Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk.

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Recent studies have shown that a high burden of mental health conditions, including depression, anxiety disorders, stress, panic attacks, impulsivity, irrational anger, somatization disorder, sleep disorders, emotional disturbance, symptoms of post-traumatic stress disorder, and suicidal thoughts, may be experienced by COVID-19 survivors. Due to differences in their susceptibility to infection and lifestyle factors, people with different medical conditions and social roles may have various kinds and severities of mental health problems. This study aimed to provide essential insights into the prevalence, types, and linkages of various mental health issues to improve patient outcomes, guide future treatments, and advance holistic well-being. Methodology This cross-sectional study examined the prevalence of common mental health issues among patients receiving treatment at Ayurvedic health centers in Udupi Taluk. Five Ayurvedic centers were chosen randomly from 275 Ayurvedic centers registered in Udupi Taluk. A total of 423 patients aged 18 years and above were selected for this study. The Perceived Stress Scale and Patient Health Questionnaire (PHQ-9) were used to collect data. Results and discussion The study revealed the presence of some level of perceived stress and depression among the participants. The factor associated with stress was the educational status of participants (p =0.01). The comparison between different stress levels revealed that moderate stress levels were significantly higher among participants with a lower educational status. Conclusion According to a study on perceived stress levels and educational status, participants with lower educational status reported feeling more stressed than those with higher educational status. 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F1000Research 2025, 14 :749 ( https://doi.org/10.12688/f1000research.165056.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] Surekha D Shetty 1 , Vidya Prabhu https://orcid.org/0000-0002-7371-0826 2 , Varalakshmi Chandra Sekaran https://orcid.org/0000-0003-3319-3075 3 , [...] Ashwini Aithal p 4 , Sapna Marpalli 5 , Ravichandran Nair K https://orcid.org/0000-0001-9563-8549 6 , Shantha Kumari BR 7 Surekha D Shetty 1 , Vidya Prabhu https://orcid.org/0000-0002-7371-0826 2 , [...] Varalakshmi Chandra Sekaran https://orcid.org/0000-0003-3319-3075 3 , Ashwini Aithal p 4 , Sapna Marpalli 5 , Ravichandran Nair K https://orcid.org/0000-0001-9563-8549 6 , Shantha Kumari BR 7 PUBLISHED 15 Sep 2025 Author details Author details 1 Division of Anatomy, Department of Basic Medical Sciences,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Department of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 3 Department of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 4 Division of Anatomy, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 5 Division of Anatomy, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 6 Department of Social and Health Innovation Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 7 Division of Pathology, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India Surekha D Shetty Roles: Data Curation, Formal Analysis, Methodology, Validation, Writing – Original Draft Preparation Vidya Prabhu Roles: Conceptualization, Data Curation, Methodology, Validation, Writing – Original Draft Preparation Varalakshmi Chandra Sekaran Roles: Methodology, Writing – Review & Editing Ashwini Aithal p Roles: Writing – Original Draft Preparation Sapna Marpalli Roles: Writing – Review & Editing Ravichandran Nair K Roles: Methodology, Validation, Writing – Review & Editing Shantha Kumari BR Roles: Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Society for Mental Health in Low- and Middle-Income Countries (SoMHiL) gateway. This article is included in the Manipal Academy of Higher Education gateway. Abstract Introduction Increased work pressure, lifestyle modifications, and deteriorated living conditions brought on by Coronavirus disease 2019 (COVID-19) can exacerbate mental health concerns such as anxiety, sleeplessness, depression, and stress-related illnesses. Recent studies have shown that a high burden of mental health conditions, including depression, anxiety disorders, stress, panic attacks, impulsivity, irrational anger, somatization disorder, sleep disorders, emotional disturbance, symptoms of post-traumatic stress disorder, and suicidal thoughts, may be experienced by COVID-19 survivors. Due to differences in their susceptibility to infection and lifestyle factors, people with different medical conditions and social roles may have various kinds and severities of mental health problems. This study aimed to provide essential insights into the prevalence, types, and linkages of various mental health issues to improve patient outcomes, guide future treatments, and advance holistic well-being. Methodology This cross-sectional study examined the prevalence of common mental health issues among patients receiving treatment at Ayurvedic health centers in Udupi Taluk. Five Ayurvedic centers were chosen randomly from 275 Ayurvedic centers registered in Udupi Taluk. A total of 423 patients aged 18 years and above were selected for this study. The Perceived Stress Scale and Patient Health Questionnaire (PHQ-9) were used to collect data. Results and discussion The study revealed the presence of some level of perceived stress and depression among the participants. The factor associated with stress was the educational status of participants (p =0.01). The comparison between different stress levels revealed that moderate stress levels were significantly higher among participants with a lower educational status. Conclusion According to a study on perceived stress levels and educational status, participants with lower educational status reported feeling more stressed than those with higher educational status. READ ALL READ LESS Keywords Ayurveda health centers, holistic well-being, common mental health problems, factors of stress, COVID-19. Corresponding Author(s) Vidya Prabhu ( [email protected] ) Close Corresponding author: Vidya Prabhu Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Shetty SD et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Shetty SD, Prabhu V, Chandra Sekaran V et al. Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.12688/f1000research.165056.2 ) First published: 30 Jul 2025, 14 :749 ( https://doi.org/10.12688/f1000research.165056.1 ) Latest published: 15 Sep 2025, 14 :749 ( https://doi.org/10.12688/f1000research.165056.2 ) Revised Amendments from Version 1 Introduction and Rationale: Revised the introduction to improve logical flow and cohesiveness by restructuring the paragraphs. Added background information on the prevalence of common mental health disorders (CMDs). Relocated the description of the study location from the Introduction to the Methodology section. Methodology: Expanded the section to include details on participant recruitment, data collection, and analysis. Specified the standard tools used to assess mental health disorders. Provided a clear explanation of the sample size calculation, including assumptions used (prevalence, confidence level, and margin of error). Data Analysis and Results: Simplified the Results section by focusing on the most significant findings and reducing excessive descriptive detail. Updated the Methods section to include a justification for Table 4 and explained its inclusion. Inferences and Confounding Factors: Revised the Discussion to avoid making causal inferences attributing stress and depression directly to COVID-19, acknowledging the limitations of the cross-sectional design. Added a statement in the Limitations section stating that pre-existing health conditions and concurrent illnesses may have influenced participants’ mental health status. References: Added seven more refences. Introduction and Rationale: Revised the introduction to improve logical flow and cohesiveness by restructuring the paragraphs. Added background information on the prevalence of common mental health disorders (CMDs). Relocated the description of the study location from the Introduction to the Methodology section. Methodology: Expanded the section to include details on participant recruitment, data collection, and analysis. Specified the standard tools used to assess mental health disorders. Provided a clear explanation of the sample size calculation, including assumptions used (prevalence, confidence level, and margin of error). Data Analysis and Results: Simplified the Results section by focusing on the most significant findings and reducing excessive descriptive detail. Updated the Methods section to include a justification for Table 4 and explained its inclusion. Inferences and Confounding Factors: Revised the Discussion to avoid making causal inferences attributing stress and depression directly to COVID-19, acknowledging the limitations of the cross-sectional design. Added a statement in the Limitations section stating that pre-existing health conditions and concurrent illnesses may have influenced participants’ mental health status. References: Added seven more refences. See the authors' detailed response to the review by Prafulla Shriyan See the authors' detailed response to the review by Pankaj Sharma READ REVIEWER RESPONSES Introduction According to the World Health Organization (WHO), health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. 1 Mental health, therefore, is a vital component of overall health and wellbeing. A healthy mind is an essential aspect of wellness, and during illness, physical limitations can manifestations as psychiatric symptoms, causing patients to experience a wide range of psychological problems. 2 This study was conducted to determine the common mental health problems among patients accessing care at Ayurvedic health centers in Udupi taluk. Common mental health disorders (CMDs), such as depression, anxiety, and stress, are leading contributors to disability worldwide. According to the WHO, one in every eight people worldwide is suffering from mental disorders, with depression and anxiety being among the most prevalent. 3 In India, the National Mental Health Survey (2015–16) reported that nearly 14% of the population suffers from mental health problems. 4 Despite its high prevalence, access to timely diagnosis and treatment remains limited, especially in nonpsychiatric healthcare settings. Coronavirus disease 2019 (COVID-19) was characterized as a pandemic by the WHOon March 11, 2020. 5 The pandemic significantly increased the burden of CMDs. In 2020, the COVID-19 pandemic led to a sharp increase in mental disorders, with a 26% increase in anxiety disorders and a 28% increase in major depressive disorders within just one year. 3 Hundreds of millions of people’s lives have been impacted, and people’s social, occupational, educational, and lifestyle choices have changed due to individual and governmental reactions to this serious public health catastrophe. Worry about infection, increased workload, lifestyle changes, and social isolation contributed to mental health problems such as anxiety, depression, insomnia, and stress-related disorders. 