Reviewer's report
Title:Prevalence and associated factors of depressive and anxiety symptoms
during pregnancy: A population based study in rural Bangladesh
Version: 1Date:9 March 2011
Reviewer: NEERJA CHOWDHARY
Reviewer's report:
This paper addresses an important public health problem and as such is
important. However, there are a number of revisions I would suggest to make this
acceptable for publication.
Discretionary Revisions
1. figure 1 seems unnecessary and does not lend anything to the quality of the
paper or what it seeks to convey. Instead the information can be incorporated
into table 1.
2. In the methods section, it may be useful to divide the variables into
explanatory and outcome variables and then describe these.
Minor Essential Revisions
1. The results section of the abstract: The abbreviation ADS is used without any
previous explanation of the full form. It is important that any abbreviation, when it
appears in the text for the first time, is expanded.
2. Results section: the authors say “previous history of depressive symptoms had
the highest contribution for ADS”. this can be reworded as “……showed the
strongest association….”.
Major Compulsory Revisions
1. The Methods (sample) section: the sample selection process requires further
elaboration. were there any inclusion and exclusion criteria apart from gestational
age? Were there any refusals to participate? if so, how many? for what reasons?
2. Data collection: The paper should really include a few more details on the
process of data collection. How many interviewers were involved, what were their
specialties/qualifications, and what were their links with the health center? In
what language (English? Bengali? Other?) were the interviews conducted? Were
the questionnaires composed in English and translated into other languages and
how were satisfactory translations arrived at?
3. it is not clear if ‘physical violence’ was ‘ever’ or within a time period. this must
be stated clearly.
4. The authors state “for the purpose of analysis, the explanatory variables were
dichotomized….”. the continuous variables must be listed. Where binary
variables were used, what was the rationale?
5. Why were other important variables such as rural/urban status, caste, and
religion ignored?
6. Analysis section: The study is described as ‘a prospective cohort study’
however there is only cross sectional results discussed. This must be clearly
stated in the methods.
7. Analysis section: the statistical methods need further elaboration. What
regression method was used – forward regression or some other? was there a
conceptual model that guided the analysis? What was considered significant
association? How were these variables treated? what were the a priori
confounders?
8. Ethical consideration: Was written consent taken? if patients were illiterate
(and unable to sign), how was consent obtained?
9. Results section: Since anxiety and depressive syptoms are commonly
co-existent, were there any patients who had both ADS and AAS?
10. Discussion: Greater attention to limitations is necessary – eg. cross sectional
nature of the study and hence doubt about causality, other possible confounders,
bias in terms of misclassification of exposure – failure to report violence due to
the sensitive nature of the topic, etc.
11. Implications of the study for practice, policy and research needs further
elaboration. What are the further plans of the researchers – what will be the
contribution of the longitudinal component of the study to these findings?
12. Since an increasing number of studies show the important impact of physical
and sexual violence on aspects of women’s health, authors (including the present
ones) should be encouraged to *briefly* mention resources available to women in
the study settings to help survivors. In the area, are there women’s organizations,
police, religious, community, or other groups who provide assistance to violence
survivors? Do referral mechanisms from the primary health center to these
resources exist? Given the authors’ findings, what mental health resources are
available in the area? These descriptions could support important policy and
practice recommendations.
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.