Association between Loneliness, Well-Being, and Life Satisfaction before and during the COVID-19 Pandemic: A Cross-Sectional Study
Round 1
Reviewer 1 Report
Good morning for the authors,
Analyzing the Manuscript (Article) with ID: 2151323-peer-review-v1, entitled "The association between loneliness, well-being, and life satisfaction before and during the COVID-19 epidemic" for a possible publication in Journal Sustainability – MDPI (ISSN: 2071-1050; IF=3.9), Section - Health, Well-Being and Sustainability; Special Issue - Impact of COVID-19 on Public Health Behaviors,
I consider that:
1. The authors of the article proposed a much-discussed topic in the medical scientific world today, namely: the negative effects of restrictive measures during the COVID-19 pandemic. The effort made by the authors was great right from the beginning of the study.
2. In Chapter 1 – Introduction (with 3 subchapters, well-structured):
- The authors presented the reasons for choosing their study. There are congruent with those of other authors cited as references.
- In subsection 1.1. Loneliness: clearly and concisely presents the negative effects of social isolation during the Covid-19 pandemic that caused major mental disorders, that can lead to anxiety, stress, depression.
- In subsection 1.2. Life satisfaction: shows all the disruptions of social and family life that had a greater impact on young people.
- In subsection 1.3. Mental Well-being: coherently presents the unfavorable effects of measures to limit interpersonal relationships on people's mental health.
3. In Chapter 2 – Materials and Methods:
- In subsection 2.1. Setting and participants: the authors clearly presented the inclusion criteria of the people enrolled in their study, the duration, the type of study for a representative sample of participants (n=664).
- They also had exclusion criteria: questionnaires with incomplete data.
- In subchapter 2.2 Data collection and analysis: the authors have explicitly described all types of tests specific to psychological research, evaluation questionnaires.
- In subsection 2.3. Ethical considerations: the authors presented the consent of the ethics committee of the institution where they conducted the study. They had a written informed consent of the participants in the study respecting all the provisions of professional ethics (according to the Declaration of Helsinki and the Oviedo Convention).
4. In Chapter 4 – Results: the authors began to present the demographic data of the study participants.
- BUT on paragraph 183 the authors present: ,,... followed by married in 32 (n=2012) and single in 27% (n=178) which does NOT correspond to the data in Table 1. It is probably a small technical editing mistake wanting to specify 32% (n=212)??!!
- AND in paragraph 184 the authors present,,...The largest proportion of participants (54.1% ???; n=366) was with secondary education...''. Since most % data are whole numbers obtained by rounding the percentage figure, I recommend you to keep the same characteristic.
- In Table 1 for Chronic disease: None (n=464) + One or more (n=202) = 666 participants?? It does NOT correspond with the number of participants from the sample presented in subchapter 2.1. Setting and participants!!
- To process the data collected from the valid questionnaires, the authors used different tests and specific statistical analysis coefficients. They had a significant value in assessing the friability of the study.
5. In the Chapter 4 – Discussions: the authors exemplified all the results of their study with the assessment of other authors, according to the references.
6. In Chapter 5 - Conclusions: the authors have clearly presented the links between the restrictions from the lock down from the Covid-19 pandemic and the deterioration of the quality of social, familial and professional life of the peoples. These results can help, in the future, the specialists in the epidemiological field in taking measures that do not affect so much the human mental status!
As a results:
1. The article follows all the specific instructions of the journal presented in: aims and scope, instructions for authors and other information about the journal.
2. The data presented in this manuscript are well structured and coherent;
3. The methods, statistical analysis and results are well presented and easy to understand;
4. The references chosen by the authors corresponds to the requirements and refers to the subject of the article.
5. All authors had an equitable contribution to the study.
In conclusion:
I Accept after minor revision!
Comments for author File: 
Comments.pdf
Author Response
Responses to Reviewer 1
Reviewer 1 Comments
Comment 1: (Results) BUT on paragraph 183 the authors present: ,,... followed by married in 32 (n=2012) and single in 27% (n=178) which does NOT correspond to the data in Table 1. It is probably a small technical editing mistake wanting to specify 32% (n=212)??!!
Response 1: Thank you for the comment. We have resolved the comment.
