Revision Summary

Mental Health and Social Isolation among Sub-Saharan African Migrants in Tunisia: A Cross-Sectional Quantitative Study

We sincerely thank the reviewers for the time and expertise they devoted to the evaluation of our manuscript. Their insightful comments and constructive suggestions have been invaluable in improving the clarity, rigour, and overall quality of this work.

Reviewer 1: Mariia Mezhenska

We thank the reviewer for the detailed and constructive evaluation of the manuscript. The comments were particularly helpful in improving the theoretical grounding, methodological clarity, and alignment between objectives, analyses, and interpretation. In response, we clarified the exploratory nature of the study and revised several sections accordingly.

Comments	Reply	Changes in the Manuscript
Insufficient theoretical framework and limited engagement with empirical studies	Recent empirical studies and systematic reviews were added to strengthen the theoretical grounding and better situate the study within current migration and mental health research.	Introduction (“Social Isolation and Mental Health”)
Biopsychosocial model insufficiently connected to research questions	The biopsychosocial framework was more explicitly linked to variable selection and research questions guiding the study.	Theoretical Framework
Superficial treatment of acculturative stress	This section was expanded with updated empirical literature and clearer positioning of acculturative stress within the study.	Acculturative Stress subsection
Objectives vague, absence of hypotheses, misalignment with analyses	Objectives were reformulated to reflect descriptive and relational aims. A Research Questions subsection was added to clarify analytical focus without formal hypothesis testing.	Introduction (Objectives; Research Questions)
Incorrect reference to Hajak et al. (2021)	The reference was clarified to reflect its relevance to stress-related constructs rather than acculturative stress per se.	Introduction
Interview methodology insufficiently justified	Methodological constraints (literacy, privacy, mistrust of written formats) were detailed, and the standardized interview protocol was clarified. Interviewer effects are now acknowledged as a limitation.	Methods (“Data Collection”); Limitations
Analytical strategy unclear or incoherent	The rationale for descriptive and univariate analyses was clarified, and statistical procedures were presented more transparently. Multivariate approaches are suggested for future research.	Methods (“Measures”; “Statistical Analysis”); Discussion (“Research Perspectives”)
Confusion between results and interpretation; inappropriate qualitative references; prevalence claims	Results and interpretation were clearly separated. Unsystematic qualitative observations were removed from Results, and references to prevalence were replaced with descriptions relative to theoretical scale midpoints.	Results; Discussion

Reviewer 2: Kamala Poudel

We thank the reviewer for the positive assessment of the manuscript and for the constructive comments regarding psychosocial resources and resilience. These suggestions helped clarify conceptual distinctions and improve the interpretation of clustering results.

Comments	Reply	Changes in the Manuscript
Nature and utilization of psychosocial resources	Definitions were clarified, and a distinction was made between perceived availability and actual utilization of resources. Differences across profiles were described more explicitly.	Methods; Results; Discussion
Measurement and variability of resilience across clusters	The resilience construct and its measurement were described in greater detail, and qualitative differences between clusters were clarified.	Measures; Results (Table 8 commentary)

Reviewer 3: Hanna Denysenko

We thank the reviewer for the comprehensive methodological feedback. The comments prompted substantial improvements in theoretical positioning, measurement transparency, and statistical interpretation.

Comments	Reply	Changes in the Manuscript
Weak theoretical framework	Engel’s biopsychosocial model and Berry’s acculturation framework were more explicitly linked to the research questions and measured dimensions.	Introduction; Theoretical Framework
Research objectives misaligned with analyses	Objective wording was revised to reflect bivariate and descriptive analyses. Limitations related to age and subgroup analyses were clarified.	Introduction (Objectives); Discussion (Limitations)
Measurement validity concerns	The feasibility-driven reduction of items was justified, internal consistency was reported, and the need for cultural validation in North African contexts was emphasized.	Methods (“Measures”); Limitations
Statistical interpretation overstated	Language implying prevalence, diagnosis, or clinical categorization was removed. “Clinical profiles” were reframed as “symptom–resource profiles.”	Abstract; Results; Discussion; Conclusions
Recommendations requiring new data	Suggestions requiring new fieldwork (larger samples, control groups, normative data) were acknowledged as priorities for future studies.	Limitations; Conclusions

Reviewer 4: Kateryna Bikir

We thank the reviewer for the encouraging feedback and for highlighting the relevance of the study. The suggestions contributed to strengthening the theoretical breadth and applied implications.

Comments	Reply	Changes in the Manuscript
Inclusion of Bronfenbrenner’s socio-ecological model	The socio-ecological framework was incorporated to acknowledge multi-level influences while maintaining an individual-level analytical focus.	Introduction; Theoretical Framework
Transit-country dynamics insufficiently explored	The discussion was expanded using recent literature to better contextualize Tunisia as a transit setting and to identify directions for future research.	Discussion (“Research Perspectives”)
Claims on social isolation require stronger empirical support	Recent umbrella review evidence was added to reinforce the public health relevance of social isolation.	Introduction; References
Need for clearer intervention pathways	The Research Perspectives section was expanded to outline evidence-informed, community-based, and culturally sensitive intervention approaches.	Discussion (“Research Perspectives”); References

The revised manuscript clarifies its exploratory scope, strengthens theoretical and methodological coherence, and adopts a more cautious and transparent interpretive stance. The revisions directly address the reviewers’ concerns while preserving the study’s contribution as an initial quantitative investigation of mental health among Sub-Saharan African migrants in Tunisia.