Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions

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Methods A total of 250 participants were included, comprising 130 students from health sciences and 120 individuals from technical fields. In total, 164 participants were females, and 192 participants were aged ≤20 years. A cross-sectional study was conducted using a self-administered electronic questionnaire. The Depression, Anxiety, and Stress Scale (DASS-21), followed by the Impact of Event Scale-Revised (IES-R), was used to retrospectively assess psychological distress linked to the pandemic. The data were analysed via the chi-square test. Results DASS severity ratings revealed that 41.3% of participants aged ≤20 years experienced severe or extremely severe anxiety, which was statistically significant (p = 0.013). The stress scores were also significantly higher in this age group (p = 0.004). Binary logistic regression analysis indicated that younger age and female sex were significantly associated with increased odds of depression and stress. Males had comparatively lower odds of experiencing psychological distress. Participants from technical fields demonstrated higher odds of anxiety and stress, although not of depression. Conclusion The long-term psychological impact of the COVID-19 pandemic appears to be more pronounced among younger individuals, females, and technical staff in healthcare institutions. Although students may have greater awareness about the disease, this awareness may contribute to heightened psychological distress. 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F1000Research 2025, 14 :862 ( https://doi.org/10.12688/f1000research.169634.1 ) 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 Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] Vignesh Kamath https://orcid.org/0000-0002-4996-448X 1 , Ann Sales https://orcid.org/0009-0007-8056-906X 1 , Umesh Pai https://orcid.org/0000-0003-2401-7467 1 , Srikant N. https://orcid.org/0000-0002-2686-0397 2 , Abhinav Bhargava 3 , Vaishnavi Jalaj 4 Vignesh Kamath https://orcid.org/0000-0002-4996-448X 1 , Ann Sales https://orcid.org/0009-0007-8056-906X 1 , [...] Umesh Pai https://orcid.org/0000-0003-2401-7467 1 , Srikant N. https://orcid.org/0000-0002-2686-0397 2 , Abhinav Bhargava 3 , Vaishnavi Jalaj 4 PUBLISHED 03 Sep 2025 Author details Author details 1 Department of Prosthodontics and Crown & Bridge, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 3 Department of Public Health Dentistry, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, 201007, India 4 Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India Vignesh Kamath Roles: Conceptualization, Data Curation, Investigation, Writing – Original Draft Preparation, Writing – Review & Editing Ann Sales Roles: Conceptualization, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Umesh Pai Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Srikant N. Roles: Conceptualization, Formal Analysis, Writing – Review & Editing Abhinav Bhargava Roles: Conceptualization, Writing – Review & Editing Vaishnavi Jalaj Roles: Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Manipal Academy of Higher Education gateway. This article is included in the Social Psychology gateway. This article is included in the Coronavirus (COVID-19) collection. Abstract Background The aim of this study is to evaluate the long-term psychological impact of the COVID-19 pandemic on students and technical personnel at healthcare institutions, with a focus on levels of depression, anxiety, and stress. Methods A total of 250 participants were included, comprising 130 students from health sciences and 120 individuals from technical fields. In total, 164 participants were females, and 192 participants were aged ≤20 years. A cross-sectional study was conducted using a self-administered electronic questionnaire. The Depression, Anxiety, and Stress Scale (DASS-21), followed by the Impact of Event Scale-Revised (IES-R), was used to retrospectively assess psychological distress linked to the pandemic. The data were analysed via the chi-square test. Results DASS severity ratings revealed that 41.3% of participants aged ≤20 years experienced severe or extremely severe anxiety, which was statistically significant (p = 0.013). The stress scores were also significantly higher in this age group (p = 0.004). Binary logistic regression analysis indicated that younger age and female sex were significantly associated with increased odds of depression and stress. Males had comparatively lower odds of experiencing psychological distress. Participants from technical fields demonstrated higher odds of anxiety and stress, although not of depression. Conclusion The long-term psychological impact of the COVID-19 pandemic appears to be more pronounced among younger individuals, females, and technical staff in healthcare institutions. Although students may have greater awareness about the disease, this awareness may contribute to heightened psychological distress. READ ALL READ LESS Keywords Anxiety, Coronavirus, Depression, DASS scale, Technical staff, Long-term impact Corresponding Author(s) Ann Sales ( [email protected] ) Close Corresponding author: Ann Sales Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Kamath V 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: Kamath V, Sales A, Pai U et al. Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :862 ( https://doi.org/10.12688/f1000research.169634.1 ) First published: 03 Sep 2025, 14 :862 ( https://doi.org/10.12688/f1000research.169634.1 ) Latest published: 14 Jan 2026, 14 :862 ( https://doi.org/10.12688/f1000research.169634.2 )  There is a newer version of this article available. Suppress this message for one day. Introduction The COVID-19 pandemic, which was declared a global health emergency by the World Health Organization, has had a profound and lasting impact on global health and quality of life. The virus’s high infectivity, rapid transmission, and initially unclear mechanism of action led to widespread fear, uncertainty, and psychological distress. In response, countries around the world implemented stringent public health measures, including lockdowns, international travel restrictions, physical distancing mandates, and compulsory mask use, all of which significantly altered daily routines and social interactions. 1 These drastic changes in social norms have contributed to considerable psychological stress, particularly among individuals in healthcare settings. Even in high-awareness environments such as medical institutions, students and trainees face heightened mental strain fueled by misinformation, fear of transmitting the virus to family members, academic disruption, and isolation. These factors lead to difficulty concentrating, disrupted sleep patterns, and reduced opportunities for social interaction, further exacerbating feelings of anxiety and stress. 2 , 3 For many students—particularly those unable to relocate or lacking nearby support systems—quarantine and physical distancing intensified symptoms of anxiety, depression, and trauma-related behaviors, including obsessive tendencies and posttraumatic stress. 4 , 5 Similar psychological effects have been observed among technical staff, who often lack adequate resources or understanding to manage the crisis, thereby increasing their vulnerability to mental health challenges. 