Emotional Exhaustion, Depersonalization, and Mental Health in Nurses from Huelva: A Cross-Cutting Study during the SARS-CoV-2 Pandemic

Round 1

Reviewer 1 Report

Thank you for this report on the mental health of nursing professionals in Huelva during these trying times. I have the following major and minor comments for the authors to consider.

Specific comments:

1. Suggest to change the study title to make it more succinct and effective. It should also be stated that this was a cross-sectional study.
2. Accuracy is essential, this is especially true when it relates to the actual topic of the paper. i.e. "SARS-CoV-2" is the name of the virus, while "COVID-19" is the name of the disease that SARS-CoV-2 can cause in people – they are not the same thing or interchangeable. "COVID-19" is also short for "Coronavirus Disease 2019" while "SARS-CoV-2" is short for "severe acute respiratory syndrome coronavirus 2".
3. "Despite the findings concerning other pandemics, there is still a lack of sufficient information on the most devastating pandemic of the last century, that is, COVID-19" - there are in fact several published reports on the mental health effects of COVID-19. In the introduction section, suggest also to cite a recent narrative review on the impact of pandemic on the mental health of healthcare workers (citation: pubmed.ncbi.nlm.nih.gov/32603985).
4. Some comments on the local COVID-19 situation on the ground during the period the survey was conducted would be helpful.
5. As no personal identifiers were collected, the possibility of duplicate responses cannot be entirely excluded.
6. Please change "27,245" to "27.245" and "0,001" to "0.001".
7. "Significant differences were found (p ≤ 0.05)" - please provide the exact p values (with the associated 95% confidence intervals) instead of simply "p<0.05". Writing "p<0.05" alone is neither informative nor useful.
8. Suggest to present some of the results in bar graph format to promote easy reading and visualization.
9. "The conclusions of other studies [18]" - suggest to cite more than a single study here.
10. Depersonalization could also be a symptom of major depression. It has been found that in patients suffering from unipolar depression, associated depersonalization symptomatology is more intense compared to healthy controls, and also that there is a positive correlation between depression and depersonalization (citation: pubmed.ncbi.nlm.nih.gov/15022041). These conditions are likely not discrete categories but rather, have common biological underpinnings and may form at least part of a continuum or affective disorder spectrum (citation: pubmed.ncbi.nlm.nih.gov/32557983). 
11. In the discussion section, as part of mitigation strategies, as resources could be particularly scarce during a serious pandemic situation, timely psychological support could also take many forms, including telemedicine and informal support groups (citation: pubmed.ncbi.nlm.nih.gov/32380875). This should be mentioned.
12. Several other study limitations exist. The use of self-reported measures is also a study limitation. Did the authors adjust for baseline depression or past psychiatric history as a covariate? Additionally, socioeconomic status still varies over time in this age range. It is also clear that this pandemic has disproportionately impacted racial minorities and lower-income families (citation: pubmed.ncbi.nlm.nih.gov/32391864).
13. There was no data availability statement. The underlying data should be made publicly available. If this was not possible, please provide a reason why.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 2 Report

Thank you for doing this important work. This article aimed at analyse “Emotional Exhaustion, Depersonalization and Self-Perceived Health in Nursing Professionals in Huelva: A Study of Mental Health during the COVID-19 Pandemic”.

Title

The MBI refers to 3 concepts, emotional exhaustion, depersonalization and low personal accomplishment, where is this last concept?

Abstract

The authors indicate: “This research examines the prevalence of emotional exhaustion, depersonalization”, why the authors do not study “personal accomplishment”.

Methods

It was a correlational study or a cross-sectional study?

Evaluation instruments

Maslach Burnout Inventory-Human Services Survey (MBI-HSS) has 3 dimensions (emotional exhaustion, depersonalization and low personal accomplishment). The low personal accomplishment dimension is missing. The concept of burnout cannot be analysed by only 2 dimensions, since the concept has 3 dimensions

What were the cut-off points of the MBI?

 Where is the correlation variables table?

Discussion

How have burnout levels changed from pre-pandemic research?

Author Response

Please see the attachment

Round 2

Reviewer 1 Report

Thank you for the revisions.

Author Response

Thank you very much for the suggestions that made a better work