Reviewer's report
Title:The increased trend in mother's hospital admissions for psychiatric
disorders in the first year after birth between 2001 and 2010 in New South
Wales, Australia
Version:1Date:17 June 2014
Reviewer: Sara Kornfield
Reviewer's report:
Major Compulsory Revisions:
1. The conclusion that access to psychiatric hospitalization for postpartum
mothers has increased does not seem to be a direct result of this study. From
this study we know that more women are being hospitalized now than in 2001
and the authors have reported on some initiatives that are designed to increase
access to these services. I think that the conclusions should include reference to
the fact that in addition to these state-wide initiatives creating more access,
perhaps other educational initiatives have increased awareness among medical
providers or the public which has thereby increased the number of providers and
family members recognizing psychiatric symptoms in the postpartum period.
2. Also, the authors seem to reference the terms they define in the introduction
incorrectly in the discussion section. How can one determine whether mental
illness is a determining factor in hospital admission if it is not the principal
diagnosis? By their own definition, the authors state that principal diagnosis is the
one chiefly responsible for the hospital admission. This is primarily stated in the
sentence beginning on line 198, beginning with “On the other hand…”.
3. Similarly, while I agree that simply because a diagnosis is not the principal
diagnosis doesn’t mean it is less severe, it seems to me that perhaps the reason
for admission might be something other than a mental illness. A patient can have
mental illness that is well controlled and therefore not the reason for admission,
even though they still have it. There is not a clear limitations section and I think
these issues should be addressed there.
Minor Essential Revisions:
1. The results are somewhat confusingly presented as two distinct numbers and
percentages are included for each result. I believe this accounts for mothers who
were admitted more than once in the first postpartum year, but I think this should
be clarified.
2. Consider placing more emphasis on the "answer" to the second question
proposed in the introduction, in the discussion. This appears to not be addressed
at all.
Discretionary Revisions:
1. The beginning of the discussion includes a lot of information that seems to fit
in better in the introduction, especially as it contains a rationale for why this study
was undertaken.
2. The writing could use some proofreading and some general reorganizing. For
example, please double check the use of diagnosis (singular) vs. diagnoses
(plural). Reference data in the plural (i.e., these data, not this data). Line 182,
sentence beginning “This study data do not include…” is very confusing as to
what is being discussed with regard to change of hospital type. In line 187, the
use of the word “confinements” is outdated. You can say “pregnancies.” Also, line
189, “The study also showed” is very confusing. Consider reorganizing to read
thus “The study also showed that having an infant admitted to the NICU and
maternal smoking were both associated with an increased risk of postpartum
psychiatric illness.”
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
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.