Reviewer's report
Title:A high prevalence of violence against women, particularly psychological
violence, in Erbil city of Kurdistan region, Iraq
Version: 2Date:16 May 2013
Reviewer: joaquim soares
Reviewer's report:
COMMENTS
ABSTRACT
Background:
1. It would be useful to state, if it is the case, that there are limited data on IPV
against women in Iraq, particularly in the Kurdistan region.
2. If I understand correctly, only the impact of physical violence was addressed.
Not the impact of different forms of IPV. It would be useful to clarify this issue.
Methods
1. It would be useful to clarify somewhat why the respondents were visiting the
hospitals to differentiate for instance those who may be pregnant from others.
2. Data were collected during more than 1 year. I suppose we are facing
consecutive cases, each woman seen only once. It would be useful to clarify this.
3. It would be useful to explain how the data was collected and by whom as well
as how the data was analyzed.
4. More details about the data collected would be useful.
Results
1. Stab wound, broken teeth, or broken bones are certainly a consequence of
abuse, but also a “form of abuse”, injury. In this context, it would have been
useful to create a category (see results and tables).
Conclusions
1. Although in terms of rates psychological abuse was a significant problem, it
seems that in terms of consequences physical abuse may be a greater problem.
This could be stated more clearly.
BACKGROUND
1. The introduction is short, which may be an advantage.
2. Nevertheless, it would be useful with a more comprehensive description of IPV
as well as consequences.
The authors state: “however, there is limited documented knowledge about
prevalence, incidence, types, impact and factors associated with violence against
women in the region”.
“This study is a component of a comprehensive assessment of this important
issue of violence against women in Erbil governorate, Iraqi Kurdistan region. The
overall aim of the assessment was to systematically explore the problems related
to violence against women in the Kurdish society in Iraqi Kurdistan region”.
3. This part of the background provides the impression that the authors are
addressing the issue of “incidence” of IPV (which seems not to be the case), all
types of IPV (only 3 are addressed), the impact of IPV (only life-time physical
abuse was addressed) and factors associated with IPV (this was not addressed
in terms of scrutinizing which factors were independently associated with IPV).
4. Questions can be raised on whether the authors systematically explore the
problems related to IPV in Kurdistan.
5. I propose to re-write this part more in line with what has been done.
METHODS
1. To facilitate reading, understanding and corroboration, it would be useful to
construct the methods as follows:
a. Participants/setting
b. Measures
c. Design/procedure
d. Statistical analyses
Thus, in participants/setting one would put: A total of ………..women
(aged……………years) living in…………….were recruited to participate in this
study (from a total population of…………………that visited the hospitals). The
women were in contact with the hospitals due to……………. Of the total number
of women recruited,………(%) answered the questionnaire and …..(%) refused to
answer. Characteristics of ……………are shown in Table 1.
In measures describe the instruments/variables used in detail. Provide reliability
parameters.
In design/procedure describe in detail the used design, how the persons were
recruited etc. The experts comments on the questionnaire, pilot study and ethical
considerations could be included here.
In statistical analyses describe what was done.
RESULTS
1. It would be useful to present the results in sub-headings. Such strategy
facilitates reading and understanding.
a. Socio-demographics
b. Psychological violence
c. Physical violence
d. Sexual violence
e. Overall violence
e. Consequences
2. In this context, one should avoid repeating what is shown in Tables.
STATISTICS/RESULTS
1. It is surprising that the authors did not tried to conduct more elaborated
analyses of their data, even considering the paucity of the socio-demographics
assessed.
2. It is surprising that analyzes of the connection between psychological and
sexual abuse and emotional and suicide were not done both life-time and past 12
months.
3. It is surprising that analyzes of the connection between physical and emotional
and suicide were not done for past year violence.
4. It is surprising that analyzes of the co-occurrence of abuse were not done.
5. It is surprising that a separate “category of violence, injury” was not created in
view that it occurred often. Usually, one separates physical abuse without injury
and with injury.
DISCUSSION
1. One could use the same strategy as in the presentation of results. That is,
create sub-headings and discuss each part.
2. An alternative is to summarize the findings and discuss each one. Important
also is to separate the discussion concerning the life-time and past 12 months
violence as well as consequences.
3. Of great concern, in my opinion, is that the authors in reality do not discuss
their findings. What they by and large do, is to state that their findings are in
accord or at odds with other results.
4. It would have been most interesting and of great interest to contextualize the
violence. From the situation of women and how society is organized to the
experiences of war, much could be said in relation to the figures presented.
CONCLUSIONS
1. The authors conclude by summarizing the findings. Some statements about
how to move forward, what can be done etc. would be useful.
LIMITATIONS
1. A specific and detailed part on limitations is lacking.
SOME CONCERNS
1. In addition to what has been said before, I have concerns although they
cannot be attended to in this manuscript. Hopefully, in future.
a. Operational definition of the different abuse types, chronicity (frequency) and
severity. For instance, are threats of remarrying and divorce cases of
psychological abuse? In any case, I did not found it in the WHO questionnaire.
The frequency of abuse is defined as Once, 2–5 times and >5 times. No
problems with once, but how many time are 2-5 and >5. In any case, I did not
found it in the WHO questionnaire.
Why severity was only described for physical abuse? etc, etc.
My point here is that there are problems with the instrument used and that the
problems make the figures presented uncertain.
Allow me the suggestion
a1. