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I am happy with the grammatical corrections made by authors in the manuscript. I feel the manuscript is ready for publication.
[# PeerJ Staff Note - this decision was reviewed and approved by Jafri Abdullah, a PeerJ Section Editor covering this Section #]
Thank you for your thorough revisions, which have significantly improved the clarity and robustness of the manuscript. The remaining issues—primarily the clarification regarding whether this is the first study conducted in Turkey or among healthcare professionals, as well as minor typographical errors—can be easily addressed during the final proofreading process. With these small refinements, your manuscript is acceptable for publication.
Thank you for the opportunity to review this manuscript again. I have read the authors' responses and the revisions made to the manuscript. I believe the authors have improved the study.
In the discussion, the authors state: "This is the first study to examine the relationship between problematic cryptocurrency trading behavior and risky alcohol use, substance use, tobacco dependence, and GD." However, there seem to be some published studies on this topic—at least regarding gambling and cryptocurrency. Do the authors mean this is the first study conducted in Turkey or among healthcare professionals? It would be helpful to specify this for clarity.
Additionally, there are some remaining typos in the manuscript that should be addressed during proofreading. Other than that, I recommend the manuscript for publication.
No comment
No comment
No comment
All comments of both reviewers (both of whom have requested Major Revisions) must be addressed
[# PeerJ Staff Note: The review process has identified that the English language must be improved. PeerJ can provide language editing services if you wish - please contact us at [email protected] for pricing (be sure to provide your manuscript number and title). Your revision deadline is always extended while you undergo language editing. #]
-The study’s background and justification would benefit from a stronger argument for the public health significance of gambling disorder and the cryptocurrency trading activity, which is established in previous literature, rather than detailing the history of gambling disorder.
-Several claims made in the introduction section of the paper are unsupported or speculative. For example, the following lines should be reviewed for supporting evidence from previous literature.
77-79
90-93
93-93
99-102
108-111
111-113
113-115
115-116
-The goal of the research stated in the introduction must be consistent with the goal stated in the conclusion. Introduction states the research will support future interventions, the conclusion states the findings will support future prevention efforts.
Referencing past research to support study rationale must be placed in the introduction, not the discussion. (Most of 295-304)
-Table 1 is inconsistent in its formatting. Starting at the covariate, Gambling Disorder, only one percentage is shown per box, and it is unclear whether it represents the percentage of people who have GD or don’t. Same can be said for substance use and risky alcohol use. Formatting needs to be more consistent and clear.
-The stress of healthcare professionals may be a confound, not a strength in the research design. This point needs to be addressed in the experimental design. The study also assumes the generalizability of the findings to be reasonable but the unique, singular work environment among the participants isn’t adequately considered.
-Equating daily smokers to tobacco dependence is inappropriate given that there are validated measures for evaluating SUDs. Dependence is more than excessive/persistent use, acknowledge this in the evaluation of tobacco dependence, or revise “tobacco dependence” to “daily tobacco use.”
-Cronbach’s alpha scores are not cited, and alpha scores for each subscale are not reported. Even if there are two subscales, only one alpha score is reported. Report an alpha value for each subscale and cite where they come from.
-While the statistical analyses are themselves sound, they are rudimentary and lacking in context such as comparisons to other populations studied which would be important to assess given the authors claim the generalizability of the findings across populations. The manuscript would benefit from additional analyses beyond the trader-non trader distinction and contextualization of results. For instance, the dataset could yield important insights into what makes certain healthcare workers who trade more likely to engage in problematic trading or experience negative consequences than others, which currently remains a missed opportunity.
-Some conclusions from the results are unsupported based on the presented results. For instance, the supposed relationship between the severity of problematic trading behavior and that of SUD would benefit from additional evidence and clarification of the shape and magnitude of the relationship, which can be elaborated graphically or using additional analyses which should be detailed.
The manuscript contains numerous grammatical errors, typos, and incoherent sentences which need to be corrected.
Thank you for the opportunity to review this interesting study. This study explores the relationship between cryptocurrency trading behavior and gambling disorder, high-risk substance use, high-risk alcohol use, and tobacco dependence among healthcare professionals in Türkiye. Given that cryptocurrency trading is relatively understudied as an addictive behavior, this research makes a valuable contribution to the field as one of the first of its kind. My primary concerns relate to the study’s sampling methodologies, which I have addressed under Additional Comments.
Custom checks
Have you checked the authors ethical approval statement? Does the study meet our article requirements?
Answer: Yes.
Has identifiable info been removed from all files?
Answer: Yes.
Were the experiments necessary and ethical?
Answer: This was not an experimental study, but ethical requirements have been met.
Basic reporting
Clear, unambiguous, professional English language used throughout.
Answer: Yes it is. I have some minor points here:
The sentence “Since the numeric data did not fit the normal distribution. (line 200)” seems incomplete?
The authors write that “only legal in our country as an investment tool … (line 295)“, I would suggest the authors to rephrase this to “in Türkiye”.
Intro & background to show context. Literature well referenced & relevant.
Answer: In essence, yes. I have some comments here (see general comments below).
