Title: A Communicative Model of Premenstrual Syndrome with Social Determinants of Health:
A Path Analysis
Version: 1 Date: 12 Mar 2025
Reviewer's report:
dear authors
pls revise this parts
1. Methodology
Issue with Inclusion/Exclusion Criteria: Criteria such as "being married" and "not pregnant"
are well-defined, but the rationale for these choices and their potential impact on results (e.g.,
excluding single or pregnant women) are not discussed. Authors should provide a scientific
justification for these decisions.
Self-Reporting Bias: As noted by the authors, reliance on self-reported questionnaires introduces
bias. In the limitations section, suggestions for mitigating this in future studies (e.g., using
objective data or clinical assessments) should be included.
Lack of Clarity on Data Collection Timing: While the data collection period (July to November
2024) is mentioned, it is unclear whether PMS symptom severity was assessed during specific
menstrual cycle phases (e.g., luteal phase). This could affect result accuracy and should be
clarified.
2. Data Analysis
Non-Significant Relationships: Variables like partner’s education and intimate partner violence
(IPV) showed no significant effect on PMS in the final model, yet this is not thoroughly analyzed.
Authors should discuss potential reasons (e.g., cultural context or definition differences).
Incomplete Path Coefficient Reporting: In Table 3, path coefficients for some variables (e.g.,
partner’s education, IPV) are non-significant, but the rationale for retaining them in the model
is unclear. Authors should explain the criteria for including or excluding variables.
Figures and Tables: Figure 2 (final path model) is provided but could be more readable (e.g., with
clearer path labels). In Table 2, correlations are reported, but the text lacks sufficient explanation
of their direction and strength.
3. Discussion
Limited Comparison with Other Studies: The discussion compares findings with some prior
studies, but geographic and cultural diversity in these comparisons is limited. Authors should
include more studies from the Middle East or developing countries to contextualize Iran’s
setting.
Lack of Mechanistic Discussion: Links between physical activity, social support, and PMS are
well-reported, but potential biological or psychological mechanisms (e.g., endorphins, stress
reduction) are not deeply explored. Adding this would enrich the discussion.
Unexplained Contradictions: For instance, the positive association between age and PMS
contradicts some Iranian studies. While noted, this is not analyzed in depth (e.g., age range
differences or confounding variables).
4. Conclusion and Implications
General Conclusion: The conclusion is well-summarized and highlights protective and risk
factors, but it is overly broad. Specific recommendations for policymakers (e.g., programs to
enhance physical activity or social support) should be added.
Practical Implications: The implications section could be more detailed. For example, how can
these findings inform clinical interventions or educational programs?
5. Writing and Structure
Language: The language is fluent and scientific, but some sentences (e.g., in the introduction)
are long and complex. Shorter, simpler sentences are recommended.
Minor Errors: In Table 1, the mean age of women is reported as 28.82, but the text states 27.82.
This inconsistency needs correction.
References: References are up-to-date and relevant, but some key recent studies on PMS in Iran
appear to be missing.