32
Age 0.693
18–39 144 (93.5%) 31 (96.9%)
40–62 10 (6.49%) 1 (3.12%)
Gender 0.591
Male 102 (66.2%) 19 (59.4%)
Female 52 (33.8%) 13 (40.6%)
Marital Status 0.118
Married 59 (38.3%) 7 (21.9%)
Single 95 (61.7%) 25 (78.1%)
Residence 0.214
Dixinn 10 (6.49%) 1 (3.12%)
Matam 1 (0.65%) 0 (0.00%)
Matoto 40 (26.0%) 15 (46.9%)
Ratoma 82 (53.2%) 12 (37.5%)
*Other 21 (13.6%) 4 (12.5%)
Occupation 0.371
Civil servant 23 (14.9%) 4 (12.5%)
Freelance 33 (21.4%) 5 (15.6%)
Housewife 0 (0.00%) 1 (3.12%)
Private sector employee 27 (17.5%) 7 (21.9%)
Unemployed 71 (46.1%) 15 (46.9%)
Education 0.594
Secondary 2 (1.30%) 1 (3.12%)
College 5 (3.25%) 1 (3.12%)
University 147 (95.5%) 30 (93.8%)
Time spent at home (hours)/day 0.082
≤8 16 (10.4%) 7 (21.9%)
>8 138 (89.6%) 25 (78.1%)
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*Participants from outside Conakry capital city.

Population perception regarding the government measures in the fight against COVID-19

About 82% of our participants had to cope with adverse impacts of COVID-19, and 64% of participants spent a hard time getting means of transportation, we found that 54% of participants had lost their job, and only 12% had been spared from the financial impact of COVID-19 (Fig 2). Almost all the participants responded that they wanted more researches on COVID-19 in Guinea (94%); the majority of participants (90%) supported both Government COVID-19 mitigate initiatives and restrictive measures; we noticed that 86% of our participants desired financial assistance from the Government (Fig 3), and most of the participants agreed with the Government penalizing measures (Fig 4).

Fig 2. COVID-19 economic impacts among Guinean population.

Fig 2

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Fig 3. Population opinions regarding government measures.

Fig 3

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Fig 4. Population perception of punishment against violators of preventive measures of COVID-19.

Fig 4

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Discussion

In the time where most countries worldwide have been coping with COVID-19 pandemic, Guinea is also struggling to do so. Although the physical effects of COVID-19 pandemic are increasingly well known, it is important to recognize its psychosocial impact as well [1, 12, 17, 18]. Responses to this pandemic hinge, on a great extent, to the capability of people to manage stress, worry and other psychosocial issues. To address COVID-19 pandemic, the Guinean Government has implemented unprecedented measures. Our study tried to identify the consequences of those measures on guinea population to inform policymakers.

Although the response rate was slightly low for IES-R (56%), our results showed that people had been differently stressed participants reported 19.6% (mild), 5.23% (moderate), and 9.15% (severe). These findings are similar to those found in a previous study [13]. The high rate of worry amongst participants could be related to the significant proportion of our study sample mainly composed of people from Ratoma municipality; this area was the most affected by COVID-19 at the time of the survey. Another relevant reason related to the occurrence of traumatic events is that nearly half of the participants were unemployed (Table 1) or had recently lost their job (Fig 2); these situations increase the level of distressful events since participants were staying at home for longer than usual (Table 1). Traumatic events of this study dovetail with the pre-pandemic situation. For instance, a study on Ebola survivors reported 15% of post-traumatic stress disorder revealing the outbreak effects [22]. Similarly, another finding revealed that bank employees stressed at different levels (very low stress = 50.47%, stress down = 44.43%, high stress = 5.09%) [23]. Participants mainly sought COVID-19 information from social media (Facebook), then come information from WHO and private web sites. The large proportion of young participants (94.5%) may explain the previous results.

Our study found no significant association between IES-R, worry scales, and sociodemographic variables. The low number of respondents and sampling frame that might have led to a selection bias may explain the latter finding. As expected, our results showed that most participants had negative impacts of COVID-19. This perception is linked to the fact that more than half of the participants had lost their job and had difficulties in meeting basic needs. Only a few of them (12%) enjoyed that time. It should be noted that even some employees were facing adverse impacts of COVID-19, due to the shutdown of other businesses that used to generate incomes. Participants wanted more support (like Government financial assistance) and requested more researches on COVID-19 by the Guinea Government. Our study sample was made up of relatively highly educated people (95%), and their opinion matched with those expectations (researches on COVID-19). For the records, the Government has made some efforts to mitigate COVID-19 effects, including making the public transport, domestic electricity, and running water free of charge for three (03) months (from March to May). Although people desired more from the Government, they instead upheld all the penalizing regulations regarding COVID-19. Given that most of our participants had a high level of education as we noticed in the study, they should easily agree with all these measures that prevent the spread of COVID-19.

The study is not representative of the overall population as its design did not take into account all social strata in Guinea. Taking part in an online survey is not an easy task for everyone, justifying some limitations in the conduct of the survey. Targeting people who are literate and have access to the internet induces a selection bias in the achievement of the study goals. In addition, even though people may have access to the internet, they are not familiar with an online survey. Otherwise, findings reported in this study might have been unlike. Another challenge was the difficulty to check for reliability of participants responses, even though the tools (IES-R and PSWQ) have shown good internal consistency in various studies [24–27]. Besides, social-psychological measurements of COVID-19 [21] have not yet been validated in Guinea. However, ascertainment of its internal validity showed good properties (S1 File).

Nonetheless, this study gives an overview of psychological dimensions in a selected population. The prevalence of traumatic events (stress and worry) indicates the need of further investigations, for psychological concerns would raise among the general population, health frontline workers, families and, patients affected by COVID-19 [8, 11, 28, 29]. Of note that a public protest took place around Conakry Capital city to denounce police brutality against violators of the Government preventive measures, such as masks wearing, the closure of worship places, and the curfew. This kind of behaviors highlights people’s social and spiritual needs which go beyond the financial sustain. For a better public perception of COVID-19 and illiterate inclusion, a good alternative to the use internet would be the method of telephone interviews or community media (radio, TV).

Conclusion

As the number of COVID-19 cases is increasing daily in Guinea, psychosocial concerns might also grow. People’s mental state must be monitored to prevent unexpected events regarding the pandemic. Although there were few cases of traumatic events, our findings merit the attention of policymakers. Even though there were no significant statistical associations between sociodemographic variables and traumatic events (stress and worry), most participants were facing the adverse impacts of COVID-19; these effects could be potential predictors of psychosocial issues. Further investigations are therefore necessary to identify and disentangle specific psychosocial concerns in other Guinean socio-cultural contexts. In the meantime, information provide in this study can be used to set up coping strategies.

Supporting information

S1 File

(DOCX)

Click here for additional data file. (14.2KB, docx)
S2 File

(ZIP)

Click here for additional data file. (93.3KB, zip)

Acknowledgments

We are very grateful to the study participants for their availability; we also thank Matthew Brookoff –English teacher at YMCA New Americans Welcome Center (New York) and Andrée Prisca Ndjoug NDOUR, DVM, PhD, Assistante de recherche, Projet ZELS/ Brucelllose en Afrique de l’ouest et du centre Postdoc Afrique One ASPIRE for their valuable time to edit our manuscript.

Data Availability

All relevant data are within the manuscript and Supporting Information files.

Funding Statement

This study was self-funded and also supported in the form of administrative support from Maferinyah training and research centre in rural health and the Koffi Annan University of Guinea.

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Decision Letter 0

Akihiro Nishi

24 Nov 2020

PONE-D-20-19796

Psychosocial impacts of COVID-19 in the Guinean population. An Online cross-sectional survey.

PLOS ONE

Dear Dr. Almamy Amara Touré,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Akihiro Nishi, M.D., Dr.P.H.

Academic Editor

PLOS ONE

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[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This paper explores the psychological effects of COVID-19 on the population of Guinea. The topic is interesting and worth of investigation. However, parts of the analysis can be improved. In addition, the presentation and typography of the paper could use further refinement. Some suggestions to improve the paper are as follows:

Major

- I would suggest a comparison of the results presented in the paper with pre-pandemic data on stress levels in the Guinea population to see how/if stress levels have risen following the pandemic.

