Early Parenting Interactions and First-Time Mothers’ Postnatal Depression and Parental Competence

Round 1

Reviewer 1 Report

Thank you for inviting me to review this interesting manuscript. Overall, the paper is original and can offer contribution to the literature. Specifically, the idea of exploring associations between a first-time parent's early life experiences and postnatal features is important and has both theoretical and clinical implications. More specific comment to the authors:

- in the Abstract, lease add, within the first sentence, what Schema Therapy is.

- Similarly, at the very beginning of the Introduction, add explanation on what Schema Therapy is: What are its core concepts? Ideas? It doesn't have to be long, but you should say something about it to so that there is some ground to start from and move on.

- Further, I feel like there should be a preceding paragraph in the Introduction, or at least several sentences at the beginning of the current first paragraph, to (broadly) present Schema Therapy's approach and conceptual thinking before delving into the specific context of the current study. In this initial introduction of ST you should also present the concept of EMS and say something about its different types.

- The third paragraph in the Introduction (starting with "First-time motherhood constitutes a vulnerable period...") comes out of nowhere: Why do you focus all of a sudden on first-time mothers? Try to link the components of your rationale more clearly and streamline your text accordingly.

- Later in this paragraph, on line 63, please change "postnatal depression" to "postnatal depressive symptoms".

- The entire rationale for examining the links between early interactions with caregivers and postnatal depressive symptoms is a bit loose: Why do early interactions with caregivers give rise to depressive symptoms particularly post-birth? How does the context of a first birth can be relevant to schemas that were created and internalized in early interactions with caregivers? Try to strengthen your rationale for these associations.

- The authors describe the participants, but it would be helpful if they could add a table describing the characteristics and sociodemographic information of the participants in more detail.

- Under Measures, the authors describe that they evaluated early interactions with mothers and early interactions with fathers, separately: Why? If there is literature pointing to differenc effects of fathers' and mothers' interactions and suggest separated analyses, please add references to this literature; or, alternatively, present results of t-tests that suggest running separate models for early interactions with fathers and with mothers. Otherwise, why not including both (i.e., "early interactions with the caregivers") within the same model? I agree that there is a possibility that you should test the models separately, but this should be clearly explained.

- Alpha values for PPSI and YPI-R2 are very high. Very high reliability scores may suggest that some items are redundant and actually test the same aspect(s) of the concept. According to Streiner (2003), a maximum alpha value of 0.90 has been recommended. Please look into it and see if there is a way to retain only items that measure the concept in some different ways so that the alpha is lower than 0.90.

(Cite: Streiner, D. L. (2003). Starting at the beginning: an introduction to coefficient alpha and internal consistency. Journal of Personality Assessment, 80(1), 99-103.‏)

- The authors measured early interactions using two different measurements? (i.e., PPSI and YPI-R2). Are you sure you need to measure positive and negative early interaction this way? Wouldn't it be right to say that high scores in PPSI, for example, mean positive interactions and low scores mean negative interactions? Why measuring it twice in two different and separated tools?

- The Results section is well-written. One minor point: Please rephrase the subtitles - it should be either "impact of early interactions with mothers/fathers on depressive symptoms" or "associations between early... and depressive symptoms".

- The Discussion is interesting and highlights important points from your study. However, please elaborate on the theoretical implications of your findings: for example, how do they inform Schema Therapy's theoretical assumptions? EMS? Also, can we learn anything new from the fact that early interactions with both fathers and mothers - albeit with a bit different effect - are associated with postpartum depressive symptoms? Additionally, what can we specifically learn about the experience of first-time motherhood and postnatal depressive symptoms within the first year of motherhood in light of these findings?

- In the second paragraph under Strengths, the authors state that, "postnatal literature also conventionally skews toward examining early experiences with negative constructs". What literature? Please provide some examples for such studies.

- The clinical implications section is convincing and well-written.

- In the Limitations section, I would suugest to add that another limitation has to do with the study's cross-sectional design: the transition to parenthood and the first year of motherhood are not static but rather, unfold and change over time; thus, a longitudinal design could capture changes and nuances during this period of time that the present study could not have identified.

Author Response

Please see attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Dear Authors, This is a very important area of research. There is indeed good evidence that perinatal maternal mental health status is associated with child cognitive and emotional development. Thus, health professionals and researchers interested in supporting women who may be more vulnerable to anxiety and/or depression appreciate effective tools for identifying women who could benefit from appropriate support. 

The main suggestion I would like to make for enhancing the manuscript concerns the practical aspects of how this new information can be applied in practice and some estimate/ discussion of costs, both in terms of health professional time and financially.  

Other small issues such as clarifying wording are on the pdf attached. 

Comments for author File: Comments.pdf

The English is fine, just some queries over the wording on the pdf attached.

Author Response

Please see attached

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The authors did a great job in responsing to my comments. I now recommend the paper for publication.