Research Article

Direct economic burden of mental health disorders associated with polycystic ovary syndrome: Systematic review and meta-analysis

School of Global Public Health, New York University, United States
Department of Obstetrics and Gynecology, Heersink School of Medicine, University of Alabama at Birmingham, United States
Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, United States
PCOS Challenge: The National Polycystic Ovary Syndrome, United States
Department of Obstetrics and Gynecology, University of California, Los Angeles, United States
Department of Health Policy, Management and Behavior, University at Albany, State University of New York, United States
Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, United States
Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, United States

Aug 3, 2023

https://doi.org/10.7554/eLife.85338

Open access
Copyright information

Peer review process
Decision letter
Author response

Peer review process

This article was accepted for publication as part of eLife's original publishing model.

Decision letter

Eduardo L Franco

Senior and Reviewing Editor; McGill University, Canada
Michel Pugeat

Reviewer
Rebecca Elaine Campbell

Reviewer; University of Otago, New Zealand

Our editorial process produces two outputs: (i) public reviews designed to be posted alongside the preprint for the benefit of readers; (ii) feedback on the manuscript for the authors, including requests for revisions, shown below. We also include an acceptance summary that explains what the editors found interesting or important about the work.

Decision letter after peer review:

Thank you for submitting your article "Direct Economic Burden of Mental Health Disorders Associated with Polycystic Ovary Syndrome: Systematic Review and Meta-analysis" for consideration by eLife. Your article has been reviewed by two peer reviewers, and I have overseen the evaluation in my dual role of Reviewing Editor and Senior Editor. The following individuals involved in the review of your submission have agreed to reveal their identities: Michel Pugeat (Reviewer #1); Rebecca Elaine Campbell (Reviewer #2).

Essential revisions:

Reviewer #2 (Recommendations for the authors):

– P3, ln 59 'Following' vs Followed.

– P5, ln 98 'PCOS is the single…' vs PCOS single.

– P6, ln 124 add 'mean annual' to costs of PCOS-associated…

– P10, ln 215 'an' vs as.

– P16, ln 381 'mental health disease' vs mental disease.

– P16, ln 379- consider revising this sentence for clarity.

– P17, ln 17 remove 'with.'

– Given the asymmetric nature of the funnel plots, an Egger's test could also be run for additional assessment of publication bias in addition to the trim and fill.

https://doi.org/10.7554/eLife.85338.sa1

Author response

Essential revisions:

Reviewer #2 (Recommendations for the authors):

– P3, ln 59 'Following' vs Followed.

– P5, ln 98 'PCOS is the single…' vs PCOS single.

– P6, ln 124 add 'mean annual' to costs of PCOS-associated…

– P10, ln 215 'an' vs as.

– P16, ln 381 'mental health disease' vs mental disease.

– P16, ln 379- consider revising this sentence for clarity.

– P17, ln 17 remove 'with.'

– Given the asymmetric nature of the funnel plots, an Egger's test could also be run for additional assessment of publication bias in addition to the trim and fill.

We conducted Egger’s test for funnel plot asymmetry. The results were significant for depression, anxiety, and eating disorders, implying potential publication bias arising from "small study" effects. Nonetheless, other factors, such as heterogeneity of study populations, covariates, or outcome definitions, could also account for the funnel plot asymmetry. The "trim and fill" method suggested that the results for anxiety and depression were robust to this type of publication bias. In contrast, results for eating disorders were somewhat less robust (Line 335; Supplemental Table 9). Please note that the power of this method to detect bias will be low with small numbers of studies. We have added this data to the Results and Discussion sections of our manuscript.

https://doi.org/10.7554/eLife.85338.sa2