Title: Mental health of clinic-attending Syrian refugee women in Jordan: associations between
social ecological risks factors and mental health symptoms
Version: 3 Date: 03 Dec 2021
Reviewer's report:
The authors considered all comments and suggestions and incorporated them.
I believe that a new round of revision is no longer necessary because all the essentials have
been settled.
But the authors are asked to check a few sentences that might be reworded.
Lines 120-122
Having a husband and children(s) may also be a seen as risk factor for women, as women may
prioritize the needs of their family instead of their own [24]
Please check what is with that "a" from "also be a seen as risk factor".
Lines 148 149 If you refer to Table 1, I believe that it is the frequency distribution, the percentage
of risk factors among those with and without mental condition, and not the frequency distribution
of mental health conditions.
Please check where the 100% total is.
For example Marriage status with 2 answer alternatives (unmarried and married):
Out of a total of 507 respondents, 9.86% are unmarried while 90.14% are married.
Out of a total of 319 persons with depression, 11.91% are unmarried and 88.09% are married
couples living together. And of the 188 people without depression, 6.38% are unmarried and
93.62% are married.
So this is the distribution of marital status among those with depression, without depression and
in total.
In order to have the distribution of the mental condition here, it would have been necessary
to calculate how many depressed people are unmarried, so it would have been necessary to
calculate how many represent 38 of the 50 unmarried respondents and 100% would have been
the total horizontally.
.....First, we examine the frequency distribution of depression, anxiety, and PTSD among our
sample of Syrian refugee women.
Same problem on lines 238-240.
Descriptive statistics were used to examine sociodemographic characteristics of Syrian refugee
women, and to examine the frequency distribution of depression, anxiety, and PTSD.
Lines 221-223
I think you need to tune the subject to the predicate ("were" instead of "was")
......Postmigration Stressors: Postmigration stressors was measured using the Postmigration
Living Difficulties (PMLD) checklist.
On line 284, you say ....PCL-5 scores ranged from 0 to 78. Isn't it 0 to 80?
Lastly, PCL-5 scores ranged from 0 to 78,
On lines 289-293, check the use of "than" and "then".
…and Syrian region of origin (p=0.002) than compared to those without depression.
Furthermore, women with anxiety had significant differences in the years in Jordan (p=0.0129),
time displaced in Syria (p=0.026), clinic location (p<0.001), and Syrian region of origin
(p=0.005), then compared to those without anxiety.
lines 307-308 Please, cancel one of the 2 "also"
.....We also found a higher proportion of women with anxiety and PTSD were also unmarried;
Please reformulate: lines 334-337
......A total of 11 of the 14 postmigration stressors examined, a significantly higher proportion of
women with a mental health condition viewed postmigration stressors as a big/very big problem.
Did you want to say that in the case of 11 of the 14 stressors, among women with depression,
anxiety or PTSD, compared to women without depression, anxiety, PTSD the proportion of
those who recognized / perceived stressors as a very severe problem was much bigger?
Line 356 I think the figure is 64% instead of 65%.
......Women who were married also had a 65% or 66% (between 13% or 19% - 85%) decreased
odds of PTSD in the unadjusted (OR:0.34, 95% CI:[0.15, 0.81]) and adjusted (aOR:0.36, 95%
CI:[0.15, 0.87]) model.
Table 4 0.34 (0.15, 0.81) 0.36 (0.15-0.87)
Please also reword the following paragraphs:
It is not women who report something that are associated with an increase in odds, but the risk
factor (reported perception) is associated with increased odds of depression.
Lines 393-400
.....We found that women who reported isolation as a big/very big problem were significantly
associated with a 159% (between 67% - 301%) increased odds of depression in the unadjusted
model (OR:2.59, 95% CI:[1.67,4.01])…..
The association is between exposure (perception) and effect (depression, etc.).
Lines 412-415
...We found women who reported worries about not receiving treatment for health problems as a
big/very big problem was significantly associated with a 89% (between 12% - 216%) increased
odds of PTSD in the unadjusted (OR:1.89, 95% CI:[1.12,3.16]) and a 105% (14% - 268%)
increased odds in the adjusted model (aOR:2.05, 95% CI:[1.14,3.68]).
Lines 415-419
....Women who reported being unable to return home in emergency as a big/very big problem
was significantly associated with a 86% (between 11% - 212%) increased odds of PTSD in the
unadjusted model (OR:1.86, 95% CI:[1.11,3.12]) and a 98% (between 11% - 254%) increased
odds in the adjusted model (aOR:1.98, 95% CI:[1.11,3.54]).
.....Women who reported discrimination was also significantly associated with an 168%
(between 24% - 481%) increased odds of PTSD in the unadjusted model (OR:2.68, 95% CI:
[1.24,5.81]) and a 258% (between 56% - 720%) increased odds in the adjusted model (aOR:3.58,
95% CI:[1.56,8.20]).
You have used “women who reported…. Was/were associated” 7 times. 4 times you used the
expression I ask you to change, referring to the exposure factor.
You can take as a model, the expression in the other 3 cases.
Lines 400-404
....We also found women who reported poor access to psychological services as a big/very big
problem to have a 99% (between 24% - 290%) increased odds of depression in the unadjusted
model (OR:1.99, 95% CI:[1.24,3.90]) and a 71% (between 5% - 180%) increased odds in the
adjusted model (aOR:1.71, 95% CI:[1.05,2.80]).
Lines 468-470
....Women who reported IPV had approximately 175%-450% increased odds of experiencing a
mental health condition (Table 4).
Lines 486-487 - were deleted but the expression is good.
Lines 520-522
....One reason why our sample of women who reported isolation had greater odds for depression
and anxiety is because of the buffering effect a social network and social support may have on
mental health.
Lines 469-470 I think the numbers are 178% -449% (Table 4)
...Women who reported IPV had approximately 175%-450% increased odds of experiencing a
mental health condition (Table 4).
Lines 496-498 I think the numbers are 28-46% Table 4
..At the community and societal level, we found that each additional postmigration stressor
increased the odds of experiencing a mental health condition by approximately 30-50%.