"Pain in my heart": Understanding perinatal depression among women living with HIV in Malawi

Katherine LeMasters; Josée Dussault; Clare Barrington; Angela Bengtson; Bradley Gaynes; Vivian Go; Mina C. Hosseinipour; Kazione Kulisewa; Anna Kutengule; Samantha Meltzer-Brody; Dalitso Midiani; Steve Mphonda; Michael Udedi; Brian Pence

doi:10.1371/journal.pone.0227935

Peer Review History

Original SubmissionJanuary 1, 2020
24 Mar 2020 Decision Letter - Ali Montazeri, Editor PONE-D-20-00046 "Pain in my heart": Understanding perinatal depression among women living with HIV in Malawi PLOS ONE Dear Dr. LeMasters, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We would appreciate receiving your revised manuscript by May 08 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: PONE-D-20-00046 "Pain in my heart": Understanding perinatal depression among women living with HIV in Malawi. The comments for the above manuscript: Short Title: Short title is just like the main title so it must be corrected. Abstract: - In the Methods: The research method is not mentioned. Introduction: - The beginning sentences for the introduction seems to be not suitable because the HIV treatment is not the main problem of the present study. - Line 45-48: It is not clear, what does it mean? - The authors have noted that the disease is associated with depression, so the need for a study is unclear. They have mentioned to “women living with HIV in low income settings” but there is not any explanation about the reasons for probable differences of the PND in this group of women with others that previous studies have conducted on them. So the necessity of the present study should be clarified. Methods: - How many women completed the EPDS questionnaire? What was the sampling method? - EPDS questionnaire is a postnatal depression scale. How the authors explain for using it during pregnancy? - What was the evidence for living with HIV? Results: - Is written in a pleasant and expressive way. - Table 1: It is better to write the percentages in the last two columns next to their related numbers (4th and 5th column) in the parenthesis. Discussion: - Is well written. Reviewer #2: This article is technically and conceptually well organized. All the criteria of a research article is considered in writing. I suggest some revision in line 85 as it is not clear whether 4 or 5 women were interviewed. Also, I think it would be better to assign the statistical tests used in table 1 in lines 132-136. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-20-00046.docx https://doi.org/10.1371/journal.pone.0227935.r001
Revision 1
14 Apr 2020 Author Response Response to Reviewers We very much appreciate the time taken to review our manuscript and for your thoughtful comments. Reviewer #1: Short Title: Short title is just like the main title so it must be corrected. - Thank you for this, it is now “Perinatal depression and HIV in Malawian Women.” Abstract: In the Methods: The research method is not mentioned. - Thank you for this. We have only included a brief description of our methods in the abstract due to word limitations, but we have been sure to include our sample size and that we used both inductive and deductive coding and narrative analysis (page 2 lines 27-29). I have also added ‘qualitative’ in front of ‘interviews’ for further clarification. Introduction: The beginning sentences for the introduction seems to be not suitable because the HIV treatment is not the main problem of the present study. - Thank you for your comment. While it is true that HIV treatment is not the only problem of this study, the statement is meant to provide a broad overview of how HIV treatment and maternal mental health intersect and may contribute to poor HIV outcomes. We hope that our revisions to what were lines 45-48 below help to clarify this. Line 45-48: It is not clear, what does it mean? - Thank you for your question. We have edited this statement, which is meant to connect poor HIV retention in care with maternal mental health (page 2 line 47-50), as our study explores the connection between the two. The authors have noted that the disease is associated with depression, so the need for a study is unclear. They have mentioned to “women living with HIV in low income settings” but there is not any explanation about the reasons for probable differences of the PND in this group of women with others that previous studies have conducted on them. So the necessity of the present study should be clarified. - Thank you for your comment. As you said, and as stated in the manuscript, we know that perinatal depression affects many women in low and middle-income countries and we know that adults living with HIV are at an increased risk for depression. However, very little is known about perinatal depression among women living with HIV. Indeed, what we do know is quantitative and/or is not specific to only women living with HIV (added to page 3 line 77).1,2 Thus, there is a need to develop a richer, qualitative understanding of PND specifically among HIV-positive women. Additionally, mental illness and its stigma is conceptualized differently in different settings, further indicating the need to deeply explore its intersection with HIV in various settings.3 Methods: How many women completed the EPDS questionnaire? What was the sampling method? - Under Results, Demographic Information (page 6, line 145), it states that 73 women were screened. This is also noted in the Abstract. - Page 4, lines 93-95 states that women were sampled consecutively at each site until the desired sample size was reached. Consecutive sampling is very similar to convenience sampling. Each eligible patient who presents for care is approached for enrollment until the desired sample size has been reached.4 The citation has now been added to the manuscript. EPDS questionnaire is a postnatal depression scale. How the authors explain for using it during pregnancy? - Thank you for your question. While originally designed to screen for postpartum depression, the EPDS is frequently used to screen for depression in antenatal settings, including in sub-Saharan Africa, which is now included in the manuscript (page 4, lines 91-92).5,6 What was the evidence for living with HIV? - Women’s health passports were used to determine their HIV status, this has been updated in the manuscript in the methods section (page 4, lines 88-89). Results: Is written in a pleasant and expressive way. - Thank you for your feedback, it’s greatly appreciated. Table 1: It is better to write the percentages in the last two columns next to their related numbers (4th and 5th column) in the parenthesis. - Thank you for this suggestion, this has been done and Table 1 reflects these changes (page 7). Discussion: Is well written. - Thank you so much for your comments. Reviewer #2: This article is technically and conceptually well organized. All the criteria of a research article is considered in writing. - Thank you very much for your review and comments. I suggest some revision in line 85 as it is not clear whether 4 or 5 women were interviewed. Also, I think it would be better to assign the statistical tests used in table 1 in lines 132-136. - Thank you for your comment. 24 women were recruited, requiring one site to have 4 women while the remaining sites recruited 5. This has been added to the manuscript (page 4, lines 94-95). Our goal in qualitative interviews was to reach saturation, where new data are redundant with data already collected.7 Given the rule of thumb of 5-10 in-depth interviews per stratum (pre- and post-natal), we expected that we would achieve saturation within our proposed sample size. This has also been added to the manuscript (page 4, lines 128-129). We hope that this change clarifies the second part of your statement, as we are not sure what the statisticial tests are that you are referencing. Attachments Attachment Submitted filename: LeMasters_ResponseReviewers_04.06.20.docx https://doi.org/10.1371/journal.pone.0227935.r002
26 May 2020 Decision Letter - Ali Montazeri, Editor "Pain in my heart": Understanding perinatal depression among women living with HIV in Malawi PONE-D-20-00046R1 Dear Dr. LeMasters, We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Ali Montazeri Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0227935.r003
Formally Accepted
28 May 2020 Acceptance Letter - Ali Montazeri, Editor PONE-D-20-00046R1 "Pain in my heart": Understanding perinatal depression among women living with HIV in Malawi Dear Dr. LeMasters: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Ali Montazeri Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0227935.r004

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