Reviewer's report
Title:Prevalence and associated factors of depressive and anxiety symptoms
during pregnancy: A population based study in rural Bangladesh
Version: 1Date:22 February 2011
Reviewer: Swee May May Cripe
Reviewer's report:
Discretionary Revisions
Since text description for Figure 1 is provided in the Results section, Figure 1 is
not really necessary.
Minor Essential Revisions
1. Introduction-Page 5, line 3: There is a missing word or phrase before
“…common mental disorder in Brazil [15].
2. Methods- Page 6, last sentence under Study Setting: Please use past tense
for “identify” and “confirm”.
3. Discussion, page 15: Does “… such problems [33].” refer to depression?
Major Compulsory Revisions
1. Page 7, Methods- Please define violence during pregnancy. Does this
measure include physical or sexual violence or both?
2. Page 7, Methods- Please define physical support from family members.
Describe the types of physical support included in the study.
3. Page 8, Methods- Please clarify “physical violence as no or few acts of
violence (score 0-2) vs. more acts of violence (score 3-4).”
4. Page 9, Methods- Please indicate whether STAI was validated among
pregnant women.
5. Methods-Analysis section: Need significant clarification. Authors need to
describe more clearly the type of analysis used for this paper with much greater
detail. E.g., How were the variables selected? I have found reading the Analysis
section and trying to understand the tables and the Results section rather
confusing and difficult to follow. The authors describe conducting bivariate
analyses (logistic regression and linear regression) first to determine possible
predictors of ADS and AAS. Unclear how this was done—did the authors first
examine each variable independently with the outcome before inclusion in the full
model?
Results - The two tables as presented are rather confusing. As presented, there
is the adjusted Full Model and adjusted Final Model. For the adjusted Full Model
in Table 2, is the OR provided for each variable the result after adjusting for all
the other variables in the table? Similar question for Table 3.
The final multiple variable regression (logistic and linear) included only variables
that were statistically significantly associated with each outcome. Again, not
completely consistent, e.g., literacy and physical support during pregnancy were
not statistically significant in the full model in Table 2.
6. Please have headings for the columns of Table 1. Please ensure that
information is aligned across rows in Tables 2 and 3. It is difficult to read the
tables. Include the categories used for each variable in the text description under
Methods. If the categories for each variable are to be included in the Tables 2
and 3, then please list them in separate rows and indicate the reference
category.
Sample sizes of depressed and non-depressed women for each variable
examined need to be included in Table 2.
Table 2: The age demographic variables need clarification.
7. Results: Were there other variables considered as potential predictors other
than the ones included in Table 2 and 3? If there were, please provide them and
indicate why they were not included in the full model. Did the authors ask about
pregnancy intendedness?
8. Discussion: This section could be strengthened significantly. A discussion of
the significant predictors in the context of this culture would be helpful. Please
explain why poverty is associated with depression or anxiety. Are there other
reasons for why literacy helps to lessen depression and anxiety (e.g., Francis et
al. 2007, Weiss et al. 2006 and others)? How does intimate partner violence
affect depression and anxiety?
The authors mention “tangible support” and “practical support” during pregnancy.
What do these refer to?
9. Discussion: The authors report in the Results section that 8 in 10 participants
reported at least one single act of physical intimate partner violence or forced sex
ever, and 18% reported physical violence during pregnancy. In the Discussion
section, the authors report that 34% of the women reported 3-4 acts of physical
violence while 80% of women reported being sexually abused by their husband.
And yet 80% of participants said that they received physical support from
husband or mother-in-law during pregnancy. An estimated 24% of women said
that they have poor relationship with their husbands. What is the reference period
when women were asked about relationship with husband (e.g., entire
relationship, during pregnancy only?). How were physical support during
pregnancy, poor relationship and the reference time period for poor relationship
defined for this study? These definitions may affect findings.
It would be helpful to describe the cultural context that might explain the high
level of support from husband or mother-in-law during pregnancy. How do
women in this culture define physical support and poor relationship. Overall, I am
somewhat surprised that prevalence of ADS is not higher given the high
prevalence of lifetime intimate partner violence.
10. Discussion: Page 14, second paragraph – Differences in estimates of
prevalence of ADS and AAS may also be due to cultural differences (especially
when comparing data collected in Hong Kong with that collected in Bangladesh)
besides differences in type of population sampled and time period data was
collected.
11. Conclusions: Authors list variables that are “independent contributory factors
of ADS and AAS”. However, the authors indicate that the variables are predictors
of ADS and AAS after adjusting for other variables in the Results section. Please
explain this discrepancy.
Level of interest: An article whose findings are important to those with closely
related research interests
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.