6 – 9 People with diverse health conditions and social roles are affected differently, depending on their vulnerability to infection and coping mechanisms. 10 Studies have also reported a high prevalence of depression, anxiety, posttraumatic stress symptoms, and suicidal ideation among COVID-19 survivors. 11 , 12 The COVID-19 pandemic, according to the United Nations, not only compromises physical health but also increases psychological distress. 13 Therefore, it is crucial to understand how communities’ mental health is affected during this pandemic. According to recent research, COVID-19 survivors may experience a high burden of mental health issues, such as depression, anxiety disorders, stress, panic attacks, irrational anger, impulsivity, somatization disorder, sleep disorders, emotional disturbance, post-traumatic stress symptoms, and suicidal ideation. 14 Additional factors associated with mental health problems during COVID-19 include age, gender, marital status, education, occupation, income, place of residence, close contact with COVID-19 patients, comorbid physical and mental health issues, exposure to COVID-19-related news and social media, coping mechanisms, stigma, psychosocial support, health communication, trust in medical services, personal protective measures, and risk of COVID-19 infection. 15 In the Indian context, multiple factors, such as age, gender, marital status, education, income, occupation, comorbidities, stigma, and exposure to health-related news, have been associated with CMDs. 16 However, much of the existing evidence comes from general or psychiatric healthcare settings, whereas alternative systems of medicine remain underexplored. Ayurveda, a millennia-old Indian medical system, exemplifies this holistic concept by recognizing the interdependence of mind, body, and spirit. 17 Ayurvedic wellness centers have become popular as alternative and complementary healthcare destinations, promising physical and emotional renewal. 18 Despite their growing use, there is limited evidence on the prevalence of CMDs among patients seeking care in such centers. Addressing this gap is essential to ensure that mental health is not overlooked in integrative healthcare models. There is a bidirectional relationship between physical health and mental health. Physical issues can lead to psychological distress, whereas mental health issues can manifest as physical symptoms. 19 In the context of Ayurveda, which encourages balance and harmony. Exploring the prevalence of common mental health issues is particularly crucial. Healthcare practitioners, policymakers, and researchers should work together to improve the overall quality of care at Ayurvedic health centers by highlighting this little-studied aspect. Furthermore, the findings of this study may help understand better-integrated healthcare approaches that prioritize mental and physical health holistically. Given the growing interest in alternative healthcare practices and the global burden of mental health disorders, this study aimed to fill a critical knowledge gap by investigating the common mental health issues encountered by patients seeking care at Ayurvedic health centers. By highlighting the mental health dimension of care in these holistic settings, the study seeks to inform future strategies to enhance patient outcomes and promote well-being in an integrative, mind-body-centered healthcare framework. Methodology This cross-sectional study was conducted between June 2022 and December 2022 in Udupi Taluk, Karnataka. Five of the 275 Ayurvedic centers registered in the region were selected using simple random sampling. All patients aged 18 years and above who attended the selected centers during the study period were eligible to participate. Using an anticipated prevalence of 50%, 95% confidence interval, and 5% margin of error, the minimum required sample size was calculated as 384. Considering a 10% nonresponse rate, 423 participants were included in the study through consecutive sampling. Ethical approval was obtained from the Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee (IEC No: 866--2021) on May 9, 2022. Written informed consent was obtained from all participants prior to data collection. Data were collected using standardized, validated tools. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depression symptoms, and the Perceived Stress Scale (PSS) was used to measure stress levels. 19 The tool also included COVID-19-related items to capture participants’ perceptions and emotional responses during the pandemic. These items were included to explore contextual factors potentially influencing mental health, given the timing of data collection during the pandemic. Results and discussion Sociodemographic characteristics of the participants are presented in Table 1 . Of the 430 participants, 61.6% were in the age group of 31–60 years, and the majority (56%) were male. Most of the participants (56.7%) had less than PUC education. Most participants (78.8%) were married, and 85.5% belonged to the Hindu religion. Table 1. Socio-demographic details of the participants. Variables Frequency & percentage Age in years 18–30 144 (33.5) 31–60 265 (61.6) More than 61 21 (4.9) Gender Male 241 (56) Female 189 (44) Educational status Less than PUC 244 (56.7) Degree and above 186 (43.3) Marital status Single 91 (21.2) Married 339 (78.8) Religion Hindu 368 (85.6) Muslim 44 (10.2) Christian 18 (4.2) Employment status Employed 297 (69.1) Unemployed 100 (23.3) Student 26 (6.0) Retired 7 (1.6) Most of the people in the population were between the ages of 31 and 60 (61.6%), followed by people between the ages of 18 and 30 (33.5%), and over 61 (4.9%). There were a slightly higher number of men (56%) than women (44%). Almost half of the people in the country had less than a Pre-University Course (PUC) education (56.7%), while 43.3% had a degree or higher. Seventy-eight percent of people were married, while only twenty-two percent were single. Hindus (85.6%), Muslims (10.2%), and Christians (4.2%). A large part of the population was working (69.1%), while smaller portions were unemployed (23.3%), school (6%), or retired (1.6%). The distribution of demographics revealed the needs and problems of the community. The prevalence of common mental health problems is presented in Table 2 . Regarding stress, most participants (93%) had experienced moderate stress, 5.1% had experienced low stress, and 1.9% had experienced high stress. Regarding depression, 41.4% had experienced minimal depression, 27.9% had experienced moderate depression, 15.8% had experienced mild depression, 14.2% had experienced moderate to severe depression, and 0.7% had experienced severe depression. Table 2. Prevalence of common mental health problems during covid-19 pandemic. Variable Frequency (%) Stress Low stress 22 (5.1) Moderate stress 400 (93) High stress 8 (1.9) Depression Minimal depression 178 (41.4) Mild depression 68 (15.8) Moderate depression 120 (27.9) Moderately severe depression 61 (14.2) Severe depression 3 (0.7) The associations between common mental health problems and demographic characteristics of the participants are presented in Table 3 . Table 3. Association between common mental health problems and demographic characteristics of the participants. Low stress Moderate stress High stress p-value Age 18-30 8 (36.4%) 130 (32.5%) 6 (75.0%) 31-60 13 (59.1%) 250 (62.5%) 2 (25.0%) 0.1 More than 61 1 (4.5%) 20 (5.0 %) 0 (0.0%) Gender Male 14 (63.6%) 222 (55.5%) 5 (62.5%) 0.7 Female 8 (36.4%) 178 (44.5%) 3 (37.5%) Educational status Less than PUC 7 (31.8%) 236 (59.0%) 1 (12.5%) Degree and above 15 (68.2%) 164 (41.0%) 7 (87.5%) 0.001 * Employment status Employed 17 (77.3%) 275 (68.8%) 5 (62.5%) Unemployed 2 (9.1%) 97 (24.2%) 1 (12.5%) 0.1 Student 2 (9.1%) 22 (5.5%) 2 (25.0%) Retired 1 (4.5%) 6 (1.5%) 0 (0.0%) Area of residence Rural 16 (72.7%) 226 (56.5%) 4 (50.0%) 0.3 Urban 6 (27.3%) 174 (43.5%) 4 (50.0%) Minimal depression Mild depression Moderate depression Moderately severe depression Severe depression p-value Age 18-30 58 (32.6%) 23 (33.8%) 42 (35.0%) 21 (34.4%) 0 (0.0%) 31-60 113 (63.5%) 42 (61.8%) 69 (57.5%) 38 (62.3%) 3 (100.0%) 0.7 More than 61 7 (3.9%) 3 (4.4%) 9 (7.5%) 2 (3.3%) 0 (0.0%) Gender Male 98 (55.1%) 42 (61.8%) 72 (60.0%) 27 (44.3%) 2 (66.7%) 0.2 Female 80 (44.9%) 26 (38.2%) 48 (40.0%) 34 (55.7%) 1 (33.3%) Educational status Less than PUC 115 (64.6%) 35 (51.5%) 61 (50.8%) 31 (50.8%) 2 (66.7%) Degree and above 63 (35.4%) 33 (48.5%) 59 (49.2%) 30 (49.2%) 1 (33.3%) 0.3 Employment status Employed 120 (67.4%) 51 (75.0%) 81 (67.5%) 43 (70.5%) 2 (66.7%) Unemployed 44 (24.7%) 14 (20.6%) 24 (20.0%) 17 (27.9%) 1 (33.3%) Student 12 (6.7%) 3 (4.4%) 10 (8.3%) 1 (1.6%) 0 (0.0%) 0.3 Retired 2 (1.1%) 0 (0.0%) 5 (4.2%) 0 (0.0%) 0 (0.0%) Area of residence Rural 107 (60.1%) 43 (63.2%) 63 (52.5%) 31 (50.8%) 2 (66.7%) 0.4 Urban 71 (39.9%) 25 (36.8%) 57 (47.5%) 30 (49.2%) 1 (33.3%) * Statistical significance at p < 0.05. Stress distribution across age groups The data suggest that the highest percentage (75%) of high stress is found among the youngest age group (18-30 years), and factors such as career uncertainty, financial instability, or life transitions may contribute to higher stress levels in younger individuals, whereas the middle-aged group (31-60 years) has a lower percentage (25%) of high stress, which may be due to a decrease in stress with age aligned with possible increases in life experience, stability, or coping mechanisms. No participants over 61 years reported high stress, which may be influenced by retirement and reduced occupational pressure. Statistical analysis revealed no significant association between age and stress level (p = 0.1). Impact of educational status on stress levels A statistically significant association was found between education status and stress (p = 0.001). Among participants with less than a PUC education, 59% experienced moderate stress, whereas 87.5% of those with a degree or higher reported high stress. People with a bachelor’s degree or higher may be more stressed because they have more responsibilities, higher career demands, or work pressures. These findings suggest that educational attainment influences stress perception and experience, which could inform targeted mental health interventions. Stress distribution across employment status The data show that people with different types of jobs experience various levels of stress. The employed individuals experienced moderate stress (68.8%), and approximately 24.2% of the unemployed people were in the moderate stress category. Notably, the students were in the high-stress category (25%). People with jobs usually feel moderate rather than high or low stress because of pressures at work, such as meeting deadlines, worrying about job stability, balancing work and life, and meeting performance standards. Stress distribution across rural and urban areas: The data revealed that 72.7% of the participants from rural areas reported low stress, whereas 27.3% were from urban areas. For moderate stress, 56.5% of the participants were from rural areas, and 43.5% were from urban areas. In the high-stress category, the distribution was equal, with 50% of the participants from rural areas and 50% from urban areas. Although these figures suggest that rural participants were more likely to report lower levels of stress, differences in stress levels between rural and urban populations were not statistically significant. The participants’ feelings and thoughts during the COVID-19 pandemic are presented in Table 4 . Approximately one-third of the participants (34.2%) were extremely afraid, while 33.7% were rarely afraid of acquiring COVID-19 when going into the public. Nearly half (49.8%) of the participants were worried about contracting COVID-19. Approximately 41.6% of the participants reported that sleep was rarely affected because of thoughts related to COVID-19. About 22.3% reported avoiding conversations on COVID-19 because of fear or anxiety. Approximately 36.7% were worried about acquiring COVID-19 when an unknown person came closer to them. Approximately 20.9% were anxious about obtaining information on COVID-19. Approximately 40.5% were concerned about acquiring COVID-19 when people coughed or sneezed. Table 4. Participants’ feelings and thoughts during COVID-19. Characteristics Frequency (%) Afraid of acquiring COVID-19 when going into the public Extremely Afraid 147 (34.2) Sometimes Afraid 113 (26.3) Rarely Afraid 145 (33.7) Not at All Afraid 25 (5.8) Feeling worried of acquiring COVID-19 Always 65 (15.1) Sometimes 214 (49.8) Rarely 120 (27.9) Never 31 (7.2) Sleep get affected because of thoughts relating COVID-19 Always 85 (19.8) Sometimes 122 (28.4) Rarely 179 (41.6) Never 44 (10.2) Avoiding conversations on COVID-19 out of fear/anxiety Always 96 (22.3) Sometimes 130 (30.2) Rarely 165 (38.4) Never 39 (9.1) Worried acquiring COVID-19 when unknown person coming close Extremely Afraid 158 (36.7) Sometimes Afraid 106 (24.7) Rarely Afraid 147 (34.2) Not at All Afraid 19 (4.4) Anxious when knowing information on COVID-19 Extremely Afraid 90 (20.9) Sometimes Afraid 138 (32.1) Rarely Afraid 167 (38.8) Not at All Afraid 35 (8.1) Concerned of acquiring COVID-19 when people cough or sneeze Extremely Afraid 174 (40.5) Sometimes Afraid 70 (16.3) Rarely Afraid 170 (39.5) Not at All Afraid 16 (3.7) Discussion The present study revealed the prevalence of common mental health disorders among patients seeking care at Ayurvedic health centers during the COVID-19 pandemic. Rather than directly attributing these findings to COVID-19, it is important to recognize that the cross-sectional design captures participants’ mental health only at a single point in time and does not establish causality. While the pandemic may have been one of several contextual stressors influencing participants, other factors, such as preexisting health conditions, ongoing treatments, and the stress of current illness, could also have contributed to their perceived stress and depressive symptoms. Pandemic-induced stressors People who took part were probably more stressed because they were always worried about their health, the health of their loved ones, and the chance of contracting the virus. A significant source of stress was worry that they would get sick and have to go to the hospital or die. Many people lost their jobs, had their incomes dropped, or were unsure of where to work in the future because of the pandemic. This lack of financial security probably stressed people, especially those who were already weak. Measures to keep people from getting too close, lockdowns, and limits on meetings all messed everyday social interactions, making people feel lonely, isolated, and disconnected. Not having friends or family during these times could have worsened the worry. People may have been too stressed by the confusing or scary information that kept coming in about the virus, how it spread, and how to stop it. The constant need to handle new information and adjust to new rules may have stressed people. However, these influences should be interpreted as potential background factors rather than definitive causes of the observed stress levels in this study. Psychological impact of prolonged uncertainty Long-lasting uncertainty about how long the pandemic would last, how well vaccines would work, and the chance of new strains added to stress. Living in a state of long-term uncertainty can be mentally draining and make you feel powerless or burnt out. Significant mental and emotional changes had to be made to deal with sudden and ongoing changes in daily routines, such as working from home or teaching, or changes in social behavior, such as wearing masks and avoiding public places. Getting used to these new rules likely made the volunteers feel more stressed. The fact that many of the people who took part in the study reported moderate amounts of stress suggests that, while not everyone was stressed out, a large part of the population was. There are many signs of mild stress, such as irritability, trouble concentrating, changes in sleep habits, or a general feeling of unease. Moderate stress was expected, which could mean that people were using ways to deal with it, like sticking to routines, getting social support, or doing things that relieve stress. However, these methods are not always sufficient to entirely reduce the stress caused by the pandemic. Different levels of stress among participants could show various levels of vulnerability and resilience. People’s mental health problems, ability to receive social support, ability to handle stress, and coping skills may all affect how they feel and deal with stress during the pandemic. Mental health interventions Many people feel moderate worry, which shows how important it is to have easy access to mental healthcare during and after the pandemic. Helping people deal with long-term stress sources could come from counselling, workshops on stress management, and neighborhood support groups. When people talk about public health, they should focus on physical and mental health, giving them tools and tips for dealing with stress. This could mean encouraging people to live healthy lives, make friends, and obtain clear, consistent knowledge to lower uncertainty. Having moderate worry over a long period could lead to more serious mental health problems such as depression or anxiety if not dealt with. It is essential to keep an eye on and help people with mental health problems as part of the overall reaction to the pandemic. Realizing that many people are under moderate stress clarifies how important it is to build group resilience. Communities are vital for helping each other, creating a sense of unity, and sharing tools to deal with stress in a group. When making decisions, policymakers should consider how the pandemic affects people’s mental health, and ensure that mental health services are adequately paid and included in plans for dealing with the pandemic. This includes helping people who may be more influenced than others, such as frontline workers, people with low incomes, and people who already have mental health problems. The study result is aligned with the study conducted in Kerala, which also reported that most of the participants had experienced moderate levels of stress during COVID–19. 21 In the current study, stress was high among participants aged 31 to 60. Stress levels were low among participants over 60 years of age. Although the finding was not statistically significant, previous research and global perceived stress reported that stressors experienced by older people are lower than those of younger people. 22 The association between gender and perceived stress showed that the moderate level of stress was higher among males than compared to females. This finding contradicts previous literature that reported lower perceived stress levels in men. 23 , 24 A comparison between educational status and perceived stress level revealed that perceived stress was higher among participants with lower educational status than among those with higher educational status. The comparison between different levels of stress revealed that moderate levels of stress were higher among participants with lower educational status, and this was found to be statistically significant. Education and stress resilience: People with more schooling usually have better access to cognitive resources and ways to deal with problems. People who attend college often learn how to solve problems, think critically, and control their emotions, which makes them better able to handle stress. Higher education levels usually improve people’s ability to find, understand, and use health knowledge, which can help them better deal with stress. They may also have more knowledge about ways to deal with stress, mental health tools, and self-care activities that can help them feel less stressed. A college degree is often linked to better job opportunities, higher income, and more stable finances, which can help lower financial stress, which is a major cause of overall stress. Financially stable people can focus on their health and happiness instead of the day-to-day worries that people with less schooling might have. People with lower levels of education may not have many ways to deal with these problems. They may not know how to handle stressful situations, making them feel more stressed, especially during tough times such as a pandemic. A lower level of education is often linked to jobs that pay less, job insecurity, and less access to healthcare and other helpful tools. Being economically vulnerable is a significant source of stress because it can make people worry about meeting their basic needs, especially during crises, such as the COVID-19 pandemic. People with less schooling may also have to deal with extra social and environmental stresses, such as living in an unsafe or crowded place, not having much social support, and being discriminated against or socially stigmatized. These factors can worsen the levels of worry. The result that people with less education had higher moderate stress levels was statistically significant. This shows a strong link between the level of education and the ability to deal with or understand stress, with less education linked to higher stress levels. Even though moderate stress is not as bad for you as high stress, it can still significantly affect your health and wellbeing. People with less schooling may be more likely to experience moderate stress because they have more trouble with money, fewer friends and family, and less access to mental health resources. Implications for interventions Based on these results, it is clear that people with less education require specific support services. Some examples of interventions include classes on how to deal with stress, handle money, and obtain affordable mental health services. Promoting higher education and learning opportunities throughout life can help people deal with stress. Even as an adult, encouraging and helping people keep learning could help vulnerable groups feel less stressed. When planning mental health interventions, public health plans should consider the educational differences. Messages