Structure conforms to PeerJ standards, discipline norm, or improved for clarity.
Answer: Yes.
Figures are relevant, high quality, well labelled & described.
Answer: No figures in the manuscript, but the tables are ok.
Raw data supplied (see PeerJ policy).
Answer: Yes, the raw data is provided in a SPSS file.
Experimental findings
Original primary research within Scope of the journal.
Answer: Yes.
Research question well defined, relevant & meaningful. It is stated how the research fills an identified knowledge gap.
Answer: Yes.
Rigorous investigation performed to a high technical & ethical standard.
Answer: Yes.
Methods described with sufficient detail & information to replicate.
Answer: In essence, yes. I have some comments here (see Additional comments, below).
Validity of the findings
Meaningful replication encouraged where rationale & benefit to literature is clearly stated.
Answer: Yes.
All underlying data have been provided; they are robust, statistically sound, & controlled.
Answer: Yes, data has been provided. The study employs fairly basic statistical methods, but given the study aims, it is sufficient.
Conclusions
Conclusions are well stated, linked to original research question & limited to supporting results.
Answer: Overall, I agree with the conclusions drawn. The study establishes a clear link between Cryptocurrency Trading and other addictions, contributing meaningfully to the research field. I have one minor comment: the authors conclude that multidisciplinary strategies should be employed to protect the holistic well-being of healthcare workers. This claim feels somewhat vague. Could the authors clarify this statement and explain how it relates to the data in the current study (i.e., why are holistic, multidisciplinary approaches necessary compared to other potential interventions)?
Additional comments
Below I have listed specific comments, per section of the manuscript.
Introduction
I liked the introduction. It was well written and outlined the study rationale in a clear way. I had a few comments.
The authors state that “GD and substance use disorders often coexist with psychiatric conditions, owing to shared pathophysiological underpinnings such as neurotransmitter system abnormalities; our research illuminates the potential interactions between these disorders” (line 97). However, they do not provide a reference to support this claim in the main text, nor do they specify the pathophysiological mechanisms involved or expand upon this in the discussion. Given that this was a survey study, it is unclear if the data provide any evidence of such pathophysiological mechanisms. Could the authors either supply a detailed, well-referenced explanation for this statement or consider redacting it?
I agree that this study addresses an important gap in the literature by linking cryptocurrency trading to other addictions. However, my primary concern is the choice of sample population. While the authors justify studying healthcare professionals as a vulnerable group for cryptocurrency trading (e.g., due to work-related stress), this rationale is not entirely convincing. Given the limited research on cryptocurrency trading, would it not be more beneficial to prioritize other populations, such as the general public or treatment-seeking patients within healthcare settings? If healthcare professionals were selected as a convenience sample, the authors might clarify this. Alternatively, they could provide a stronger rationale for why healthcare professionals are particularly relevant to the study outcomes compared to other vulnerable groups.
Methods
Could the authors provide more detail on their sampling methods? Was convenience sampling, snowball sampling, or another method used? How were the 300 potential participants identified and approached?
Did the study employ formal inclusion and exclusion criteria? If so, could the authors specify these in the manuscript?
The authors note that their sample constitutes 1.6% of the hospital staff and is representative in terms of the range of professions included. However, a considerable number of participants were excluded, such as those with personal health issues. Could the authors discuss how these exclusions may have potentially influenced the study’s findings? Additionally, it was unclear why participants with chronic health conditions were excluded and how addictive behaviors might interact with these conditions in ways that could introduce bias. Could the authors provide an explanation?
Nearly half of the sample did not have a university education, yet most participants were nurses or doctors. Are nurses not required to have a university education in Türkiye?
The absence of a cut-off score for the PCTS scale could be problematic for accurately distinguishing between problematic and non-problematic cryptocurrency trading groups. I am not entirely convinced that using a >mean score classification is a valid or reliable approach, as it seems somewhat arbitrary. An alternative approach could have been to report any problematic trading (e.g., >1 total score) as a cut-off, given that these behaviors are less studied. Alternatively, the authors might consider listing the lack of a defined cut-off as a study limitation.
Results
Given the scope of the study, I don’t mind that the statistical methods used are fairly basic (I actually appreciated the choice of non-parametric tests!). However, the results section feels somewhat sparse. Perhaps the authors might consider adding some additional research questions, such as examining addictive behavior outcomes by specific professions.
Discussion
I enjoyed the discussion and found it both interesting and engaging. I have only a few comments to add here.
The authors note that the GD participants engaged in lotteries, among other forms of gambling. This was somewhat surprising, as lotteries are generally considered a less-addictive type of gambling. Could this be a cultural characteristic specific to Türkiye?
I also appreciated the section that addressed the unique challenges faced by migrating health care professionals in Türkiye.
A general limitation of the study, in my view, is that it focused exclusively on health care professionals. Since cryptocurrency trading is relatively understudied, this focus may make the results somewhat difficult to interpret. Are these problems more (or less) prevalent among health care professionals compared to other populations? I would encourage the authors to discuss these considerations in relation to the study results.
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