{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T14:59:20Z","timestamp":1783177160966,"version":"3.54.6"},"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UNICEF MALAYSIA","award":["MOH\/2022\/02"],"award-info":[{"award-number":["MOH\/2022\/02"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec018\">\n<jats:title>Background<\/jats:title>\n<jats:p>COVID-19 has greatly affected the population, especially those in the low socio-economic group, including residents of the People\u2019s Housing Project (PPR) in Malaysia. Adolescents residing in PPR communities are among the most vulnerable groups of young people in urban areas, given their pre-existing conditions of vulnerability, face even greater challenges due to the pandemic. Understanding their mental health and coping strategies is vital to grasp how the pandemic impacts their well-being. Hence, this study aims to explore the coping strategies and barriers to help-seeking behaviour among adolescents living in the Malaysia\u2019s PPR communities, focusing on the unique mental health challenges exacerbated by the COVID-19 pandemic<jats:italic>.<\/jats:italic> Given the socio-economic vulnerabilities and the heightened mental health challenges during the pandemic, this study provides critical insights into how adolescents in PPR communities navigate psychological distress and mental health support.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec019\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This qualitative study used a phenomenological research design and was conducted from January to December 2022, involving 47 adolescents aged 10 to 17 years old from 37 PPRs in the Klang Valley. Participants were recruited using the purposive sampling method as this study purposely selected adolescents with moderate, moderately severe, and severe for PHQ-9 and\/or moderate and severe for GAD-7 based on the screening. Participants who agreed to participate were recruited (with consent from parents\/guardians) and interviews were set at the participants\u2019 convenience. Data were collected using a semi-structured interview guide to conduct the in-depth interviews (IDI). After each IDI session, the recorded interviews were transcribed. Data from the voice recorder were stored on a password-protected computer, and participants\u2019 names were replaced with specific codes to ensure confidentiality. The researchers coded all transcripts independently. The transcripts were analysed inductively using a thematic approach to identify recurring themes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec020\">\n<jats:title>Results<\/jats:title>\n<jats:p>From the 37 PPRs, 194 adolescents were identified as having psychological distress based on the screening. Among them, 47 agreed to participate in the IDIs, which revealed that these adolescents utilized mainly maladaptive coping strategies, such as avoidance (cognitive distancing, externalization, and internalization), self-harm, vaping, and smoking to deal with stressors related to COVID-19. As for hindrances to help-seeking, three themes were identified such as lack of trust, perceived ineffectiveness of support, and personality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec021\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Psychological distress among adolescents was prevalent during the pandemic, and they faced hindrances in seeking help. Coping strategies have been identified to help adolescents manage their psychological distress during the pandemic. It is concerning that some had resorted to maladaptive coping mechanisms. These findings emphasized the need for targeted mental health interventions and support systems tailored to vulnerable communities. These interventions could inform policies aimed at strengthening mental health services, fostering better coping strategies and promoting help-seeking behaviours among adolescents in socio-economically challenged communities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0318381","type":"journal-article","created":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T17:54:27Z","timestamp":1742579667000},"page":"e0318381","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Noteworthy trends in maladaptive coping strategies and hindrances to help-seeking behaviour among adolescents living in Malaysia\u2019s People\u2019s Housing Project (PPR) during the COVID-19 pandemic: A qualitative study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2317-4057","authenticated-orcid":true,"given":"Siti