Page/Line: 5/205-219
Six hundred sixty-four participants participated in the study, of which 484 (73 %) were female and 180 (27 %) were male. The mean age was 39.45 years (SD = 12.75; Mdn = 39; IQR = 19). In terms of relationship status, the highest proportion was in an extramarital relationship (35%(n=234)234 (35%), followed by married in 32% (n=2012) and single in 27% (n=178)). The largest proportion of participants (54.1%; n =366) was with secondary education, followed by participants with high or higher education (27%, n=177) and postgraduate education in 13% (n=89). 462 (70 %) participants had no chronic disease, and 202 (30%) had at least one chronic illness. 320 (48%) of participants live with partners, and 79 (12%) live alone. Most of them (530, 80%) were employed. 40% (n=264) participants self-assessed that their mental well-being was changed, the same percentage self-assessed their social life, and 50% (n=329) self-assessed that their life satisfaction was altered. 50% (n=334) self-assessed that their economic status was changed, and 82% (n=542) assessed their quality of life. The majority (523, 79%) self-assessed that during the CovidOVID-19 epidemic, the frequency of use of information communication technology has changed. Also, 60% (n=395) of participants stated fear due to CovidOVID-19.
Comment 2: (Results) AND in paragraph 184 the authors present,,...The largest proportion of participants (54.1% ???; n=366) was with secondary education...''. Since most % data are whole numbers obtained by rounding the percentage figure, I recommend you to keep the same characteristic.
Response 2: Thank you for the comment. We have resolved the comment.
Page/Line: 5/205-219
Six hundred sixty-four participants participated in the study, of which 484 (73 %) were female and 180 (27 %) were male. The mean age was 39.45 years (SD = 12.75; Mdn = 39; IQR = 19). In terms of relationship status, the highest proportion was in an extramarital relationship (35%(n=234)234 (35%), followed by married in 32% (n=2012) and single in 27% (n=178)). The largest proportion of participants (54.1%; n =366) was with secondary education, followed by participants with high or higher education (27%, n=177) and postgraduate education in 13% (n=89). 462 (70 %) participants had no chronic disease, and 202 (30%) had at least one chronic illness. 320 (48%) of participants live with partners, and 79 (12%) live alone. Most of them (530, 80%) were employed. 40% (n=264) participants self-assessed that their mental well-being was changed, the same percentage self-assessed their social life, and 50% (n=329) self-assessed that their life satisfaction was altered. 50% (n=334) self-assessed that their economic status was changed, and 82% (n=542) assessed their quality of life. The majority (523, 79%) self-assessed that during the CovidOVID-19 epidemic, the frequency of use of information communication technology has changed. Also, 60% (n=395) of participants stated fear due to CovidOVID-19.
Comment 3: (Results) In Table 1 for Chronic disease: None (n=464) + One or more (n=202) = 666 participants?? It does NOT correspond with the number of participants from the sample presented in subchapter 2.1. Setting and participants!!
Response 3: Thank you for the comment. We have resolved the comment and fixed typo in Table 1.
Comment 4: (Results) To process the data collected from the valid questionnaires, the authors used different tests and specific statistical analysis coefficients. They had a significant value in assessing the friability of the study.
Response 4: Thank you for the comment.
Comment about English language and style: With the assistance of a senior researcher, a native speaker of English, we have extensively rewritten our manuscript for clarity and accuracy.
Author Response File: 
Author Response.docx
Reviewer 2 Report
This study attempted to investigate the association of loneliness with mental well-being and life satisfaction during COVID-19 pandemic, by conducting a survey on a convenient sample of adult population from Slovenia. I listed some of my major concerns on this study below:
1. The authors only conducted a cross-sectional survey during a period at pandemic. It is not clear how they got all the results for before covid-19. If patients only recall their experience before covid-19, the answers are subject to serious recall bias as the recall period is very long.
2. the study used three questionnaires to assess loneliness, mental well-being and life satisfaction, respectively. The authors should discuss whether there are other instruments to measure these concepts and why these three instruments are chosen for this study.
3. the authors conducted a convenient sample, and the majority of respondents are female. therefore, it is unlikely that the results can represent the general population.
4. this paper needs to be qc'ed thoroughly before resubmission, as there are some obvious errors. e.g., in line 183, "followed by married in 32 (n=2012)", n=2012 can't be right as the total sample is 664. In addition, there are many incomplete sentences and grammar mistakes throughout the manuscript, e.g., line 116, 137-138. All these issues make it hard to understand the content.
