Reviewer's report
Title:Social, behavioral, and sleep characteristics associated with depression
symptoms among undergraduate students at a women's college: A
cross-sectional stress and depression survey, 2012
Version:1Date:3 November 2013
Reviewer: Liisa Hantsoo
Reviewer's report:
This study assessed correlations among self-reported social / behavioral
characteristics and depressive symptoms in women’s college students. While the
research question itself is clear, the authors provide little contextual information
on what makes this line of research novel. For instance, why would we expect
women’s college students to differ from co-ed college students, or the general
population in terms of predictors of depression / depressive symptoms? The
methods included self-report surveys, conducted online by students who
responded to email recruitment. The authors should provide more information on
the measures used; while their outcome variables (CESD, DASS) are
well-established instruments, it is not clear how they assessed other variables,
including sleep quantity / quality, social support, or mental health history. As
these constitute their main findings, the authors should provide more detail on
how these items were assessed. In general, the data appear sound, and the
manuscript adheres to the relevant standards for reporting and data deposition.
The discussion and conclusions are reasonably balanced but should include
more detailed discussion of ALL outcomes; as it stands, the Dicsussion focuses
mostly on the authors’ findings on sleep and depressive symptoms, but do not
contextualize (e.g. discuss past research and how their findings fit into the larger
literature) findings on social support or mental health history. The limitations of
the work are clearly stated, but the authors should provide more detail on work
upon which they are building. The writing is of good quality. Specific items that
the authors should address are below.
Major Compulsory Revisions
1. The use of “stress” is the title seems to overstate the focus of the study. The
authors should consider removing reference to stress in the title; the research
focuses mainly on depressive symptoms, and the authors do not discuss the
relevant stress literature.
2. The authors should provide more information on rationale for the study. Poor
social support, prior depressive episodes, and sleep dysregulation are all
established in the literature as being correlated with depression. How / why
would this be different in a women's college population? What does this study
add to the literature? In the Background, the authors state that there are “few
established risk factors for depression among US college students.” This is
surprising, as there is substantial literature on risk factors for depression in the
general population. Why would risk factors for college students (co-ed or
women’s college) be different than those for the general population? Please
describe in more detail.
3. 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?
4. 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?
5. In the Methods, the authors mention directed acyclic graph theory was used.
Please describe further.
6. In the Results: the CESD includes questions on sleep, so it's not surprising
that sleep quality was associated with CESD score. Is this a case of
redundancy? The authors should address this.
7. The authors might describe more clearly whether associations between factors
were positive or negative in the Results and Discussion. This is hard to follow at
times, particularly for the social support finding. Specifically, tn the discussion
(paragraph 1), the authors mention that “A self-reported strong social support
group … remained significant predictors in backward and stepwise elimination
models for depression.” However, in the Results (paragraph 5), they state that
“The absence of a self-reported strong social support group … remained
significant in the backward and stepwise elimination models for current
depression by CES-D.” It is not clear what the directionality of the association
between social support and depressive symptoms is. Please clarify
8. 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?
Minor Essential Revisions
9. The authors should include the n in the Abstract.
10. The authors should consider reformatting the tables for clarity, ensuring that
the tables are consistent with APA style, and including an asterisk to incidate
statistically significant differences between groups.
Discretionary Revisions
11. None.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.