Reviewer's report
Title:Exploratory randomized controlled trial of a group psychological intervention
for Postnatal Depression in British mothers of South Asian origin - A post
intervention qualitative study
Version:3Date:7 May 2015
Reviewer: Huynh-Nhu Le
Reviewer's report:
This study explored a subsample of 17 women who had participated in an
exploratory randomized controlled trial evaluating the feasibility and acceptability
of a culturally adapted cognitive behavioral intervention (Positive Health
Programme or PHP) for postnatal depression in British South Asian women. This
is an interesting follow up study that is typically not conducted in intervention
trials, and is important to understand qualitatively women’s experiences with an
intervention post-intervention. However, several issues can be further clarified to
improve the quality of the manuscript.
Major compulsory revisions
1. Background (paragraph 1): the authors cite one article based on the EPDS to
indicate that ethnicity is a risk factor for postnatal depression. However, ethnicity
as a risk factor is mixed in the overall research, which should be noted in the
introduction.
2. Background (paragraph 2): the authors note that British Pakistani women have
the highest birthrates in the UK. Are there any data suggesting that they may
have higher rates of postnatal depression? This should be clarified, as this is
assumed in this manuscript.
3. Background/Main Trial paragraph describes the RCT that was conducted. This
section was a bit confusing and difficult to follow because this was not the main
part of this study. For example, there were results provided with measures (DAS,
Hamilton) that were never defined a-priori. It was not until the aims section (2
pages later) that the reader found out the purpose of this qualitative study. In
addition, given that the main quantitative findings were not overall positive, did
the authors consider asking participants about why this intervention was not
efficacious in reducing symptoms of depression (above and beyond finding out
that this was acceptable/feasible)? It would help the reader to make this section
much shorter to get to the point more quickly.
4. The intervention was based on cognitive behavioral theory; however, there
was limited description of this actual model and the 9 sections that pertained to
this model. Self-esteem and confidence were important to consider for the
cultural adaptation for Pakistani women.
5. The authors are commended for having bilingual research staff and facilitators.
As a reviewer, I wondered why this intervention was also not also translated in
the first place as part of the intervention adaptation phase – especially as
language seems to be a prominent barrier to care.
6. The definition of “completer” was 4 or more classes out of 12. This seems to
be a very conservative definition, as the mean number of classes was 6. It would
help to note this as a limitation in the discussion section. However, this is also
interesting in that although the average number of sessions attended was low,
some of these women mentioned wanting more sessions.
7. Method/Recruitment section: The authors indicated that participants in this
qualitative study were randomly selected from the intervention participants. Did
this random selection take into account the attendance data - e.g. completers vs.
non completers? If not, how would this affect the results collected?
8. Method/Analysis/results section: Please specify and clarify the language in
which the interviews, analyses, and results were in. For example, what was the
language of the interviews? Was the coding and analysis conducted in the same
language as the interviews? Were the results translated into English and
presented in the results section?
9. Discussion – overall, this was well described. A little more information on the
partner dynamics and Pakistani culture would have been helpful here to
understand women’s motivation to attend these courses.
- Minor Essential Revisions
1. Specify the number of participants in the abstract
2. The O’Hara & Swain review article is out of date. Since 1996, there have been
several meta-analyses and systematic reviews that have been conducted to
report on the prevalence of postpartum depression. These figures and citations
should be updated.
- Discretionary Revisions
1. The title can be better reflected to note that this included a subsample of your
larger RCT study.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.