and support services tailored to the needs of people with less schooling can help to close the gap in their ability to deal with stress. Policy implications: Reducing educational inequality can help people feel less stressed and better about their general health in the long term. Stress differences could be lessened by policies that ensure equal access to good schools, job training, and adult education. A significant social factor affecting health is education level. Policymakers should consider how education affects health, such as stress, and work to lower hurdles to education, especially in areas that do not receive enough help. Obtaining help and tools for people with less education through community-based programs can be very helpful in lowering stress. Community centers may offer educational classes, counselling for mental health issues, and social support networks as part of these efforts. A comparison between employment status and perceived stress level revealed that perceived stress was higher among employed participants, although the association was not statistically significant. A comparison between different levels of perceived stress reported that moderate levels of perceived stress were higher among employed participants. As compared to area of residence the rural participants experienced more perceived stress as compared to urban participants. Except for educational status, none of the factors were found to be statistically significant. The present study revealed that some levels of depression were exhibited by participants during COVID-19. Depression was high among the participants aged 31–60 years. Stress levels were low among participants over 60 years of age. The association between gender and PHQ-9 depression score was higher among males than among females. A comparison between educational status and PHQ-9 scores showed that depression was higher among participants with a lower educational status than among those with a higher educational status. The comparison between employment status and PHQ-9 revealed that depression was higher among employed participants. Depression was higher among rural participants than among urban participants. None of the factors were statistically significant. Conclusion This study aimed to determine the prevalence of common mental health problems among patients accessing care at Ayurvedic health centers during the COVID-19 pandemic. The study revealed the presence of varying level of perceived stress and depression among the participants. The reasons for perceived stress and depression, and effective measures to overcome these problems need to be explored. The further research needs to be carried out to investigate the reasons and measures to overcome these problems. This may help to overcome stress and depression during crises. Limitations The cross-sectional design prevents the establishment of causal relationships between COVID-19 and observed stress and depression levels. The study did not differentiate between patients with or without a COVID-19 diagnosis and did not control for potential confounders such as pre-existing health conditions. These factors may have independently influenced participants’ mental health outcomes. Therefore, the results should be interpreted as an assessment of mental health status in the context of the pandemic rather than as direct consequences of COVID-19 itself. Ethical approval and consent The approval has been obtained from Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee (IEC No: 866-2021), and written consent from the participants was also obtained. The ethical clearance was obtained on May 9, 2022. Data availability statement Underlying data Figshare: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk https://doi.org/10.6084/m9.figshare.29320637.v2 25 The project contains the following underlying data: • Mental stress.xls. (Anonymised answers to questionnaire). Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Figshare: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk https://doi.org/10.6084/m9.figshare.29320637.v2 25 The project contains the following data: • Questionnaire.pdf Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgments We thank all respondents who participated in this study. We acknowledge the support of B. Devadas Shetty for the execution of this project. References 1. World Health Organization: Constitution of the World Health Organization. Geneva: World Health Organization; 1946. [cited 2025 Jul 28]. Reference Source 2. Gunathilaka HJ, Vitharana P, Udayanga L, et al. : Assessment of Anxiety, Depression, Stress, and Associated Psychological Morbidities among Patients Receiving Ayurvedic Treatment for Different Health Issues: First Study from Sri Lanka. Biomed. Res. Int. 2019; 2019 : 1–10. PubMed Abstract | Publisher Full Text | Free Full Text 3. World Health Organization: Depression and other common mental disorders: global health estimates Geneva: World Health Organization; 2017. 4. Gururaj G, Varghese M, Benegal V, et al. : National Mental Health Survey of India, 2015–16: Summary. Bengaluru: National Institute of Mental Health and Neurosciences, NIMHANS Publication. No. 128; 2016. 5. Cucinotta D, Vanelli M: WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020; 91 (1): 157–160. PubMed Abstract | Publisher Full Text | Free Full Text 6. Pulvirenti F, Cinetto F, Milito C, et al. : Health-Related-Quality of Life in Common Variable Immunodeficiency Italian patients switched to remote assistance during the COVID-19 pandemic. J. Allergy Clin. Immunol. 2020; 8 (6): 1894–1899.e2. PubMed Abstract | Publisher Full Text | Free Full Text 7. Zhang C, Yang L, Liu S, et al. : Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak. Front. Psych. 2020; 11 : 306. PubMed Abstract | Publisher Full Text | Free Full Text 8. Pappa S, Ntella V, Giannakas T, et al. : Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav. Immun. 2020 May; 88 :901–907. PubMed Abstract | Publisher Full Text | Free Full Text 9. Campos JADB, Oliveira JF, Silva LAA, et al. : Impact of social isolation during the COVID-19 pandemic on the mental health of university students: a systematic review. J. Affect. Disord. 2023; 314 :1–9. Free Full Text 10. Tan BYQ, Chew NWS, Lee GKH, et al. : Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore. Ann. Intern. Med. 2020; 173 (4): 317–320. PubMed Abstract | Publisher Full Text | Free Full Text 11. Rogers JP, Chesney E, Oliver D, et al. : Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020 Jul; 7 (7):611–627. PubMed Abstract | Publisher Full Text | Free Full Text 12. Berrent D: Why so many long COVID patients are reporting suicidal thoughts. Time. 2022 Jul 14. https://time.com/6186429/suicide-long-covid/ 13. United Nations: UN leads call to protect most vulnerable from mental health crisis during and after COVID-19.2020. 14. Wu T, Jia X, Shi H, et al. : Prevalence of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis. J. Affect. Disord. 2021; 281 : 91–98. PubMed Abstract | Publisher Full Text | Free Full Text 15. Hossain MM, Tasni S, Sultana A, et al. : Epidemiology of mental health problems in COVID-19: a review. F1000Res. 2020; 9 : 636. PubMed Abstract | Publisher Full Text | Free Full Text 16. Patel V, Kirkwood BR, Pednekar S, et al. : Gender disadvantage and reproductive health risk factors for common mental disorders in women: a community survey in India. Lancet. 2006 Apr 1; 367 (9516):651–657. Publisher Full Text 17. Jaiswal YS, Williams LL: A glimpse of Ayurveda – The forgotten history and principles of Indian traditional medicine. J. Tradit. Complement. Med. 2017; 7 (1): 50–53. PubMed Abstract | Publisher Full Text | Free Full Text 18. Verma SK, Pandey M, Sharma A, et al. : Exploring Ayurveda: principles and their application in modern medicine. Bull. Natl. Res. Cent. 2024; 48 : 77. Publisher Full Text 19. Fiorillo A, Girolamo G, Simunovic IF, et al. : The relationship between physical and mental health: an update from the WPA Working Group on Managing Comorbidity of Mental and Physical Health. World Psychiatry. 2023; 22 (1): 169–170. PubMed Abstract | Publisher Full Text | Free Full Text 20. Chandu VC, Pachava S, Vadapalli V, et al. : Development and Initial Validation of the COVID-19 Anxiety Scale. Indian J. Public Health. 2020; 64 (6): 201–204. Publisher Full Text 21. Laxmi Suresh B, Janarthanan Pillai M, Janardhanan KA: Prevalence of Perceived Stress, Due To COVID-19 Among Faculties of Government Dental Colleges in Kerala, India. Cogent Psychol. 2021; 8 : 1978635. Publisher Full Text 22. Stawski RS, Sliwinski MJ, Almeida DM: Reported exposure and emotional reactivity to daily stressors: the roles of adult age and global perceived stress. Psychol. Aging. 2008; 23 (1): 52–61. PubMed Abstract | Publisher Full Text | Free Full Text 23. Flores E, Tschann JM, Dimas JM: Perceived discrimination, perceived stress, and mental and physical health among Mexican-origin adults. Hisp. J. Behav. Sci. 2008; 30 (4): 401–424. Publisher Full Text 24. Meira TM, Paiva SM, Antelo OM: Perceived stress and quality of life among graduate dental faculty. J. Dent. Educ. 2020; 84 (10): 1099–1107. PubMed Abstract | Publisher Full Text 25. Shetty SD, et al. : Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [Dataset]. figshare. 2025. Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 30 Jul 2025 ADD YOUR COMMENT Comment Author details Author details 1 Division of Anatomy, Department of Basic Medical Sciences,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Department of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 3 Department of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 4 Division of Anatomy, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 5 Division of Anatomy, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 6 Department of Social and Health Innovation Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 7 Division of Pathology, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India Surekha D Shetty Roles: Data Curation, Formal Analysis, Methodology, Validation, Writing – Original Draft Preparation Vidya Prabhu Roles: Conceptualization, Data Curation, Methodology, Validation, Writing – Original Draft Preparation Varalakshmi Chandra Sekaran Roles: Methodology, Writing – Review & Editing Ashwini Aithal p Roles: Writing – Original Draft Preparation Sapna Marpalli Roles: Writing – Review & Editing Ravichandran Nair K Roles: Methodology, Validation, Writing – Review & Editing Shantha Kumari BR Roles: Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 15 Sep 2025, 14:749 https://doi.org/10.12688/f1000research.165056.2 version 1 Published: 30 Jul 2025, 14:749 https://doi.org/10.12688/f1000research.165056.1 Copyright © 2025 Shetty SD et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Shetty SD, Prabhu V, Chandra Sekaran V et al. Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.12688/f1000research.165056.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 15 Sep 2025 Revised Views 0 Cite How to cite this report: Tanwar AK. Reviewer Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.187956.r428982 ) The direct URL for this report is: https://f1000research.com/articles/14-749/v2#referee-response-428982 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Nov 2025 Ankur Kumar Tanwar , Kriya Sharir, Divya Jyoti Ayurvedic Medical College and Hospital, Sarita Vihar, New Delhi, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.187956.r428982 1. Author should add COVID-19 in title as the study focused on mental health issue after COVID-19. 2. Considering that the title highlights a common mental health issue, it is essential for the author to also explore additional mental ... Continue reading READ ALL 1. Author should add COVID-19 in title as the study focused on mental health issue after COVID-19. 2. Considering that the title highlights a common mental health issue, it is essential for the author to also explore additional mental health concerns that may be interconnected. 3. The methodology section should specify the statistical test employed and provide a clear description of the exclusion criteria. 4. The discussion section should incorporate additional references Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Physiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Tanwar AK. Reviewer Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.187956.r428982 ) The direct URL for this report is: https://f1000research.com/articles/14-749/v2#referee-response-428982 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Somanadhapai S. Reviewer Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.187956.r428988 ) The direct URL for this report is: https://f1000research.com/articles/14-749/v2#referee-response-428988 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 13 Nov 2025 Sangeeth Somanadhapai , Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana, India Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.187956.r428988 Summary Cross-sectional survey of patients attending five randomly selected Ayurvedic centres in Udupi Taluk (June–Dec 2022) using the PHQ-9 and Perceived Stress Scale (PSS) to estimate prevalence and investigate associations between stress/depression and sociodemographic factors. Sample size reported as ... Continue reading READ ALL Summary Cross-sectional survey of patients attending five randomly selected Ayurvedic centres in Udupi Taluk (June–Dec 2022) using the PHQ-9 and Perceived Stress Scale (PSS) to estimate prevalence and investigate associations between stress/depression and sociodemographic factors. Sample size reported as 423 (calculated from 384 + 10% nonresponse). Major Strengths Topical and understudied setting: Studying mental health in patients attending Ayurvedic centres addresses a real gap in integrative/alternative care contexts. Use of validated instruments & open data: The PHQ-9 and PSS are established tools; the anonymised dataset and questionnaire are shared on Figshare (good reproducibility practice). Ethics documented: Institutional Ethics Committee approval and written informed consent are clearly stated (IEC No: 866-2021). Major Concerns Inconsistency in reported sample size / participant count: Methods mention 423 participants but Results state 430; needs clarification and explanation of exclusions or errors. Extremely skewed stress distribution: 93% moderate stress is highly unusual — authors should specify version, scoring, and categorization of PSS and include descriptive stats for raw scores. Statistical methods insufficiently described: Tests used are unclear; report exact methods, effect sizes, confidence intervals, and consider multivariable analysis. Sampling & representativeness: Discuss potential cluster sampling bias; justify 5-centre selection, show prevalence by centre, and clarify representativeness. Confounding and interpretation: Avoid causal language, discuss unmeasured confounders, and address possible selection bias. Multiple testing & selective reporting: Address risk of type I error; pre-specify hypotheses or adjust for multiple comparisons. Minor Concerns / Presentation Issues Ensure consistency in tables (totals, percentages) and fix all formatting issues. Provide statistical software details, test names, and missing-data handling methods. Add comparison with similar Indian or international studies for context. Add figures (histogram or boxplots for PSS and PHQ-9 scores). Improve typographical consistency (spacing, percentage notation, etc.). Concrete, Actionable Suggestions Resolve N discrepancy and provide participant flow diagram. Report raw instrument data with mean, SD, median, IQR; specify cutoffs and references. Clearly state statistical tests, software, alpha level, and multiple comparison handling. Discuss or account for clustering (centre-level analysis). Revise discussion for causal tone and add limitation details. Improve tables with N, test statistics, and clear p-value alignment. Add data visualization plots for key scales. Recommendation Major revision required. The study is relevant and can be potentially indexed after clarifying sample details, improving statistical rigor, addressing design limitations, and enhancing transparency in data presentation. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Somanadhapai S. Reviewer Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.187956.r428988 ) The direct URL for this report is: https://f1000research.com/articles/14-749/v2#referee-response-428988 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 30 Jul 2025 Views 0 Cite How to cite this report: Shriyan P. Reviewer Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.181650.r403575 ) The direct URL for this report is: https://f1000research.com/articles/14-749/v1#referee-response-403575 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Aug 2025 Prafulla Shriyan , Public Health Foundation of India, New Delhi, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.181650.r403575 The article summarizes the common mental health disorders among patients accessing care at selected Ayurvedic hospitals during Covid-19 pandemic. I appreciate the effort of authors in their interest on assessing mental health disorders among patients seeking care at the health ... Continue reading READ ALL The article summarizes the common mental health disorders among patients accessing care at selected Ayurvedic hospitals during Covid-19 pandemic. I appreciate the effort of authors in their interest on assessing mental health disorders among patients seeking care at the health facility. Although the topic was interesting I found major concerns associated with the article. Here is a consolidated comments attached below. Introduction and Rationale: The introduction lacks a logical flow, with disconnected paragraphs that do not build a cohesive argument. It fails to provide sufficient background evidence on the prevalence of common mental health disorders (CMDs) and their contributing factors in the study population, which is essential for establishing context. Furthermore, the study location is inappropriately placed in the introduction rather than the methodology section. Methodological Weaknesses: The methodology section is notably brief and lacks critical details. It does not adequately describe the activities undertaken during the study, nor does it specify the standard tools or instruments used to assess mental health disorders, exposures, and outcomes. A crucial omission is the absence of a clear explanation of the sample size and the justification for its selection. Data Analysis and Presentation of Results: The results section is overly descriptive and could be simplified by focusing on the most significant findings rather than detailing every variable. The authors have not appropriately categorized the stress/depression b Additionally, data presented in Table 4 appears to be entirely new information, as it was not mentioned or justified within the methodology section. Inferences and Confounding Factors: The most critical concern is the absence of logic when attributing the findings to COVID-19. The study's cross-sectional design only captures the patients' mental health at a single point in time. The method section does not distinguish them are Covid-19 patients or other patients. It fails to account for other potential confounding factors, such as the patients' pre-existing health conditions and its relationship with the stress of their current illness, all of which could independently contribute to their mental state. Therefore, the statement that the observed stress and depression levels were a direct result of COVID-19 is an unfounded inference that is not supported by the study's design. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Mental health disorders, Environmental health, maternal and child health and Nutrition I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Shriyan P. Reviewer Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.181650.r403575 ) The direct URL for this report is: https://f1000research.com/articles/14-749/v1#referee-response-403575 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 15 Sep 2025 Vidya Prabhu , Department of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104, India 15 Sep 2025 Author Response Response to the reviewer: The article summarizes the common mental health disorders among patients accessing care at selected Ayurvedic hospitals during Covid-19 pandemic. I appreciate the effort of authors ... Continue reading Response to the reviewer: The article summarizes the common mental health disorders among patients accessing care at selected Ayurvedic hospitals during Covid-19 pandemic. I appreciate the effort of authors in their interest on assessing mental health disorders among patients seeking care at the health facility. Although the topic was interesting I found major concerns associated with the article. Here is a consolidated comments attached below. 1. Comment Introduction and Rationale: The introduction lacks a logical flow, with disconnected paragraphs that do not build a cohesive argument. It fails to provide sufficient background evidence on the prevalence of common mental health disorders (CMDs) and their contributing factors in the study population, which is essential for establishing context. Furthermore, the study location is inappropriately placed in the introduction rather than the methodology section. Response: We thank for your valuable feedback. We have revised the introduction to improve the logical flow and cohesiveness by restructuring the paragraphs. We have also included information on the prevalence of CMDs. Regarding the study location, we have moved this information from the introduction to the methodology section as suggested, ensuring that the introduction now focuses only on the rationale and background for the study. 2.Comment Methodological Weaknesses: The methodology section is notably brief and lacks critical details. It does not adequately describe the activities undertaken during the study, nor does it specify the standard tools or instruments used to assess mental health disorders, exposures, and outcomes. A crucial omission is the absence of a clear explanation of the sample size and the justification for its selection. Response: We thank the reviewer for this valuable comment. In the revised version, we have expanded this section to clearly describe the activities undertaken during the study, including the participant recruitment, data collection and analysis. We have also specified the standard tools used to assess mental health disorders, Furthermore, we have now provided a clear explanation of the sample size calculation, including the assumed prevalence, confidence level, and margin of error. 3.Comment Data Analysis and Presentation of Results: The results section is overly descriptive and could be simplified by focusing on the most significant findings rather than detailing every variable. The authors have not appropriately categorized the stress/depression Additionally, data presented in Table 4 appears to be entirely new information, as it was not mentioned or justified within the methodology section. Response: We thank the reviewer for this valuable feedback. We have revised the Results section to highlight the most significant findings and avoid excessive descriptive detail, thereby improving clarity and readability. Regarding the categorization of stress/depression, we have now restructured the presentation and aligned it with the methodology to ensure consistency. Also, we recognize the concern about Table 4. W e have revised the Methods section and added explanation its inclusion. 4. Comment Inferences and Confounding Factors: The most critical concern is the absence of logic when attributing the findings to COVID-19. The study's cross-sectional design only captures the patients' mental health at a single point in time. The method section does not distinguish them are Covid-19 patients or other patients. It fails to account for other potential confounding factors, such as the patients' pre-existing health conditions and its relationship with the stress of their current illness, all of which could independently contribute to their mental state. Therefore, the statement that the observed stress and depression levels were a direct result of COVID-19 is an unfounded inference that is not supported by the study's design. Response: We sincerely thank the reviewer for highlighting this important limitation. We agree that the cross-sectional design restricts causal inference, and therefore, it is not possible to attribute stress and depression solely to COVID-19 and acknowledged in the Limitations section that factors such as pre-existing health conditions and concurrent illness may have influenced participants’ mental health status. We believe these revisions improve the scientific accuracy and transparency of the manuscript. Response to the reviewer: The article summarizes the common mental health disorders among patients accessing care at selected Ayurvedic hospitals during Covid-19 pandemic. I appreciate the effort of authors in their interest on assessing mental health disorders among patients seeking care at the health facility. Although the topic was interesting I found major concerns associated with the article. Here is a consolidated comments attached below. 1. Comment Introduction and Rationale: The introduction lacks a logical flow, with disconnected paragraphs that do not build a cohesive argument. It fails to provide sufficient background evidence on the prevalence of common mental health disorders (CMDs) and their contributing factors in the study population, which is essential for establishing context. Furthermore, the study location is inappropriately placed in the introduction rather than the methodology section. Response: We thank for your valuable feedback. We have revised the introduction to improve the logical flow and cohesiveness by restructuring the paragraphs. We have also included information on the prevalence of CMDs. Regarding the study location, we have moved this information from the introduction to the methodology section as suggested, ensuring that the introduction now focuses only on the rationale and background for the study. 2.Comment Methodological Weaknesses: The methodology section is notably brief and lacks critical details. It does not adequately describe the activities undertaken during the study, nor does it specify the standard tools or instruments used to assess mental health disorders, exposures, and outcomes. A crucial omission is the absence of a clear explanation of the sample size and the justification for its selection. Response: We thank the reviewer for this valuable comment. In the revised version, we have expanded this section to clearly describe the activities undertaken during the study, including the participant recruitment, data collection and analysis. We have also specified the standard tools used to assess mental health disorders, Furthermore, we have now provided a clear explanation of the sample size calculation, including the assumed prevalence, confidence level, and margin of error. 3.Comment Data Analysis and Presentation of Results: The results section is overly descriptive and could be simplified by focusing on the most significant findings rather than detailing every variable. The authors have not appropriately categorized the stress/depression Additionally, data presented in Table 4 appears to be entirely new information, as it was not mentioned or justified within the methodology section. Response: We thank the reviewer for this valuable feedback. We have revised the Results section to highlight the most significant findings and avoid excessive descriptive detail, thereby improving clarity and readability. Regarding the categorization of stress/depression, we have now restructured the presentation and aligned it with the methodology to ensure consistency. Also, we recognize the concern about Table 4. W e have revised the Methods section and added explanation its inclusion. 4. Comment Inferences and Confounding Factors: The most critical concern is the absence of logic when attributing the findings to COVID-19. The study's cross-sectional design only captures the patients' mental health at a single point in time. The method section does not distinguish them are Covid-19 patients or other patients. It fails to account for other potential confounding factors, such as the patients' pre-existing health conditions and its relationship with the stress of their current illness, all of which could independently contribute to their mental state. Therefore, the statement that the observed stress and depression levels were a direct result of COVID-19 is an unfounded inference that is not supported by the study's design. Response: We sincerely thank the reviewer for highlighting this important limitation. We agree that the cross-sectional design restricts causal inference, and therefore, it is not possible to attribute stress and depression solely to COVID-19 and acknowledged in the Limitations section that factors such as pre-existing health conditions and concurrent illness may have influenced participants’ mental health status. We believe these revisions improve the scientific accuracy and transparency of the manuscript. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 15 Sep 2025 Vidya Prabhu , Department of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104, India 15 Sep 2025 Author Response Response to the reviewer: The article summarizes the common mental health disorders among patients accessing care at selected Ayurvedic hospitals during Covid-19 pandemic. I appreciate the effort of authors ... Continue reading Response to the reviewer: The article summarizes the common mental health disorders among patients accessing care at selected Ayurvedic hospitals during Covid-19 pandemic. I appreciate the effort of authors in their interest on assessing mental health disorders among patients seeking care at the health facility. Although the topic was interesting I found major concerns associated with the article. Here is a consolidated comments attached below. 1. Comment Introduction and Rationale: The introduction lacks a logical flow, with disconnected paragraphs that do not build a cohesive argument. It fails to provide sufficient background evidence on the prevalence of common mental health disorders (CMDs) and their contributing factors in the study population, which is essential for establishing context. Furthermore, the study location is inappropriately placed in the introduction rather than the methodology section. Response: We thank for your valuable feedback. We have revised the introduction to improve the logical flow and cohesiveness by restructuring the paragraphs. We have also included information on the prevalence of CMDs. Regarding the study location, we have moved this information from the introduction to the methodology section as suggested, ensuring that the introduction now focuses only on the rationale and background for the study. 2.Comment Methodological Weaknesses: The methodology section is notably brief and lacks critical details. It does not adequately describe the activities undertaken during the study, nor does it specify the standard tools or instruments used to assess mental health disorders, exposures, and outcomes. A crucial omission is the absence of a clear explanation of the sample size and the justification for its selection. Response: We thank the reviewer for this valuable comment. In the revised version, we have expanded this section to clearly describe the activities undertaken during the study, including the participant recruitment, data collection and analysis. We have also specified the standard tools used to assess mental health disorders, Furthermore, we have now provided a clear explanation of the sample size calculation, including the assumed prevalence, confidence level, and margin of error. 3.Comment Data Analysis and Presentation of Results: The results section is overly descriptive and could be simplified by focusing on the most significant findings rather than detailing every variable. The authors have not appropriately categorized the stress/depression Additionally, data presented in Table 4 appears to be entirely new information, as it was not mentioned or justified within the methodology section. Response: We thank the reviewer for this valuable feedback. We have revised the Results section to highlight the most significant findings and avoid excessive descriptive detail, thereby improving clarity and readability. Regarding the categorization of stress/depression, we have now restructured the presentation and aligned it with the methodology to ensure consistency. Also, we recognize the concern about Table 4. W e have revised the Methods section and added explanation its inclusion. 