Determinants of depression among ever-married adolescent girls in Bangladesh: Evidence from the Bangladesh Adolescent Health and Wellbeing Survey 2019–2020

Mehedi Hasan; Md Al Amin

doi:10.1371/journal.pone.0314283

Peer Review History

Original SubmissionFebruary 2, 2024
30 Jul 2024 Decision Letter - Md. Shahjalal, Editor PONE-D-24-04225Determinants of Depression Among Ever Married Adolescent Girls in Bangladesh: Evidence from Bangladesh Adolescent Health and Wellbeing Survey 2019-2020PLOS ONE Dear Dr. Hasan, 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. ============================== ACADEMIC EDITOR: Please insert comments here and delete this placeholder text when finished. 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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 provide a complete Data Availability Statement in the submission form, ensuring you include all necessary access information or a reason for why you are unable to make your data freely accessible. If your research concerns only data provided within your submission, please write "All data are in the manuscript and/or supporting information files" as your Data Availability Statement. [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: Partly Reviewer #2: Partly ******** 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: No Reviewer #2: No ****** 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: 1. It is a secondary data analysis. Then it should be described so. 2. Introduction can be made more coherent. 3. Table 1 - Check spelling (Syber Bullying) 4. Inconsistent use of abbreviation (IPV not used even after prior elaboration earlier) 5. Statement in 346-347 needs reference 6. Many mistakes in spelling-concrete 6. 7. Meaning of Line 369-379 not clear 8. Line 401 -should be though not through 9. Is it multivariate/univariate analysis? Use standard terms 10. The study is important, but the manuscript needs significant language edits and spell checks Reviewer #2: Thank you for the opportunity to review the paper titled "Determinants of Depression Among Ever Married Adolescent Girls in Bangladesh: Evidence from Bangladesh Adolescent Health and Wellbeing Survey 2019-2020." The study provides valuable insights into the factors influencing depression in this demographic, utilizing data from a comprehensive national survey. Here is my points. Introduction The introduction is informative and thorough. However, streamlining certain sections could enhance readability. You might consider combining similar points and adopting more concise language to improve the flow. Introducing a theoretical framework could significantly bolster the study's conceptual foundation. For instance, applying the ecological systems theory or the life course perspective might provide valuable insights into the factors influencing depression among married adolescent girls. To improve clarity and focus, explicitly stating the specific objectives of the study would be beneficial. While the introduction suggests the research aims, clear articulation of these objectives is recommended. It would be helpful to include precise definitions of key terms such as "depression" and "adolescence." This will ensure consistency and clarity throughout the manuscript. Enhance the connection between the identified risk factors for depression (e.g., social isolation, limited autonomy) and the specific context of married adolescent girls in Bangladesh. Address potential ethical considerations pertinent to conducting research with this vulnerable population. Methods Considering the complex sampling design, it would be helpful to indicate whether sample weights were applied in the analysis to account for the sampling design and enhance the representativeness of the results. The exclusion of 383 pregnant women and 394 cases with missing data is mentioned. Providing a more detailed explanation of the missing data mechanisms (e.g., missing completely at random, missing at random, missing not at random) would add clarity. The information provided on the reliability and validity of the PHQ-9 is not adequate. Further elaboration on the rationale for selecting the specific covariates would be appreciated. Was the selection guided by a theoretical framework? Clarifying how missing data for covariates were managed (e.g., imputation, listwise deletion) would strengthen the methodology section. Discussion While the discussion provides a good overview of the associations between depression and the studied factors, it could be strengthened by exploring potential mechanisms underlying these relationships. For example, how might physical violence lead to depression? The discussion could be expanded to provide more specific policy recommendations based on the study findings. What types of interventions could be implemented to address the high prevalence of depression among married adolescent girls? The authors could elaborate on the potential directions for future research to build upon the findings of this study. For example, longitudinal studies could be conducted to examine the causal relationships between the studied factors and depression. Consider incorporating a theoretical framework to guide the interpretation of the findings and to explain the potential mechanisms underlying the observed associations. Discuss the potential role of cultural factors in shaping the mental health experiences of married adolescent girls in Bangladesh. Provide more specific recommendations for interventions targeting different levels of prevention (primary, secondary, and tertiary) and for different stakeholders (e.g., government, healthcare providers, community organizations). Conclusion: While the conclusion calls for policy interventions, it could be strengthened by providing more specific recommendations. For example, the authors could outline potential policy targets, such as strengthening law enforcement against violence, increasing access to mental health services, or promoting gender equality. The conclusion could end with a strong call to action, emphasizing the urgency of addressing the mental health needs of married adolescent girls. ****** 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.0314283.r001
