Title: Exploring the connection between maternal mental health and partnership, parental role,
and satisfaction with various aspects of life using pairfam data: a cross-sectional analysis
Version: 2 Date: 21 Dec 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Not sure - key details are missing from the manuscript
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Not sure - key details are missing from the manuscript
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This manuscript reports the results of a secondary analysis of
existing data. It lacks several details on the methods for readers to appraise and understand the
results.
REQUESTED REVISIONS:
1. The study design must be explicitly stated in the title or abstract.
2. This study included only “mothers in a cohabiting partnership,” and this should be reflected
in the title or abstract.
3. This study used cross-sectional data; thus, the relationships found should be referred to
as associations. Terms like “predict,” “predictors,” “attributed,” “significant influence,” and
“significant effect” are not appropriate to describe the results, as they can be misleading.
4. In the abstract, revise the sentence: “It furthermore aims to identify relevant factors for disease
prevention and therapy for mothers.” This is a cross-sectional study this aim is not achievable.
5. The phrase “Aspects of the parental role” should be elaborated in the abstract.
6. The Background section requires restructuring and expansion. The research issue, maternal
mental health, should be defined and the magnitude of the problem summarized in the first
paragraph. Subsequent paragraphs should review theories and literature on the determinants of
maternal mental health, discuss the issue in the German context, and conclude with research
gaps/rationale and study aims.
7. Paragraph two appears irrelevant as this study does not focus on interventions/service use.
Instead, describe the maternal mental health status of the general population in Germany.
8. Rewrite the study aims. The “first” and “second” aims appear to be the same. Move the
methodology for addressing the aims from the Background to the Methods section.
9. The rationale for this study is unconvincing. The associations between the “three domains”
and women’s mental health are well-documented. Clarify the unique contribution of this study.
10. Clearly state the study design at the beginning of the Methods section.
11. Provide a detailed description of the “pairfam” study, including its aims, sample size,
participant recruitment, and data collection, in a separate subsection of the Methods section.
12. The “pairfam” study is longitudinal. Explain why longitudinal data were not utilized for
more robust results on directional relationships.
13. Create a separate subsection, “Participants,” detailing the inclusion and exclusion criteria
of the present study.
14. Specify the number of participants excluded due to missing data.
15. State the sample size and justify it using a sample size/power calculation.
16. Improve the description of SF-12. List the “eight subscales,” explain how SF-12 was scored,
and confirm whether it has been validated in Germany. Not all readers will be familiar with
this tool.
17. In the sentence: “A cut-off value was created by subtracting one standard deviation from the
mean value,” elaborate on the population for the standard deviation and mean value. Has the
cut-off been locally validated for women? If so, provide psychometric properties.
18. The MCS was interpreted as “A high value on the scale means a high health-related quality
of life or, in other words, a low health-related restriction”, explain why “mothers with a value <
41 on the MCS were categorized as mentally stressed, and mothers with a value # 41 as mentally
not stressed.”
19. Justify why only the three “domains” of determinants were examined.
20. Provide more details about the “Parental role.” Clarify what is meant by: “The parental role
is modeled by the variables.” Specify if “parental competence,” “unspecific strain,” “missing
autonomy in the parenting role,” and “overprotectiveness” are subscales. Detail scoring and
interpretation. What does “latent variable” mean? The term “latent variable” is usually used in
structural equation modelling.
21. Indicate whether the instruments used to assess the three “domains” are standardized or
study-specific and whether they have been validated.
22. Clarify how each of the “control variables” was measured.
23. Explain why major determinants of mental health, such as ethnicity, life adverse events,
social support/capital, substance use, and physical activity, were not included.
24. Discuss whether the assumptions of the multiple linear regression model were checked.
Although bootstrapping can address certain assumption violations, it does not replace
assumption checking. Justify its use in detail.
25. Provide more details about the bootstrapping method used. Specify if resampling was done
with or without replacement.
26. Justify the exclusion of “satisfaction with leisure activities, hobbies, interests” and
“satisfaction with friends, acquaintances, social contacts” from the model, as they are important
factors for mental health. Even if not a primary focus, they could act as confounders.
27. In Table 1, round the SD values to one decimal place.
28. Table 3 is too busy. Consider removing either the crude coefficients or standardised
coefficients and present the 95% CI for the remaining one. Remove the SE and T columns.
29. Remove the second paragraph of the Discussion section because it just repeats the results.
30. Discuss the potential bias of using only self-reported data from women.
31. Discuss the generalisation of the findings.
32. The manuscript should be edited by a professional language editing service for improved
clarity and readability.