Reviewer's report
Title:Social, behavioral, and sleep characteristics associated with depression
symptoms among undergraduate students at a women's college: A
cross-sectional depression survey, 2012
Version:2Date:30 December 2013
Reviewer: Liisa Hantsoo
Reviewer's report:
1. In the Background, the authors mention that “Studies among female
undergraduate students have identified sleep deficit [12], lack of certain types of
exercise [22], and binge eating [23] as predictors of depression.” Do these
factors predict depression in a prospective / longitudinal manner, or are they
simply associated with depression?
a. The authors did respond to this item, that now states “Prospective
observational studies among female undergraduate students have identified
sleep deficit [12], lack of certain types of exercise [22], and binge eating [23] as
predictors of depression.” They here state that the three studies cited (12, 22, 23)
are prospective. However, it appears that only the third citation (23) is truly a
prospective study.
2. In the Methods section, the authors state “The survey instrument collected
self-reported information on students’ demographics, individual behaviors,…”
What were these behaviors? How were they assessed? Were these single-item
questions? Were they drawn from established instruments? If students were
merely asked to rate their sleep quality (E.g. poor, good, excellent), were the
students provided metrics / definitions for what constitutes “good” sleep quality?
The authors do not mention use of a well-validated measure, such as the PQSI.
How was "overall health" measured / operationalized? Similarly, the results/data
refer to "social support group" - how was this defined?
a. The authors removed reference to surveying “individual behaviors.” However,
they still rely on single-item questions, devised by the authors themselves and
not included in the manuscript, to assess sleep quality and social support. Sleep
quality and social support are two of the main outcomes in the study, and the
authors focus greatly on the sleep and social support findings in their Results and
Discussion. (e.g. Discussion: “Previous history of a mental disorder and the
absence of a self-reported strong social support group remained significant
predictors of depression … students with poor sleep quality had approximately
2.8 times the odds of depression (by both CES-D and DASS-21) compared to
that of students who reported higher quality sleep.” However, these findings are
based only on two single-item questions devised by the authors. In fact,it is
difficult to evaluate these results as the single-item questions are not even
included in the Methods.
3. In the Discussion, the authors describe their findings on sleep and depressive
symptoms in the context of previous research. However, the same is not done for
their findings on social support or mental health history. Why is this? The fact that
strong social support was associated with depressive symptoms is surprising in
the context of previous research, and the authors should explain their results
further. Previously, they mention that it is ABSENCE OF strong social support
that's associated w depression - which is it?
a. The authors have added one sentence to the Discussion on the association
between social support and depression. There should be further description – in
general, the Discussion would benefit from more detail and development.
Level of interest: An article of limited interest
Quality of written English: Acceptable
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.