Revision 1
20 Sep 2024 Author Response Review of manuscript for PLOS ONE: “Determinants of Depression Among Ever Married Adolescent Girls in Bangladesh: Evidence from Bangladesh Adolescent Health and Wellbeing Survey 2019-2020” Manuscript number: PONE-S-24-05514 # Journal requirements: Comment: Please ensure that your manuscript meets PLOS ONE's style requirements Response: Thank you for your concern. We have taken a thorough look on the guideline and checked our formatting and styles in the manuscript as per journal requirements Comment: Please provide a complete Data Availability Statement in the submission form, ensuring you include all necessary access information or a reason for why you are unable to make your data freely accessible. If your research concerns only data provided within your submission, please write "All data are in the manuscript and/or supporting information files" as your Data Availability Statement. Response: Thank you for your suggestion. Since the data utilized in this study were extracted from a national survey (secondary source), therefore, we recommend restricting the data access to manuscript submission purposes only, rather than make it freely accessible. We put the recommended statement “All data are in the manuscript and/or supporting information files" in Data Availability Statement. # Reviewer(s)' Comments to Author: Reviewer: 1 Overall Comment: It is a secondary data analysis. Then it should be described so. Response: We appreciate your valuable feedback. We mentioned it in the introduction section Comment: Introduction can be made more coherent. Response: We appreciate your insightful feedback. We try our best to make this section more inclusive and coherent through comprehensive review Comment: Check spelling (Syber Bullying) Response: Many thanks, we corrected it accordingly Comment: Inconsistent use of abbreviation (IPV not used even after prior elaboration earlier) Response: We appreciate your insightful feedback. We checked this inconsistency and corrected accordingly Comment: Statement in 346-347 needs reference Response: Thanks for your insightful feedback. Line 346 indicates the association between sexual violence and depression that found in our study, therefore no reference is needed for this line, on the other hand, for line 347-348, we added the appropriate reference Comment: Many mistakes in spelling-concrete 6. Response: Thanks, we corrected the spelling accordingly Comment: Meaning of Line 369-379 not clear Response: Thanks for your excellent observation. Indeed, in our multivariate analysis (AOR- Table-3), education didn’t appear as significant factor in determining the depressive symptoms but appear significant in univariable analysis (COR- Table-3). Therefore, to support and justify our findings, we discussed the relevant literature on the association between education and depression in lines 369-389. In this part of discussion, we have edited few sentences to make it more precise and understandable. Comment: Line 401 -should be though not through Response: Thanks, we corrected the spelling accordingly. Comment: Is it multivariate/univariate analysis? Use standard terms Response: Thanks for your insightful feedback. In the statistical analyses section, we used the term 'univariable analysis' to represent the Crude Odds Ratio (COR), which does not account for any potential confounders in the model during the analysis (Table 3). On the other hand, we used 'multivariable analysis,' also referred to as 'multivariate analysis,' to indicate the Adjusted Odds Ratio (AOR) in the model, which accounts for potential covariates in the analysis (Table 3). Our findings in the manuscript were interpreted based on this multivariable/multivariate analysis. Comment: The study is important, but the manuscript needs significant language edits and spell checks Response: Thanks for your valuable feedback. We put our best efforts to navigate this problem and improve the flow. We have checked thoroughly for settling the grammatical and linguistic errors in our revised paper to make it easier for the readers. Reviewer: 2 Introduction Comment: The introduction is informative and thorough. However, streamlining certain sections could enhance readability. You might consider combining similar points and adopting more concise language to improve the flow. Response: Thanks for your insightful comments. We have given a thorough look to fix all the inconsistencies including linguistics and grammatical mistakes throughout the introduction. Further, we have revised the flow of the introduction to make it easier to understand for the readers. Comment: Introducing a theoretical framework could significantly bolster the study's conceptual foundation. For instance, applying the ecological systems theory or the life course perspective might provide valuable insights into the factors influencing depression among married adolescent girls. Response: Thanks for your insightful suggestion. Yes, we follow a theoretical framework in the introduction section to have a solid foundation for conducting this study. The introduction section was systematically guided by a matrix/framework that are as follows: 1. describing the outcome of interest (depression) and its relevance; 2. describing the problem in global and national context as well as highlighted the relevance of the study by stating the available evidence and existing knowledge gap. 3. adopting a theoretical framework based on the socio-ecological model, which indicate individual’s mental health are influenced by multiple levels of indicators among the married adolescents in the context of Bangladesh, including individual, community, and societal (Socio-demographic) factors and discuss accordingly in the introduction section. For instance, we discuss the association between violence and different spectrums of mental health conditions among the married adolescents in Bangladesh. As well as we also discuss the social determinants of depression among the respondents in Bangladesh. 