Title: GASTROINTESTINAL SYMPTOMS IN ABUSED NONPATIENT WOMEN
Version: 2 Date: 28 Oct 2024
Reviewer's report:
This manuscript investigates the association between abuse history and gastrointestinal (GI)
symptoms in women, comparing those seeking legal assistance with those residing in
antiviolence centers. While the study addresses an important topic and provides valuable
preliminary findings, there are methodological limitations that need to be carefully considered
when interpreting the results.
Strengths:
Important and under-researched topic: the study examines a critical issue with significant
implications for women's health and well-being.
Unique comparison groups: The comparison between women seeking legal assistance and those
in antiviolence centers offers a novel perspective on the impact of abuse severity and social
context.
Standardized measures: The use of validated questionnaires enhances the reliability and
comparability of the data.
Detailed abuse information: The study collects comprehensive information on various aspects
of abuse, allowing for a nuanced analysis.
Clinical implications: The findings underscore the importance of screening for abuse history in
patients with GI complaints and providing holistic care.
Limitations and Recommendations for the Manuscript:
The authors should explicitly acknowledge and thoroughly discuss the following limitations in
their manuscript:
Sampling and Selection Bias:
The control group recruited through lawyer offices may not be representative of the general
population, potentially overestimating the prevalence of abuse in this group.
Including only women who had already received counseling at antiviolence centers may
underestimate the impact of abuse on GI symptoms in this population.
The relatively small sample size, particularly in the control group, limits the generalizability of
the findings.
Measurement and Data Collection:
Reliance on self-reported data may introduce recall bias and subjective interpretation of
symptoms and abuse experiences.
The lack of standardized psychological assessments prevents a comprehensive understanding of
the role of mental health in the abuse-GI symptom relationship.
The study primarily focuses on physical and sexual abuse, with limited exploration of emotional
or psychological abuse and lacks details on the duration and frequency of abuse.
Analysis and Interpretation:
The study may not have fully accounted for all potential confounding factors that could
contribute to GI symptoms.
While the study identifies an association, it cannot definitively establish a causal relationship
between abuse and GI symptoms.
Recommendations for the Authors:
Transparent Discussion of Limitations: Expand the discussion section to thoroughly address the
limitations mentioned above and their potential impact on the findings.
Cautious Interpretation: Avoid overgeneralization and use cautious language when discussing
the results, emphasizing the preliminary nature of the findings.
Focus on Associations: Clearly state that the study demonstrates an association, not causation,
between abuse and GI symptoms.
Highlight Strengths and Unique Contributions: Emphasize the value of the comparison groups
and the detailed abuse information.
Conclusion:
Despite the limitations, this study offers valuable preliminary insights into the association
between abuse history and GI symptoms in women. By carefully acknowledging the limitations
and framing the findings appropriately, the authors can ensure that their research is interpreted
responsibly and contributes meaningfully to the field.