4. Comment Inferences and Confounding Factors: The most critical concern is the absence of logic when attributing the findings to COVID-19. The study's cross-sectional design only captures the patients' mental health at a single point in time. The method section does not distinguish them are Covid-19 patients or other patients. It fails to account for other potential confounding factors, such as the patients' pre-existing health conditions and its relationship with the stress of their current illness, all of which could independently contribute to their mental state. Therefore, the statement that the observed stress and depression levels were a direct result of COVID-19 is an unfounded inference that is not supported by the study's design. Response: We sincerely thank the reviewer for highlighting this important limitation. We agree that the cross-sectional design restricts causal inference, and therefore, it is not possible to attribute stress and depression solely to COVID-19 and acknowledged in the Limitations section that factors such as pre-existing health conditions and concurrent illness may have influenced participants’ mental health status. We believe these revisions improve the scientific accuracy and transparency of the manuscript. Response to the reviewer: The article summarizes the common mental health disorders among patients accessing care at selected Ayurvedic hospitals during Covid-19 pandemic. I appreciate the effort of authors in their interest on assessing mental health disorders among patients seeking care at the health facility. Although the topic was interesting I found major concerns associated with the article. Here is a consolidated comments attached below. 1. Comment Introduction and Rationale: The introduction lacks a logical flow, with disconnected paragraphs that do not build a cohesive argument. It fails to provide sufficient background evidence on the prevalence of common mental health disorders (CMDs) and their contributing factors in the study population, which is essential for establishing context. Furthermore, the study location is inappropriately placed in the introduction rather than the methodology section. Response: We thank for your valuable feedback. We have revised the introduction to improve the logical flow and cohesiveness by restructuring the paragraphs. We have also included information on the prevalence of CMDs. Regarding the study location, we have moved this information from the introduction to the methodology section as suggested, ensuring that the introduction now focuses only on the rationale and background for the study. 2.Comment Methodological Weaknesses: The methodology section is notably brief and lacks critical details. It does not adequately describe the activities undertaken during the study, nor does it specify the standard tools or instruments used to assess mental health disorders, exposures, and outcomes. A crucial omission is the absence of a clear explanation of the sample size and the justification for its selection. Response: We thank the reviewer for this valuable comment. In the revised version, we have expanded this section to clearly describe the activities undertaken during the study, including the participant recruitment, data collection and analysis. We have also specified the standard tools used to assess mental health disorders, Furthermore, we have now provided a clear explanation of the sample size calculation, including the assumed prevalence, confidence level, and margin of error. 3.Comment Data Analysis and Presentation of Results: The results section is overly descriptive and could be simplified by focusing on the most significant findings rather than detailing every variable. The authors have not appropriately categorized the stress/depression Additionally, data presented in Table 4 appears to be entirely new information, as it was not mentioned or justified within the methodology section. Response: We thank the reviewer for this valuable feedback. We have revised the Results section to highlight the most significant findings and avoid excessive descriptive detail, thereby improving clarity and readability. Regarding the categorization of stress/depression, we have now restructured the presentation and aligned it with the methodology to ensure consistency. Also, we recognize the concern about Table 4. W e have revised the Methods section and added explanation its inclusion. 4. Comment Inferences and Confounding Factors: The most critical concern is the absence of logic when attributing the findings to COVID-19. The study's cross-sectional design only captures the patients' mental health at a single point in time. The method section does not distinguish them are Covid-19 patients or other patients. It fails to account for other potential confounding factors, such as the patients' pre-existing health conditions and its relationship with the stress of their current illness, all of which could independently contribute to their mental state. Therefore, the statement that the observed stress and depression levels were a direct result of COVID-19 is an unfounded inference that is not supported by the study's design. Response: We sincerely thank the reviewer for highlighting this important limitation. We agree that the cross-sectional design restricts causal inference, and therefore, it is not possible to attribute stress and depression solely to COVID-19 and acknowledged in the Limitations section that factors such as pre-existing health conditions and concurrent illness may have influenced participants’ mental health status. We believe these revisions improve the scientific accuracy and transparency of the manuscript. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Sharma P. Reviewer Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.181650.r407185 ) The direct URL for this report is: https://f1000research.com/articles/14-749/v1#referee-response-407185 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 22 Aug 2025 Pankaj Sharma , Department of Rejuvenative and Reproductive Medicine in Ayurveda, KLE University's Shri B M Kankanawadi Ayurveda Mahavidyalaya, Belagavi, Karnataka, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.181650.r407185 It is a clearly and accurately written and presented paper. Need to consider a few points and incorporate them into the methodology part: 1. What complaints patients presented to Ayurvedic health centres are not mentioned, and how only mental problems ... Continue reading READ ALL It is a clearly and accurately written and presented paper. Need to consider a few points and incorporate them into the methodology part: 1. What complaints patients presented to Ayurvedic health centres are not mentioned, and how only mental problems were taken into account or sorted, needs to be clarified. 2. Whether any Ayurveda interventions were given and if they caused any changes could be a point of discussion in the methodology. A few more points: 1. The paper mentions " some level of perceived stress " — the idea is not clear. 2. Keywords — it would be better if in alphabetical order. Apart from that, it is an informative and appropriate study. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Ayurveda, Indian Medicine, Rasayana and Vajikarna, Rejuvenative and Reproductive Medicine in Ayurveda, Marma Chikitsa, Clinical Nutrition, Ayurveda Psychology and Psychotherapy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Sharma P. Reviewer Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.181650.r407185 ) The direct URL for this report is: https://f1000research.com/articles/14-749/v1#referee-response-407185 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 15 Sep 2025 Vidya Prabhu , Department of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104, India 15 Sep 2025 Author Response The suggested changes are incorporated Competing Interests: No competing interests were disclosed. The suggested changes are incorporated The suggested changes are incorporated Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 15 Sep 2025 Vidya Prabhu , Department of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104, India 15 Sep 2025 Author Response The suggested changes are incorporated Competing Interests: No competing interests were disclosed. The suggested changes are incorporated The suggested changes are incorporated Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 30 Jul 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 Version 2 (revision) 15 Sep 25 read read Version 1 30 Jul 25 read read Pankaj Sharma , KLE University's Shri B M Kankanawadi Ayurveda Mahavidyalaya, Belagavi, India Prafulla Shriyan , Public Health Foundation of India, New Delhi, India Sangeeth Somanadhapai , Shree Guru Gobind Singh Tricentenary University, Gurugram, India Ankur Kumar Tanwar , Divya Jyoti Ayurvedic Medical College and Hospital, Sarita Vihar, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Tanwar A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Nov 2025 | for Version 2 Ankur Kumar Tanwar , Kriya Sharir, Divya Jyoti Ayurvedic Medical College and Hospital, Sarita Vihar, New Delhi, India 0 Views copyright © 2025 Tanwar A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. Author should add COVID-19 in title as the study focused on mental health issue after COVID-19. 2. Considering that the title highlights a common mental health issue, it is essential for the author to also explore additional mental health concerns that may be interconnected. 3. The methodology section should specify the statistical test employed and provide a clear description of the exclusion criteria. 4. The discussion section should incorporate additional references Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Physiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Tanwar AK. Peer Review Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.187956.r428982) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-749/v2#referee-response-428982 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Somanadhapai S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 13 Nov 2025 | for Version 2 Sangeeth Somanadhapai , Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana, India 0 Views copyright © 2025 Somanadhapai S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Summary Cross-sectional survey of patients attending five randomly selected Ayurvedic centres in Udupi Taluk (June–Dec 2022) using the PHQ-9 and Perceived Stress Scale (PSS) to estimate prevalence and investigate associations between stress/depression and sociodemographic factors. Sample size reported as 423 (calculated from 384 + 10% nonresponse). Major Strengths Topical and understudied setting: Studying mental health in patients attending Ayurvedic centres addresses a real gap in integrative/alternative care contexts. Use of validated instruments & open data: The PHQ-9 and PSS are established tools; the anonymised dataset and questionnaire are shared on Figshare (good reproducibility practice). Ethics documented: Institutional Ethics Committee approval and written informed consent are clearly stated (IEC No: 866-2021). Major Concerns Inconsistency in reported sample size / participant count: Methods mention 423 participants but Results state 430; needs clarification and explanation of exclusions or errors. Extremely skewed stress distribution: 93% moderate stress is highly unusual — authors should specify version, scoring, and categorization of PSS and include descriptive stats for raw scores. Statistical methods insufficiently described: Tests used are unclear; report exact methods, effect sizes, confidence intervals, and consider multivariable analysis. Sampling & representativeness: Discuss potential cluster sampling bias; justify 5-centre selection, show prevalence by centre, and clarify representativeness. Confounding and interpretation: Avoid causal language, discuss unmeasured confounders, and address possible selection bias. Multiple testing & selective reporting: Address risk of type I error; pre-specify hypotheses or adjust for multiple comparisons. Minor Concerns / Presentation Issues Ensure consistency in tables (totals, percentages) and fix all formatting issues. Provide statistical software details, test names, and missing-data handling methods. Add comparison with similar Indian or international studies for context. Add figures (histogram or boxplots for PSS and PHQ-9 scores). Improve typographical consistency (spacing, percentage notation, etc.). Concrete, Actionable Suggestions Resolve N discrepancy and provide participant flow diagram. Report raw instrument data with mean, SD, median, IQR; specify cutoffs and references. Clearly state statistical tests, software, alpha level, and multiple comparison handling. Discuss or account for clustering (centre-level analysis). Revise discussion for causal tone and add limitation details. Improve tables with N, test statistics, and clear p-value alignment. Add data visualization plots for key scales. Recommendation Major revision required. The study is relevant and can be potentially indexed after clarifying sample details, improving statistical rigor, addressing design limitations, and enhancing transparency in data presentation. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Somanadhapai S. Peer Review Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.187956.r428988) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-749/v2#referee-response-428988 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Shriyan P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Aug 2025 | for Version 1 Prafulla Shriyan , Public Health Foundation of India, New Delhi, India 0 Views copyright © 2025 Shriyan P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The article summarizes the common mental health disorders among patients accessing care at selected Ayurvedic hospitals during Covid-19 pandemic. I appreciate the effort of authors in their interest on assessing mental health disorders among patients seeking care at the health facility. Although the topic was interesting I found major concerns associated with the article. Here is a consolidated comments attached below. Introduction and Rationale: The introduction lacks a logical flow, with disconnected paragraphs that do not build a cohesive argument. It fails to provide sufficient background evidence on the prevalence of common mental health disorders (CMDs) and their contributing factors in the study population, which is essential for establishing context. Furthermore, the study location is inappropriately placed in the introduction rather than the methodology section. Methodological Weaknesses: The methodology section is notably brief and lacks critical details. It does not adequately describe the activities undertaken during the study, nor does it specify the standard tools or instruments used to assess mental health disorders, exposures, and outcomes. A crucial omission is the absence of a clear explanation of the sample size and the justification for its selection. Data Analysis and Presentation of Results: The results section is overly descriptive and could be simplified by focusing on the most significant findings rather than detailing every variable. The authors have not appropriately categorized the stress/depression b Additionally, data presented in Table 4 appears to be entirely new information, as it was not mentioned or justified within the methodology section. Inferences and Confounding Factors: The most critical concern is the absence of logic when attributing the findings to COVID-19. The study's cross-sectional design only captures the patients' mental health at a single point in time. The method section does not distinguish them are Covid-19 patients or other patients. It fails to account for other potential confounding factors, such as the patients' pre-existing health conditions and its relationship with the stress of their current illness, all of which could independently contribute to their mental state. Therefore, the statement that the observed stress and depression levels were a direct result of COVID-19 is an unfounded inference that is not supported by the study's design. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Mental health disorders, Environmental health, maternal and child health and Nutrition I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 15 Sep 2025 Vidya Prabhu, Department of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104, India Response to the reviewer: The article summarizes the common mental health disorders among patients accessing care at selected Ayurvedic hospitals during Covid-19 pandemic. I appreciate the effort of authors in their interest on assessing mental health disorders among patients seeking care at the health facility. Although the topic was interesting I found major concerns associated with the article. Here is a consolidated comments attached below. 1. Comment Introduction and Rationale: The introduction lacks a logical flow, with disconnected paragraphs that do not build a cohesive argument. It fails to provide sufficient background evidence on the prevalence of common mental health disorders (CMDs) and their contributing factors in the study population, which is essential for establishing context. Furthermore, the study location is inappropriately placed in the introduction rather than the methodology section. Response: We thank for your valuable feedback. We have revised the introduction to improve the logical flow and cohesiveness by restructuring the paragraphs. We have also included information on the prevalence of CMDs. Regarding the study location, we have moved this information from the introduction to the methodology section as suggested, ensuring that the introduction now focuses only on the rationale and background for the study. 2.Comment Methodological Weaknesses: The methodology section is notably brief and lacks critical details. It does not adequately describe the activities undertaken during the study, nor does it specify the standard tools or instruments used to assess mental health disorders, exposures, and outcomes. A crucial omission is the absence of a clear explanation of the sample size and the justification for its selection. Response: We thank the reviewer for this valuable comment. In the revised version, we have expanded this section to clearly describe the activities undertaken during the study, including the participant recruitment, data collection and analysis. We have also specified the standard tools used to assess mental health disorders, Furthermore, we have now provided a clear explanation of the sample size calculation, including the assumed prevalence, confidence level, and margin of error. 3.Comment Data Analysis and Presentation of Results: The results section is overly descriptive and could be simplified by focusing on the most significant findings rather than detailing every variable. The authors have not appropriately categorized the stress/depression Additionally, data presented in Table 4 appears to be entirely new information, as it was not mentioned or justified within the methodology section. Response: We thank the reviewer for this valuable feedback. We have revised the Results section to highlight the most significant findings and avoid excessive descriptive detail, thereby improving clarity and readability. Regarding the categorization of stress/depression, we have now restructured the presentation and aligned it with the methodology to ensure consistency. Also, we recognize the concern about Table 4. W e have revised the Methods section and added explanation its inclusion. 4. Comment Inferences and Confounding Factors: The most critical concern is the absence of logic when attributing the findings to COVID-19. The study's cross-sectional design only captures the patients' mental health at a single point in time. The method section does not distinguish them are Covid-19 patients or other patients. It fails to account for other potential confounding factors, such as the patients' pre-existing health conditions and its relationship with the stress of their current illness, all of which could independently contribute to their mental state. Therefore, the statement that the observed stress and depression levels were a direct result of COVID-19 is an unfounded inference that is not supported by the study's design. Response: We sincerely thank the reviewer for highlighting this important limitation. We agree that the cross-sectional design restricts causal inference, and therefore, it is not possible to attribute stress and depression solely to COVID-19 and acknowledged in the Limitations section that factors such as pre-existing health conditions and concurrent illness may have influenced participants’ mental health status. We believe these revisions improve the scientific accuracy and transparency of the manuscript. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Shriyan P. Peer Review Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.181650.r403575) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-749/v1#referee-response-403575 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Sharma P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 22 Aug 2025 | for Version 1 Pankaj Sharma , Department of Rejuvenative and Reproductive Medicine in Ayurveda, KLE University's Shri B M Kankanawadi Ayurveda Mahavidyalaya, Belagavi, Karnataka, India 0 Views copyright © 2025 Sharma P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions It is a clearly and accurately written and presented paper. Need to consider a few points and incorporate them into the methodology part: 1. What complaints patients presented to Ayurvedic health centres are not mentioned, and how only mental problems were taken into account or sorted, needs to be clarified. 2. Whether any Ayurveda interventions were given and if they caused any changes could be a point of discussion in the methodology. A few more points: 1. The paper mentions " some level of perceived stress " — the idea is not clear. 2. Keywords — it would be better if in alphabetical order. Apart from that, it is an informative and appropriate study. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Ayurveda, Indian Medicine, Rasayana and Vajikarna, Rejuvenative and Reproductive Medicine in Ayurveda, Marma Chikitsa, Clinical Nutrition, Ayurveda Psychology and Psychotherapy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 15 Sep 2025 Vidya Prabhu, Department of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104, India The suggested changes are incorporated View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Sharma P. Peer Review Report For: Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk. [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :749 ( https://doi.org/10.5256/f1000research.181650.r407185) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-749/v1#referee-response-407185 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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