Title: Prevalence and Risk Factors of Postpartum Depression among Women Attending Primary
Healthcare Centers in Northern of West Bank/ palestine : A cross-sectional study, 2022
Version: 8 Date: 10 Nov 2023
Reviewer:  Akihiro Seita
Reviewer's report:
Thanks a lot for the clarifications and modifications to the manuscript. I still have the following
comments.
First is on the appropriateness of method and research design.
1. Dataset reliability
Although the author added one sentence that “One of the researchers was present at the site
of data collection to ensure that the questionnaire is comprehensive.”, it does not clarify the
completeness and accuracy of the responses unless it is described what approach the researcher
took to ensure this point. For example, was there any cross-check on the response, instruction
on how to fully complete the questionnaire, or setting a brief mock test to allow the mothers to
practice completing the questionnaire? This is to ensure the dataset's reliability and findings. It
should be mentioned as a limitation.
2. Appropriateness of the chosen data collection method
I understand it is complex to affirm the appropriateness between different data collection
methods for the PPD study. This is because the suitability of the data collection method is defined
by the nature of your research questions, the sensitivity of your study topic being addressed, the
cost-effectiveness based on the sample size and the degree you want to dig in. Therefore, even
if the umbrella health theme is the same under PPD, the method varies by researchers. Although
you described “For several reasons, self-administered questionnaires are often considered more
reliable than face-to-face or telephone interviews (2).”, the referred study (2) does not increase
justification to choose a self-administrated questionnaire over a face-to-face method for your
case. You need to clarify why you considered it was appropriate for your own research question
from the above-mentioned aspects.
3. Selection bias
You described in the limitation section that “The numbers of participants who lived in rural
(villages) and in the refugee camps were too small to assess PPD risk factors associated with
those living situations. This could still be resulted in a selection bias in participant selection, as
the prevalence of PPD may increase in rural and refugee areas”. Also, in the method section,
you illustrated that “there were 28,273 live births in the northern of West Bank in 2020 (18)”.
However, according to the annual report by UNRWA, there were 14,767 new pregnancy
registrations during 2022 in the West Bank as a whole. Although the year and regional size
covered are not same as your study case, this number cannot be described as small number
that caused selection bias because the 4 governorates (Nablus, Tulkarem, Jenin, and Qalqelia)
account for nearly 35% population of whole West Bank [State of Palestine 2021: https://
www.pcbs.gov.ps/Portals/_Rainbow/Documents/LUS3E.html].
The next is on the ethical consideration
4. Lack of coordination for the consequence of this study
When researchers address a research topic related to mental health or any sensitive topic, it is
critical to prepare coordination between the sample participants and psychological aid as a part
of the study design. Conducting a study to investigate the prevalence of sensitive health illness
and ending the study while leaving the at-risk patients in limbo question the accountability of
the study.
Any measure could have been arranged in advance, such as coordinating with potential host
health facilities in case the screening identified an at-risk patient.