Title: Exploring Women's Perception and Attitude Towards Antidepressant Use: A Cross-
Sectional Study
Version: 1 Date: 27 May 2024
Reviewer:  Dushad Ram
Reviewer's report:
The reviewer has the following comments to make about the manuscript:
Introduction:
General comment: Highlight the high prevalence of depression among women, particularly
during pregnancy, and underscore the challenges posed by cultural stigma, underreporting, and
the complexities of discontinuing antidepressants during pregnancy. Emphasizes the need for
early screening and understanding of influencing factors.
Specific Comment:
1. Literature about the prevalence of depression among women and
perceptions of antidepressants is lacking (e.g.  DOI: 10.1111/jcap.12429;
https://doi.org/10.1155/2023/8854120; https://doi.org/10.15537/smj.2021.42.6.20200790;
DOI:10.5742/MEWFM.2022.95251360; doi: 10.7759/cureus.51335); doi: 10.7759/
cureus.56180; DOI https://doi.org/10.2147/RMHP.S454926). It is strongly advised to conduct
the literature review and formulate a reason for the study.
2. There is no operation definition of “Perception”, “Attitude” and “Antidepressants” for this
study, audience understanding may vary about the concept, hence clarification is needed.
3. The introduction section mentioned that “we aim to identify cultural and non-cultural factors
that may influence the decision to use antidepressants and the attitude toward dealing with
depression during pregnancy and non-pregnancy.”. Clarification is needed about “Cultural” and
“Non-cultural” factors. Reviewer did not able to find out any standard tools that assessed these
variables.
Methods
General comment: Justify convenient sampling, sample size calculation assumptions,
participation rate, detailed statistical analysis plan.
Specific comment:
1. Needs justification for the tool developed and used in this study, when standard tools are
available. Also provide sources from which the tools were constructed / developed. Provide
details of the validation process in more detail, such as justifying the sample size of the pilot
study, specific changes made to the questionnaire based on pilot feedback, which would be
important for transparency and understanding the refinement process.
2. There appears to be an arbitrary cut-off point (75% cut-off point). Please provide justification
for this specific threshold, or a comparison with other potential cut-offs would be helpful.
3. Provide details about how the missing data was managed.
Results
1. It is unclear that the authors mentioned, “Nine hundred ninety-one respondents were reached.
However, a total of 966 respondents were included.”.
2.  The authors used binary logistic regression analysis but did not provide details of justification,
on the specific variables included, or how the models were adjusted for potential confounders.
Also, there is no mention of how missing data were handled in the analysis.
3. There appears to be some repetition in the presentation of results, particularly regarding
perceptions and attitudes toward depression and antidepressants.
4. There appears to be ambiguity in the measure of perception and Attitude. The criteria for
ascertaining of the “positive" & "negative" perceptions; or "favorable and “favourable" &
"unfavourable" attitudes are not clearly explained. How these were quantitatively measured and
analysed should be detailed to understand the basis of these classifications.
Discussion
1. Explore in depth about the implications of the key findings. For example, while the lack of
awareness about antidepressants' benefits is mentioned, there is insufficient analysis of how this
lack of knowledge affects behaviour and treatment outcomes.
2. The authors appears to reiterate general findings without exploring the nuances. Specific
factors influencing attitudes, such as the role of physicians in decision-making, are mentioned
but not analysed in depth.
3. The authors did not provide the explanation of negative perceptions among previously
diagnosed patients. The suggestion that it is based on poor past experiences is plausible but
requires more detailed examination and evidence.
4. Regarding cultural and religious influences, the authors have acknowledged it but do not
sufficiently explore how these factors specifically impact attitudes toward antidepressants.
5. Conclusion should be specific of finding based on the results, not a vague statement. The
conclusion provided in the manuscript appears to be more of an author's opinion about the
finding rather than actual conclusions.
6. There is a need to provide suggestion to address the issue of causality in future research, so
does the specific suggestions for future research, such as investigating the impact of targeted
educational interventions or exploring the role of healthcare providers in shaping attitudes,
would be beneficial.