Title: The Social determinants of mental health disorders among women with infertility: a
systematic review
Version: 0 Date: 14 Aug 2023
Reviewer's report:
Thank you for the opportunity to review this very exciting and timely review. Below are my
comments and suggestions for the authors.
Whole manuscript: please check all the manuscripts to make sure the point comes after the
citation, not before.
Abstract: I suggest authors check for the PRISMA Abstract guidelines one more, to make sure
the abstract includes all the items stated in the guideline. Also,
Line 74: "solid and robust" sounds repetitive, even synonymous, please consider a different
phrase here.
Line 68-72: In my opinion, this part looks like it belongs to the results and not the discussion.
Introduction:
Line 104-105: there seem to be some references missing here, please make sure you add the
relevant citation for this argument.
Line 122: I’m suggesting a smoother conjunction between the paragraph above which tells about
psychological problems of women who suffer from infertility and the paragraph starts with social
determinants of health.
Line 132: “a limited number of social determinants” Could authors provide some examples of
social determinants here?
Line 133-135: A reference seems to be missing to support the argument.
Line 136-140: . By understanding the determinants, we can integrate a holistic approach towards
understanding infertility, its impacts and treatment options. Understanding the SDoH will also
enable tailored and individualised psychosocial support and services for women to minimise the
impact of infertility on their mental health.” Here some references would improve the quality
of the manuscript, otherwise, it reads like a very enthusiastic take and too much to expect from
a systematic review.
Method:
I’d write two separate paragraphs for the inclusion and exclusion criteria with the PICOS
template. Or at least a short paragraph describing the exclusion criteria would also help the
reader.
When was the search conducted?
Types of studies to include: here the authors give two reasons to limit the publication date of
articles as inclusion criteria: one concerning providing contemporary evidence and the other one
WHO report from 2010. The latter is not very convincing in my opinion, since WHO has no
power to enforce anything on health systems all over the world. I’d just go with the first reason
or come up with a better one.
Main outcome: please consider joining this subtitle with the “outcomes” , they cover the same
info, which is repetitive.
Line 156: socioeconomic determinants? Throughout the introduction, this concept is referred to
as social determinants, not socioeconomic determinants. I’d choose one and stick to it throughout
the manuscript.
Line 173: please make sure to define which social determinants of health you are included in
your review and make sure to define how they might be measured in the included studies. Also
please discuss this heterogeneity in terms of different measurement tools used when measuring
the same outcome in the discussion section.
Line 223: what do the authors mean by “societal factors” ? Some examples would improve the
manuscript.
Line 230: I recommend using a different term than “race” since there is only one race, that
is the human race. Moreover, this information is not reported on the results, but just the
geographical information of the study place. Further reading: https://jamanetwork.com/journals/
jama/fullarticle/2783090
Results:
In general, there were many many results reported, as a reader difficult to follow, could authors
think of a different way to report so many results?
The outcomes should be defined in more detail in the method section so that the results section
could have a more clear flow and readability would increase accordingly.
Line 328: what do the authors mean by “ standard mental health scales” ?
Line 341-342: there seems to be a verb missing in this sentence.
Line 349: what do authors mean by “… women who were not used” ? I’m guessing a typo.
Line 354: how is social class measured? This outcome was not mentioned before in the
manuscript.
Line 386: there seems to be a reference missing for this sentence.
Line 391: “quality of life” outcome came out of nowhere. Please refer to my previous comments
about more detailed definitions of outcomes, and please make sure you only report the outcomes
you defined in the methods section.
Line 400-402: the cited study only found one significant result concerning age: older women
have higher FSD levels than younger women. How did the authors come up with this statement?
Line 402-403: in the cited reference the study was conducted with 83 Japanese women, this is
not a representative sample at all, please paraphrase this sentence.
Line 403-405: please define the participants’ features a bit, is it the infertile women? Or another
group?
Line 410: It is not clear which results are referring to the effect size reported in this sentence,
please clarify.
Line 415: being Muslim compared to which other religious beliefs? Please elaborate.
Line 416: What do authors mean by “ mental status” ?
Discussion: I’d hope to see a discussion and possible reasoning for the contradictory findings
of the review compared to previous individual studies.
Line 501: “and how they need an evidence-based and multi-level approach to minimise and
eliminate the adverse mental health consequences” how did authors come up with this result
based on their review?
Line 502-503: there seems to be a reference missing for this sentence.
Line 503-506: there seems to be a reference missing for this sentence.
Paragraphs starting from line 500 and ending at line 519 reads more like an opinion piece, I
would make sure supporting the arguments with appropriate references.
Line 514: how is “ accessing and utilizing ART treatment” related to this review? It seems very
much out of the scope of this review.
Line 520: Reference missing.
Line 520-526: These recommendations read very enthusiastically, based on the limited scope of
this review. I’d like to read some future direction recommendations based on the limitations of
the included studies. Further research should first improve the efficacy and effectiveness of the
treatment options, before going for cost-effectiveness I believe.