Title: Magnitude of psychological distress and associated factors among war survivor women
in Northern, Ethiopia, 2022: A community-based cross- sectional survey
Version: 2 Date: 14 Feb 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Thank you for the opportunity to review this interesting paper that
examines the magnitude of psychological distress and associated factors among war survivor
women in Northern, Ethiopia in 2022. This is a novel study in that there is a dearth of literature
regarding the mental health of women who have survived war, particularly in the global
south. The intersectional work presented in this paper is interesting and worthy of publication.
However, I have several concerns that must be addressed before the paper may be accepted for
publication. I have provided my feedback for each section of the paper. I’m happy to review the
paper again after the authors have had the opportunity to review and revised their manuscript.
Abstract
Please provide the overall response rate of the study. Please remove the sentence about using
SPSS from the abstract. Please also remove this sentence “The strengths of the association are
explained with an adjusted odds ratio (AOR) and 95% confidence interval (CI).”
Introduction
I’d like to see greater examination of the literature related to war and mental health. The authors
discuss it in the first paragraph, and this is central to their paper. However, there needs to be
added literature to strengthen the research gap and the need for this study. I’d also like the authors
to consider adding more literature from Ethiopia and other African countries.
Methods
Why did the interviewers use English version of the questionnaires? This needs to be explained.
Moreover, the psychometric properties of the WHO multi-country study on women’s health and
domestic violence against women questionnaire must be reported. The authors should use the
same way that they reported for the K-10.
The version of SPSS should be reported here. I’d also add additional details about the analytic
plan, including the variables included in the descriptive and inferential statistics. Please indicate
the variables that were adjusted in the logistic regression models
Results
Please report the response rate of the survey in this section.
For Table 1, please report the findings to one place after the decimal. Also for all the variables,
please list them in reverse chronological order (highest to lowest) and report the sample size for
the sample and each variable in the table. Please use this same format for the other tables
The logistic regression is well explained and easy to follow.
Discussion
Please incorporate the findings of this paper about psychological distress into the extant
literature.  I’d like to see an expansion of this section. The authors should also provide greater
explanation of how their finding about educational status (ability to read and write) was
associated with elevated psychological distress. This is particularly important since it goes
against the existing literature. There needs to be greater analyses of the findings
REQUESTED REVISIONS:
I have provided my feedback for each section of the paper. I welcome the opportunity to review
the revised manuscript