Reviewer's report
Title:Emotional Suppression and Depressive Symptoms in Women Newly
Diagnosed with Early Breast Cancer
Version:3Date:6 July 2015
Reviewer: Jingwei Wu
Reviewer's report:
This paper investigated the incidence of depressive symptoms in the women
newly diagnosed with early breast cancer in mainland China and also examined
the relationships of emotional suppression and depressive symptoms in the
patients. The descriptive and regression analyses concluded that emotional
suppression was related with depressive symptoms in women newly diagnosed
with breast cancer; anger suppression played an important role among the
others.
Major Compulsory Revisions:
1. Method: Although authors spend two paragraphs to describe CECS (The
Chinese version of Courtauld Emotional Control Scale), it is still unclear how
items are rated. Is this also a X-point Likert scale instrument? If so, how the
score range is ranging from?
2. Result: Page 11, line 13, the authors mentioned ‘no depression’, ‘clinical
depression ‘, and ‘major depression’, those terms are not defined previously. Are
they classified based on ‘CESD<16’, ‘16<=CESD<27’ and ‘CESD>=27’? To me,
if you use cut-point of 16, you should get similar incidence of depressive
symptom (36.4% v.s. 34.8%) between two groups. In other words, the distinct of
depressive symptoms happened only for the severe (or major depression)? A
3x2 table may be useful for us to understand the distribution of CESD (classified
by levels) and two groups.
3. Did the authors check the distribution of each variable? To me, years of
schooling must be highly skewed, so the Pearson correlation may not be an
appropriate method, maybe need to report Spearmen’s Coefficient instead.
4. Page 12, line 16, ‘type of sample’, what did it mean? Group (patients/healthy
women)? Please clarify, this term also appeared in the abstract, please make
sure the readers can understand its definition at the beginning.
5. In table 2, last variable ‘Total emotional suppression’ is displayed, but in the
paper, it is not defined. I am assuming it is the sum of the three subscales,
please clarify. Also, is there any missingness of your data? If patients had
missing data in one of the subscale, it is not appropriate to sum them up (you will
have to use mean imputation method to calculation the total score instead).
Please provide missingness of your study data.
6. My big concern is the collinearity issues in your multiple regression model. In
table 3, authors had already demonstrated strong correlation among three
subscale of suppression, in step 3 of regression model, those three highly
correlated items were put into the model altogether, there must be a severe
collinearity problem. Also, anxiety symptoms are also highly correlated with
anxiety suppression. Can authors provide us diagnosis statistics for
multi-collinearity?
7. Discussion: Related to #6 comment, it may not be surprised to only see anger
suppression is significant associated with depressive symptom due to the
collinearity problem, but you may potentially lost the important information that
anxiety/depression suppression are also very relevant variables in relation to
depressive symptom (again, take a look at Table 3, those correlation coefficients
are high).
Minor Essential Revisions:
1. On page 7, line 8, authors mentioned ‘Of 255 women who met the first three
inclusion criteria,…’, but I only saw two inclusion criteria in line 1-2. Please justify.
2. In Table 1, I’d rather out statistics and p-values for these categorical variables
in the line with each variable. For example, put ‘1.021, 0.796’ in the line of
‘Educational Level (%)’ etc.
3. Some grammar correction: for example, page 3, line 7, change to ‘China
presented…’; also page 4, line 9, need to change to ‘by calculation..’
4. I think author need to change keyword ‘emotion suppression’ to ‘emotional
suppression’ since this is the terms used throughout the whole article.
Discretionary Revisions:
1. The authors always used ‘the mean of a variable is A+/- B…’. I’d rather to
change to ‘the mean (+/- SD) of a variable is A (+/- B)…’
2. Page 4 line 5 should change to ‘20% to 30%’
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