6 In response to these widespread psychological consequences, the importance of implementing mental health support systems—such as counselling and resilience-building programs—has become increasingly apparent. 7 , 8 Educational institutions also recognized the urgent need for policy adaptations to accommodate the shift from in-person to virtual learning, as well as to support the psychological well-being of students and staff. 9 To develop effective mental health strategies, it is essential to understand the specific stressors and mental health outcomes that continue to affect these populations during the postpandemic period. This study was designed to retrospectively assess the long-term psychological impact of the COVID-19 pandemic on students and technical staff in healthcare institutions. By identifying persistent symptoms of depression, anxiety, and stress, this study aims to contribute valuable insights for future mental health interventions and policy planning. Materials & Methods This cross-sectional study was conducted among a total of 250 participants, comprising 130 students from health sciences and 120 technical staff (nontaching personnel) working in healthcare institutions. Among the total participants, 164 were female, and 192 were aged ≤20 years. Ethical approval for the study was obtained from the Institutional Ethics Committee (IEC:231/2021). To retrospectively assess the psychological effects of the COVID-19 pandemic, a self-administered electronic questionnaire was used. The questionnaire was created via Google Forms, enabling contactless data collection. This study employed two widely used and previously validated instruments: the Depression, Anxiety and Stress Scale – 21 Items (DASS-21) 10 and the Impact of Event Scale – Revised (IES-R). 11 The DASS-21 is a shortened version of the original DASS-42, developed and validated by Lovibond & Lovibond (1995) to assess symptoms of depression, anxiety, and stress [Link to DASS manual]. The IES-R, developed and validated by Weiss & Marmar (1997), is a well-established measure for assessing subjective distress caused by traumatic events [Link to IES-R scale]. As both scales are universally recognized and psychometrically validated, no further validation was undertaken in the present study. Participant lists were obtained from student records and the human resources department. A systematic sampling method was applied, selecting every third individual from the compiled lists. The survey link was distributed individually to participants via social media messaging platforms. A consent section was included at the beginning of the form, where participants responded to a yes/no question to indicate their willingness to participate in the study. The first section of the questionnaire collected sociodemographic information, including age, sex, and occupational category (student or technical staff ). Additional items were used to assess participants’ knowledge of COVID-19, personal diagnosis status, and contact history with individuals who tested positive or were suspected of having the virus. The second section focused on assessing the long-term psychological impact of the pandemic. It comprises two standardized tools: the 21-item Depression, Anxiety, and Stress Scale (DASS-21), followed by the 22-item Impact of Event Scale–Revised (IES-R). Responses on the DASS-21 were scored on a 4-point Likert scale ranging from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time). Total scores for depression, anxiety, and stress were calculated and categorized as normal, mild, moderate, severe, or extremely severe, following the established scoring guidelines. The methodology was adapted from a similar study conducted by Hakami Z et al. 7 The IES-R was used to assess trauma-related distress and included questions related to the psychological impact of stressful life events. The scores were interpreted in three categories: mild (24–32), moderate (33–36), and severe (≥37) psychological impact. Associations between mental health outcomes and demographic variables (age ≤20 vs. >20 years, sex, and field of work or study) were analysed via the chi-square test. Results A greater proportion of participants in the ≤20 years age group, females, and those from the health sciences field exhibited severe or extremely severe depression on the basis of DASS-21 severity ratings; however, these differences were not statistically significant. A similar pattern was observed for anxiety. Notably, 41.3% of individuals aged ≤20 years reported severe or extremely severe anxiety, which was statistically significant (p = 0.013). The stress levels were also significantly greater in this age group (p = 0.004). While females and participants from the technical field presented elevated stress scores, these findings were not statistically significant. IES-R scoring revealed that most participants across all subgroups had scores within the normal range. Nonetheless, slightly higher proportions of individuals in the ≤20 years group, females, and technical staff fell into the category of “high enough to be immunosuppressive.” These differences, however, did not reach statistical significance [ Table 1 ]. Table 1. Chi square test to compare the DASS severity rating and IES-R scoring among age groups, gender, and field of teaching. Categories N AGE Gender Field 20 years (N (%)) Female (N (%)) Male (N (%)) Health Science (N (%)) Technical (N (%)) Dass Severity Rating-Depression Normal 118 21 (36.2) 97 (50.5) 76 (46.3) 42 (48.8) 59 (45.4) 59 (49.2) Mild 30 7 (12.1) 23 (12) 20 (12.2) 10 (11.6) 17 (13.1) 13 (10.8) Moderate 62 17 (29.3) 45 (23.4) 40 (24.4) 22 (25.6) 33 (25.4) 29 (24.2) Severe 22 7 (12.1) 15 (7.8) 16 (9.8) 6 (7) 13 (10) 9 (7.5) Extremely Severe 18 6 (10.3) 12 (6.2) 12 (7.3) 6 (7) 8 (6.2) 10 (8.3) Chi square (P value) 4.508 (0.342) 0.626 (0.96) 1.343 (0.854) Dass Severity Rating-Anxiety Normal 114 20 (34.5) 94 (49) 68 (41.5) 46 (53.5) 62 (47.7) 52 (43.3) Mild 14 2 (3.4) 12 (6.2) 9 (5.5) 5 (5.8) 7 (5.4) 7 (5.8) Moderate 53 12 (20.7) 41 (21.4) 35 (21.3) 18 (20.9) 28 (21.5) 25 (20.8) Severe 28 6 (10.3) 22 (11.5) 19 (11.6) 9 (10.5) 14 (10.8) 14 (11.7) Extremely Severe 41 18 (31) 23 (12) 33 (20.1) 8 (9.3) 19 (14.6) 22 (18.3) Chi square (P value) 12.592 (0.013) 5.894 (0.207) 0.868 (0.929) Dass Severity Rating-Stress Normal 154 28 (48.3) 126 (65.6) 98 (59.8) 56 (65.1) 83 (63.8) 71 (59.2) Mild 35 6 (10.3) 29 (15.1) 23 (14) 12 (14) 17 (13.1) 18 (15) Moderate 28 9 (15.5) 19 (9.9) 17 (10.4) 11 (12.8) 15 (11.5) 13 (10.8) Severe 28 14 (24.1) 14 (7.3) 22 (13.4) 6 (7) 13 (10) 15 (12.5) Extremely Severe 5 1 (1.7) 4 (2.1) 4 (2.4) 1 (1.2) 2 (1.5) 3 (2.5) Chi square (P value) 15.47 (0.004) 3.107 (0.54) 1.051 (0.902) IES-R Scoring Consequence Normal 129 26 (44.8) 103 (53.6) 85 (51.8) 44 (51.2) 75 (57.7) 54 (45) Clinical Concern 22 3 (5.2) 19 (9.9) 12 (7.3) 10 (11.6) 11 (8.5) 11 (9.2) Probable Diagnosis of PTSD 13 5 (8.6) 8 (4.2) 9 (5.5) 4 (4.7) 5 (3.8) 8 (6.7) High Enough to be Immunosuppresive 86 24 (41.4) 62 (32.3) 58 (35.4) 28 (32.6) 39 (30) 47 (39.2) Chi square (P value) 4.569 (0.206) 1.401 (0.705) 4.462 (0.216) Binary logistic regression analysis demonstrated that age and sex were significantly associated with psychological outcomes. Participants aged ≤20 years had significantly greater odds of experiencing