Reviewer ’s report  
 
Title: Loneliness among mothers raising children under the age of 3 year s and predictors with  
special reference to the use of SNS: A community -based cross -sectional study  
 
Version: 0 Date: 07 Mar 2017  
 
Reviewer: Nicola Beamish  
 
Reviewer's report:  
Thank you for the opportunity to review this most interesting and well conducted stud y. I have 
thoroughly enjoyed reading it. I offer some detailed feedback about the paper for consideration by 
the authors. I hope is helpful.  
General comments  
1. Please consider taking out abbreviations as they make reading more difficult.  
Title  
2. Infant is often defined as 0 -1 years old in the literature. Please consider defining infant 
more broadly to include the early years or changing the title to include up to three year olds.  
Background - The background was easy to read and informative. It i ncluded information about the 
universal struggles of parenthood in a changing society and the role and effects of loneliness. As 
well the authors presents an interesting insight into the Japanese culture and the particular issues 
that exist in Japan relate d to cultural beliefs about being a woman with children and the role fathers 
take in raising children.  Specific revisions for consideration are:  
3. Please consider some revision of Lines 85 -89. The sentences appear to be incomplete and 
this makes understa nding more difficult.  
4. Line 105 - I wonder if it should read "assessing SNS use..."   
5. Lines 100 and 105 - "recognition patterns of interpersonal relationship" is not a term I am 
familiar with. Perhaps this needs to be explained or re worded?  
Methods - The methods is overall well written. I do not consider myself qualified to assess statistics 
in the manuscript so have recommended additional statistical review. However, the descriptions 
of participants is easy to understand, as are descriptions of the use  and development of the 
questionnaire and statistical analysis. Specific revisions for consideration are:  
6. Line 125 - "women aged in their 10s to 30s" - should this read 20s to 30s?  
7. Line 131 - please consider if a brief description of interpersonal perce ption patterns or 
examples of what they are would help the reader understand this concept.  
8. Line 136 - 140- Please consider more information on why the pre -test results lead to use of 
the secure attachment subscale only. When reading, I am unclear about w hy that decision was 
made.  
9. Line 143 - please check whether the K6 measures anxiety and mood disorders (also in line 
268). I understanding is that the K6 measures psychological distress and discriminates between 
those with and without serious mental illne ss. I am not sure whether it has any role in providing 
diagnostic information about depression and anxiety.  
Results - I do not feel qualified to assess the statistics in the manuscript, I have recommended 
additional review. However, I make these comments.  
10. The descriptions of recruitment, participation in trial and failure to complete survey 
numbers are clearly presented in word and in the participant flow chart.  
11. Participants characteristics are presented in table 1 with clear reference in the body of the 
paper to characteristics that were associated with a sign difference in  loneliness score. I just 
comment that an association was reported with age, however the study included very few young 
mothers (n=5). I wonder if this needs to be reported here as well as in the limitations?  
12. I found the descriptive data in table 2 very interesting and think that providing more of this 
data in the body of the study may interest international readers. For example, it is my experience 
that in other countries, s uch high levels of intact families with parents who live in would be 
uncommon, and a wide spread of educational levels would not be common in a study of mothers. 
I was also interested that despite the introduction identifying a very low level of father inv olvement 
in child raising, 88% if mothers said they receive help from their spouse. All the above could be 
interesting to present in the discussion as well as limitations.  
13. Line 181 - 195. Line 181 states "Mean Loneliness Scale scores according to each group as 
categorized by basic characteristics are shown in Table 2." It seems the p values are related to the 
significance of an association with loneliness in each descriptive domain measured. If so, I am not 
clear of the significance of any difference fo und within groups, especially as the SD appear often 
to overlap within a group, Could a p value have been provided for each group within the descriptive 
domains?   
14. Line 186 - states "Loneliness Scale scores for teenage mothers were 10 points higher than  
mothers in their 20s and 30s". Please consider reviewing how this finding is presented including 
more information about the significance of the findings. My reading of table 2 is that participants 
less than 19 years old were very few (n=5) and also that l oneliness increased in older mothers (40 -
49) which is a finding not presented in the body of the work.  
15. Line 204 -206. This is a very interesting finding and doesn't seem to be noted elsewhere in 
the study - i.e. not in discussion. Need to consider repo rting here on significance of finding? It also 
seems to go against the conclusions of the study that increase time on smartphones increases 
loneliness. My impression of the data is that if the difference within the loneliness scale is 
significant, what tab le 4 shows is that not having a smartphone and very little smartphone use 
(<0.5hours) is associated with higher levels of loneliness (very similar to use of greater than 3 
hours), and that there are is perhaps an optimal time for use with an association oc curring between 
use of 0.5 -2 hours a day and lower loneliness  
16. Line 204 -208- I am not sure whether the statements here reflect the findings in table 4 - it 
seems on my reading that the most important finding might be that most mothers don't own a tablet 
or traditional cell phone. While scores in the tablet group and time using a tablet do appear to 
increase with time of use, the n is very small (down to one participant in greater than 3 hours/day 
use). That is, I am uncertain how clinically significant or  reliable the reported findings re tablet 
use are, beyond that mothers preferred mobile interface is clearly smartphones.  
17. Line 210 - 218 and table 5 - Please considering providing a more detailed account in the 