4. Discuss and highlight the significance of the current study by articulating the research gap among the married adolescents 5. Statement of the study objective. Comment: To improve clarity and focus, explicitly stating the specific objectives of the study would be beneficial. While the introduction suggests the research aims, clear articulation of these objectives is recommended. Response: Thanks for your insightful feedback. As recommended, we explicitly stated the specific objectives of the study Comment: It would be helpful to include precise definitions of key terms such as "depression" and "adolescence." This will ensure consistency and clarity throughout the manuscript. Response: Thanks for your insightful feedback. Yes, the elaborate and precise definition of these key terms was absent in the manuscript. As suggested, we elaborately defined the “depression, and “adolescence”, according to WHO definition Comment: Enhance the connection between the identified risk factors for depression (e.g., social isolation, limited autonomy) and the specific context of married adolescent girls in Bangladesh. Response: Thanks for valuable suggestion. As suggested, we discussed the relevant associations in the introduction section Comment: Address potential ethical considerations pertinent to conducting research with this vulnerable population. Response: Thanks for your concern. We conducted this analysis utilizing the national survey data (secondary source) for this study. The original cross-sectional survey obtained ethical approval from the relevant institutional review board and ensured that all respondents or their caregivers provided informed consent before participating in the interviews including the assessment of depression. The details of the ethical considerations, including the participant consent form, were submitted separately during the first submission. However, leveraging this secondary data in our analysis complies with the ethical standards for research involving human subjects, and no additional ethical approval was required for this secondary analysis. Methods Comment: Considering the complex sampling design, it would be helpful to indicate whether sample weights were applied in the analysis to account for the sampling design and enhance the representativeness of the results Response: Thanks for valuable suggestion. Since our study utilized secondary data, we incorporated sampling weights in the regression model (Table-3) to enhance the robustness and generalizability of our findings. As suggested, we have included this information in the 'Statistical Analysis' section of the manuscript Comment: The exclusion of 383 pregnant women and 394 cases with missing data is mentioned. Providing a more detailed explanation of the missing data mechanisms (e.g., missing completely at random, missing at random, missing not at random) would add clarity. Response: Thanks for valuable suggestion. In the methodology section, we explicitly addressed the mechanisms of missing data. For instance, a total of 383 observations from pregnant women were excluded purposively due to the known association between depression and pregnancy/early childbearing. Additionally, 394 observations were excluded from the analysis due to missing information on harassment and violence indicators. Given that this missing data was random and unrelated to the outcome of depression, we applied a listwise deletion process to systematically exclude these observations to maintain the integrity of our results. Comment: The information provided on the reliability and validity of the PHQ-9 is not adequate. Response: Thanks for valuable suggestion. As suggested, we tried to provide detail information on PHQ-9. Comment: Further elaboration on the rationale for selecting the specific covariates would be appreciated. Was the selection guided by a theoretical framework Response: Thanks for valuable recommendations. We were guided by relevant literature from LMICs, that report the determinants of depression among adolescents. Based on this review, we considered the potential covariates for our study. Additionally, we employed a conceptual framework to select these covariates, focusing specifically on socio-demographic factors and indicators of violence, to select the relevant variables. Comment: Clarifying how missing data for covariates were managed (e.g., imputation, listwise deletion) would strengthen the methodology section. Response: Thanks for valuable suggestion. Due to 394 missing data points for physical and sexual harassment and other covariates, a listwise deletion process was applied. This approach systematically excluded 394 observations related to depression status to ensure the accuracy and completeness of the analysis. Discussion Comment: While the discussion provides a good overview of the associations between depression and the studied factors, it could be strengthened by exploring potential mechanisms underlying these relationships. For example, how