Author Response
Responses to Reviewer 2
Reviewer 2 Comments
Comment 1: The authors only conducted a cross-sectional survey during a period at pandemic. It is not clear how they got all the results for before covid-19. If patients only recall their experience before covid-19, the answers are subject to serious recall bias as the recall period is very long.
Response 1: Thank you for your comment. We have highlighted this concern under research limitations.
Page/Line: 9/357-358
Second, recall bias can occur in a cross-sectional study, which we point out as a potential study limitation.
Comment 2: the study used three questionnaires to assess loneliness, mental well-being and life satisfaction, respectively. The authors should discuss whether there are other instruments to measure these concepts and why these three instruments are chosen for this study.
Response 2: Thank you for your comment, and we have added an explanation of why we chose these three questionnaires.
Page/Line: 3/126-129
In the literature, various questionnaires measure loneliness, life satisfaction and mental well-being. Still, these three questionnaires are most often used for their assessment, so we have chosen them.
Comment 3: the authors conducted a convenient sample, and the majority of respondents are female. therefore, it is unlikely that the results can represent the general population.
Response 3: Thank you for your comment. We have highlighted this concern under research limitations.
Page/Line: 10/372-374
Due to the majority share of one gender, we cannot generalize the entire results to the whole population.
Comment 4: this paper needs to be qc'ed thoroughly before resubmission, as there are some obvious errors. e.g., in line 183, "followed by married in 32 (n=2012)", n=2012 can't be right as the total sample is 664. In addition, there are many incomplete sentences and grammar mistakes throughout the manuscript, e.g., line 116, 137-138. All these issues make it hard to understand the content.
Response 4: Thank you for the comment. We have resolved the comment.
Page/Line: 5/205-219
Six hundred sixty-four participants participated in the study, of which 484 (73 %) were female and 180 (27 %) were male. The mean age was 39.45 years (SD = 12.75; Mdn = 39; IQR = 19). In terms of relationship status, the highest proportion was in an extramarital relationship (35%(n=234)234 (35%), followed by married in 32% (n=2012) and single in 27% (n=178)). The largest proportion of participants (54.1%; n =366) was with secondary education, followed by participants with high or higher education (27%, n=177) and postgraduate education in 13% (n=89). 462 (70 %) participants had no chronic disease, and 202 (30%) had at least one chronic illness. 320 (48%) of participants live with partners, and 79 (12%) live alone. Most of them (530, 80%) were employed. 40% (n=264) participants self-assessed that their mental well-being was changed, the same percentage self-assessed their social life, and 50% (n=329) self-assessed that their life satisfaction was altered. 50% (n=334) self-assessed that their economic status was changed, and 82% (n=542) assessed their quality of life. The majority (523, 79%) self-assessed that during the CovidOVID-19 epidemic, the frequency of use of information communication technology has changed. Also, 60% (n=395) of participants stated fear due to CovidOVID-19.
Comment about English language and style: With the assistance of a senior researcher, a native speaker of English, we have extensively rewritten our manuscript for clarity and accuracy.
Author Response File: Author Response.docx
Reviewer 3 Report
Dear Authors,
I read with interest your manuscript. Please find below my comments.
[Line 26] I suggest to put references at the end of the sentence, avoiding the first author, to enhance readability.
[Lines 31-42] are difficult to read. Please rephrase this paragraph.
- Acronyms must be explained the first time they are used.
- Restrictions present during the data collection should be expplained better.
- Could the convenience sampling have affected results? This should be discussed. Similarly, is Styria representative of the entire Slovenia?
- I suggest to use the median (instead of mean) for age.
- When reporting quantities (e.g., number of subjects), the spelling should be te same for all of them (see lines 180 and following)
- COVID-19 terms should be used properly. Please check capitals, and when referring to the pandemic saying only "During Covid-19" is not correct.
- As far as I understand, Table 2 represents answers given by respondents during COVID-19 Pandemic, but referring both to the "covid" and "non-covid" periods. This results could be affected by the recall bias, and this limitation should be stated clearly.
- I suggest avoiding the use of "influence" term, "association" is preferable.
- The fact that the study has been conducted in the Styria region should be clearly stated in the abstract, as well as into the title.
- Similarly, the title might state the type of research and should be more informative. A better title could be like: "Association between loneliness, well-being, and life satisfaction before and during the COVID-19 epidemic in the Styria region, Slovenia. A cross-sectional study."
- I see different typing errors. Authors must accurately check the entire manuscript before next submission.