body of the paper, including descriptive da ta, related to phone use versus other ways that mothers 
seek information. For example, I was interested that most mothers never use SNS to seek 
information (64%),  and of those who do 11.5% do so only once a month, with only 7%  were 
using it twice a week.  Compared to this almost all mothers use their parents as an information 
source, and 32.2% are doing this twice a week. In relation to friends, it seems that many mothers 
(41%) are only using friends as an information source once a month and neighbours rar ely (57% 
never, 18% once a month). This makes me wonder why? My comments re these finding are, it 
seems parents are trusted and regular sources to seek advice and perhaps the authors could consider 
hypotheses why in the discussion. It also seems that frien ds and neighbours are not regular sources 
of information, again consideration of why in the discussion would be very interesting. I do wonder 
if this table is presenting different and overlapping things, ie are there two things presented -? The 
first  might  be who parents turn to (parents, friends, neighbours, specialists),  and the second might 
be how they access information (government home pages, company homepages, personal 
homepages, SNS, magazine/books, TV, Pamphlets). Please consider whether reporting this data 
differently would assist the reader in understanding the findings.  
18. Lines 220 - 233 including table 6 - recommend further statistical review on the basis of my 
lack of expertise in this area.  
19. The low scores on the internal working model and their association with loneliness are an 
interesting finding. It is only presented in passing in the results but is appropriately considered in 
the discussion at greater length. I would have been interested to see what the study found if insecure 
subscales  were gathered in the method (I have already commented on this in the comments re the 
methods). Please consider whether further information in the results could be presented in the 
paper. My immediate question was how might seeking of information from othe rs be affected by 
lower secure attachment score, and do the attachment scores interact with SNS use or frequency 
of use?  
Discussion - Please consider revision of the discussion.  Please note also that I think that the 
findings of the study are very interest ing, and that the discussion is certainly well written and 
interesting reading. Specific revisions for consideration are:  
20. One question I have about the discussion and its focus relates to the title/aim and focus of 
the paper. The title of the paper sug gests consideration of SNS use in loneliness is the focus, but 
the aims of the study were far broader (the social and personal factors influencing loneliness).  I 
think that the authors need to consider what it is that they want to focus on in this paper. My interest 
is in device use in parents and the effects on parenting and children, so I was left wanting more 
discussion of this in relation to the findings. If the authors wishes is to focus on SNS use, then that 
requires a more focused discussion on the complex findings of the study in relation to SNS and 
smartphone use and how this interacts with loneliness, as well as more focus on the literature in 
the area of how people use internet enabled interfaces to seek information and what effect this use 
has o n loneliness (there is little literature in parents/mothers - but there is some - and more literature 
related to intimate and family relationships including some on personality style and social media 
use). If the focus is intended to be more on the social an d personal factors that affect loneliness, 
then the title perhaps needs to be reconsidered and SNS use just considered a one personal/social 
feature to be considered with others, in which case the discussion fits quite well with the aims of 
the study.  
21. The discussion at times seems to raise ideas that are not supported by the study or elsewhere 
(for example line 255 - that tablets are more likely to be used as gaming devices and line 276 - that 
teenage mother's relationship with her mother is not strong).  Adding references to these comments, 
or being more clear that this is a potential but untested reason for the findings would be helpful.  
22. I am not sure that the discussion of device/SNS use related to loneliness well represents 
the findings of the stu dy. Please consider review of this. I have outlined my thoughts on this in the 
results comments.  
Limitations - the limitations are well considered and presented. I have already made comments on 
other things that might be discussed as limitations in comments  11 and 12.  
23. Another comment, perhaps not so much a limitation of the study, but rather an area that 
needs further investigation in future studies, is that the study is not able to provide information on 
what mothers used their smartphones for, and how  much of their use was on SNS. I think that this 
limits how the findings in relation to smart phone use and loneliness are interpreted, ie the study 
doesn't know why/how mothers are using their phones. This is a significant gap in the literature 
world wide . 
Conclusions - I am not sure that the conclusions support my reading of the findings. Specifically, I 
think there is evidence of a more complicated relationship between device use and loneliness that 
is not presented (for example that not having a smartpho ne has an association with loneliness, or 
lower amounts of daily phone use may reduce loneliness).  
Again, thank you for allowing me to read this most interesting paper. It is clearly the result of a 
rigorous research project. I hope that my comments are h elpful. My intention has been to offer 
them as constructive not critical comments and hope that they have been read in that way.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in the manuscript or would you recommend an additional 
statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
I recommend additional statistical review  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, fund ing, or salary from an 
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3. Do you hold or are you currently applying for any patents relating to the content of the 
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or has applied for patents relating to the content of the manuscript?  
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