PONE-D-24-08898Psychological Experience of Patients with Postpartum Depression:A qualitative Meta-synthesisPLOS ONE

Dear Dr. xue,

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The manuscript must be returned for major corrections. For the following reasons: The prism flowchart used has four stages, the one currently used has 3 stages, consult Prisma (https://www.prisma-statement.org/prisma-2020-flow-diagram) since it is not a frequent analysis method, it is important that the authors detail the data extraction process to arrive at three main themes and how subtopics arise within them. So that anyone can reproduce the study. In turn, since a psychometric measure is used for the discrimination of women with depression, the cultural factors evidenced in the limitations of the study require greater precision, since the psychometric instrument has validity and reliability independent of the cultural group. In the discussion, since it is a study that favors the deep understanding of depression, it is important to discuss each of the topics found. These topics should be discussed about the implications they have for the current scientific community, public policy-making, and women and family members so that they know how they can use the results of the study. In the table of results it is important to homogenize the presentation of the last study, it does not have a synthesis of results as they have been presenting in the previous studies in the table

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Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Introduction:

The introduction provides a comprehensive view of postpartum depression, which is a very common health problem among postpartum women worldwide, causing distress and serious negative impacts on mothers and their families, and has received extensive attention in several countries. This effectively contextualizes the importance of conducting a recent systematic review on the psychological experiences of patients with postpartum depression using qualitative studies.

Methods:

Its methods section is good for its clarity and systematic approach. The procedures for the systematic search (protocol and registry, systematic search, study selection, data extraction and quality assessment, data synthesis and analysis) are meticulously detailed.

Results:

The presentation of results is clear and concise, offering a step-by-step account of the articles selected for systematic review (selection and characteristics of trials, primary results, secondary results).

Discussion:

Their discussion effectively connects the findings of their study to previous research on qualitative studies on the psychological experience of postpartum depressed patients. Her discussion addresses topics on pregnancy, the physiological and psychological factors that produce changes in the maternal body, of which postpartum depression is one of the most common health problems among postpartum women around the world.

Limitations of the study.

The authors mention as a limitation qualitative studies published only in journals indexed in English or Chinese according to the inclusion criteria and another limitation is the specific details of postpartum depression, which may be different between countries.

Conclusion.

In summary, the most relevant finding revealed that the impact of negative physical and psychological aspects, the discomfort of role transformation and the notable lack of support in patients with postpartum depression, specifies the lack of more studies to address mental health during pregnancy.

The article is accepted for publication.

Reviewer #2: Thank you for the opportunity to review this manuscript: “Psychological Experience of Patients with Postpartum Depression: A qualitative Meta-synthesis”

This manuscript provides an important synthesis of the literature around postnatal depression and the key themes that warrant further consideration in formulating strategies for supporting women suffering PND. I strongly support the publication of this article, however, while the study itself was conducted well, I feel that the extracted findings were inadequately discussed and synthesized. Importantly, I’m concerned that there are important subthemes that may be missing. Also, given the inclusion of both Chinese and International studies, I am interested in knowing whether there are sociocultural determinants of PND in Asian and Western contexts, and whether/how these might influence the recommendations the authors might make to improve PND outcomes in these very different contexts. In light of these issues I am recommending this manuscript as ACCEPT WITH MAJOR REVISIONS to allow the authors time to address these concerns and to make the necessary changes. I am looking forward to seeing the revised manuscript in due course

Thanks and best wishes.

OVERALL

Language is mostly good throughout but a few spelling and grammatical errors throughout. Some of the spelling errors are in quotes so not sure what to do about those.

Do you have supplementary material for this study? It would be useful to be able to inspect the quotes extracted from each paper and detail on how they were grouped into themes.

ABSTRACT

May need to be updated following changes to the results/discussion.

INTRODUCTION

Remove “etc.” throughout. Scientific articles should be as specific as possible.

Some studies have reported that the global average incidence of postpartum depression is 17.7%[4] – I read this paper and could not find this statistic. Could you please clarify?

METHODS

One issue here is that the included literature is now 9 months out of date. Would be great if the authors could update the search to September 2024. I can’t imagine this would identify too many new articles but it would give the most comprehensive snapshot of the literature.

Section 2.3 – the example search term for PubMed isn’t necessary and you could move this to supplemental.

RESULTS

Can you briefly describe what "doing the month" is? I see it is mentioned in the quote further down but a brief description above would be valuable for non-Chinese readers.

I’m not familiar with this specific form of analysis but I am wondering whether it would be appropriate to calculate and describe which were the themes or subthemes that appeared most frequently across many studies? This might give an indication which themes are “universal” across different social and cultural contexts, or even common within cultures (e.g., Asian vs Western), which may give an indication as to which themes or subthemes should be addressed as a matter of priority.

I am wondering if it is appropriate to broaden the range of themes and subthemes identified. I can imagine emotional experiences, cognitive experiences, physical experiences, social and interpersonal experiences, behavioural changes (in self and others), identity and role transition, support experiences (friends, family, healthcare), coping strategies, feelings about impact of parenting on baby, cultural and societal influences amongst others as being key contributors. I note that you’ve included many of these but I am wondering if there are more themes that might have significant evidence. One of the key domains that I think could be expanded are around meta-theme 3 – support. For example, there seemed to be a several comments that could suggest that another relevant sub-theme could be “lack of practical support” (as distinct from “other support”) – I could see this being a strong contributor to PND having a husband or mother-in-law that won’t provide practical support for domestic duties. I could also see stronger recommendations around the expectations that husbands and other family members support new mothers post partum as being particularly helpful in alleviating some of the main modifiable physical stressors.

DISCUSSION

The first paragraph justifying the need for qualitative approach is redundant. If necessary you could include some of this detail in the justification in the introduction? Otherwise I would just start the discussion by summarising your main findings.

I think the discussion could benefit from some more structure and depth. You’ve just synthesized some very interesting literature but the discussion as written missed a significant opportunity to make sense of these findings and propose some steps forward. As a starting point, I think that subheadings for each of the 3 main meta-themes would be helpful. I think under these headings it would be useful to 1) summarise the findings from this meta-synthesis, and 2) provide recommendations for how these might inform solutions and how these might reduce the risk of PND.

I agree with you completely regarding the role of support. I believe this is a critical component and I would like to see this expanded in the discussion. People generally fare much better in life when they feel supported and informed, both practically and emotionally, and this is particularly the case with new mothers. I would like to see more in depth discussion and recommendation around this point.

As mentioned above, it would be useful to know how person-centred care might be applied across cultural contexts – Asian vs Western contexts.

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Reviewer #1: Yes: Horacio Almanza-Reyes

Reviewer #2: No

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Psychological Experience of Patients with Postpartum Depression:A qualitative Meta-synthesis

PONE-D-24-08898R1

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Academic Editor

PLOS ONE

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