Title: Investigating the relationship between MIND diet and postpartum depressive symptoms
Version: 0 Date: 08 Apr 2024
Reviewer's report:
The article titled “Investigating the relationship between MIND diet and postpartum depression"
represents an interesting article on the relationship between the MIND diet and the presence of
depressive symptoms in the postpartum period. I am reporting some comments as follows in
order to recommend some implementations.
Introduction
Authors wrote “Postpartum depression (PPD) is a psychiatric disorder”.
- Postpartum depression is not recognized as a psychiatric disorder in its own right, but there
is a depressive disorder specifier in the DSM-5-TR called "with peripartum onset" to indicate
depressive disorders onset in pregnancy or postpartum. Authors should refer to the most up-to-
date classification systems.
The authors in the introduction write generically, “Available studies have shown evidence of a
possible relationship between healthy eating patterns and depression which can help reduce the
risk and symptoms of depression [4-6]”.
- The authors need to argue this by referring to previous studies on diet and postpartum
depression and findings from more recent literature in order to lend support to the objectives
of their study. In addition, they should elaborate already in the introduction on the description
of studies that have already evaluated the relationship between MIND diet and reduced risk of
depression in general.
The authors write, "Data were collected using Edinburgh, Beck, and semi-quantitative food
frequency questionnaires including 148 food items (FFQ).”
- The names of psychometric instruments should be written clearly and in full indicating
their correct acronyms, also in the abstract (es. Edinburgh Postnatal Depression Scale, EPDS;
International Physical Activity Questionnaire, IPAQ etc.)
- Moreover, please add information about the quality of the Food Frequency Questionnaires,
e.g. reliability, etc.
- The International Physical Activity Questionnaire (IPAQ) should be included among the other
instruments, its name should be spelled out in full, and the test should be described more
precisely.
Authors wrote: “To ensure valid and reliable data collection, a training and role-playing
simulation session was held for the data collection team. In these meetings, important issues
such as the correct method of data collection, definition of questionnaire variables and making a
common understanding between the questioners were discussed. Furthermore, 10% of random
samples from the questionnaires were examined to ensure their acceptability”.
- Authors should clearly specify who conducted this training and whether there were
psychologists or psychiatrists who participated in it.
- Also, how did the authors handle cases of elevated depressive symptoms?
The authors write "postpartum depression," this is a significant error.
- Replace the term "postpartum depression" with the expression "risk of developing postpartum
depression" or "postpartum depressive symptoms" in the title, abstract, hypotheses, description
of instruments, results, and discussion. The Edinburgh Postnatal Depression Scale (EPDS) is a
widely used screening tool to detect depression in the perinatal period. However, the diagnosis
of postnatal depression should be made by a mental health professional using also a validated
structured or semistructured interview such as one based on the DSM-5 or DSM-5 TR. This
should be administered within 2 weeks of the administration of the depression screening tool
(such as the EPDS). As a matter of fact, DSM-5 criteria for depression consider symptoms that
have occurred within the last 2 weeks. In addition, although there is no separate diagnosis in the
DSM-5 for depression during pregnancy or postpartum, there is specification for cases of major
depression with "peripartum onset," the period including pregnancy and postpartum. Thus, due
to the exclusive use of the EPDS, Authors throughout the text should refer to "postpartum
depressive symptoms" or "risk of postpartum depression," and not use the term "postpartum
depression" loosely (e.g., they could write "Investigating the relationship between MIND diet
and risk of postpartum depression").