- I suggest enlisting the help of a scientific technical writer who is familiar with the field

Minor

- In Figure 4, I would suggest using a more noticeable color for "Strongly Agree" as it is difficult to see the respective bar upon first glance

Reviewer #2: This is a cross-sectional study of the psychosocial impact of COVID-19 in the Guinean population. It recruited via social media and had a study population of 275 people. The response for the psychological measures were lower at 56% and two thirds (should give the n and % for both questionnaires rather than 2/3).

My main concerns with this study are sample size and whether the study population is representative of the Guinean population or are significantly biased.

An internet search gives estimates of average number of Facebook friends worldwide as 338 with a median of 200 (brandwatch.com). I would worry that with a sample size of 275 this could be a particularly restricted social group. How were internet users identified to receive the survey link - was this based on targeted demographics via advertisement or via peers/social contacts of the researchers?

It would be good to have an idea of how typical this sample is in terms of demographics compared with the general population of Guinea. There is a high level of university education in the unemployed group and I wonder how typical that would be in general or if this is a particularly vulnerable group in a pandemic.

The manuscript is mostly well written although there are some problems with tenses and some typographical errors eg

- abstract: methods: 'we did an online cross-sectional survey among people' - could change to "we carried out an online cross-sectional study amongst internet users in Guinea"

- introduction - take out 'the' before global health, distanciation is referred to more commonly as "social distancing", capital city was (not were) isolated, first time to face more usually "first time facing", 2interested in to" could b e "aimed to"

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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PLoS One. 2021 Feb 2;16(2):e0245751. doi: 10.1371/journal.pone.0245751.r002

Author response to Decision Letter 0

8 Dec 2020

2020/12/07

Dear Akihiro Nishi, M.D, Dr P.H.

Academic Editor

PLOS ONE

Subject: Submission of revised paper PONE-D-20-19796 (manuscript ID number that the journal assigned).

Dear Dr Nishi,

First of all, we would like to thank you for your email of November 24th, 2020, and the opportunity to resubmit the revised version of our manuscript. We appreciate the time and effort that you and the reviewers dedicated to providing feedback on our manuscript and are grateful for your insightful and valuable comments on our paper.

We have incorporated the suggestions made by the reviewers. Our responses are given in a point-by-point manner in italic font. Changes to the manuscript are highlighted in yellow font. In this revised version of the manuscript, we did our best to address all comments made by the Reviewers.

We hope that the Reviewers and the Editors will be satisfied with our responses to their "comments".

Sincerely yours,

Almamy Amara TOURE

Head of monitoring/Evaluation unit

National Centre for Training and Research in Rural Health of Maferinyah, Forecariah, Guinea.

On behalf of the authors

Reviewer #1: This paper explores the psychological effects of COVID-19 on the population of Guinea. The topic is interesting and worth of investigation. However, parts of the analysis can be improved. In addition, the presentation and typography of the paper could use further refinement. Some suggestions to improve the paper are as follows:

Major

- I would suggest a comparison of the results presented in the paper with pre-pandemic data on stress levels in the Guinea population to see how/if stress levels have risen following the pandemic.

- I suggest enlisting the help of a scientific technical writer who is familiar with the field

Response

Thank you for having raised that question; we believe it was worth to be mentioned. For the records, our country (Guinea) has been facing a couple of health crises such as cholera, meningitis, Ebola, and now COVID-19. Before undertaking this study, we did an in-depth review of the literature to look at what has been done. Unfortunately, we found no specific information about psychosocial impact in the Guinea general population during the pre epidemic or pandemic period in Guinea. However, to reply to your thoughtful remark, we inserted in the discussion section as follow: “Traumatic events of this study dovetail with the pre-pandemic situation. For instance, a study on Ebola survivors reported 15% of post-traumatic stress disorder revealing the outbreak effects[]. Similarly,another finding revealed that bank employees stressed at different levels (very low stress=50.47%,stress down=44.43% ,high stress=5.09%).” (page 12, from line 8 to 11).

Minor

- In Figure 4, I would suggest using a more noticeable color for "Strongly Agree" as it is difficult to see the respective bar upon first glance.