might physical violence lead to depression? Response: Thanks for your suggestion. Based on available literature, we explicitly discussed the potential pathways for the associations that induce depression among adolescents. Since, there is scarce of information in the context of Bangladesh regarding these pathways, therefore we recommend further research to explore the underlying mechanisms that lead to depression. Comment: The discussion could be expanded to provide more specific policy recommendations based on the study findings. What types of interventions could be implemented to address the high prevalence of depression among married adolescent girls? Response: Thanks for insightful recommendation We recommended implementing community-based screening programs for the early detection of depression as part of a primary prevention approach. Additionally, we suggest engaging community healthcare providers to ensure continuity of care reduce this the burden as part of secondary prevention approach. Moreover, we added a section namely “Policy implications” for elucidating these recommendations. Comment: The authors could elaborate on the potential directions for future research to build upon the findings of this study. For example, longitudinal studies could be conducted to examine the causal relationships between the studied factors and depression. Response: Thanks. We elaborately discussed this issue in the limitation section. Since we utilized survey/cross-sectional data for this study, that could not establish a causal or dose-response relationship between the risk factors and the outcome of interest (depression). Therefore, we recommend conducting longitudinal or follow-up studies to establish causal associations. Furthermore, we also recommend to explore the potential mediator/pathway of the determinants that later on lead to depression, to fill the knowledge gap and take appropriate interventions. Comment: Consider incorporating a theoretical framework to guide the interpretation of the findings and to explain the potential mechanisms underlying the observed associations. Response: We guided by a framework to interpret our findings align with each of the factors that led depression. For example, we explain how various factors—such as socio-demographic characteristics, exposure to violence, and harassment—affect mental health outcomes by considering the context, social norms, and practices in Bangladesh. By integrating this framework, we provided a comprehensive explanation of the pathways that lead to depression, supported by the associations observed in our study. We also discuss the strength and limitations of our observed findings and provide specific recommendations in terms of different prevention approaches. Comment: Discuss the potential role of cultural factors in shaping the mental health experiences of married adolescent girls in Bangladesh. Response: We discuss the different dimensions of cultural factors such as such as early marriage, IPV, inequality, poor subjective happiness and limited mobility that shaping and influencing the mental health status in the context of Bangladesh. Comment: Provide more specific recommendations for interventions targeting different levels of prevention (primary, secondary, and tertiary) and for different stakeholders (e.g., government, healthcare providers, community organizations). Response: We provided recommendations for preventing and controlling depression, focusing on various prevention mechanisms and engaging with different stakeholders. In addition, we added a section namely “Policy implications” for elucidating these recommendations. Conclusion Comment: While the conclusion calls for policy interventions, it could be strengthened by providing more specific recommendations. For example, the authors could outline potential policy targets, such as strengthening law enforcement against violence, increasing access to mental health services, or promoting gender equality. Response: As recommended, we incorporated this into the conclusion. For example, we recommended introducing the screening program into the community level; enforce the strict law; and behavioral change interventions to prevent any form of violence and harassment Comment: The conclusion could end with a strong call to action, emphasizing the urgency of addressing the mental health needs of married adolescent girls Response: This issue is also mentioned in the section as suggested. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0314283.r002
8 Nov 2024 Decision Letter - Md. Shahjalal, Editor Determinants of Depression Among Ever Married Adolescent Girls in Bangladesh: Evidence from The Bangladesh Adolescent Health and Wellbeing Survey 2019-2020 PONE-D-24-04225R1 Dear Mr. Mehedi, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Md. Shahjalal Academic Editor PLOS ONE Additional Editor Comments (optional): 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 #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 #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? 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 #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 #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 #3: (No Response) ****** 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 #3: Yes: Dr Md Ahedulla ******** https://doi.org/10.1371/journal.pone.0314283.r003
Formally Accepted
13 Nov 2024 Acceptance Letter - Md. Shahjalal, Editor PONE-D-24-04225R1 PLOS ONE Dear Dr. Hasan, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@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. Md. Shahjalal Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0314283.r004

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