Reviewer ’s report  
 
Title: Correlates of depressive symptoms in late middle -aged Taiwanese women: Findings fro m 
the 2009 Taiwan National Health Interview Survey  
 
Version: 4 Date: 05 Mar 2017  
 
Reviewer: Masakazu Terauchi  
 
Reviewer's report:  
 
It is disappointing that the authors seem to be satisfied stating that "... the presence of 
psychological symptoms ... did not appear to increase the risk of depressive symptoms. This 
finding is not too surprising since the C ES-D 10 was used to assess overall depressive symptoms 
whereas the variable "psychological climacteric symptoms" focused only on climacteric -related 
psychological symptoms (P12 L216 -)." The items on the authors' "psychological climacteric 
symptoms", namely  "anxiousness, dysphoria, panic attacks, feeling depressed, and forgetfulness" 
have been repeatedly shown to be associated with, or almost identical to, the depressive 
symptoms, such as listed on CES -D 10. It would not be likely that a woman answers differ ently 
to these two questionnaires just because one is general depression checklist and the other is one 
focusing on menopause. The authors should definitely elaborate on why these two closely 
associated variables have so low correlation coefficient, as thi s kind of contradiction undermine 
the study's credibility.  
 
For this new research question I consider that a different statistical approach should be used. As I 
understand, the new research question has  a descriptive character. The aim of the authors is to 
report the prevalence of depressive symptomatology in a population -based sample and 
investigate associated socio -demographic and health characteristics. For that reason, I would 
prefer to see only desc riptive statistic and no exploratory analysis.  
 
Again Table 1 needs no p -values; there are no hypotheses behind that arbitrary testing. The 
reader can see whether depressed mood participants or non -depressed participants are similar or 
different on those ch aracteristics independently of statistical significance.  
 
Furthermore, the choice of an automated backward selection is not clear to me. The use of 
automated backward selection has been severely criticized and it is recommended not to use it to 
take decisio ns about inclusion of covariates in a model (McNamee R, Occup Environ Med 2005; 
62:500 -6). If a variable is a possible confounder, you need to control for it independently of the 
statistical significance. For example in the association between being marrie d and depressive 
symptoms, a variable such as age could be a confounding factor. When analyzing the association 
between marital status and mental health, it is important to account for the mental health 
problems related to the age of people who get divorce d (maybe younger or older as the others). 
As a final point, many of the variables included (and probably several from those excluded) in 
the multivariate model are collinear, which impacts the validity of the model.  
 
 
Minor points:  
Psychological climacteric symptoms includes depressed mood. I would suggest removing that 
item, to avoid the item's correlation with the depressed symptomatology.  
 
Do you have information on social support? It would be very valuable to include it on the 
analyses.  
 
The association bet ween physical activity and depressed mood could also be due to reverse 
causality.  
 
 
 
 
Are the methods appropriate and well described?  
If no t, 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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by t he data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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, ple ase specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
 
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