PONE-D-22-27546Estimating the effect of anticipated depression treatment-related stigma on depression remission among people with depression in MalawiPLOS ONE

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PLOS ONE

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: This study explored the role of treatment-related stigma in depression care by estimating the effect of patients’ baseline anticipated treatment-related stigma on their 3-month probability of depression remission when newly identified with depression.

This work makes important contributions to the literature regarding the public mental health issues.

However, the manuscript can be further strengthened by some reframing of the introduction, addition of further details regarding the methods, and clarification of study findings. I have provided additional details below.

Since the participants in this study are all patients with chronic diseases, it is suggested that the author should make it clear in the title that this research group is NCD patients with depressive symptoms, rather than "people with depression" as currently described.

Abstract:

It should be clarified that this study is based on cohort study design.

In methods of abstract, the author stated that this study measured the data at four time points, but only analyzed the data after the third month in the text, which makes readers confused. I can understand that the data of this manuscript comes from a large research project and the observation at four time points is the design of the parent study. If the data in this manuscript does not use the follow-up data at the last two time points, it is recommended to modify this description in the abstract to avoid misunderstanding.

Introduction:

There are some descriptions of the limitations of existing literature around mental illness stigma. However, the rationale for studying this topic in Malawi specifically could be bolstered. Specifically, additional support is needed for why you explored a series of confounding factors in method section (P9, line 131-159)? The main confounding factors considered in this study should be justified in the background.

Methods:

Interesting that the author considered multiple psychosocial indicators as confounding factors, but did not mention participants' chronic diseases, such as NCD condition and other physical health related characteristics.You could link this more clearly to the limitations section which discusses the overall healthiness of your study population.

Please omit the following sentences, “In general, this sample of participants had high levels of baseline social support and post-traumatic stress symptoms (P12, line 28-219).” And instead describe the actual findings presented in Table 1.

Moreover, because the author did not describe the assessment method of social support and PTSD symptoms in method section, there is no basis for how to judge the "high level" here.

Result

The presentation of Table 2 is a bit confusing. It is suggested that the author present demographic characteristic variables together. Then it can be considered to put the observed variables after the baseline and three-month follow-up into a table and list them by two columns for comparison.

I think Table S3 can present the main results better than Table 3.

Discussion

As the author stated (in the methodology section), the stigma experienced by the participants was different from the anticipated stigma. However, I didn't see the author mention in the discussion what kind of targeted intervention should be adopted against the “anticipated treatment-related stigma”in this study. And, whether it is necessary to design and intervene the content of this type of stigma from the perspective of patients themselves, rather than reducing the discriminatory attitude towards community people in general? Please clarify.

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Reviewer #1: No

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Estimating the effect of anticipated depression treatment-related stigma on depression remission among people with noncommunicable diseases and depressive symptoms in Malawi

PONE-D-22-27546R1

Dear Dr Dussault,

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.

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Kind regards,

Dr Gayathri Delanerolle

Academic Editor

PLOS ONE