PONE-D-21-10000Health care professionals’ experiences of screening immigrant mothers for postpartum depression – a meta-synthesisPLOS ONE

Dear Dr. Skoog,

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.

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Senior Editor

PLOS ONE

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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: N/A

Reviewer #2: N/A

**********

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: PONE-D-21-10000

Article Type: Research Article

Full Title: Health care professionals’ experiences of screening immigrant mothers for postpartum

depression – a meta-synthesis

I read this manuscript with great interest. Postpartum depression is a major public health problem and immigrant mothers could be at particular risk. The authors present a meta-synthesis on health care professionals’ experiences of screening immigrant mothers for postpartum depression. The manuscript is well written. It highlights the fear and frustration that health care professionals experienced.

The introduction is adequate and well written.

Considering method, the section on search strategy and screening, as well as the section on data extraction and synthesis, could be shorter.

Table 1 and Table 2 could be presented as supplementary materials.

Search outcomes: One article received CASP scores below 6. What was this article about? Do the results differ from the eight other studies?

Description of the included studies: Table 3 could be shorter. For example, I think it is not necessary to present titles and all authors (first author et al) could be adequate.

Discussion: A few words on PPD management in these women could be added.

Minor remarks:

Abstract: Introduction add HCPs after health care professionals.

Discussion: First sentence I think it is eight and not seven studies.

Reviewer #2: The manuscript is well written. I have few comments:

1. Some discussions on other screening tools of depressive symptoms should come in the introduction

2. I would suggest the authors should present different phases of data extraction and synthesis in a graphical way

3. The authors should state the implication of the findings in the context of LMIC countries.

**********

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Reviewer #1: No

Reviewer #2: Yes: Ranadip Chowdhury

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PONE-D-21-10000R1Health care professionals’ experiences of screening immigrant mothers for postpartum depression – a systematic reviewPLOS ONE

Dear Dr. Skoog,

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 respond to the specific comments from Reviewers 1 and 3:Reviewer 1: the reviewer 2 suggested some discussions on other screening tools of depressive symptoms in the discussion. The authors presented this point in the introduction. I think it could be in the discussion, as reviewer 2 suggested Reviewer 3:

Suggest stating aim more clearly in the abstract. In addition, the aim needs to be clearly articulated either prior to or at the start of methods. What is written there is more an implied aim for the review.

As an overall point I wondered why the review had not included – antenatal or perinatal depression. Often screening using the EPDS etc is routine in pregnancy and many HCPs have commented on the challenges they experience. This stood out for me even more when I noted that at least three of the papers included in the review actually focus on the perceptions of HCPs who work in antenatal settings -for example the research by Nithianandan; Stapleton and Willey

I would suggest that the review should either have the broader focus or at least the intention to include studies of HCPs working antenatally with women as well as following birth. This could also be addressed in the limitations.

Introduction

In the Introduction I noted that a number of points particularly related to prevalence of PPD are referenced to quite old papers eg refs 3,4,8,9,13

Suggest all these scales need referencing here in introduction “There are specific scales developed to screen for symptoms of depression in the peripartum and postpartum period; the Edinburgh Postpartum Depression Scale (EPDS), the Postpartum Depression Screening Scale and the

Pregnancy Risk Questionnaire,”

Worth noting here “Screening for PPD using the EPDS is generally found acceptable by health care professionals (HCPs) [22, 23], although different aspects of administering the scale have been identified as important [24].” That screening also appears to be acceptable to women – Kingston is a good reference for that particularly in primary care.

I was confused by the use of term indigenous – my immediate thought was that this referred to Frist Nations populations – and I suggest that each time indigenous is used it should eb with a capital ‘I” but then I think that you may be referring to the dominant population group in a country. This needs clarifying please.

Results

I had wondered about the title of the first sub theme – referring to being a good friend… I think it is a little misleading in terms of the practice of the HCP because they correct themselves and do not emphasise becoming friends rather the quote says “…but that we have a good relationship. That they feel they are liked and that I listen to them. I…”

In the second sub theme I am reading here the importance of continuity and seeing women overt time to recognise the change in their presentation or demeanour. I think you do address this in the discussion but it is a very important point.

I wondered if more could be said about taking a different approach to screening whereby the EPDS or other tool is used as the basis of a conversation rather than just the pen and paper exercise. But this more conversational approach is probably much more relevant for the psychosocial questions that may accompany the screening using a tool.

Please submit your revised manuscript by Jun 10 2022 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: https://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,

Alessandra N. Bazzano

Academic Editor

PLOS ONE

Journal Requirements:

1. When submitting your revision, we need you to address these additional requirements.

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. Please ensure that you have addressed all items recommended in the PRISMA checklist including identifying the study as a systematic review in the title.

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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 #1: All comments have been addressed

Reviewer #3: (No Response)

**********

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 #1: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #3: N/A

**********

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 #1: 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 #1: 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 #1: The authors improved their manuscript.

The sections on search strategy and screening have been shortened.

The table has been shortened.

The text is easy to follow.

In the discussion, a section has been added on HCPs experiences of PPD management

in immigrant mothers.

All comments have been addressed. However, the reviewer 2 suggested some discussions on other screening tools of depressive symptoms in the discussion. The authors presented this point in the introduction. I think it could be in the discussion, as reviewer 2 suggested.

Reviewer #3: Thank you for the opportunity to review this paper – this is a really important issue and challenging for HCPs.

I offer the following comments to strengthen the paper.

Suggest stating aim more clearly in the abstract

In addition, the aim needs to be clearly articulated either prior to or at the start of methods. What is written there is more an implied aim for the review.

As an overall point I wondered why the review had not included – antenatal or perinatal depression. Often screening using the EPDS etc is routine in pregnancy and many HCPs have commented on the challenges they experience. This stood out for me even more when I noted that at least three of the papers included in the review actually focus on the perceptions of HCPs who work in antenatal settings -for example the research by Nithianandan; Stapleton and Willey

I would suggest that the review should either have the broader focus or at least the intention to include studies of HCPs working antenatally with women as well as following birth. This could also be addressed in the limitations.

Introduction

In the Introduction I noted that a number of points particularly related to prevalence of PPD are referenced to quite old papers eg refs 3,4,8,9,13

Suggest all these scales need referencing here in introduction “There are specific scales developed to screen for symptoms of depression in the peripartum and postpartum period; the Edinburgh Postpartum Depression Scale (EPDS), the Postpartum Depression Screening Scale and the

Pregnancy Risk Questionnaire,”

Worth noting here “Screening for PPD using the EPDS is generally found acceptable by health care professionals (HCPs) [22, 23], although different aspects of administering the scale have been identified as important [24].” That screening also appears to be acceptable to women – Kingston is a good reference for that particularly in primary care.

I was confused by the use of term indigenous – my immediate thought was that this referred to Frist Nations populations – and I suggest that each time indigenous is used it should eb with a capital ‘I” but then I think that you may be referring to the dominant population group in a country. This needs clarifying please.

Results

I think you have done an excellent job in identifying and articulating the translation of the key themes

I had wondered about the title of the first sub theme – referring to being a good friend… I think it is a little misleading in terms of the practice of the HCP because they correct themselves and do not emphasise becoming friends rather the quote says “…but that we have a good relationship. That they feel they are liked and that I listen to them. I…”

In the second sub theme I am reading here the importance of continuity and seeing women overt time to recognise the change in their presentation or demeanour. I think you do address this in the discussion but it is a very important point.

The discussion covers important issues and addresses the findings

I wondered if more could be said about taking a different approach to screening whereby the EPDS or other tool is used as the basis of a conversation rather than just the pen and paper exercise. But this more conversational approach is probably much more relevant for the psychosocial questions that may accompany the screening using a tool.

**********

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 #1: 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.

PONE-D-21-10000R2Health care professionals’ experiences of screening immigrant mothers for postpartum depression – a systematic reviewPLOS ONE

Dear Dr. Skoog,

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.

==============================The authors have done an excellent job of addressing reviewer's comments. There is an important final revision needed after which the paper will be accepted, the authors should revise the title of their manuscript to describe the study as a "qualitative systematic review" and cite the ENTREQ reporting guidelines in the Methods section, along with completing the ENTREQ checklist. See: https://www.equator-network.org/reporting-guidelines/entreq/ There is also a minor change needed, there appears to be a grammatical error in Table 3 where the word "women" should replace "woman", or else indicate this was the verbatim quote using [sic].Please ensure that your decision is justified on PLOS ONE’s publication criteria and not, for example, on novelty or perceived impact.

For Lab, Study and Registered Report Protocols: These article types are not expected to include results but may include pilot data. 

==============================

Please submit your revised manuscript by Aug 07 2022 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: https://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,

Alessandra N. Bazzano

Academic Editor

PLOS ONE

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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.

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Reviewers' comments:

[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.

Health care professionals’ experiences of screening immigrant mothers for postpartum depression – a qualitative systematic review

PONE-D-21-10000R3

Dear Dr. Skoog,

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.

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Kind regards,

Alessandra N. Bazzano

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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