PONE-D-22-22410Perinatal suicidal behavior in Sub-Saharan Africa: A study protocol for a systematic review with meta-analysisPLOS ONE

Dear Dr. Hajure,

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 Feb 02 2023 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.

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María Eugenia Gómez López, Ph.D.

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

PONE-D22-22410 is a very interesting work, the topic is relevant not only for the African reasearch, but also for the perinatal mental health research in the world. However, the authors must consider the following. After a preliminary review of the submission, following the publication criteria of PLOS ONE, based on the AMSTAR and PRISMA checklists systematic reviews, it is my assessment:

According to AMSTAR guidelines, the following items are missing from the article:

1. Research question(s)

2. Objective (s) of the systematic review

3. Inclusion criteria must include: population, intervention, and comparator group (PICO)

4. Explanation of the selection of the study designs (If the authors will include RCTs, NRSI or both).

Based on PRISMA CHECKLIST (S1 Table), the following items are missing from the article:

1. Administrative information: identification and registration (must be on page 3 instead of 4).

2. Introduction: Objectives are missing and also the explicit statement of the question(s) the review will address according to PICO.

3. Methods: in the eligibility criteria are missing the study characteristics: PICO, study design, time frame and report characteristics. And also are missing the items such as: Outcomes and priorization, Meta-bias, and Confidence in cumulative evidence.

These resuIts of the preliminary review have led me to believe it is necessary to have the author work on the missing items mentioned above to complete their protocol before any reviewers can be invited to provide their assessment.

Best regards,

María Eugenia Gómez López, PhD

Academic Editor

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Reviewers' comments:

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Attachments

Attachment

Submitted filename: PLOS ONE_SUBMISSION_REVIEW PONE-D-22-22410.docx

PONE-D-22-22410R1Perinatal suicidal behavior in Sub-Saharan Africa: A study protocol for a systematic review with meta-analysisPLOS ONE

Dear Dr. Hajure,

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.

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

Reviewer 1

1) Does suicidal behavior include suicidal ideation? right now this point is unclear, although the authors included suicidal ideation in the search strategy and defined suicidal ideation, it is not covered in the definition of suicidal behaviors defined in Definition of concepts.

2) For eligibility criteria, why exclude studies published before the year 2000?

3) The description of the search strategy is somewhat hard to follow. Can the authors list the main search strategy with the key terms and then report the variations used for each key term? or if the authors have other better ways to present the search strategy it will be acceptable as long as easy to follow.

Reviewer 2

Abstract:

In the context of maternal morbidity, the ICD-10 classifies suicide as a direct cause of death, not an indirect cause of death as stated here. Please review same.

"Perinatal mental illnesses" are mental illnesses that exist during the perinatal period so this statement is misleading as it conveys a sense that they are separate, when they are not. Please revise for clarity.

The perinatal period alone does not increase susceptibility to suicidal behaviour. Again, this is misleading and should be reviewed.

For the abstract, there is too much detail provided in the methods section and a synopsis only should be provided.

Introduction:

Again perinatal mental illnesses are mental illnesses that exist during the perinatal period so this statement is misleading as it conveys a sense that they are separate, when they are not. Please revise for clarity.

Suicide is a symptom and not a condition. Please revise for clarity.

"Suicidal behaviour WAS thought to be a leading..." if this is past-tense, what is currently thought?

Again, the perinatal period alone does not increase susceptibility to suicidal behaviour. This is nuanced and should be reviewed.

Again, in the context of maternal morbidity, the ICD-10 classifies suicide as a direct cause of death, not an indirect cause of death as stated here. Please review same.

"During the perinatal period women have..." - this is not reflective of all countries and is too nuanced to be this clear-cut. There is evidence that despite women having regular contact with HCP's, women's mental health needs are not addressed and therefore, this needs to be reviewed to reflect this.

Specific objectives:

Please define what is meant by 'level'

Specific questions:

Please define what is meant by 'determines it'

Methods:

Please provide rationale for choosing 21 year timeframe.

Psych Info - please amend to read PsycINFO

Please consider language in search terms "committed" is no longer an accepted term in the context of suicide.

Screening procedure:

Please consider an alternative phrase to "get rid of" (omit, remove etc.)

Discussion

It is accepted little evidence exists in terms of sub-Saharan Africa, however, several reviews have been conducted on the prevalence rates and psychosocial risk factors relating to perinatal suicide/suicidal ideation or suicidal behaviours - please provide commentary on the state of the evidence currently and what gaps this review aims to address.