- Regression (and other analyses used in the manuscript) are intended to measure the association between two samples, not to certify a correlation. For this reason, I suggest to use more cautious terms in the discussion (e.g., line 249: "could explain" instead of "can explain"). This is particularly important considering the study design and the possible bias.
Author Response
Responses to Reviewer 3
Reviewer 3 Comments
Comment 1: [Line 26] I suggest to put references at the end of the sentence, avoiding the first author, to enhance readability.
Response 1: Thank you for the comment and the suggestion. We have rewritten the sentence.
Page/Line: 1/26-30
Sepúlveda-Loyola, et al. [3], Wand, et al. [4] and Sheffler, et al. [5] report mental well-being problems resulting from prolonged social isolation, such as those observed during periods of community closure Mental well-being problems can be increased during social isolation, such as those observed during periods of social distancing [3-5].
Comment 2: [Lines 31-42] are difficult to read. Please rephrase this paragraph.
Response 2: Thank you for the comment and the suggestion. We have rephrase this paragraph.
Page/Line: 1-2/32-45 and 46-51.
The consequences of reducing social life include reducing daily physical activity, leading to obesity and reduced life satisfaction [6]. Reduced physical activity also hurts the general population's mental well-being and dissatisfaction. Life satisfaction is an individual's life assessment, while the quality of life refers to overall well-being. Both can be plotted on a continuum, but life satisfaction is more subjective and can be influenced by how one feels on a given day. In contrast, the quality of life is measurable and less volatile. However, an individual's quality of life assessment can also be subjective and dependent on mood or circumstances (e.g., the current pandemic) and is, therefore, similarly variable. Literature [7] has defined positive well-being as subjective well-being, which emphasises happiness and satisfaction, and psychological well-being, which focuses on fulfilling one's potential. Especially in combination with loneliness, as the pandemic is ongoing and the restriction of contact continues [8]. Consequences of reduced social life include reduced daily physical activity, leading to obesity and decreased life satisfaction [6]. Reduced physical activity also adversely affects mental well-being and dissatisfaction among the general population. Life satisfaction is an individual's life assessment, while the quality of life refers to general well-being. An individual's assessment of the quality of life can also be subjective and dependent on mood or circumstances (e.g. pandemic). In the literature [7], positive well-being is defined as personal happiness and satisfaction, and psychological well-being focuses on fulfilling a social need. Loneliness and pandemic restrictions have negatively affected the population's well-being [8].
Comment 3: Acronyms must be explained the first time they are used.
Response 3: Thank you for the comment and the suggestion. We have the acronyms explained and highlighted throughout the manuscript.
Comment 4: Restrictions present during the data collection should be expplained better.
Response 4: Thank you for your coment. Data collection took place in a time frame where the COVID-19 restrictions did not have a major impact on their collection. The participant was asked to participate when they visited any Health Centers in Slovenia or were visited by community register nurses at home (in the Styria region) and give a questionnaire if they agreed with the participation.
Comment 5: Could the convenience sampling have affected results? This should be discussed. Similarly, is Styria representative of the entire Slovenia?
Response 5: Thank you for the comment and the suggestion. We have added the concern about convenience sampling in the limitation section. Regarding the Styrian province, there was incorrect wording used, as not only participants from this province were invited, but from all of Slovenia. Only the participants who received regular visits (from community register nurses at home came) from the Styrian region. We added this explanation under the sample section.
Page/Line: 3/117-121
This study used convenience sampling to invite adults visiting participating Health Centres in Slovenia or needing a visit from community register nurses in the Styria region in Slovenia. This study used convenience sampling. Adults who visited any Health Centers in Slovenia or were visited by community register nurses at home (in the Styria region) and met the inclusion criteria were invited to participate in the study.
Page/Line: 9/357-358
Another limitation of the study could present the type of sampling and its effect on the results.
Comment 6: I suggest to use the median (instead of mean) for age.
Response 6: Thank you for the comment and the suggestion. We have added the median (instead of the mean) for age.
Page/Line: 5/205-207
Six hundred sixty-four participants participated in the study, of which 484 (73 %) were female and 180 (27 %) were male. The mean age was 39.45 years (SD = 12.75; Mdn = 39; IQR = 19).
Comment 7: When reporting quantities (e.g., number of subjects), the spelling should be te same for all of them (see lines 180 and following).
Response 7: Thank you for the comment and the suggestion. We have corrected and highlighted throughout the manuscript.