depression (OR: 1.86; p = 0.048) and stress (OR: 2.05; p = 0.022). Compared with females, males had significantly lower odds of depression, anxiety, and stress (OR: 0.55; p = 0.034). Interestingly, individuals from technical fields showed increased odds of anxiety and stress, but not depression. Greater awareness of COVID-19, knowing someone infected, or having contact with a suspected case were associated with higher odds of psychological distress, but these associations were not statistically significant [ Table 2 ]. Table 2. Binary logistic regression analysis to assess the odds of depression, anxiety or stress adjusted for age, sex, field, awareness and association with COVID 19 infected individuals. Prediction of depression Prediction of anxiety Prediction of stress Beta OR (95% CI) P value Beta OR (95% CI) P value Beta OR (95% CI) P value AGE (20 years) 0.622 1.86 (1.01, 3.45) 0.048 0.624 1.87 (0.99, 3.51) 0.053 0.72 2.05 (1.11, 3.81) 0.022 Gender (Male Compared to female) -0.088 0.92 (0.54, 1.57) 0.748 -0.595 0.55 (0.32, 0.96) 0.034 -0.358 0.7 (0.39, 1.24) 0.221 Field (Technical compared to Health Sciences) -0.169 0.85 (0.51, 1.41) 0.521 0.277 1.32 (0.78, 2.24) 0.303 0.246 1.28 (0.74, 2.2) 0.375 Awareness (Ref No awareness) 0.541 1.72 (0.27, 10.82) 0.564 0.618 1.86 (0.29, 12.06) 0.517 -0.17 0.84 (0.13, 5.55) 0.86 Known someone who infected with Covid19 (Ref No) 0.165 1.18 (0.69, 2.03) 0.552 0.396 1.49 (0.85, 2.59) 0.163 0.512 1.67 (0.95, 2.93) 0.074 Contacted with someone who suspected with Covid19 (Ref No) 0.216 1.24 (0.51, 3.03) 0.635 0.677 1.97 (0.75, 5.17) 0.169 0.749 2.12 (0.86, 5.23) 0.105 Have first degree relatives whom are medical field related professional (Ref No) -0.017 0.98 (0.59, 1.63) 0.949 0.153 1.17 (0.7, 1.96) 0.562 0.44 1.55 (0.91, 2.65) 0.106 Constant -0.52 0.586 -0.771 0.428 -0.965 0.326 Discussion The COVID-19 pandemic represents one of the most severe public health crises in modern history. In addition to its devastating mortality toll, the pandemic has had a profound psychological impact on populations worldwide. Individuals across all age groups and professions experienced heightened levels of despair, anxiety, and stress due to prolonged uncertainty, isolation, and social disruption. 12 , 13 Measures such as social distancing, remote work, and online education radically altered daily life and revealed underlying inequalities, disproportionately affecting marginalized and vulnerable communities. 9 These challenges have continued to influence mental well-being, even in the postpandemic period, underscoring the ongoing need to prioritize mental health support at the institutional and governmental levels. Depression, anxiety, and stress, while often interrelated, manifest differently across individuals and contexts. 2 , 14 In this study, each variable was evaluated separately via standardized tools, taking into account age, sex, and professional background. The analysis revealed that participants aged ≤20 years, females, and individuals from the health sciences presented higher proportions of severe and extremely severe depression, although these findings were not statistically significant. These results are consistent with previous research by Ansari et al., who reported elevated psychological symptoms in young adult populations during the pandemic. Similarly, Chi et al. reported a high prevalence of posttraumatic, depressive, and anxiety symptoms among Chinese university students. 15 A key observation in the present study was the significantly higher rate (41.3%) of severe or extremely severe anxiety among participants aged ≤20 years (p = 0.013). This trend was more pronounced among females and those in the health sciences. These findings are in line with those of studies by Verma et al. and Sundarasen et al., which documented widespread psychological distress in similar demographic groups during and after the pandemic. 9 , 16 Notably, dental students in their clinical years—facing academic disruption and uncertainty—were reported to have higher anxiety levels than preclinical students did, a pattern echoing the results of the present study. 4 Our stress scale and IES-R results further support these trends, which aligns with findings from Changwon Son et al., who highlighted elevated mental health symptoms among university students during the pandemic. 4 A nationwide survey by Hakami et al. in Saudi Arabia reported significantly greater depression, anxiety, and stress among dental students, particularly females and those living alone. 7 Binary logistic regression in our study confirmed that age and sex were significantly associated with increased odds of depression and stress. These results mirror those of Debowska et al., who reported greater psychological distress among female students and those aged 18–24 years than among older students. 16 – 18 Khan et al. also reported increased anxiety and fear among healthcare workers, particularly females, during postings in COVID-19 wards. 19 While the study provides valuable insights, it is not without limitations. The use of an e-questionnaire allows for safe and efficient data collection, but it may not fully capture the depth of participants’ emotional states. Furthermore, the tools used—while validated—were not specifically designed to assess COVID-19-related psychological distress, such as the Coronavirus Anxiety Scale (CAS), which may have provided more targeted insights. 10 , 20 Additionally, the study’s sample primarily comprised individuals from medical backgrounds, which may limit the generalizability of the findings. Another limitation is the lack of assessment of potential confounding factors such as socioeconomic status, family dynamics, substance use, and preexisting mental health conditions. These variables can significantly influence psychological outcomes. A more comprehensive multivariate analysis incorporating these factors would offer a deeper understanding of the long-term mental health implications for healthcare students and professionals. Despite these constraints, the findings of this study contribute to the growing body of evidence highlighting the sustained psychological burden of the COVID-19 pandemic. As we move forward, it is essential to implement ongoing mental health monitoring and support systems tailored to the needs of high-risk groups within healthcare environments. Conclusion Despite certain limitations, this study provides important insights into the lasting psychological effects of the COVID-19 pandemic on students and technical staff in healthcare institutions. These findings indicate that younger individuals and females continue to face significant mental health challenges—particularly symptoms of anxiety, depression, and stress—well beyond the acute phase of the pandemic. These results underscore the urgent need for sustainable mental health support systems. Governments, academic institutions, and healthcare organizations must work collaboratively to develop and implement accessible, evidence-based psychological care strategies. Universities can play a key role by offering ongoing mental health services and digital education programs that extend support to students in remote or underserved areas. Partnerships with internet service providers, along with financial aid in the form of scholarships or student loans, can help ensure equitable access to these resources. In addition, there is a need for community and familial engagement in promoting mental well-being. Encouraging supportive, low-pressure environments at home can help young individuals cope with ongoing stressors related to academic and professional development. Overall, the findings from this study highlight the importance of a coordinated and long-term approach to addressing the psychological aftermath of the COVID-19 pandemic. By proactively supporting mental health among students and healthcare workers, we can foster resilience and ensure a more prepared, emotionally healthy workforce for the future. Ethical approval Ethical clearance for the study was obtained from Kasturba Medical College and Kasturba Hospital Institutional Ethics committee (IEC:231/2021). Informed consent Consent to participate in the study was obtained and recorded. Registration ECR/146/Inst/KA/2013/RR-19. Preregistered data analysis This study was not preregistered with an independent registry, and no prior data analysis plan was submitted. Data availability Underlying data are available from Figshare at: https://doi.org/10.6084/m9.figshare.29957747.v1 . This project contains the following underlying data: • Ethical_Clearance_and_NOC.pdf (Institutional ethical clearance documentation and no-objection certificate from the Principal Investigator) • Questionnaire.pdf (The study’s survey instrument on depression, anxiety, stress, and COVID-19 impact) • Questionnaire_Responses.csv (Raw responses collected from participants) • Statistical_Analysis_Output.pdf (Detailed outputs from statistical analyses conducted) • Study_Results.pdf (Summary of the analyzed results as presented in the Results section) • SRQR_Checklist.pdf (Standards for Reporting Qualitative Research checklist completed for the study) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. 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PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 03 Sep 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Prosthodontics and Crown & Bridge, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 3 Department of Public Health Dentistry, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, 201007, India 4 Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India Vignesh Kamath Roles: Conceptualization, Data Curation, Investigation, Writing – Original Draft Preparation, Writing – Review & Editing Ann Sales Roles: Conceptualization, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Umesh Pai Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Srikant N. Roles: Conceptualization, Formal Analysis, Writing – Review & Editing Abhinav Bhargava Roles: Conceptualization, Writing – Review & Editing Vaishnavi Jalaj Roles: Data Curation, Writing – Original Draft Preparation, 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: 14 Jan 2026, 14:862 https://doi.org/10.12688/f1000research.169634.2 version 1 Published: 03 Sep 2025, 14:862 https://doi.org/10.12688/f1000research.169634.1 Copyright © 2025 Kamath V 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 Kamath V, Sales A, Pai U et al. Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :862 ( https://doi.org/10.12688/f1000research.169634.1 ) 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 1 VERSION 1 PUBLISHED 03 Sep 2025 Views 0 Cite How to cite this report: Chowdhry A. Reviewer Report For: Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :862 ( https://doi.org/10.5256/f1000research.186992.r413194 ) The direct URL for this report is: https://f1000research.com/articles/14-862/v1#referee-response-413194 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 15 Oct 2025 Aman Chowdhry , Sharda University, Greater Noida, Uttar Pradesh, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.186992.r413194 The manuscript, although submitted somewhat later than ideal, contributes valuable insights into the sustained psychological sequelae of the COVID-19 pandemic among healthcare-associated academic and technical populations. The study is relevant and timely in exploring long-term psychological outcomes, particularly among groups ... Continue reading READ ALL The manuscript, although submitted somewhat later than ideal, contributes valuable insights into the sustained psychological sequelae of the COVID-19 pandemic among healthcare-associated academic and technical populations. The study is relevant and timely in exploring long-term psychological outcomes, particularly among groups often underrepresented in post-pandemic mental health research. The methodology is generally well-described, but would benefit from further clarity and structuring according to the PICO framework, as follows: P (Population): Clearly define the population — specify which categories of students (undergraduate, postgraduate, interns) and technical staff (laboratory technicians, administrative support, nursing aides, etc.) were included. Additionally, identify the nature of the healthcare institutions (medical, dental, nursing, or allied health) to enhance context and reproducibility. I (Intervention): The use of DASS-21 and IES-R scales is appropriate for assessing depression, anxiety, stress, and trauma-related distress. However, the authors should include a short rationale for employing both instruments concurrently, explaining how they complement each other in evaluating different but overlapping aspects of psychological impact. C (Comparator): The absence of baseline (pre-pandemic) data is a key limitation. Without a comparator, attributing observed mental health outcomes solely to COVID-19 is difficult. The manuscript should explicitly acknowledge this gap and discuss how potential confounding variables (e.g., prior mental health history, socioeconomic status, or workload differences) were addressed or at least recognised. O (Outcome): The sample size (n = 250), while adequate for a preliminary cross-sectional assessment, limits the generalizability of findings. If participants were drawn from a single or limited number of institutions, this should be stated as a limitation. Furthermore, as a cross-sectional design, the study captures only a single time-point, preventing conclusions about causality or long-term trends. Lastly, although the manuscript addresses an important topic, COVID-19 has been extensively studied in recent years . To strengthen the relevance and currency of this work, it is recommended to incorporate at least two recent publications (published between 2023 and 2025) that align with the study’s focus on the long-term psychological impact of the pandemic. Overall Recommendation: The study holds merit for indexing after methodological refinement and clarification of the PICO elements. The limitations — particularly the lack of baseline data, potential sampling bias, and absence of longitudinal follow-up — should be clearly acknowledged in the Discussion section to strengthen the manuscript’s transparency and scientific rigour. 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? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly 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. Reviewer Expertise: I have previously published papers on COVID-19 and healthcare, including work on “Strengthening Health Care Research and Academics During and After the COVID-19 Pandemic.” In one of my articles, I have also discussed the evolving challenges and opportunities faced by healthcare institutions in the post-pandemic era. 