Response

Thank you for this observation

We changed colour for the label "Strongly Agree", you can notice in the manuscript (page number 12).

Reviewer #2: This is a cross-sectional study of the psychosocial impact of COVID-19 in the Guinean population. It recruited via social media and had a study population of 275 people. The response for the psychological measures were lower at 56% and two thirds (should give the n and % for both questionnaires rather than 2/3).

Response

Thank you for this remark

We gave the n and % in the appropriate place.

My main concerns with this study are sample size and whether the study population is representative of the Guinean population or are significantly biased.

An internet search gives estimates of average number of Facebook friends worldwide as 338 with a median of 200 (brandwatch.com). I would worry that with a sample size of 275 this could be a particularly restricted social group. How were internet users identified to receive the survey link - was this based on targeted demographics via advertisement or via peers/social contacts of the researchers?

It would be good to have an idea of how typical this sample is in terms of demographics compared with the general population of Guinea. There is a high level of university education in the unemployed group and I wonder how typical that would be in general or if this is a particularly vulnerable group in a pandemic.

Response

Thank you for your comments; this is an interesting observation.

As we have mentioned in the manuscript, participants came from everywhere as shows in this statement "A free online e-survey ( https://esurv.org ) platform was used to send questionnaires to the internet users, they were encouraged to pass it to each other through social media (Facebook, WhatsApp, messenger) by using snowball sampling". Each author sent a questionnaire through groups of social media organize not only the researcher, and then they were encouraged to pass it to each other. Of note that we recoded the variable profession so that it can be more readable; for we noticed more than 100 categories socio-professionals accounting for all potential users of the Internet in Guinea. Another reason to consider our sample not representative of our entire population is based on the fact that not everyone uses the Internet in Guinea. Even among the literate people, Internet use is minimal. Besides, the spreading of the internet is relatively new (less than 10 years) in Guinea. Dear reviewer to address your concerns, we added more explanations in the description of the study population in the manuscript as follow:" The study population were diverse and came from all the sectors of activities in Guinea, but essentially focused on those who were active in using the internet, for the period of the study was short" (page number 3 from line 4 to 6 ), we also precise the social group that our survey focused on in the discussion section “ Targeting people who are literate and have access to the internet introduces a selection bias in the achievement of the study” (page number13, second paragraph, from line 3 to 4).

The manuscript is mostly well written although there are some problems with tenses and some typographical errors eg

- abstract: methods: 'we did an online cross-sectional survey among people' - could change to "we carried out an online cross-sectional study amongst internet users in Guinea"

- introduction - take out 'the' before global health, distanciation is referred to more commonly as "social distancing", capital city was (not were) isolated, first time to face more usually "first time facing", 2interested in to" could be "aimed to"

Response

Thank you for this valuable input.

We corrected all your observations;

-Abstract : methods: we replaced "did" by “carried out” the first line of the section.

-Introduction: “the” taken out (page 2 from line 5 to 6) , “distanciation changed” in “social distancing” (introduction, page number 2, second paragraph, line 4), capital city was inserted (introduction, page number 2, second paragraph, line 5), "first time facing" inserted instead of “first time to face” (introduction, page number 2, third paragraph, line 5), "aimed to" inserted instead of “interested in” (introduction, page number 2, last paragraph).

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file. (19.3KB, docx)

Decision Letter 1

Akihiro Nishi

7 Jan 2021

Psychosocial impacts of COVID-19 in the Guinean population. An online cross-sectional survey.

PONE-D-20-19796R1

Dear Dr. Almamy Amara Touré,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Akihiro Nishi, M.D., Dr.P.H.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

I am please to recommend an accept and an immediate publication.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: This is an important and timely topic which adds to the international literature on the impact of COVID-19 in a country that has experienced the trauma of other significant outbreaks of illness.

The authors have stated the limitations around sampling more clearly.

The standard of written English in the paper has been improved.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Acceptance letter

Akihiro Nishi

22 Jan 2021

PONE-D-20-19796R1

Psychosocial impacts of COVID-19 in the Guinean population. An online cross-sectional survey.

Dear Dr. Touré:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Akihiro Nishi

Academic Editor

PLOS ONE

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