Reviewer's report
Title:Prevalence and associated factors of depressive and anxiety symptoms
during pregnancy: A population based study in rural Bangladesh
Version: 2Date:16 April 2011
Reviewer: Swee May May Cripe
Reviewer's report:
For future reference, it would be great if the authors could respond point-by-point
to the comments offered by reviewers. It would make re-reviewing so much more
efficient when the reviewer can read original comments and authors’ responses
to each comment.
The authors have made great effort to respond to the original comments and
provided greater clarity to several issues in question. Below are a few points that
require some clarification. I have included the original review comments and
authors’ response to each comment, followed by my comments on the response
provided by the authors.
6. Please have headings for the columns of Table 1. Please ensure that
information is aligned across rows in Tables 2 and 3. It is difficult to read the
tables. Include the categories used for each variable in the text description under
Methods. If the categories for each variable are to be included in the Tables 2
and 3, then please list them in separate rows and indicate the reference
category.
Sample sizes of depressed and non-depressed women for each variable
examined need to be included in Table 2.
Table 2: The age demographic variables need clarification.
Authors: Following suggestion from the reviewer, headings for the columns of
Table 1 is added and information is aligned across rows in Table 2 and 3. Same
categories are used for the variables in the text description under methods,
results and Tables. In Table 2, reference category is indicated by 1. In Table 3,
three variables are used as continuous scale and in case of
dichotomous/categorical variables reference category was indicated by 0.
Sample size for depressed and non-depressed is added in Table 2. Also, the
categories of the demographic variable age are specified.
The authors have done a good job in making the Tables more understandable
and readable. The authors have added the sample size for depressed and
non-depressed women for Table 2. I apologize if my original request was not
clear. My original request was for the authors to include the sample sizes [n (%)
for depressed and non-depressed women] for EACH category of EACH variable
in Table 2.
8. Discussion: This section could be strengthened significantly. A discussion of
the significant predictors in the context of this culture would be helpful. Please
explain why poverty is associated with depression or anxiety. Are there other
reasons for why literacy helps to lessen depression and anxiety (e.g., Francis et
al. 2007, Weiss et al. 2006 and others)? How does intimate partner violence
affect depression and anxiety?
The authors mention “tangible support” and “practical support” during pregnancy.
What do these refer to?
Authors: 7. In the discussion section, predictors such as poverty, intimate partner
violence are described in the context of culture (page 16-17).
Authors: 8. The terms ‘tangible’ or ‘physical’ support are replaced by the term
‘practical’ support throughout the text. Specification of practical support is given
in the description of explanatory variables in the methods section (page 8,
paragraph 1).
On page 16, authors discuss the role of literacy as improving social networks and
social support, thus contributing to a decrease in depressive and anxiety
symptoms. It is unclear how literacy improves social networks and social support.
Please explain.
Other researchers (e.g., Francis et al. 2007, Weiss et al. 2006) reported that
literacy improves self-efficacy, thus improving self-esteem and reducing
depressive and anxiety symptoms.
10. Discussion: Page 14, second paragraph – Differences in estimates of
prevalence of ADS and AAS may also be due to cultural differences (especially
when comparing data collected in Hong Kong with that collected in Bangladesh)
besides differences in type of population sampled and time period data was
collected.
Authors: Regarding the difference in prevalence between our study and the study
in Hong Kong, the authors believe it is due to the difference in the contexts. In
Hong Kong, the sample was drawn from a clinical setting whereas the sample of
our study is drawn from the community. This is indicated in the text (page 15).
Antenatal depression and anxiety among pregnant women in the study in Hong
Kong were assessed using the HAD scale (Hospital Anxiety and Depression
Scale), which is a different scale than that used in this study. So, it can not be
compared directly.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.