Title: Young mothers' use of and experiences with mental health care services in Ontario,
Canada: a qualitative descriptive study
Version: 1 Date: 28 Mar 2022
Reviewer's report:
Thank you for the opportunity to review this manuscript. This paper adds to the literature
concerning experiences of adolescent perinatal mental health. I commend the use of the visual
ecomap as a way of opening up discussions in the interviews. I also like the exploration of
understanding the attributes of organisations and professionals as apposed to majoring on the
barriers to access.
Overall
The content of the paper is logical. My main issues concern the presentation of the manuscript.
I have some comments below for consideration to enhance this manuscript.
The use of ‘supports’ as opposed to ‘support’ sometimes sounds strange in the sentences. Could
the word ‘support’ be used? It also needs to be consistent throughout.
Throughout the manuscript there are many long sentences that need shortening or breaking down
into several sentences. There is an overuse of parentheses (…), which could be removed in
most places. There are also a lot of numbered lists within paragraphs which would be better
incorporated into sentences without numbering. I have highlighted a few of each of the above.
Abstract
When was this study undertaken- either mention the dates here or in the methods section.
Line 66 – could you briefly mention the descriptive quantitative survey – how long between the
survey and the interview?
Line 79 long sentence – a whole paragraph? Shorter sentences would make the main points
clearer.
Keywords
The word ‘pregnancy’ the ‘post-partum mood disorders’ is confusing. Is the study looking at
only postnatal mood disorders or both pregnancy and postnatal mood disorders. The word mood-
disorders is only mentioned once in the manuscript, is this the best word to use? You mention
anxiety and depression and mental health difficulties/problems/disorders.
Introduction
Background to adolescence and mental health is clear. Is there a distinction between mental
health problems, difficulties and disorders. If they are the same word maybe use the same
throughout or describe the differences.
Line 96 – ‘in the last 5 years…’ could the actual dates be in ‘between 2017-2022..’
Line 108 – ‘Fewer data speak to clinically other mental health difficulties…’ This sentence
needs rewording.
Line 129 – it unusual to have conjoining words in a numbered list, are these necessary e.g. 129
‘and their’ and line 132 ‘and’. Could these just be left out?
Method
Suitable method used.
Good description of the process for the interview phase.  Consider adding a couple of extra
words to the background survey phase to help readers who have not read the other paper from
this study. These could include which year did each phase occur, who recruited participants,
were the questionnaires paper copies, where were they completed and how many participants
agreed to a follow up interview.
Line 139 - could ‘or not’ be incorporated into the sentence rather than in parentheses.
Line 147 – this could be a list of inclusion criteria without the numbers.
Line 156 - Who are the research team? Nurses, researchers, medical staff? Was this the same
team members as the survey phase?
Line 169 - missing word? ‘..learn about their experiences of parenting with a mental health
issue..’
Line 174 – this is a very long sentence, could it be reworded to be shorter?
Line 187 - who transcribed the recordings?
Results
Tables
I think there are two many tables for one paper. You may need to prioritise or add some as
supplementary data.
Do you need to add % after each number when you have already put % in the heading of the
table. Table 1- if you are going to leave % in the table could you do the same for the cell ‘Born
in Canada’ and have % after the number not before the words.
Table 2 and 3- it would be better if the % (n) were the same in both tables and the same throughout
the table.
Overuse of parentheses in this section. For example lines 229, 230, 241, 242, 268 – 272 are the
parentheses all necessary. Most of these can be incorporated into the sentences.
I am not sure about the quantity of words in speech marks, are these all needed. They detract
from the sentence. Could they be reduced throughout the results section, this would make them
more of an emphasis when they are used.
Is it possible to add participant number, parity and age of participants after the quotes.
Line 330 – why is this part of the sentence rather than an indented quote?
Line 395 - birth not delivery
Lines - 428-437 there is repetition of the stroller and stairs in the description and quote, it is also
a very long quote – could this be reduced in length.
Line 562 – I am confused by the short results section relating to young mothers’
recommendations…. Other sections have tables related to them and are presented in the results
section. Yet this section which was noted as one of the objectives of the study has no information
or quotes.
Discussion
Lines 585 – 592, a sentence of 105 words is far to long. Again are these numbers necessary?
The sentence would be better broken up into several shorter sentences.
Line 624 – long sentence
Line 683 – what are ‘warm’ referrals?
Strengths and limitations
Line 694 - the use of ‘purposefully’ twice in a sentence makes it a bit difficult to read, could it
just read ‘While we initially sought to introduce variation….’. The sentence is again a very long
sentence. Consider braking it down into smaller sentences to make the point clearer.
Conclusions
The conclusion is long. Good use of one point per paragraph. Please remove the parentheses
in the conclusion. Points should be short, without expanding on findings, these have already be
explored in the discussion section.
The last paragraph reads like a conclusion, to the conclusion. Use the last paragraph or the rest
of the conclusion but not both.