Comment 8: COVID-19 terms should be used properly. Please check capitals, and when referring to the pandemic saying only "During Covid-19" is not correct.
Response 8: Thank you for the comment and the suggestion. We have corrected and highlighted throughout the manuscript.
Comment 9: As far as I understand, Table 2 represents answers given by respondents during COVID-19 Pandemic, but referring both to the "covid" and "non-covid" periods. This results could be affected by the recall bias, and this limitation should be stated clearly.
Response 9: Thank you for your comment, and we have added this concern under the study limitation.
Page/Line: 9/357-358
Second, recall bias can occur in a cross-sectional study, which we point out as a potential study limitation.
Comment 10: I suggest avoiding the use of "influence" term, "association" is preferable.
Response 10: Thank you for the comment and the suggestion. We have corrected and highlighted throughout the manuscript.
Comment 11: The fact that the study has been conducted in the Styria region should be clearly stated in the abstract, as well as into the title.
Response 11: Thank you for the comment and the suggestion. Regarding the Styrian province, there was incorrect wording used, as not only participants from this province were invited, but from all of Slovenia. Only the participants who received regular visits (from community register nurses at home came) from the Styrian region. For that reason, we can not state this in the abstract, but we have added the sample section to explain who was included in the study to avoid confusion.
Page/Line: 3/117-121
This study used convenience sampling to invite adults visiting participating Health Centres in Slovenia or needing a visit from community register nurses in the Styria region in Slovenia. This study used convenience sampling. Adults who visited any Health Centers in Slovenia or were visited by community register nurses at home (in the Styria region) and met the inclusion criteria were invited to participate in the study.
Comment 12: Similarly, the title might state the type of research and should be more informative. A better title could be like: "Association between loneliness, well-being, and life satisfaction before and during the COVID-19 epidemic in the Styria region, Slovenia. A cross-sectional study."
Response 12: Thank you for the comment. Regarding the Styrian province, there was incorrect wording used, as not only participants from this province were invited, but from all of Slovenia. Only the participants who received regular visits (from community register nurses at home came) from the Styrian region. Therefore, we can not add the Styria region in the title, but we have added the sample section to explain who was included in the study to avoid confusion.
Page/Line: 3/117-121
This study used convenience sampling to invite adults visiting participating Health Centres in Slovenia or needing a visit from community register nurses in the Styria region in Slovenia. This study used convenience sampling. Adults who visited any Health Centers in Slovenia or were visited by community register nurses at home (in the Styria region) and met the inclusion criteria were invited to participate in the study.
Comment 13: I see different typing errors. Authors must accurately check the entire manuscript before next submission.
Response 13: Thank you for the comment and the suggestion. We have corrected and highlighted throughout the manuscript.
Comment 14: Regression (and other analyses used in the manuscript) are intended to measure the association between two samples, not to certify a correlation. For this reason, I suggest to use more cautious terms in the discussion (e.g., line 249: "could explain" instead of "can explain"). This is particularly important considering the study design and the possible bias.
Response 14: Thank you for the comment and the suggestion. We have rewritten it into cautious terms.
Page/Line: 8/298-299
Our results show that loneliness can could explain 48% of the total variability of mental well-being and 52% of the variability of life satisfaction.
Comment about English language and style: With the assistance of a senior researcher, a native speaker of English, we have extensively rewritten our manuscript for clarity and accuracy.
Author Response File: Author Response.docx
Reviewer 4 Report
Lorber and colleagues conducted a survey to assess the association between loneliness, well-being, and life satisfaction before and during the COVID-19 epidemic. The epidemiological methodology involved in this study is decent in general and the manuscript is well-written. The reviewer had the following comments and suggestions for the authors’ reference to further refine this manuscript.
1. Section 2.1, line 118 - How was cognitive ability assessed during the enrollment?
2. Section 2.1, line 120 - Consider elaborating more on how sample size was calculated, and specify any population-related parameters if needed.
3. Results, page 6, para 1 - It would be helpful to comment on the direction of differences in loneliness, life satisfaction, and use of ICT by sociodemographic characteristics
4. Discussion - I suggest the authors started the Discussion section with a brief summary of findings and highlights of this study followed by public health impact and implications to improve the readability.
Minor:
5. Please confirm the necessity of whether “ICT” should be spelled out when it first appeared in the text
6. Section 2.2, line 123 - Please confirm the completeness of this sentence
7. Please reference Table 1 in the corresponding text
Author Response
Responses to Reviewer 4
Reviewer 4 Comments
Comment 1: Section 2.1, line 118 - How was cognitive ability assessed during the enrollment?