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 Chowdhry A. Reviewer Report For: Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :862 ( https://doi.org/10.5256/f1000research.186992.r413194 ) The direct URL for this report is: https://f1000research.com/articles/14-862/v1#referee-response-413194 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 16 Jan 2026 Ann Sales , Department of Prosthodontics and Crown & Bridge, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, 576104, India 16 Jan 2026 Author Response We thank the reviewer for their careful evaluation of our manuscript and for the constructive suggestions that have helped strengthen the clarity, transparency, and methodological rigour of the study. We ... Continue reading We thank the reviewer for their careful evaluation of our manuscript and for the constructive suggestions that have helped strengthen the clarity, transparency, and methodological rigour of the study. We have addressed each point in detail below and revised the manuscript accordingly. 1. Clarification of Population (PICO – Population) Reviewer comment: The population should be clearly defined, including student categories, technical staff roles, and the nature of healthcare institutions. Response: We have revised the Materials & Methods section to explicitly define the study population. Student participants are now clearly described as undergraduate students, postgraduate students, and interns. Technical staff are specified as laboratory technicians, clinical assistants, and administrative support personnel involved in healthcare education or delivery. Additionally, the participating institutions are described as healthcare-related academic institutions, and the limited institutional setting has been acknowledged as a factor affecting generalizability. 2. Rationale for Use of DASS-21 and IES-R (Intervention) Reviewer comment: A rationale should be provided for the concurrent use of DASS-21 and IES-R. Response: We have added a clear justification in the Materials & Methods section explaining that DASS-21 was used to assess generalized emotional states (depression, anxiety, and stress), while the IES-R was employed to capture trauma-related distress linked specifically to the COVID-19 pandemic. The complementary nature of these instruments is now explicitly stated, highlighting their combined value in providing a comprehensive assessment of long-term psychological impact. 3. Absence of Baseline Data and Confounders (Comparator) Reviewer comment: The lack of pre-pandemic baseline data should be acknowledged, and potential confounders should be discussed. Response: We have explicitly acknowledged the absence of baseline pre-pandemic mental health data in both the Materials & Methods and Limitations sections. The manuscript now clarifies that findings should be interpreted as indicative of persistent psychological symptoms rather than causal effects. We have also discussed unmeasured confounding factors, including prior mental health status, socioeconomic variables, and workload differences, and acknowledged their potential influence on outcomes. 4. Sample Size, Generalizability, and Study Design (Outcome) Reviewer comment: Limitations related to sample size, institutional setting, and cross-sectional design should be stated. Response: The manuscript has been revised to clarify that the sample size (n = 250) is adequate for a cross-sectional analysis but limits broader generalizability. The cross-sectional design and its inability to assess causality or longitudinal trends are now clearly discussed in the Limitations section. Overall Response We believe that these revisions have improved the clarity, methodological transparency, and interpretative balance of the manuscript. The limitations are now explicitly acknowledged, the rationale for methodological choices is clearer, and the study’s contribution to understanding long-term psychological effects of COVID-19 among healthcare-associated populations is more clearly articulated. We thank the reviewer for their careful evaluation of our manuscript and for the constructive suggestions that have helped strengthen the clarity, transparency, and methodological rigour of the study. We have addressed each point in detail below and revised the manuscript accordingly. 1. Clarification of Population (PICO – Population) Reviewer comment: The population should be clearly defined, including student categories, technical staff roles, and the nature of healthcare institutions. Response: We have revised the Materials & Methods section to explicitly define the study population. Student participants are now clearly described as undergraduate students, postgraduate students, and interns. Technical staff are specified as laboratory technicians, clinical assistants, and administrative support personnel involved in healthcare education or delivery. Additionally, the participating institutions are described as healthcare-related academic institutions, and the limited institutional setting has been acknowledged as a factor affecting generalizability. 2. Rationale for Use of DASS-21 and IES-R (Intervention) Reviewer comment: A rationale should be provided for the concurrent use of DASS-21 and IES-R. Response: We have added a clear justification in the Materials & Methods section explaining that DASS-21 was used to assess generalized emotional states (depression, anxiety, and stress), while the IES-R was employed to capture trauma-related distress linked specifically to the COVID-19 pandemic. The complementary nature of these instruments is now explicitly stated, highlighting their combined value in providing a comprehensive assessment of long-term psychological impact. 3. Absence of Baseline Data and Confounders (Comparator) Reviewer comment: The lack of pre-pandemic baseline data should be acknowledged, and potential confounders should be discussed. Response: We have explicitly acknowledged the absence of baseline pre-pandemic mental health data in both the Materials & Methods and Limitations sections. The manuscript now clarifies that findings should be interpreted as indicative of persistent psychological symptoms rather than causal effects. We have also discussed unmeasured confounding factors, including prior mental health status, socioeconomic variables, and workload differences, and acknowledged their potential influence on outcomes. 4. Sample Size, Generalizability, and Study Design (Outcome) Reviewer comment: Limitations related to sample size, institutional setting, and cross-sectional design should be stated. Response: The manuscript has been revised to clarify that the sample size (n = 250) is adequate for a cross-sectional analysis but limits broader generalizability. The cross-sectional design and its inability to assess causality or longitudinal trends are now clearly discussed in the Limitations section. Overall Response We believe that these revisions have improved the clarity, methodological transparency, and interpretative balance of the manuscript. The limitations are now explicitly acknowledged, the rationale for methodological choices is clearer, and the study’s contribution to understanding long-term psychological effects of COVID-19 among healthcare-associated populations is more clearly articulated. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 16 Jan 2026 Ann Sales , Department of Prosthodontics and Crown & Bridge, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, 576104, India 16 Jan 2026 Author Response We thank the reviewer for their careful evaluation of our manuscript and for the constructive suggestions that have helped strengthen the clarity, transparency, and methodological rigour of the study. We ... Continue reading We thank the reviewer for their careful evaluation of our manuscript and for the constructive suggestions that have helped strengthen the clarity, transparency, and methodological rigour of the study. We have addressed each point in detail below and revised the manuscript accordingly. 1. Clarification of Population (PICO – Population) Reviewer comment: The population should be clearly defined, including student categories, technical staff roles, and the nature of healthcare institutions. Response: We have revised the Materials & Methods section to explicitly define the study population. Student participants are now clearly described as undergraduate students, postgraduate students, and interns. Technical staff are specified as laboratory technicians, clinical assistants, and administrative support personnel involved in healthcare education or delivery. Additionally, the participating institutions are described as healthcare-related academic institutions, and the limited institutional setting has been acknowledged as a factor affecting generalizability. 2. Rationale for Use of DASS-21 and IES-R (Intervention) Reviewer comment: A rationale should be provided for the concurrent use of DASS-21 and IES-R. Response: We have added a clear justification in the Materials & Methods section explaining that DASS-21 was used to assess generalized emotional states (depression, anxiety, and stress), while the IES-R was employed to capture trauma-related distress linked specifically to the COVID-19 pandemic. The complementary nature of these instruments is now explicitly stated, highlighting their combined value in providing a comprehensive assessment of long-term psychological impact. 3. Absence of Baseline Data and Confounders (Comparator) Reviewer comment: The lack of pre-pandemic baseline data should be acknowledged, and potential confounders should be discussed. Response: We have explicitly acknowledged the absence of baseline pre-pandemic mental health data in both the Materials & Methods and Limitations sections. The manuscript now clarifies that findings should be interpreted as indicative of persistent psychological symptoms rather than causal effects. We have also discussed unmeasured confounding factors, including prior mental health status, socioeconomic variables, and workload differences, and acknowledged their potential influence on outcomes. 4. Sample Size, Generalizability, and Study Design (Outcome) Reviewer comment: Limitations related to sample size, institutional setting, and cross-sectional design should be stated. Response: The manuscript has been revised to clarify that the sample size (n = 250) is adequate for a cross-sectional analysis but limits broader generalizability. The cross-sectional design and its inability to assess causality or longitudinal trends are now clearly discussed in the Limitations section. Overall Response We believe that these revisions have improved the clarity, methodological transparency, and interpretative balance of the manuscript. The limitations are now explicitly acknowledged, the rationale for methodological choices is clearer, and the study’s contribution to understanding long-term psychological effects of COVID-19 among healthcare-associated populations is more clearly articulated. We thank the reviewer for their careful evaluation of our manuscript and for the constructive suggestions that have helped strengthen the clarity, transparency, and methodological rigour of the study. We have addressed each point in detail below and revised the manuscript accordingly. 1. Clarification of Population (PICO – Population) Reviewer comment: The population should be clearly defined, including student categories, technical staff roles, and the nature of healthcare institutions. Response: We have revised the Materials & Methods section to explicitly define the study population. Student participants are now clearly described as undergraduate students, postgraduate students, and interns. Technical staff are specified as laboratory technicians, clinical assistants, and administrative support personnel involved in healthcare education or delivery. Additionally, the participating institutions are described as healthcare-related academic institutions, and the limited institutional setting has been acknowledged as a factor affecting generalizability. 2. Rationale for Use of DASS-21 and IES-R (Intervention) Reviewer comment: A rationale should be provided for the concurrent use of DASS-21 and IES-R. Response: We have added a clear justification in the Materials & Methods section explaining that DASS-21 was used to assess generalized emotional states (depression, anxiety, and stress), while the IES-R was employed to capture trauma-related distress linked specifically to the COVID-19 pandemic. The complementary nature of these instruments is now explicitly stated, highlighting their combined value in providing a comprehensive assessment of long-term psychological impact. 3. Absence of Baseline Data and Confounders (Comparator) Reviewer comment: The lack of pre-pandemic baseline data should be acknowledged, and potential confounders should be discussed. Response: We have explicitly acknowledged the absence of baseline pre-pandemic mental health data in both the Materials & Methods and Limitations sections. The manuscript now clarifies that findings should be interpreted as indicative of persistent psychological symptoms rather than causal effects. We have also discussed unmeasured confounding factors, including prior mental health status, socioeconomic variables, and workload differences, and acknowledged their potential influence on outcomes. 4. Sample Size, Generalizability, and Study Design (Outcome) Reviewer comment: Limitations related to sample size, institutional setting, and cross-sectional design should be stated. Response: The manuscript has been revised to clarify that the sample size (n = 250) is adequate for a cross-sectional analysis but limits broader generalizability. The cross-sectional design and its inability to assess causality or longitudinal trends are now clearly discussed in the Limitations section. Overall Response We believe that these revisions have improved the clarity, methodological transparency, and interpretative balance of the manuscript. The limitations are now explicitly acknowledged, the rationale for methodological choices is clearer, and the study’s contribution to understanding long-term psychological effects of COVID-19 among healthcare-associated populations is more clearly articulated. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Sunil S. Reviewer Report For: Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :862 ( https://doi.org/10.5256/f1000research.186992.r413188 ) The direct URL for this report is: https://f1000research.com/articles/14-862/v1#referee-response-413188 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 24 Sep 2025 Shruti Sunil , Qatar University, Doha, Qatar Approved VIEWS 0 https://doi.org/10.5256/f1000research.186992.r413188 The manuscript is well written, comprehensive, and makes a valuable contribution to the field that addresses an important issue. Its impact could be further enhanced by discussing potential directions for future research, particularly in relation to the acknowledged limitations. ... Continue reading READ ALL The manuscript is well written, comprehensive, and makes a valuable contribution to the field that addresses an important issue. Its impact could be further enhanced by discussing potential directions for future research, particularly in relation to the acknowledged limitations. In addition, refining the conclusion to emphasize concrete, practical recommendations would strengthen the study’s applicability and provide clearer guidance. 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? Yes 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: Medical education, Epidemiology, QoL, AI in medical and dental research 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 Sunil S. Reviewer Report For: Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :862 ( https://doi.org/10.5256/f1000research.186992.r413188 ) The direct URL for this report is: https://f1000research.com/articles/14-862/v1#referee-response-413188 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 Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 03 Sep 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) 14 Jan 26 read read Version 1 03 Sep 25 read read Shruti Sunil , Qatar University, Doha, Qatar Aman Chowdhry , Sharda University, Greater Noida, India Rachana Prabhu , Yenepoya Dental College, Mangaluru, India Claudia Chiarolanza , Sapienza - University of Rome, Rome, Italy 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 © 2026 Chiarolanza C. 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 Feb 2026 | for Version 2 Claudia Chiarolanza , Department of Dynamic and Clinical Psychology and Health Studies, Sapienza - University of Rome, Rome, Italy 0 Views copyright © 2026 Chiarolanza C. 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 Thanks for the opportunity to read this article. First of all, the introduction doesn't clearly distinguish the impact of COVID-19 on the general population, which could differ for students and trainees, at least according to the Authors. So, this goal should be clearly stated in the introduction and the conclusion. I would suggest extending the theoretical background to the studies elaborated by Arnett on emerging adulthood. Regarding the statistical analyses, the chi-square value is related to the number of groups; therefore, I suggest checking the adjusted residuals to verify whether the significant difference is solely due to sample size. There is a lack of clarity about the choice of the sample; so I think that it is important to deepen this aspect. 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? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Quantitative and qualitative methodology, close relationships, emerging adulthood, coping strategies 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) Chiarolanza C. Peer Review Report For: Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :862 ( https://doi.org/10.5256/f1000research.195093.r452998) 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/14-862/v2#referee-response-452998 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Prabhu R. 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. 24 Jan 2026 | for Version 2 Rachana Prabhu , Yenepoya Dental College, Mangaluru, Karnataka, India 0 Views copyright © 2026 Prabhu R. 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 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 This research article explores the long-term psychological impact of the COVID-19 pandemic on a defined population using a questionnaire-based cross-sectional design. The study addresses a timely and clinically relevant issue, particularly in the context of prolonged pandemic-related stressors. The authors present descriptive and inferential analyses to identify levels of anxiety, depression, and stress, and attempt to correlate these outcomes with demographic variables. The findings provide useful insight into the persistent mental health burden associated with COVID-19 and underscore the need for targeted psychological support strategies. The manuscript is generally well organized, and the results are clearly presented, contributing to the growing body of post-pandemic mental health literature Positives: Relevant and timely topic: The long-term psychological effects of COVID-19 remain an important area of investigation. Clear objective: The aim of evaluating psychological impact using standardized measures is well defined. Use of validated assessment tools: Established scales enhance the credibility of the findings. Structured presentation: The manuscript follows a logical flow from introduction to conclusion. Negatives: Cross-sectional design: Limits causal inference regarding psychological outcomes. Limited discussion of confounding factors: Socioeconomic status and pre-existing mental health conditions could have been explored further. 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? Yes 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 Public health, healthcare research, clinical sciences 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 (0) Prabhu R. Peer Review Report For: Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :862 ( https://doi.org/10.5256/f1000research.195093.r413192) 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/14-862/v2#referee-response-413192 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Chowdhry 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. 15 Oct 2025 | for Version 1 Aman Chowdhry , Sharda University, Greater Noida, Uttar Pradesh, India 0 Views copyright © 2025 Chowdhry 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 (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 manuscript, although submitted somewhat later than ideal, contributes valuable insights into the sustained psychological sequelae of the COVID-19 pandemic among healthcare-associated academic and technical populations. The study is relevant and timely in exploring long-term psychological outcomes, particularly among groups often underrepresented in post-pandemic mental health research. The methodology is generally well-described, but would benefit from further clarity and structuring according to the PICO framework, as follows: P (Population): Clearly define the population — specify which categories of students (undergraduate, postgraduate, interns) and technical staff (laboratory technicians, administrative support, nursing aides, etc.) were included. Additionally, identify the nature of the healthcare institutions (medical, dental, nursing, or allied health) to enhance context and reproducibility. I (Intervention): The use of DASS-21 and IES-R scales is appropriate for assessing depression, anxiety, stress, and trauma-related distress. However, the authors should include a short rationale for employing both instruments concurrently, explaining how they complement each other in evaluating different but overlapping aspects of