Title: Prevalence and Factors Associated with Loneliness Among Indonesian Female
Adolescents: A Cross-Sectional Study
Version: 1 Date: 03 Jun 2022
Reviewer's report:
The present work describes loneliness feelings in Indonesia female adolescents. The strengths
are the large sample size that is being used and the examination of a wide variety of associated
factors. It is important to gain insight into such associations within specific populations.
For specific feedback, please see below.
Would be good to mention the uniqueness of this study (the innovation) in the abstract as well.
Also, I feel that authors are underselling their study as it says in the conclusion that loneliness is
lower than previously reported. The main conclusion may also read something like this: “several
health risk behaviors and contextual factors were associated with loneliness. It is important to
gain insight in the exact interplay between factors and loneliness since that could inform future
intervention development and lead to better wellbeing among youth” (something like that).
In the introduction, please consider to include the sentence on the WHO definition of
adolescence (page 2) right after mentioning adolescents. Example: “This experience among
adolescents, defined by the WHO as the phase of life between childhood and adulthood, aged
10 - 19 years old (5), has recently gained global recognition as a public health concern because
the developmental process increases their vulnerability and frequent experience of loneliness.”
Please include this reference on gender differences as well:
Gender Differences in Loneliness Across the Lifespan: A Meta-Analysis by Marlies
Maes,Pamela Qualter,Janne Vanhalst,Wim Van den Noortgate,Luc Goossens. Eur J of Pers:
https://onlinelibrary.wiley.com/doi/full/10.1002/per.2220
In the second paragraph on page 2 it is mentioned “the increasing trend…” but it was not
described before whether there actually is an increasing trend. This comes a bit out of the blue.
You could consider adding some more literature on that specific topic.
Would it be possible to derive prevalence numbers from the previous studies regarding female
adolescents only? Authors are making the case that it is innovative to study loneliness in female
adolescents only, but my guess would be that previous studies also described prevalences for
this gender only.
The method section would profit from a section describing procedures. How were adolescents
recruited, what kind of informed consent was used, how long did it take to fill in all questions,
was it paper-and-pencil or digital, etcetra. Also, it would be great to provide information on
the other measures as well (to have some more insight for the reader to interpret the findings.
For example: is smoking about how much one smokes, or about whether one smokes or not?
This is similar for the other measures (it may be the case that word limit is a constraint here).
In order to being able to interpret the Chi-square test (in other words: how have the measures
been dichotomized?)
For the loneliness measure, it would be good to give information on operationalization. For
example, “to estimate the prevalence within this sample, all adolescents with a score of 5 on this
item are considered feeling lonely”. (this would solve the problem with the first sentence of the
results section as well, because the reader could not know how prevalence was defined).
Table 1 is very helpful in providing information on all the constructs that have been examined.
Please mention in your manuscript that all distress, risk and protective factors could be found in
that table (in-text it now only refers to the demographics, which is not the case).
A more urgent matter is: all these factors show significance according to table 1. Why have
authors chosen to highlight only a few? Have they settled on a certain cut-off value (i.e. % >
15?). If I notice correctly, for the protective factors these percentages are ‘only’ 5% but are still
being mentioned in the manuscript (they are really important so it is good that these are being
described). This could be considered a somewhat arbitrary choice.
One question for clarification: Why is age dichotomized in table 1?
And please check for mistakes in the ‘passive smoking’ line.
For the regression analyses, please clarify that AOR refers to adjusted odds ratio.
The discussion describes that social connectedness and high income could explain differences
(in first paragraph). A suggestion would be to nuance this a bit: It may be more about the socio-
cultural values that are being assigned to social connectedness than social connectedness perse.
Would be good to add a meta-analysis describing prevalence differences between collectivist
versus individualist countries here to see what research generally tells.
A more urgent matter in the discussion is that it is not always clear whether authors are referring
to their Table 1 OR Table 2 findings. For example, is paragraph 2 referring to Table 1 and
paragraph 3 to Table 2 (it sometimes seems to be mixed-up)?  The interpretation of findings for
the two tables should be different but authors refer consistently to ‘associations’. The discussion
would benefit from more clearly describing what the results actually mean.
Would be interesting to speculate on to why passive smoking and loneliness would be related
(authors state that feeling hungry could actually be low SES, but what about smoking?).
The paragraph on (lower) prevalence in Indonesia could be moved up to first paragraph of
discussion.