Revi ewer’s report  
 
Title: The Association Between Labor Epidural Analgesia and Postpartum Depression A  
Systematic Review and Meta -Analysis  
 
Version: 1 Date: 04 Jan 2020  
 
Reviewer: Ahmed M. Kamel  
 
Reviewer's report:  
 
Thank you for submitting your work to BMC Women's health. The methods were detailed and 
conclusions were supported by the result s. However, I had the following inquiries/comments:  
 
1- The current meta -analysis included eight studies in the final analysis. However, authors did 
not include three studies that should be relevant. One of them was even published in 2001:  
 
a- Johnstone et . al. 2001 (Johnstone SJ, Boyce PM, Hickey AR, Morris -Yates AD, Harris MG. 
Obstetric risk factors for postnatal depression in urban and rural community samples. Aust N Z J 
Psychiatry 2001;35:69 -74) 
 
b- Eckerdal et. al. 2019 (] Eckerdal P, Kollia N, Karlsso n L, Skoog -Svanberg A, Wikstrom A -K, 
Hogberg U, et al. Epidural analgesia during childbirth and postpartum depressive symptoms: a 
population -based longitudinal cohort study. Anesth Analg: Epub ahead of print; 2019 Jun 24)  
 
c- Wu et. al. 2018 (Wu YM, McArth ur E, Dixon S, Dirk JS, Welk BK. Association between 
intrapartum epidural use and maternal postpartum depression presenting for medical care: a 
population -based. Matched Cohort Study. Int J Obstet Anesth 2018;35:10 -6.) 
 
A recent publised meta -analysis incl uded these three studies in addition to the eight included by 
authors (https://doi.org/10.1016/j.jclinane.2019.109658). Authors need to clarify why these three 
manuscripts were not included in the meta -analysis.  
 
2- Reference 15 was cited as Gillard 2013 i n the forest plot and Table 2 and as Gillard 2014 in 
Table 1. Please correct.  
 
3- Line 37: Please correct "inhiation" to "Initiation"  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
 
 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in  your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declara tion of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript , either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any pa tents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competin g interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I dec lare that I have no competing interests.  
 
 
 
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named re port 
including any attachm ents I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
whic h I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal