Differential Diagnosis in Disorders with Depressive Symptoms: Exact Clinical Framing and Proposal of the “Perrotta Depressive Symptoms Assessment”
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsPlease see attached file "depr dx"
Comments for author File: 
Comments.pdf
A number of sentences are excessively complex to be understood. I've offered possible solutions.
Author Response
Dear colleague, thank you very much for your help and support and I understand your concerns, but this is a pilot study, that's why the number of patients is small. Once this publication is approved, we will proceed with the expanded study and with the representative population sample. The scheme, as you yourself indicate, is revolutionary, and for this reason on some points it differs from the literature, but it has already demonstrated a certain interpretative stability in the pilot sample. This is why we are convinced that it can really work. We cannot block this publication because it is a pilot study and already has statistical dignity. Attached you will find my answers to your questions. Thank you for your valuable contribution!!!
Author Response File: Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsThis study seems to introduce a promising approach to detect depressive symptoms and severity. I have several comments for improvement.
1/ The literature review in the Introduction covers a lot of ground, which is good. However, some of it needs to be reframed. This study aims to correct gaps evident in current models. That should be specified clearly upfront and those current models need attention. For example, there are depression severity scales currently being used (PHQ-9; HAMD-17). This paper is trying to improve on those models, correct? That should be clear from the outset and the Introduction should highlight the contributions and limitations of related/rival models and approaches.
2/ Given the foregoing point, the research questions should be revised. See below for my recommendations.
- 1) Can the difference between depressive symptoms and depressive disorders be more accurately determined by mental health clinicians?
- 2) Is it possible to improve on currently utilized severity scales of depressive manifestation?
- 3) Could a refined model more correctly frame the patient's clinical condition when he or she presents with depressive symptoms?
3/ Figure 1 is really helpful. Please say more about the reduction from 2399 studies to 34 studies for the literature review. Was it only related to the publication time frame? What attributes of the 6 more studies permitted their inclusion to bring the sample to 40?
4/ How common it is for an author's name to be integrated into the title of an assessment method? I come from a non-psychology/psychiatry background, so I am not opposed to this but thought I'd ask.
5/ The abbreviation of the assessment could be confused with Plan-Do-Study-Act (PDSA). I recognize that an acronym can stand for more than one thing. Just FYI.
6/ My experience is as a program evaluator of mental health promotion, drug treatment, and related interventions. Therefore, I am not the best judge of the PDSA content as relayed in Tables 2-5 and the relevant narrative. That said, can you share advice about how program evaluators might examine implementation fidelity of this model as well as its effectiveness? I'm not asking for evaluation instruments or extensive treatment of this issue. But some attention to how PDSA can be capably evaluated (one paragraph perhaps) would be welcome.
7/ I'd like to see the pilot study methodology and data also covered in the Materials and Methods section. Right now, it focuses only on the literature review methods. I am not an expert on instrument validation and leave that to other reviewers with more expertise in that area. Was power analysis conducted to ensure that the sample has sufficient statistical power to conduct the research and produce meaningful findings?
8/ How is an IRB statement not applicable in a study using human subjects? What human subject protections were utilized?
Additional items: The final paragraph of the Introduction is a single sentence. I suspect that could be folded into the preceding paragraph. Some phrasing in this manuscript could be refined for comprehensibility. It could benefit from some copyediting.
Comments on the Quality of English LanguageThere are some phrasing issues that could benefit from copyediting.
Author Response
Dear colleague, thank you very much for your intervention and for your precious help. Attached you will find my comments.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsThe manuscript by Giulio Perrotta and Irene Petruccelli presents a review that introduces the Perrotta Depressive Symptoms Assessment (PDSA), a novel tool for differential diagnosis of depressive symptoms, allowing to address gaps in current diagnostic practices. The authors highlight the risks of misdiagnosing depressive symptoms as structured disorders, which can lead to inappropriate pharmacological interventions. The proposed model, scale, and questionnaire provide an approach to distinguish depressive conditions, disorders, and mixed forms. The authors describe a pilot study to validate the proposed methodology, which will be interesting to the journal's readership.
General comments:
Please provide a better clarification of the relationship between PDSA and existing tools (e.g., PICI-3, which is cited but not explained).
Please expand the discussion to address limitations (e.g., sample size, preliminary nature of the validation, and plans for broader testing).
Specific comment:
Table 6: Each of the columns "Interpretation" of this table contains the same values. Hence, these columns are unnecessary and can be removed with indicating the information in the text or in the table footnotes.
Summarizing, I recommend acceptance of the manuscript for publication after minor revision.
Author Response
Thank you for your deep understanding of our work and your contribution to its improvement. Thank you very much. Attached are my responses.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsI commend the authors on a sound revision.
The authors have delivered a capable and comprehensive revision. I'd suggest just a few quick changes.
First, I'd revise the objectives slightly as follows.
"2) Can a new scale of severity of depressive manifestation be determined with *reasonable* certainty that can fill the current gap in literature?
3) Can we propose a model that helps to correctly frame the patient's clinical condition when *he/she/they present(s) with* depressive symptoms?"
Second, the section header Discussions should be Discussion.
Finally, the capitalization of the last section heading should be adjusted for parity with other section headings to read this way. "Limitations and Future Prospects"
Well done!
Author Response
Thank you for your participation and for approving the publication.