Reviewer’s report  
 
Title: Culturally -adapted cognitive behavioural therapy based intervent ion for maternal 
depression: A mixed -methods feasibility study.  
 
Version: 0 Date: 08 Mar 2018  
 
Reviewer: Pauline Slade  
 
Reviewer's report:  
 
This is a really important topic area and has th e potential to make an important contribution to 
the topic area despite the fact that the data itself is now quite old it still provides helpful guidance 
in an area where literature is limited.  However there are several points of clarification or 
addition al information that would improve the paper .  
 
In terms of background whilst literature is limited there is a qualitative literature on the needs of 
perinatal women from ethnic minorities in the UK from as far back as the 1990s and this body of 
information is omitted. In the introduction it is noted the lack of social support and difficulties in 
marital relationships are predictors of postnatal depression. This is not specific to Pakistani 
women and in fact mirrors much of the literature and it is important that this is noted .  
 
If participants had already taken part in a postnatal study prior to recruitment for interviews 
which in turn were prior to participating in the intervention how long after giving birth was each 
phase of this work?  Therefore at the ti me of the intervention did the sample still fulfil the 
criterion for postnatal ie up to one year after  having their babies? This information needs to be 
included .  
 
In terms of the adaptations that are derived from the qualitative work it is really not cle ar what 
these were and how they were derived. Multiple data sources were combined is too non specific : 
which sources , how were they combined and exactly what modifications were made? Similarly 
in the table of the therapy sessions  the detail is very limi ted and specific adaptations need to be 
identified.  
 
Also the EPDS has been used and it would be useful to incorporate more detailed consideration 
of the utility of the instruments in women of Pakistani origin  rather than just say it has been used  
in such  samples.   
 
How did the authors decide on  what constituted therapy completion?  Clearly the criterion 
selected drives the percentages who were deemed to complete and 4 sessions from 12 seems very 
low indeed. It is unclear who were sporadically continuing and how many  women actually 
discontinued? Did one of the factors identified in the qualitative work husbands preventing 
uptake come inin relation to satisfaction the Verona scale needs to be specifically mentioned by 
name again.  
 
The sample included women  who were first and second generation migrants.   It would have 
been useful to have considered  if perspectives and needs were  different in any way. Also 
whether there was any use of interpreters or presentation of material in different languages by 
thera pist would be useful to clarify .  There are therefore points where additional clarifications 
and explanations are required.  
 
  
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:  
 
Acceptable  
 
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