Title: Decoding Acculturative Stress and Psychological Distress in Mexican Immigrant
Women: Insights from a Path Mediation Analysis
Version: 4 Date: 17 Sep 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are major issues
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 - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is a revised version (R1) of a path analysis of acculturative stress
among Mexican immigrant women in the United States (n = 257).  Data were drawn from the
National Latino Asian American Survey (NLAAS), which was completed in 2004.  The study
aimed to explore the contextual factors that shape these experiences.  The article is organized
into three parts: (1) a narrative literature review of Mexican immigrant women's experiences of
acculturative stress, (2) a mediation path analysis of acculturative stress, and (3) a discussion
of the implications of the findings.  The authors have addressed most of the comments and
suggestions made by previous reviewers on the existing literature.  Regarding the path models,
this is a formative model of SEM.  The presentation of the structural model (Figure 1) should
be improved.  It caught my attention that "familism" is a contributing construct to psychological
distress, but no effect was found for acculturative stress. The thickness of the arrow should be
explained with interpretations, as well as its coefficients (Table 2).  The section "Review of
Results" could be better replaced by "Discussion".  At the moment, there are too many "Research
implications" and "Implications for practice", which are suggestions of the authors without a
rigorous support of the data.
This study allows the understanding of specific issues of acculturation processes, contextual
factors and their impact on psychological distress within this population.  The examination of
this process is very timely because the Latino population is in a significant proportion in the U.S.
Also, I would commend on the use of sophisticated MPlus to establish a structural model for
acculturation.  While the attached narrative review is not common, this brief literature review
has paved the way on the topic of acculturation.
On the other hand, this is a secondary analysis of quite old data.  It is unusual to present
"p = 0.00" in the text, perhaps the authors would like to replace this with p < 0.001.  The
current Title suggests a "qualitative study".  I recommend changing this with the study design
(epidemiological survey) and/or the analysis strategy (path mediation analysis).  There is no
overall hypothesis in the Introduction to fully appreciate the author's perspective throughout the
article.  Possibly, both Social Determinants of Health framework and resilience theory can be
used to build a sound hypothesis. As stated in the Limitations, future research should use more
recent datasets and longitudinal designs to better capture the evolving experiences of Mexican
immigrants. Data were collected 20 years ago, not a decade ago as stated.  It is possible that the
Conclusions may prove to be attenuated after several generations of Mexican immigrants in the
U.S. As such, the applicability of the author's proposal in terms of immigration policy is elusive.
REQUESTED REVISIONS:
Objectives: were not clearly stated.  Replace the description of the structure of the manuscript
with the objectives of the study.
Design: The manuscript states that the data are from the National Latino Asian American Study
(NLAAS), but a brief description of this survey and its design should be reported.
Execution: The core of the study was the empirical analysis of the NLAAS data.  Since the
path analysis should be based on previous literature, the manuscript can benefit from more
explanation of how the model of acculturation was built.  The lengthy literature review section
and the excerpts from the social determinants of health framework and resilience theory can be
shortened.  Similarly, the implications were speculative and not always supported by data.
Statistics: In general, the main steps of path analysis were adequately described, but I missed
additional tips for interpreting the results.
Interpretation: The effort to link key findings to research and practice has overshadowed a
fair discussion of the validity of the primary and secondary findings themselves.  Thus, the
implications sections contain comments that are unfocused and non-sequitur, with inferential
statements without data support.  I would suggest more emphasis on key findings.
ADDITIONAL REQUESTS/SUGGESTIONS:
The article has an unusual structure, many sections should be summarized.  Although the data
are old, it is beneficial to publish the core findings to compare this baseline study (NLAAS)
with the current available evidence.  The authors need to put their interpretation into perspective.
Perhaps an intergenerational study could be a good bet.