Reviewer's report
Title:Retrospective Observation of Mental Disorders during Pregnancy and
Postpartum Period: Results from the Singapore Mental Health Study
Version:1Date:13 July 2015
Reviewer: Marta Rondon
Reviewer's report:
MAJOR COMPULSORY REVISIONS
The paper is titled:” Retrospective Observation of Mental Disorders during
Pregnancy and Postpartum Period: Results from the Singapore Mental Health
Study”
However it only looks at the onset of depressive and anxiety disorders for a
period of 24 months after pregnancy.
Background
In relation to the risk factors for perinatal depression, the most usual one, i.e.,
history of depression is not mentioned.
The description of Singapore lack mention of some unique features: the high
population density, the favorable macroeconomic figures and the fact that this
small country has achieved a good level of human development
Discussion
The rates of onset of depression up to two years after pregnancy found in this
paper are extremely low by comparison with Fisher et al conservative figures
(quoted by authors) and by comparison with results by other authors (Gavin et al
2005; Mohammad K, 2011, Shivalli S, 2015) both in high and in low and middle
-income countries. This finding is insufficiently addressed in the discussion.
Recall bias may certainly be a factor, but stigma and other situations may also
play a role. Authors should look at other possible reasons for this discrepancy:
under-reporting due to reluctance to share negative states with a stranger, or the
possibility that the instrument used (based on Western conceptualization of
mental disorders) may not capture the expression of depression and anxiety in
Asians.
There is no description of differences in the prevalence rates in women of
different ethnic origin. Of note, Subramaniam et al report a higher risk for the
Indian population in the 2014 general report.
The fact that OCD has a higher prevalence in Singapore than in other settings
where the same instruments have been used is not mentioned; this salient
finding (reported by Subramaniam et al 2014) provides context to the
comparatively high prevalence of OCD in postpartum women in Singapore.
In order to give some socioeconomic context to the low rates of depressive
disorders in this group, it may be worthwhile to mention the privileged condition
of women in Singapore, with very favorable Human Development Index and
Gender Inequity Index reports (United Nations 2013)
Figure 1 and 2: there is no unit label in the x axis. Is it years?
This paper raises a series of important questions, especially about the risk and
protective factors for depressive disorders and for OCD in the postpartum- as
research should. These are not made explicit by the authors; in my opinion, this
is a lost opportunity.
DISCRETIONARY REVISIONS
Perhaps a comparison with the results in the general population and in women of
comparable age (women with children v women in general) would be helpful in
understanding the relevance of Sagayadevan et al’s findings.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I have no competing interests