psychological impact. C (Comparator): The absence of baseline (pre-pandemic) data is a key limitation. Without a comparator, attributing observed mental health outcomes solely to COVID-19 is difficult. The manuscript should explicitly acknowledge this gap and discuss how potential confounding variables (e.g., prior mental health history, socioeconomic status, or workload differences) were addressed or at least recognised. O (Outcome): The sample size (n = 250), while adequate for a preliminary cross-sectional assessment, limits the generalizability of findings. If participants were drawn from a single or limited number of institutions, this should be stated as a limitation. Furthermore, as a cross-sectional design, the study captures only a single time-point, preventing conclusions about causality or long-term trends. Lastly, although the manuscript addresses an important topic, COVID-19 has been extensively studied in recent years . To strengthen the relevance and currency of this work, it is recommended to incorporate at least two recent publications (published between 2023 and 2025) that align with the study’s focus on the long-term psychological impact of the pandemic. Overall Recommendation: The study holds merit for indexing after methodological refinement and clarification of the PICO elements. The limitations — particularly the lack of baseline data, potential sampling bias, and absence of longitudinal follow-up — should be clearly acknowledged in the Discussion section to strengthen the manuscript’s transparency and scientific rigour. 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? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly 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. Reviewer Expertise I have previously published papers on COVID-19 and healthcare, including work on “Strengthening Health Care Research and Academics During and After the COVID-19 Pandemic.” In one of my articles, I have also discussed the evolving challenges and opportunities faced by healthcare institutions in the post-pandemic era. 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 16 Jan 2026 Ann Sales, Department of Prosthodontics and Crown & Bridge, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, 576104, India We thank the reviewer for their careful evaluation of our manuscript and for the constructive suggestions that have helped strengthen the clarity, transparency, and methodological rigour of the study. We have addressed each point in detail below and revised the manuscript accordingly. 1. Clarification of Population (PICO – Population) Reviewer comment: The population should be clearly defined, including student categories, technical staff roles, and the nature of healthcare institutions. Response: We have revised the Materials & Methods section to explicitly define the study population. Student participants are now clearly described as undergraduate students, postgraduate students, and interns. Technical staff are specified as laboratory technicians, clinical assistants, and administrative support personnel involved in healthcare education or delivery. Additionally, the participating institutions are described as healthcare-related academic institutions, and the limited institutional setting has been acknowledged as a factor affecting generalizability. 2. Rationale for Use of DASS-21 and IES-R (Intervention) Reviewer comment: A rationale should be provided for the concurrent use of DASS-21 and IES-R. Response: We have added a clear justification in the Materials & Methods section explaining that DASS-21 was used to assess generalized emotional states (depression, anxiety, and stress), while the IES-R was employed to capture trauma-related distress linked specifically to the COVID-19 pandemic. The complementary nature of these instruments is now explicitly stated, highlighting their combined value in providing a comprehensive assessment of long-term psychological impact. 3. Absence of Baseline Data and Confounders (Comparator) Reviewer comment: The lack of pre-pandemic baseline data should be acknowledged, and potential confounders should be discussed. Response: We have explicitly acknowledged the absence of baseline pre-pandemic mental health data in both the Materials & Methods and Limitations sections. The manuscript now clarifies that findings should be interpreted as indicative of persistent psychological symptoms rather than causal effects. We have also discussed unmeasured confounding factors, including prior mental health status, socioeconomic variables, and workload differences, and acknowledged their potential influence on outcomes. 4. Sample Size, Generalizability, and Study Design (Outcome) Reviewer comment: Limitations related to sample size, institutional setting, and cross-sectional design should be stated. Response: The manuscript has been revised to clarify that the sample size (n = 250) is adequate for a cross-sectional analysis but limits broader generalizability. The cross-sectional design and its inability to assess causality or longitudinal trends are now clearly discussed in the Limitations section. Overall Response We believe that these revisions have improved the clarity, methodological transparency, and interpretative balance of the manuscript. The limitations are now explicitly acknowledged, the rationale for methodological choices is clearer, and the study’s contribution to understanding long-term psychological effects of COVID-19 among healthcare-associated populations is more clearly articulated. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Chowdhry A. Peer Review Report For: Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :862 ( https://doi.org/10.5256/f1000research.186992.r413194) 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/14-862/v1#referee-response-413194 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Sunil 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. 24 Sep 2025 | for Version 1 Shruti Sunil , Qatar University, Doha, Qatar 0 Views copyright © 2025 Sunil 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) 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 The manuscript is well written, comprehensive, and makes a valuable contribution to the field that addresses an important issue. Its impact could be further enhanced by discussing potential directions for future research, particularly in relation to the acknowledged limitations. In addition, refining the conclusion to emphasize concrete, practical recommendations would strengthen the study’s applicability and provide clearer guidance. 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? Yes 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 Medical education, Epidemiology, QoL, AI in medical and dental research 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 (0) Sunil S. Peer Review Report For: Long-term Psychological Impact of the COVID-19 Pandemic: A Cross-Sectional Survey among Students and Technical Staff in Health Care Institutions [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :862 ( https://doi.org/10.5256/f1000research.186992.r413188) 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/14-862/v1#referee-response-413188 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 Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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