Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support

Md Jahirul Islam; Lisa Broidy; Kathleen Baird; Mosiur Rahman; Khondker Mohammad Zobair

doi:10.1371/journal.pone.0251419

Peer Review History

Original SubmissionAugust 14, 2020
9 Sep 2020 Decision Letter - Yukiko Washio, Editor PONE-D-20-25535 Early exclusive breastfeeding cessation and postpartum depression: assessing the mediating and moderating role of maternal stress and social support PLOS ONE Dear Dr. Islam, 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. Please submit your revised manuscript by Oct 24 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Yukiko Washio, Ph.D. Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. 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If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” If any authors received a salary from any of your funders, please state which authors and which funders. If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 5. We noted in your submission details that a portion of your manuscript may have been presented or published elsewhere. "It is an outcome of a large project. Some of the variables of this manuscript are similar to my previously published articles." Please clarify whether this publication was peer-reviewed and formally published. If this work was previously peer-reviewed and published, in the cover letter please provide the reason that this work does not constitute dual publication and should be included in the current manuscript. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. 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: Very nice manuscript that does add to the literature on this topic. I appreciate your discussion about the varied findings of the relationship between PPD and early termination of EPF at the bottom of page 3/top of page 4. I think it would be helpful to provide a bit more detail about the difference between mediating and moderating effects. Reviewer #2: This is an exceptionally well-written, well-designed and optimally referenced paper and should be published, requiring only minimal edits. While recognizing the weaknesses of employing exclusive use of survey data, somewhat temporally removed from the outcome of interest and the limitations of a cross-sectional design, the “n” of over 400 women is meaningful. The highly significant increases in depression recorded among women who stop exclusive breastfeeding early may warrant a closer look at this population when screening for postpartum depression. It is of interest that more than 25% of women reported either a past history of depressive symptoms or early sexual abuse; these clearly represent a high-risk group. Not entirely surprising, although an important observation, was the strong association of postpartum depression with an increase in reported levels of stress and the lack of social support. The paper would be significantly strengthened by the authors having access to the medical record or to have minimally questioned women on the clinical outcomes of their baby at delivery and since the time of birth, as this would be an important confounder. The first sentence citing PPD rates in the conclusion section is confusing and should be rewritten. This paper suggests that the screening for depression might occur early, at 2-3 months, and again at 4-6 months, although this screening interval would require validation. In all, this study from Bangladesh imparts new and important information and should stimulate additional research in new techniques and methodology for screening of postpartum depression. It reinforces the deed for social support and indicates the importance of additionally focusing on women who stop exclusive breastfeeding early. Identification of postpartum depression begs the question of limited treatment options available to women in under-resourced countries. ****** 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.] 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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0251419.r001
Revision 1
13 Jan 2021 Author Response Comment 1: During our internal evaluation of the manuscript, we noted that your study utilizes existing data collected in 2015 for a previously published study, and that you did not perform any additional experiments or collect new data for the current study. Response: It is clearly evidenced that a misunderstanding regarding our statement of the dataset has arisen. We mentioned that the current manuscript uses existing data collected in 2015 for a large research project that focused on the links between pregnancy, intimate partner violence, and maternal health and wellbeing outcomes. The project consists six research questions/objectives. It is clearly imaginable how large was the magnitude of the study. With each of the objectives, we have published/prepared one separate manuscript using the relevant portion of the same dataset. We have never before used these data to examine the links between the early termination of exclusive breastfeeding and postpartum depression. We confirm this work has not been previously published anywhere. However, in the method and result sections, there might have been little similarities due to the common methodology used in the data collection process and use of some of the common socio-demographic variables, e.g. age, education, income, parity, etc. Comment 2: We would like to make you aware that copying extracts from previous publications, especially outside the methods section, word-for-word is unacceptable. In addition, the reproduction of text from published reports has implications for the copyright that may apply to the publications. Response: We are fully aware of the editor’s concern. Because of the use of the common methodology and some of the similar socio-demographic variables, it may show some similarities with the previous articles. However, we have extensively revised the aforementioned sections of the current manuscript to address the issue. Comment 3: Please revise the manuscript to ensure that any portions of the manuscript that have been previously published are fully referenced and cited; rewritten or rephrased; and, if applicable, that permission for republication is obtained and uploaded alongside your submission. Response: We have rewritten and rephrased some of the more generic sections of the manuscript where we found overlaps with our other papers. Additionally, we have referenced and cited our previously published articles (pages 5 & 6). We are not going to republish any articles as each of the manuscripts has a distinct objective. So, copyright permission is not needed. Comment 4: We ask that you also provide details as to how the current manuscript advances on previous work. Please note that further consideration is dependent on the submission of a manuscript that addresses these concerns about the overlap in text with published work. Response: We have added more detail to clarify how the current manuscript advances on previous work (See page 5). Overall, though, this manuscript is fundamentally distinct from others using this large dataset and we are confident it offers important new insights about the relationship between early termination of breastfeeding and postpartum depression. We appreciate the opportunity to revise and strengthen the manuscript. Attachments Attachment Submitted filename: Response to Editor and or reviewers.docx https://doi.org/10.1371/journal.pone.0251419.r002
20 Apr 2021 Decision Letter - Yukiko Washio, Editor PONE-D-20-25535R1 Early exclusive breastfeeding cessation and postpartum depression: assessing the mediating and moderating role of maternal stress and social support PLOS ONE Dear Dr. Islam, 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. Please submit your revised manuscript by Jun 04 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Yukiko Washio, Ph.D. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Partly Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes Reviewer #3: Yes ****** 6. 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 #2: The authors appear to have addressed prior concerns of the reviewers, many of which were focused on being certain that the paper’s conclusions were not a duplicate of data already published from the larger trial. The weaknesses inherent in a survey-based cross-sectional study are not sufficiently addressed. However, the authors do note the importance of “directionality” (i.e. cause/effect of exclusive breastfeeding on subsequent rates of postpartum depression). It would be meaningful if the authors were to specifically comment on why women who employ a combination of breast along with bottle feeding had higher rates of PPD as compared to those who exclusively utilized bottle feeding and infant formula. Despite some limitations of the manuscript, the importance of stress and family support show strong associations with both breastfeeding and postpartum depression. The need to recognize and screen for PPD among women who do not practice EBF for 6 months, whatever the reason, appears to be compelling. Reviewer #3: The manuscript does not mention whether gestational age was considered in the evaluation, which it appears to not have. If not, this should be mentioned as potential limitation of the study as well as fact that it was self-report. ****** 7. 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 #2: No Reviewer #3: 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.] 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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0251419.r003
Revision 2
24 Apr 2021 Author Response We appreciate the generally positive reviews and the insightful comments made by reviewers. We have revised our manuscript in response to editor and reviewers’ comments and have detailed the responses below. We believe the revised manuscript addresses the concerns raised by the editor and reviewers, improving the clarity and overall strength of the document. Reply to Editor and Reviewer comments Editorial Office Comment: While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. Response: We have uploaded figure files following the recommendation. Reviewer 2: Comment 1: The authors appear to have addressed prior concerns of the reviewers, many of which were focused on being certain that the paper’s conclusions were not a duplicate of data already published from the larger trial. Response: Thank you very much for the positive decisions regarding the issue raised for the dataset. Comment 2: The weaknesses inherent in a survey-based cross-sectional study are not sufficiently addressed. However, the authors do note the importance of “directionality” (i.e., cause/effect of exclusive breastfeeding on subsequent rates of postpartum depression). Response: The issue of a survey-based cross-sectional study has been addressed in page 21. Comment 3: It would be meaningful if the authors were to specifically comment on why women who employ a combination of breast along with bottle feeding had higher rates of PPD as compared to those who exclusively utilized bottle feeding and infant formula. Response: Postpartum depression might cause negative effects on maternal self-esteem and cognition and have a detrimental effect on their belief that they can breastfeed their baby. PPD can also lead to a lack of interactions with their baby, such as less skin – to skin, less touching, which can further increase their lack of confidence in their own ability to breastfeed their babies, and lead decreased satisfaction related to their infant feeding practices and further increase in depressive symptoms and increase the need for infant formula. This association has been added into the manuscript (page 19-20). Comment 4: Despite some limitations of the manuscript, the importance of stress and family support show strong associations with both breastfeeding and postpartum depression. The need to recognize and screen for PPD among women who do not practice EBF for 6 months, whatever the reason, appears to be compelling. Response: We appreciate the positive concluding remarks regarding the manuscript. Reviewer 3: Comment 1: The manuscript does not mention whether gestational age was considered in the evaluation, which it appears to not have. If not, this should be mentioned as potential limitation of the study as well as fact that it was self-report. Response: Gestational age was not considered in the evaluation which has been addressed as a potential limitation of the study. We have also addressed the issue of self-report (See page 21). We appreciate the opportunity to revise and strengthen the manuscript. Attachments Attachment Submitted filename: Response to Editor and or reviewers.docx https://doi.org/10.1371/journal.pone.0251419.r004
27 Apr 2021 Decision Letter - Yukiko Washio, Editor Early exclusive breastfeeding cessation and postpartum depression: assessing the mediating and moderating role of maternal stress and social support PONE-D-20-25535R2 Dear Dr. Islam, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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 help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- 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. Kind regards, Yukiko Washio, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0251419.r005
Formally Accepted
29 Apr 2021 Acceptance Letter - Yukiko Washio, Editor PONE-D-20-25535R2 Early exclusive breastfeeding cessation and postpartum depression: assessing the mediating and moderating role of maternal stress and social support Dear Dr. Islam: I'm 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 let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Yukiko Washio Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0251419.r006

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