Response 1: Thank you for the comment. The cognitive ability was assessed so that the healthcare professional considered which participants could be offered participation in the study. In doing so, they looked at the absence of known organic or psychiatric affecting cognitive ability. We add this explanation.
Page/Line: 3/122-125
… (cognitive ability was assessed so that the healthcare professional considered which participants could be offered participation in the study. In doing so, they looked at the absence of known organic or psychiatric affecting cognitive ability) …
Comment 2: Section 2.1, line 120 - Consider elaborating more on how sample size was calculated, and specify any population-related parameters if needed.
Response 2: Thank you for the comment. We have added more in-depth elaboration on how we estimate the sample size in the manuscript.
Page/Line: 3/127-131
According to the Statistical Office of the Republic of Slovenia (SURS), the share of adults in the total population in 2021 was 1,732,182. Based on the above formula, we have calculated that a representative sample of 384 (e = 95%; z = 5%) should be. We estimated that the representative sample should be n = 384 (e = 95%; z = 5%).
Comment 3: Results, page 6, para 1 - It would be helpful to comment on the direction of differences in loneliness, life satisfaction, and use of ICT by sociodemographic characteristics.
Response 3: Thank you for the comment and suggestion. We have added differences in loneliness, life satisfaction, and use of ICT by sociodemographic characteristics.
Page/Line: 6/227-241.
With the Mann-Whitney test (Table 1), we found significant differences in loneliness (U=6.048, p<.001) and life satisfaction (U=3.438, p<.001) and use the ICT (U=3.005, p=.003) according to gender. Men are felt lonelier and rate their life satisfaction lower than women. We also found significant differences in loneliness (χ2(2)=18.216, p<.001), well-being (χ2(2)=14.456, p=.002) and use the ICT (χ2(2)=32.265, p<.001) according to level of education., where found that adults with higher level of education are felt less lonely and are more satisfied with their life. According to the frequency of contact with relatives found, that those who had daily contacts with relatives are felt loneliness significant lower a significant difference in loneliness (χ2(2)=19.350; p<.001), life satisfaction (χ2(2)=8.362, p=.039), and well-being (χ2(2)=29.343, p<.001). According to the age found significant differences in loneliness (χ2(2)=32.241; p<.001), life satisfaction (χ2(2)= 19.508; p<.001) and well-being (χ2(2)= 1.332; p=.514), where was found that with age people felt less lonely, they are more satisfied with life and also had higher mental well-being. We did not find significant differences in any studied variables if participants had a chronic disease. Also, the percentage of self-assessed for mental well-being (77%) is comparable to that for the Warwick-Edinburgh scale (73%).
Comment 4: Discussion - I suggest the authors started the Discussion section with a brief summary of findings and highlights of this study followed by public health impact and implications to improve the readability.
Response 4: Thank you for the comment and suggestion. We have added a summary of the findings and highlights of this study in the discussion section.
Page/Line: 8/273-285
We aimed to evaluate the loneliness, mental well-being and life satisfaction of adults in Slovenia in the time of COVID-19 pandemic. The results show that loneliness as an important variable associated with life satisfaction, mental well-being and the use the ICT. This study provides an initial step towards raising awareness about the problem of loneliness in todays' modern time, not only in older generation, but also in all other younger generations what is during the extraordinary circumstances, as it was pandemic, even more important. It exposes a major topic that, if not assessed and well managed by the healthcare system, might have a negative impact on the ability of owns' needs because of decreased life satisfaction and mental well-being. Concern for higher mental well-being not only to take care for being independent in everyday life, is the main goal for public health, which to the greatest extent, is taken care of by community nurses. Our positive results revealed that mean values show slightly positive life satisfaction and slightly positive mental well-being despite higher level of loneliness.
Comment 5: Please confirm the necessity of whether “ICT” should be spelled out when it first appeared in the text.
Response 5: Thank you for the comment. We have spelt out at first appearance.
Page/Line: 3/119-120
In the present study, we asked people living in Slovenia to evaluate their loneliness, life satisfaction, using the information and communication technology (ICT) and mental …
Comment 6: Section 2.2, line 123 - Please confirm the completeness of this sentence.
Response 6: Thank you for the comment. We have resolved the sentence.
Comment 7: Please reference Table 1 in the corresponding text.
Response 7: Thank you for the comment. We have reference Table 1 in the corresponding text.
Page/Line: 6/227
With the Mann-Whitney test (Table 1), we found …
Comment about English language and style: With the assistance of a senior researcher, a native speaker of English, we have extensively rewritten our manuscript for clarity and accuracy.
Author Response File: Author Response.docx
Round 2
Reviewer 2 Report
Thank you for considering my comments. The language for the added paragraph in Discussion still looks awkward. Please check grammar of the following sentences:
"This study provides an initial step towards raising awareness about the problem of loneliness in todays' modern time, not only in older generation, but also in all other younger generations what is during the extraordinary circumstances, as it was pandemic, even more important. It exposes a major topic that, if not assessed and well managed by the healthcare system, might have a negative impact on the ability of owns' needs because of decreased life satisfaction and mental well-being. Concern for higher mental well-being not only to take care for being independent in everyday life, is the main goal for public health, which to the greatest extent, is taken care of by community nurses."
Author Response
Responses to Reviewer 2
Reviewer 2 Comments
Comment 1: Thank you for considering my comments. The language for the added paragraph in Discussion still looks awkward. Please check grammar of the following sentences:
"This study provides an initial step towards raising awareness about the problem of loneliness in todays' modern time, not only in older generation, but also in all other younger generations what is during the extraordinary circumstances, as it was pandemic, even more important. It exposes a major topic that, if not assessed and well managed by the healthcare system, might have a negative impact on the ability of owns' needs because of decreased life satisfaction and mental well-being. Concern for higher mental well-being not only to take care for being independent in everyday life, is the main goal for public health, which to the greatest extent, is taken care of by community nurses.".
Response 1: Thank you for your comment. With the assistance of a senior researcher, a native speaker of English, we have extensively rewritten our manuscript and the paragraph for clarity and accuracy. We are also attaching a certificate.
Page/Line: 7-8/253-268
This study represents the initial approach to bringing the issue of loneliness in modern society to the attention of the younger generations, not only those who are older. This is particularly crucial when there are unprecedented circumstances, like the pandemic. It raises a significant issue that, if not evaluated and adequately managed by the healthcare system, could negatively affect an individual's capacity to meet their demands due to decreased life satisfaction and mental well-being. This study provides an initial step towards raising awareness about the problem of loneliness in todays' modern time, not only in older generation, but also in all other younger generations what is during the extraordinary circumstances, as it was pandemic, even more important. It exposes a major topic that, if not assessed and well managed by the healthcare system, might have a negative impact on the ability of owns' needs because of decreased life satisfaction and mental well-being. Concern for higher mental well-being, not only to take care for being independent in everyday life, is the main goal for public health, which to the greatest extent, is taken care of by community nursescare for being independent in everyday life, is the main goal of public health, which is taken care of by community nurses to the greatest extent.
Author Response File: Author Response.docx
Reviewer 3 Report
Authors accurately addressed reviewers' comments. I do not have further comments. However, as a last, minor but important improvement, I continue to suggest changing the title in "Association between loneliness, well-being, and life satisfaction before and during the COVID-19 epidemic in Slovenia: a cross-sectional study."
Author Response
Responses to Reviewer 3
Reviewer 3 Comments
Comment 1: Authors accurately addressed reviewers' comments. I do not have further comments. However, as a last, minor but important improvement, I continue to suggest changing the title in "Association between loneliness, well-being, and life satisfaction before and during the COVID-19 epidemic in Slovenia: a cross-sectional study."
Response 1: Thank you for the comment and the suggestion. We have added some of your suggestions. With the assistance of a senior researcher, a native speaker of English, we have extensively rewritten our manuscript and the paragraph for clarity and accuracy. We are also attaching a certificate.
Page/Line: 1/2-4
AThe association between loneliness, well-being, and life satisfaction before and during the COVID-19 pandemic: A cross-sectional study
Author Response File: Author Response.docx
Reviewer 4 Report
Thank you for taking my suggestions into consideration. I do not have additional comments or concerns.
Author Response
Responses to Reviewer 4
Reviewer 4 Comments
Comment 1: Thank you for taking my suggestions into consideration. I do not have additional comments or concerns.
Response 1: Thank you for the comment. With the assistance of a senior researcher, a native speaker of English, we have extensively rewritten our manuscript and the paragraph for clarity and accuracy. We are also attaching a certificate.
Author Response File: Author Response.docx
