Reviewer ’s report  
 
Title: Anxiety and depression among infertile women: a cross -sectional survey from Hungary  
 
Versio n: 0 Date: 18 Jan 2017  
 
Reviewer: Ruth M.A. van Nispen  
 
Reviewer's report:  
 
This study compares depression and anxiety in infertile vs fertile women and investigates factors 
that might be associated to psychological d istress in infertile women. The authors conclude that 
in infertile women, anxiety and depression are more prominent and that age, social and sexual 
concern and maternal relationship stress explained a large part of the variance of depression and 
anxiety. T he paper is important and well written. Some small issues with the structure of the 
analysis might further improve the paper, if solved.  
 
 
 
 
Analysis issues:  
 
1. To compare infertile vs fertile women independent samples t -tests were used. However, 
there were so me differences in characteristiscs between the two groups, which implies 
that it would be very useful to present the corrected mean difference (=beta/regression 
coefficient) between the two groups as well. Most interesting would be to present the 
uncorrect ed beta of the regression analysis (determinant (in)fertility, dependent variable 
depression or anxiety) and then the corrected regression analysis. This could be a 
correction based on the characteristic differences between groups and/or correction on 
theoretical grounds.  Preferably also present the 95% confidence interval around the 
betas.  
 
 
2. The authors speak of "prevalence of depressive symptoms" p10, however, I think mean 
scores on the questionnaires are presented? Prevalence should be a percentage. Fu rther 
on, severity is mentioned in percentages, this could be considered prevalence of clinically 
significant symptoms.  
 
 
3. Did the authors check the correlation between depression and anxiety? How many 
women had both clinically significant symptoms on the STAI and BDI?  
 
 
4. Why do a separate t -test for ART vs no -ART since  something similar is entered in the 
next regression model, which probably gives a fairer presentation of the data because of 
interrelations with other variables. I advise to remove the t -test step and maybe enter 
ART vs no -ART in the regression models instead of "number of ART", the latter variable 
maybe skewed?  
 
 
5. With regard to the assumptions of multivariate regression analyses, were the assumptions 
checked? Linearity, multicollinearity etc? 
 
 
6. Better speak of associations instead of predictions; latter may imply causality which is 
not the outcome of this cross -sectional study, as also argued by the authors in the 
discussion section.  
 
 
 
 
Minor remarks:  
 
- The abstract starts with a (incorrect)  definition of infertility (infertility is a permanent 
chronic state of stress), where I believe the authors want to say that: infertility is 
"associated with" a permanent, …   
 
 
- Please state clearly in the statistical analysis section that the regression models were 
performed on the infertile group only, makes it easier for the reader to follow.  
 
 
- Presentation of the regression tables: could be one table for BDI and STAI (Table 3 and 
4), would be nice to compare results in one glance.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments t o 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 manus cript:  
 
Acceptable  
 
 
 
 
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