Reviewer's report
Title:Depression, Social Support and Associated Factors Among Women Living
in Rural China: a Cross-sectional Study
Version:4Date:3 November 2014
Reviewer: Chee Ng
Reviewer's report:
The study aimed to examine the relationship between distress/depression and
social support among women living in rural China. It has the strength of studying
the association among a large and representative rural sample in northern
Sichuan, and unique especially for this target population in China.
• Major Revisions
1. The paper described risk and protective factors for depression in the abstract.
Yet, the authors also acknowledged that a cross-sectional study design
precludes any causal analyses. Hence describing factors such as social support
as being associated with depression would be more accurate, given that being
unemployed, having financial difficulties, having poor perception of health status,
and perceived lack of social support can each be a consequence of depression.
2. Further information about the psychometric quality of the DSSI – Chinese
version for measuring the criterion variable would further support the validity of
the finding, especially since 85% of the sample had little or no education.
3. The reader could benefit from further explanation on why women who had a
previous diagnosis of any mental problems were excluded, and how surveying
only those who were home during the day could result in sample bias that could
affect the study results.
4. Apart from perceived social support, perceived household income and health
status were particularly important factors (depression were > 10 times greater in
both groups). It would thus be of interest to the readership if these factors are
further explored in the discussion as to why there is such a strong association,
and what future study design to confirm the causal relationship.
• Minor Essential Revisions
1. The hypothesis of the study can be specified more clearly in the background.
2. Page 9, line 6 ….CES-D is not a clinical diagnostic tool (but rather is) a
self-report inventory that….
3. Although the paper has highlighted the association between depression and
social support, the readership would be curious as to why this factor has been
overlooked in current cultural context/ health system, and how this should be
address in the future health care model.
4. The conclusion on page 11 could be significantly improved. It may not be
consistent to describe that women in rural China are facing ‘psychiatric problems’
when the study has focussed on distress/ depressive symptoms rather than
using diagnostic categories. Indeed such broad criteria could be the main reason
for the high prevalence of 12.4% compared to diagnostic field survey. It is not
usual to introduce new referenced materials [57-59] that are not part of the study
findings. The ‘economic transformation of the past three decades has challenged
the family-focused basis for social cohesion’ could be included in the discussion
rather than as a study conclusion.
• Discretionary Revisions
1. Lack of significance was found in regards to the ‘left-behind’ spouses. This
was sufficiently described in the results and discussion section. Hence, to reduce
paper length Table 4 may be omitted.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests