Title: Period Poverty, Reuse Needs, and Depressive Symptoms among Refugee Menstruators
in Jordan’s Camps: A Cross-Sectional Study
Version: 1 Date: 21 May 2024
Reviewer:  Janet S. Carpenter
Reviewer's report:
Thank you for tackling this important topic and for the careful interpretation of the study results.
The comments below are intended to strengthen the paper.
Throughout - Please see attached document with tracked changes for your consideration to
improve conciseness, grammar, and readability.
Throughout - The only measure of mental health was the PHQ-9 which is a depressive symptoms
measure. Please replace “mental health” with depressive symptoms in title, abstract and text.
Throughout - Please change women to menstruators to encompass both girls and women who
were enrolled in this study as well as varying gender identities (especially applicable to US and
world studies and statistics).
Throughout – this study included peri and postmenopausal women due to the inclusion criteria
of having a period in the past 6 months. Postmenopausal is defined using the internationally-
accepted STRAW+10 criteria as absence of menses in the past 12 months. Because of the way
menses were assessed, perimenopausal women could have been included in both the 1-3 month
and 3-6 months groups. Therefore, I recommend eliminating premenopausal, perimenopausal
and postmenopausal and simply discussing these women as menstruators. Please also clarify if
you mean 1 to less than 3 months and 3 to 6 months so that categories were not overlapping?
Throughout – there is some inconsistency in “living in Jordan” and “living in camps in Jordan”.
Please be consistent throughout.
Introduction – please define UNHCR and UNRWA.
Methods – please delete the statement about Cronbach’s alphas being calculated on 22 pre-test
subjects and be sure the provided alphas reflect those from the larger, final sample.
Ethics – please clarify informed consent was obtained in writing in the methods (as stated later
in the ethics declaration).
Statistical analysis – please clarify what groups were used in analyses. There is no prior mention
of grouping within the study purpose/aims or sample. Please clarify t-tests (variables, groups).
This section could be longer with additional details provided so the reader has more of a road
map of what results will be showing up.
Results – do not repeat statistics in text if they appear in tables. Use broader statements in the
results (most women were) rather than re-stating percentages or scores that appear in tables.
Discussion – please do not compare JOD to USD. This does not take into consideration cost
of living and the exorbitant prices of menstrual products and health care in the USA. A box
of 40 cotton tampons is between $16 and $20 USD. The average insured American pays about
$14,000 in healthcare costs annually.
Discussion – please do not suggest additional descriptive work is needed. Rather programs or
interventional studies that provide menstrual products are needed (as stated in your conclusion).
Discussion – please add lack of anxiety measurement as a limitation.
References – please add No authors listed to reference 1.
Table 1 – please make separate columns for N, %, M, SD (leaving cells blank where appropriate)
or have two tables – one with n(%) categorial variables and one with M (SD) continuous
variables). Please add a table footnote explaining how the various scale scores are interpreted.
Table 2 – please add a footnote to explain how depressive symptom categories were defined,
explain abbreviations, etc.
Table 3 would be better displayed as a bar chart figure.
Table 4 – please provider overall model statistics (F, p, % variance explained, etc).
Figure 1 and 2 should be eliminated as they categorize the PHQ scores which decreases power.
Analyses presenting total score differences (t-tests, ANOVA) are better suited to show these
associations.