Reviewer's report
Title:Obstetric and psychological characteristics of women seeking multiple
abortions in the region of Monastir (Tunisia): Results of a cross-sectional study
Version:2Date:19 February 2015
Reviewer: Elena Toffol
Reviewer's report:
Obstetric and psychological characteristics of women seeking multiple abortions
in the region of Monastir (Tunisia): Results of a cross-sectional design
This paper aims at studying the factors associated with repeated abortions in a
specific population of 500 women seeking abortion in a region in Tunisia. The
topic is of actual interest gynecologists, mental health and public health
professionals. The results have some valuable clinical and practical implications
that could be even more emphasized in the discussion. However, I have some
concerns regarding the manuscript in its actual form:
1. The main limitation of this study is its cross-sectional design. Specifically, I
would recommend not using any time- and causality- specifiers when describing
the associations between repeated abortion and CMD. In fact, the mental health
status was assessed only post-abortion; thus, it cannot be ruled out that these
women had high (and possibly even higher) levels of psychological distress
before the abortion itself (e.g., in relation to the unwanted pregnancy). I would
suggest not talking about “development” of CDM, but rather about associations.
This point should be addressed in a “Limitations” section.
2. Abstract, page 2, line 26: as above, I would not claim that repeated abortion
“can cause some mental disorders”. Similarly, at line 46: the authors may
consider using a difference word instead of “develop” (e.g., “report”).
3. Introduction, page 3, lines 70-73: the authors should check the
appropriateness of the reference #6. The study by Wallin Lundell et al. does not
show that “women who had abortions were more likely than delivering women to
develop common mental disorders (CMD), as anxiety, depression and sleep
disturbances especially when the pregnancy is Unwanted”. Rather, the study
reports the prevalence of PTSD, PTSS, other psychiatric symptoms and
traumatic experiences in women seeking abortion.
4. Methods, page 4, line 104: the authors claim that they evaluated anxiety,
depression and sleep disturbances. However, in the methods they describe only
the instrument used for assessing depression and anxiety, but there is no
description of how sleep disturbances were assessed. Similarly, there is no
further mention of sleep disturbances in the “Data analysis” section or in any
other part of the manuscript.
5. Discussion, page 6, lines 162-163: the authors mention that “The aim of our
study was to identify the rate of women seeking repeated abortions in the region
of Monastir (Tunisia)”. Is the prevalence of women seeking repeated abortion at
the RHC the same as the prevalence of women seeking repeated abortion in the
whole region of Monastir? Are all women residing in the Monastir region referred
to the RHC, or could they go to other clinics/structures to seek abortion?
Minor concerns:
1. Methods, pages 4-5: the section “Measures” is a repetition of the last two
paragraphs in the section “Setting and sampling”. The authors may consider
either merging the two sections or omitting the description from the “Setting and
sampling” section.
2. Results: the prevalence of CMD should be mentioned/reported in Table 1.
3. In general there are minor typos/grammar errors. The manuscript would
benefit of an overall language revision.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.