Limitations

Please ensure all language is future-tense, such as English language WILL be included as opposed to was included. Also I would query the line "in most studies, the death of the mother..." this reads as though the study has been completed so it is important not to confuse the protocol with the findings of the review.

General:

There are issues with the reference list - please ensure to address these.

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

Please submit your revised manuscript by May 18 2023 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,

María Eugenia Gómez López, 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.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: No

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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

**********

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 #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a study protocol for a systematic review with meta-analysis on perinatal suicidal behavior in Sub-Saharan Africa. Perinatal psychiatric illness in particular suicidal behavior is a critical condition and has substantial influences on the development of the fetus and child. A systematic and meta analytic approach will help synthesize the evidence of previous studies and provide important insights that can guide future investigations. In general, I find the manuscript well written in an intelligible fashion and the authors have adequately addressed the editor and reviewers' concerns. I have three additional comments for the authors to address, which may help further enhance the manuscript.

1), does suicidal behavior include suicidal ideation? right now this point is unclear, although the authors included suicidal ideation in the search strategy and defined suicidal ideation, it is not covered in the definition of suicidal behaviors defined in Definition of concepts.

2), for eligibility criteria, why exclude studies published before the year 2000?

3), the description of the search strategy is somewhat hard to follow. Can the authors list the main search strategy with the key terms and then report the variations used for each key term? or if the authors have other better ways to present the search strategy it will be acceptable as long as easy to follow.

Reviewer #2: Authors,

Thank you for compiling this review protocol for a very worthy subject matter. My comments are intended to enhance and improve the paper.

Q3 above - As you have chosen to undertake a search of grey literature and unpublished studies, it would be difficult to replicate this. Therefore, I have answered 'no' to this question.

Abstract:

In the context of maternal morbidity, the ICD-10 classifies suicide as a direct cause of death, not an indirect cause of death as stated here. Please review same.

"perinatal mental illnesses" are mental illnesses that exist during the perinatal period so this statement is misleading as it conveys a sense that they are separate, when they are not. Please revise for clarity.

The perinatal period alone does not increase susceptibility to suicidal behaviour. Again, this is misleading and should be reviewed.

For the abstract, there is too much detail provided in the methods section and a synopsis only should be provided.

Introduction:

Again perinatal mental illnesses are mental illnesses that exist during the perinatal period so this statement is misleading as it conveys a sense that they are separate, when they are not. Please revise for clarity.

Suicide is a symptom and not a condition. Please revise for clarity.

"Suicidal behaviour WAS thought to be a leading..." if this is past-tense, what is currently thought?

Again, the perinatal period alone does not increase susceptibility to suicidal behaviour. This is nuanced and should be reviewed.

Again, in the context of maternal morbidity, the ICD-10 classifies suicide as a direct cause of death, not an indirect cause of death as stated here. Please review same.

"During the perinatal period women have..." - this is not reflective of all countries and is too nuanced to be this clear-cut. There is evidence that despite women having regular contact with HCP's, women's mental health needs are not addressed and therefore, this needs to be reviewed to reflect this.

Specific objectives:

Please define what is meant by 'level'

Specific questions:

Please define what is meant by 'determines it'

Methods:

Please provide rationale for choosing 21 year timeframe.

Psych Info - please amend to read PsycINFO

Please consider language in search terms "committed" is no longer an accepted term in the context of suicide.

Screening procedure:

Please consider an alternative phrase to "get rid of" (omit, remove etc.)

Discussion

It is accepted little evidence exists in terms of sub-Saharan Africa, however, several reviews have been conducted on the prevalence rates and psychosocial risk factors relating to perinatal suicide/suicidal ideation or suicidal behaviours - please provide commentary on the state of the evidence currently and what gaps this review aims to address.

Limitations

Please ensure all language is future-tense, such as English language WILL be included as opposed to was included. Also I would query the line "in most studies, the death of the mother...." this reads as though the study has been completed so it is important not to confuse the protocol with the findings of the review.

General:

There are issues with the reference list - please ensure to address these.

**********

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 #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.

Perinatal suicidal behavior in Sub-Saharan Africa: A study protocol for a systematic review with meta-analysis

PONE-D-22-22410R2

Dear Dr. Hajure:

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,

María Eugenia Gómez López, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: