Title: Young mothers' use of and experiences with mental health care services in Ontario,
Canada: a qualitative descriptive study
Version: 1 Date: 04 Apr 2022
Reviewer's report:
Thanks you for the opportunity to review this important work. This is an important study and
will be important for the development of supportive programs for first-time young mothers. The
manuscript can be improved further with the following suggestions.
Title: Young mothers’ use of and experiences with mental health care services in Ontario,
Canada: A qualitative descriptive study.
Summary: The purpose of the study is to describe the mental health supports used by Young
mothers in the perinatal period, and to identify the attributes of services and professionals that
influence their decision to engage with mental health services. Research participants (n=29)
were selected from a larger sample of 450. Quantitative surveys, interviews, and ecomaps were
employed to collect data. Data were analyzed using conventional content analysis and reflexive
thematic analysis. Results indicate that mothers required at least one supportive individual
(informal or formal service provider) such that they could discuss their mental health concerns
and seek help. Previous negative experiences with care providers, inability to engage in their
care, and increased involvement of child protection workers are barriers to accessing care.
Organization and providers’ attributes that impact young mothers’ decision to access care
are highlighted. Trauma-and-violence-informed care is proposed to create an emotionally and
physically safe environment for young mothers to access mental health services. The need to
actively listen to young mothers, provide non-judgemental and safe care and engage them in
decision-making about their care are emphasized.
Please mention in the background/footnote a definition of a young mother as relevant for this
study.
Sample: The information provided in this section is a bit confusing to follow. This should be
included in the background in lines 124 -127.
Please provide a brief description of the Young Mothers Health study, the objective of the study,
and any preliminary results if available in the background.
Next mention how the current study was derived/ or is a subset of the Young Mothers Health
study or was it used to identify the participants for this study. Please provide a sentence justifying
the current study.
Methods:
Line 137-138 is a bit confusing. It might help if the principles of qualitative description are
explained here first. Mention the methods that were followed to answer each of the research
questions for the current study and describe which procedure was followed to collect what data.
Line 161: how was low and high utilization of mental health services defined.
Line 165: “Descriptive survey data” this is a bit confusing please provide more information on
what information was collected through this source and was this used to recruit 450 participants ?
Data Collection: The three types of data collection methods mentioned in lines 165-166 should
be mentioned in three separate paragraphs.
Data analysis: Please mention the methods followed to analyze each type of data in separate
paragraphs.
Line 189-191: How were the ratings carried out and by whom.
Results:
Participants’ demographics: Were these collected from the quantitative survey? If yes please
mention that.
Table 1: Looks like for ‘Relationships’ multiple options were allowed. Marital status and living
arrangements are mentioned together under this category.  Living with partners and Living with
parents is a bit confusing. It appears that “living with parents” includes those living with partners
and parents. I think it would be better if the following categories are mentioned a) living with
partners only, b) living with partner and parents, and c) living with parents only.
Participants’ social support network: Is there a table that can provide more information about
this which was commonly mentioned as informal or formal support. That can be mentioned here.
Participants’ Mental Health: Was this data collected from the Edinburgh Postpartum Depression
Scale mentioned in Line 153?
How were the diagnoses mentioned in Table 2 gathered?
Subheadings are needed in this category (Participant’s Mental Health).
Line 263: Was this meant to be a heading and a direct quote at the same time? A better heading
would be what is needed to access mental health support or something to that effect.
Line 326: Was there any indication that participants used a staged approach in which participants
tried to manage their mental health issues independently first. If that did not work then the next
step would be to reach out to family and friends and the final step would be to seek professional
help? A study carried out with new immigrants demonstrated that this staged approach was
used for accessing mental health support among new immigrants (Pandey M., Kamrul, R., Clara
Rocha Michaels, C. R.,& McCarron. M (2020). Perceptions of mental health and utilization
of mental health services among new immigrants in Canada: A qualitative study. Community
Mental Health Journal.) Wonder if this was also the case here or was it individuals just choose
one of three approaches based on their level of comfort.
It might be worthwhile to refer to Andersen and Newman’s Framework of Health Services
Utilization here to organize this section better (Young mothers' decisions to seek mental health
care)
Line 400: Not sure if this was meant to be a heading or to emphasize the idea.
Line 487: Subheadings in this category would be helpful.
Line 558: In this section just list the major recommendations mentioned by mothers and then
refer the reader to the table.
Overall the result section can be better organized with subheadings and a summary sentence
either at the beginning of the paragraph or the end highlighting the key idea that is being
discussed.
Discussion:
Line 571: Impacts of trauma and adverse childhood experiences on various aspects of physical
and mental health have received much attention. A little more discussion is needed on this topic
to show how the current study adds to that literature. Please mention whether Adverse Childhood
Experiences increase the risk for early pregnancy and mental health diagnoses.
Line 595: Does this mean that young mothers are more open to receiving mental health support
or the study indicates there is a greater need for mental health services.
Line 627: More information as found in this study should be mentioned to justify Trauma-and
violence-informed care for mothers
Conclusions: Should be short and highlight the keys findings, 3-4 sentences should be enough.
The rest can be mentioned in the Discussion section.
Table 6: Individual Mental Health Professional Attributes refer to client-centered and client-
engaged care. This can be shortened by organizing the points under broad categories such as
communication, therapeutic relationships, etc.
Table 7: Instead of Description  Strategies to achieve the recommendation might be a better fit.
Were these also suggested by the participants or are these derived by the authors?