Title: Causal Relationship Between Major Depressive Disorder, Anxiety Disorder and
Constipation: A Two-sample Mendelian randomization study
Version: 0 Date: 08 Jul 2024
Reviewer:  Shikai Wang
Reviewer's report:
Mendelian randomization is a research method that has emerged in recent years. Depression,
anxiety often combined with the problem of constipation, the difference is that depression
patients more often occur constipation, and anxiety patients often appear diarrhea, or diarrhea
and constipation alternating irritable bowel syndrome. This study uses big data to study the
correlation between them from an evidence-based perspective, which appears to be more clinical
value. I think the manuscript can be published after minor revisions.
1. “With a worldwide prevalence exceeding 300 million people,  MDD is a prevalent psychiatric
condition . The lifetime prevalence of MDD in adults in the United States is  estimated to be
17% . An increasing body of research has revealed a link between MDD and constipation.  In
a cross-sectional study by Wang et al.,  depression of all severities was significantly associated
with constipation . The incidence of constipation in  patients with varying severity of depression
was 7.8% (mild depression), 13.0% (moderate depression), and 22.6% (moderately severe to
severe depression)  ". This section should be integrated into the introduction.
2. "CRF, stress pathways, brain-gut axis, dysregulation of the intestinal flora" The contents of
these mechanisms should be included in the prospects for further research and implementation.
Title: Causal Relationship Between Major Depressive Disorder, Anxiety Disorder and
Constipation: A Two-sample Mendelian randomization study
Version: 0 Date: 08 Jul 2024
Reviewer:  Shikai Wang
Reviewer's report:
Mendelian randomization is a research method that has emerged in recent years. Depression,
anxiety often combined with the problem of constipation, the difference is that depression
patients more often occur constipation, and anxiety patients often appear diarrhea, or diarrhea
and constipation alternating irritable bowel syndrome. This study uses big data to study the
correlation between them from an evidence-based perspective, which appears to be more clinical
value. I think the manuscript can be published after minor revisions.
1. “With a worldwide prevalence exceeding 300 million people,  MDD is a prevalent psychiatric
condition . The lifetime prevalence of MDD in adults in the United States is  estimated to be
17% . An increasing body of research has revealed a link between MDD and constipation.  In
a cross-sectional study by Wang et al.,  depression of all severities was significantly associated
with constipation . The incidence of constipation in  patients with varying severity of depression
was 7.8% (mild depression), 13.0% (moderate depression), and 22.6% (moderately severe to
severe depression)  ". This section should be integrated into the introduction.
2. "CRF, stress pathways, brain-gut axis, dysregulation of the intestinal flora" The contents of
these mechanisms should be included in the prospects for further research and implementation.
Please review this paper.
user
Title: Causal Relationship Between Major Depressive Disorder, Anxiety Disorder and
Constipation: A Two-sample Mendelian randomization study
Version: 0 Date: 08 Jul 2024
Reviewer:  Shikai Wang
Reviewer's report:
Mendelian randomization is a research method that has emerged in recent years. Depression,
anxiety often combined with the problem of constipation, the difference is that depression
patients more often occur constipation, and anxiety patients often appear diarrhea, or diarrhea
and constipation alternating irritable bowel syndrome. This study uses big data to study the
correlation between them from an evidence-based perspective, which appears to be more clinical
value. I think the manuscript can be published after minor revisions.
1. “With a worldwide prevalence exceeding 300 million people,  MDD is a prevalent psychiatric
condition . The lifetime prevalence of MDD in adults in the United States is  estimated to be
17% . An increasing body of research has revealed a link between MDD and constipation.  In
a cross-sectional study by Wang et al.,  depression of all severities was significantly associated
with constipation . The incidence of constipation in  patients with varying severity of depression
was 7.8% (mild depression), 13.0% (moderate depression), and 22.6% (moderately severe to
severe depression)  ". This section should be integrated into the introduction.
2. "CRF, stress pathways, brain-gut axis, dysregulation of the intestinal flora" The contents of
these mechanisms should be included in the prospects for further research and implementation.
assistant