Nur Farhana","family":"Harun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noorlaile","family":"Jasman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feisul","family":"Mustapha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norrafizah","family":"Jaafar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siti Nadiah Busyra","family":"Mat Nadzir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zanariah","family":"Zaini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manimaran","family":"Krishnan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2361-4780","authenticated-orcid":true,"given":"Ponnusamy","family":"Subramaniam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"key":"pone.0318381.ref001","unstructured":"UNFPA Ua. Families on the Edge (Issue 4) Two-steps forward, one step back: The new normal for Malaysia\u2019s urban poor? 2021. Contract No.: 4."},{"issue":"10","key":"pone.0318381.ref002","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1177\/0706743720935646","article-title":"COVID-19 impacts on child and youth anxiety and depression: challenges and opportunities","volume":"65","author":"D Courtney","year":"2020","journal-title":"Can J Psychiatry"},{"issue":"3","key":"pone.0318381.ref003","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1007\/s11126-020-09744-3","article-title":"The effect of COVID-19 on youth mental health","volume":"91","author":"L Liang","year":"2020","journal-title":"Psychiatr Q"},{"key":"pone.0318381.ref004","doi-asserted-by":"crossref","first-page":"826911","DOI":"10.3389\/fpubh.2022.826911","article-title":"Profiles of Stress and Coping Associated With Mental, Behavioral, and Internet Use Problems Among Adolescents During the COVID-19 Pandemic: A Stratified Random Sampling and Cluster Analysis","volume":"10","author":"R She","year":"2022","journal-title":"Front Public Health"},{"issue":"11","key":"pone.0318381.ref005","doi-asserted-by":"crossref","first-page":"1218-1239.e3","DOI":"10.1016\/j.jaac.2020.05.009","article-title":"Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19","volume":"59","author":"ME Loades","year":"2020","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"11","key":"pone.0318381.ref006","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1001\/jamapediatrics.2021.2482","article-title":"Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis","volume":"175","author":"N Racine","year":"2021","journal-title":"JAMA Pediatr"},{"issue":"2","key":"pone.0318381.ref007","first-page":"58","article-title":"Covid-19 pandemi s\u00fcrecinde ergenlerin depresyon-anksiyete d\u00fczeyleri ve ba\u015fa \u00e7\u0131kma stratejileri","volume":"10","author":"F Turk","year":"2021","journal-title":"Turkish J Education"},{"issue":"4","key":"pone.0318381.ref008","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1002\/smi.3039","article-title":"Coping among public safety personnel: A systematic review and meta-analysis","volume":"37","author":"PM Di Nota","year":"2021","journal-title":"Stress Health"},{"issue":"3","key":"pone.0318381.ref009","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1080\/01639625.2017.1422457","article-title":"Moving Beyond Anger and Depression: The Effects of Anxiety and Envy on Maladaptive Coping","volume":"40","author":"AZ Daniels","year":"2018","journal-title":"Deviant Behavior"},{"issue":"2","key":"pone.0318381.ref010","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1007\/s11469-020-00422-w","article-title":"The Role of Avoidance Coping and Escape Motives in Problematic Online Gaming: A Systematic Literature Review","volume":"20","author":"F Melodia","year":"2020","journal-title":"Int J Ment Health Addiction"},{"issue":"1","key":"pone.0318381.ref011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40429-019-0237-z","article-title":"Dissociation in Problematic Gaming: a Systematic Review","volume":"6","author":"F Guglielmucci","year":"2019","journal-title":"Curr Addict Rep"},{"key":"pone.0318381.ref012","article-title":"Brief assessment of adaptive and maladaptive coping strategies during pandemic","author":"P Cortez","year":"2023","journal-title":"Trends in Psychology"},{"key":"pone.0318381.ref013","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1192\/bjp.186.4.297","article-title":"Help-seeking behaviour in men and women with common mental health problems: cross-sectional study","volume":"186","author":"MI Oliver","year":"2005","journal-title":"Br J Psychiatry"},{"issue":"3","key":"pone.0318381.ref014","doi-asserted-by":"crossref","first-page":"110","DOI":"10.30597\/mkmi.v17i3.13827","article-title":"Differences in Help-Seeking Behavior in Adolescents with Anxiety Disorder During the COVID-19 Pandemic","volume":"17","author":"EI Mustikawati","year":"2021","journal-title":"MKMI"},{"key":"pone.0318381.ref015","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/1471-244X-12-81","article-title":"A systematic review of help-seeking interventions for depression, anxiety and general psychological distress","volume":"12","author":"A Gulliver","year":"2012","journal-title":"BMC Psychiatry"},{"issue":"10","key":"pone.0318381.ref016","doi-asserted-by":"crossref","first-page":"995","DOI":"10.4103\/indianjpsychiatry.indianjpsychiatry_667_23","article-title":"Stigma towards mental illness in Asian nations and low-and-middle-income countries, and comparison with high-income countries: A literature review and practice implications","volume":"65","author":"M Vaishnav","year":"2023","journal-title":"Indian J Psychiatry"},{"key":"pone.0318381.ref017","article-title":"The relationship between social supports on mental health among university students in Klang Valley","author":"S Amin","year":"2024","journal-title":"International Journal of Academic Research in Business and Social Sciences"},{"key":"pone.0318381.ref018","article-title":"The development of adolescent mental health services in Malaysia: A review","author":"H Pauzi","year":"2023","journal-title":"International Journal of Academic Research in Business and Social Sciences"},{"key":"pone.0318381.ref019","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1002\/9781118993811.ch21","article-title":"Lazarus and Folkman\u2019s psychological stress and coping theory.","volume-title":"The handbook of stress and health: A guide to research and practice","author":"A Biggs","year":"2017"},{"key":"pone.0318381.ref020","doi-asserted-by":"crossref","unstructured":"Braun V, Clarke V. Thematic analysis. APA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological. APA handbooks in psychology\u00ae. Washington, DC, US: American Psychological Association. 2012. p. 57\u201371.","DOI":"10.1037\/13620-004"},{"issue":"4","key":"pone.0318381.ref021","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: exploring its conceptualization and operationalization","volume":"52","author":"B Saunders","year":"2018","journal-title":"Qual Quant"},{"issue":"3","key":"pone.0318381.ref022","article-title":"Munsell LOMCM. Coping with COVID","volume":"31","author":"SE Munsell","year":"2020","journal-title":"Educational Research: Theory and Practice"},{"key":"pone.0318381.ref023","doi-asserted-by":"crossref","unstructured":"Zhou J, Yuan X, Qi H, Liu R, Li Y, Huang H, et al. Prevalence of depression and its correlative factors among female adolescents in China during the coronavirus disease 2019 outbreak. Global Health. 2020;16(1):69.","DOI":"10.1186\/s12992-020-00601-3"},{"issue":"4","key":"pone.0318381.ref024","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1177\/1359105320967086","article-title":"Psychological symptoms of the outbreak of the COVID-19 confinement in Spain","volume":"27","author":"P Odriozola-Gonz\u00e1lez","year":"2022","journal-title":"J Health Psychol"},{"issue":"1","key":"pone.0318381.ref025","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13034-022-00474-x","article-title":"Adolescents\u2019 mental health and maladaptive behaviors before the Covid-19 pandemic and 1-year after: analysis of trajectories over time and associated factors","volume":"16","author":"L Pedrini","year":"2022","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"pone.0318381.ref026","doi-asserted-by":"crossref","unstructured":"Demuthova S, Demuth A. Self-Harm in Adolescence as Maladaptive Coping. BRAIN Broad Research in Artificial Intelligence and Neuroscience. 2020;11(2Sup1):37-47.","DOI":"10.18662\/brain\/11.2Sup1\/92"},{"issue":"7","key":"pone.0318381.ref027","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.3390\/healthcare10071334","article-title":"School Students\u2019 Concerns and Support after One Year of COVID-19 in Austria: A Qualitative Study Using Content Analysis","volume":"10","author":"A Jesser","year":"2022","journal-title":"Healthcare (Basel)"},{"issue":"3","key":"pone.0318381.ref028","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1037\/0022-3514.54.3.466","article-title":"Coping as a mediator of emotion","volume":"54","author":"S Folkman","year":"1988","journal-title":"J Pers Soc Psychol"},{"key":"pone.0318381.ref029","unstructured":"Stemmet L. General and specific avoidance coping. The Development and Validation of a New Scale. [Psychology]: University of Canterbury; 2013."},{"issue":"1","key":"pone.0318381.ref030","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s40359-021-00603-9","article-title":"How have people been coping during the COVID-19 pandemic? Patterns and predictors of coping strategies amongst 26,016 UK adults","volume":"9","author":"M Fluharty","year":"2021","journal-title":"BMC Psychol"},{"issue":"20","key":"pone.0318381.ref031","doi-asserted-by":"crossref","first-page":"10947","DOI":"10.3390\/ijerph182010947","article-title":"The Impact of Different Coping Styles on Psychological Distress during the COVID-19: The Mediating Role of Perceived Stress","volume":"18","author":"Y Ding","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0318381.ref032","first-page":"1","article-title":"Coping with COVID-19 stress: Associations with depression and anxiety in a diverse sample of U.S. adults","author":"MJ Coiro","year":"2021","journal-title":"Curr Psychol"},{"issue":"2","key":"pone.0318381.ref033","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jbct.2023.05.005","article-title":"The association between coping behaviors and the interpersonal theory of suicide in college students","volume":"33","author":"Z Hussain","year":"2023","journal-title":"Journal of Behavioral and Cognitive Therapy"},{"key":"pone.0318381.ref034","doi-asserted-by":"crossref","first-page":"1182309","DOI":"10.3389\/fpsyg.2023.1182309","article-title":"Internalizing and externalizing symptoms in children during the COVID-19 pandemic: a systematic mixed studies review","volume":"14","author":"A Levante","year":"2023","journal-title":"Front Psychol"},{"issue":"65","key":"pone.0318381.ref035","doi-asserted-by":"crossref","first-page":"320","DOI":"10.17066\/tpdrd.1138538","article-title":"Evaluation of Children\u2019s Anxiety During the Pandemic Based on Their Drawings","volume":"12","author":"FN ARAS KEMER","year":"2022","journal-title":"T\u00fcrk Psikolojik Dan\u0131\u015fma ve Rehberlik Dergisi"},{"key":"pone.0318381.ref036","doi-asserted-by":"crossref","first-page":"706168","DOI":"10.3389\/fpsyg.2021.706168","article-title":"Parental Mental Health and Hostility Are Associated With Longitudinal Increases in Child Internalizing and Externalizing Problems During COVID-19","volume":"12","author":"JE Khoury","year":"2021","journal-title":"Front Psychol"},{"issue":"3","key":"pone.0318381.ref037","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1017\/S0954579421001309","article-title":"The interplay between parenting and environmental sensitivity in the prediction of children\u2019s externalizing and internalizing behaviors during COVID-19","volume":"35","author":"F Lionetti","year":"2023","journal-title":"Dev Psychopathol"},{"issue":"22","key":"pone.0318381.ref038","first-page":"1","article-title":"Global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents between 1989 and 2018: A meta-analysis","volume":"16","author":"K Lim","year":"2019","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"pone.0318381.ref039","doi-asserted-by":"crossref","DOI":"10.1590\/1413-82712021260410","article-title":"Self-harming adolescents: how do they perceive and explain this behavior?","volume":"26","author":"L Selbach","year":"2021","journal-title":"Psico-USF"},{"key":"pone.0318381.ref040","doi-asserted-by":"crossref","first-page":"104641","DOI":"10.1016\/j.cognition.2021.104641","article-title":"How peer influence shapes value computation in moral decision-making","volume":"211","author":"H Yu","year":"2021","journal-title":"Cognition"},{"key":"pone.0318381.ref041","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.neubiorev.2016.04.003","article-title":"Nicotine, adolescence, and stress: A review of how stress can modulate the negative consequences of adolescent nicotine abuse","volume":"65","author":"E Holliday","year":"2016","journal-title":"Neurosci Biobehav Rev"},{"key":"pone.0318381.ref042","doi-asserted-by":"crossref","first-page":"107365","DOI":"10.1016\/j.addbeh.2022.107365","article-title":"Nicotine vaping for relaxation and coping: Race\/ethnicity differences and social connectedness mechanisms","volume":"132","author":"CD Donaldson","year":"2022","journal-title":"Addict Behav"},{"key":"pone.0318381.ref043","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2174\/1745017901208010047","article-title":"Formal and informal help-seeking for mental health problems. A survey of preferences of italian students","volume":"8","author":"B D\u2019Avanzo","year":"2012","journal-title":"Clin Pract Epidemiol Ment Health"},{"issue":"4","key":"pone.0318381.ref044","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.adolescence.2010.09.004","article-title":"Trust, autonomy and relationships: the help-seeking preferences of young people in secondary level schools in London (UK)","volume":"34","author":"G Leavey","year":"2011","journal-title":"J Adolesc"},{"issue":"2","key":"pone.0318381.ref045","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s00787-019-01469-4","article-title":"Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies","volume":"30","author":"J Radez","year":"2021","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"1","key":"pone.0318381.ref046","doi-asserted-by":"crossref","first-page":"391","DOI":"10.5334\/pb.1034","article-title":"COVID-19 Help-Seeking Behaviors: Application of the Theory of Planned Behavior","volume":"61","author":"M Aldalaykeh","year":"2021","journal-title":"Psychol Belg"},{"issue":"1","key":"pone.0318381.ref047","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1080\/07853890.2022.2154943","article-title":"Perceived social support and COVID-19 impact on quality of life in college students: an observational study","volume":"55","author":"A Cahuas","year":"2023","journal-title":"Ann Med"},{"key":"pone.0318381.ref048","doi-asserted-by":"crossref","first-page":"2780","DOI":"10.3389\/fpsyg.2018.02780","article-title":"Coping With Depressive Symptoms in Young Adults: Perceived Social Support Protects Against Depressive Symptoms Only Under Moderate Levels of Stress","volume":"9","author":"M Ioannou","year":"2019","journal-title":"Front Psychol"},{"issue":"11","key":"pone.0318381.ref049","doi-asserted-by":"crossref","first-page":"2577","DOI":"10.1111\/jan.12423","article-title":"Factors that influence young people\u2019s mental health help-seeking behaviour: a study based on the Health Belief Model","volume":"70","author":"PJ O\u2019Connor","year":"2014","journal-title":"J Adv Nurs"},{"key":"pone.0318381.ref050","doi-asserted-by":"crossref","first-page":"101789","DOI":"10.1016\/j.ijdrr.2020.101789","article-title":"Personality, trait EI and coping with COVID 19 measures","volume":"51","author":"C Prentice","year":"2020","journal-title":"Int J Disaster Risk Reduct"},{"key":"pone.0318381.ref051","doi-asserted-by":"crossref","unstructured":"Naidu ES, Paravati E, Gabriel S. Staying happy even when staying 6 ft apart: The relationship between extroversion and social adaptability. Personality and Individual Differences. 2022;190:111549.","DOI":"10.1016\/j.paid.2022.111549"},{"issue":"11","key":"pone.0318381.ref052","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1177\/01461672211050515","article-title":"Helpful or Harmful? The Role of Personality Traits in Student Experiences of the COVID-19 Crisis and School Closure","volume":"48","author":"K Iterbeke","year":"2022","journal-title":"Pers Soc Psychol Bull"},{"issue":"13","key":"pone.0318381.ref053","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1177\/1049732318788379","article-title":"Generalizability in Qualitative Research: A Tale of Two Traditions","volume":"28","author":"L Carminati","year":"2018","journal-title":"Qual Health Res"},{"issue":"11","key":"pone.0318381.ref054","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1016\/j.ijnurstu.2010.06.004","article-title":"Generalization in quantitative and qualitative research: myths and strategies","volume":"47","author":"DF Polit","year":"2010","journal-title":"Int J Nurs Stud"},{"key":"pone.0318381.ref055","doi-asserted-by":"crossref","first-page":"211","DOI":"10.2147\/JMDH.S104807","article-title":"Information bias in health research: definition, pitfalls, and adjustment methods","volume":"9","author":"A Althubaiti","year":"2016","journal-title":"J Multidiscip Healthc"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0318381","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T17:56:54Z","timestamp":1742579814000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0318381"}},"subtitle":[],"editor":[{"given":"Adobea Yaa","family":"Owusu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,21]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0318381","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,21]]}}}