Reviewer ’s report  
 
Title:  Perceptions of Mexican Women Regarding Barriers in Mental Health Services in Primary 
Care.  
 
Version: 0 Date: 21 Nov 2016 
 
Reviewer:  Melanie  Straiton  
 
Reviewer’s report:  
 
This article looks at the barriers Mexican women experien ce to mental health services. While the 
findings of the study can have important implications for the service, I feel the article would 
benefit from a clearer purpose. What is important or unique about this study? What new 
knowledge does this study show?  
 
Additionally, the article needs to be thoroughly proof read. The authors should also be cautious 
of using long sentences - these can be difficult to follow.  
 
In the abstract and the opening of the introduction the authors mention 'in our country' - they 
should explicitly state Mexico given that you want to publish in an international journal.  
 
 
INTRODUCTION: The introduction could be strengthened. It would benefit from more 
information about the structure of health care in Mexico. Paragraphs 2 and 3 on page 4  say are 
repetitive.  
 
The authors need to make clearer the purpose of this study and why it is needed, since they 
mention already identified barriers on page 5 and 6? What is unique about this study?  
 
 
The METHOD section would benefit from more information. For example, explain more about 
the recruitment centres in this section - are they mental health centres or Primary care ones? Who 
were the women e.g. age range / married / working etc. A lot of this comes later in the article but 
would be more useful here for setting the context inc. table 2.  
 
I don't think the sentence 'in this type of sample…can be interpreted' is necessary - this is true of 
qualitative research in general.  
 
'Intentionally selected' - 'purposively selected' is the more common phrase to use I think.  
 
Techniques and instruments: What was the overall aim of the interviews? Was it to look at 
barriers or were there other topics and themes that were discussed that are not the focus of the 
article?  
 
Analysis: Meaning categorisation - can you explain more about what this is - I'm not sure if this 
is the correct translation -  do you mean interpretative analyses? More explanation about the 
method will regardless be beneficial for the reader. Tabl e 1 appears to contain the findings - I 
don't think this should be mentioned in the method section yet.  
 
 
RESULTS: The main reasons for visits to the centres are mentioned but the authors also write 
that majority reported emotional disorders - was this par t of the inclusion criteria? Please 
mention more about this in the method.  
 
The results are split into two main barriers, each with several sub -categories. I feel some of these 
categories are very descriptive and lack interpretation (if that is the method t he authors are using) 
and are more a general reporting of what the women have said - is this more of a thematic 
analysis?  
 
To me the first section relates to the accessibility of services or more simply put, systemic 
barriers: the cost, the organisation, se rvice hours and availability of psychologists.  
 
Within the second theme - barriers associated with perception of mental disorders and 
professional care - I wonder if it would make more sense to reorganise the sub -categories into 
two different main themes - one relating to social stigma (privacy of personal problems and 
negative perceptions) and one relating to health care providers and/or communication - (the 
characteristics of the psychologists, mistrust of treatment)?  
 
Extra expenditure - this section is c onfusing because earlier the authors mention that some 
centres have psychologists but here it says that the centres do not provide mental health services  
 
 
CONCLUSIONS: I think lines 40 -50 on page 17 need more explanation - how does this relate to 
the findi ngs? Lines 54 -56 I'm not sure what the authors mean by 'continuity of this set of 
barriers'.  
 
Page 18, lines 24 -32 - did the women indicate this during the interviews? If so, perhaps mention 
this in the results section as this statement seems to come out of  the blue.  
 
If the authors decide to reorganise the results, please update the conclusions accordingly. 
Regardless, the athors should discuss characteristics and attitudes of psychologists / 
communication with clients as this is obviously an issue for some  women.  
 
Close with what this study adds to the research - at the moment this is not clear.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
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, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financial ly from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the  above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
'I declare that I have no competing interests  
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