Reviewer ’s report  
 
Title: Correlates of depressive symptoms in late middle -aged Taiwanese women: Findings fro m 
the 2009 Taiwan National Health Interview Survey  
 
Version: 1 Date: 18 Jun 2016  
 
Reviewer: Thomas von Lengerke  
 
Reviewer's report:  
 
This paper utilizes cross -sectional data from the 2009 Taiwan National Health Interview Survey 
to assess associations of diabetes and depressive symptoms in postmenopausal women. It finds 
that, in multiple logistic regression, diabetes was associated with depressive symptoms, defined 
as a score of 10+ on the Chinese version of the CES -D 10 (OR 2.94). Besides, sedentary lifestyle 
and living alone were associated with this outcome as well, with even higher OR than diabetes 
(5.55 and 6.10, respectively). The a uthors conclude that these findings lend support to the 
association of depressive symptoms and diabetes in postmenopausal women, and that clinicians 
should be vigilant for the presence of depressive symptoms as a comorbid condition, and provide 
treatment t o minimize its adverse consequences. In general, the paper is solid, and the response 
rate of the survey (84%) above -average. At the same time, the findings are not exceedingly 
surprising, given abundant research on the positive associations of diabetes, p hysical inactivity, 
and social isolation with depressive symptoms. This said, I recommend the following revisions:  
 
Essential revisions  
- The major drawback that the rationale for the analysis is not well enough stated. That is, 
the authors should provide  convincing arguments that their analysis adds to the 
knowledge base regarding the associations of diabetes, physical inactivity, and social 
isolation with depressive symptoms.  
- The authors could increase the merit of their analysis if they would look at physical 
activity and living with a partner as factors buffering the impact of diabetes on depressive 
symptoms. Thus, I recommend to add appropriate stratified analyses and/or interaction 
terms into the analytic scheme.  
- The authors should state whether " diabetes" is to denote "type 2 diabetes" in their paper, 
and if not, how many had type 1 diabetes, how this distinction was assessed, and if there 
are different results.  
 
Minor issues  
- Page 4, lines 13 -18: … that increased age, female sex, and being separ ated or divorced in 
terms of marital status are …  
- The dichotomization of BMI as "underweight or normal weight" vs. "preobese or obese" 
is rather crude. The authors should state whether, on the one hand, omitting underweight 
respondents and, on the other hand, distinguishing preobese (25 -29.9) vs. obese (30+) 
affects their results.  
- The regression analysis underlying table 2 is multiple (more than one regressor), not 
multivariate (which would be more than one regressand).  
Of course, the abstract should b e amended in accordance with the above revisions.  
 
Are the methods appropriate and well described?  
If no t, 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 t he 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, ple ase 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:  
 
Acceptable  
 
 
 
 
 
 
 
 
 
 
Declaration of competing interests  
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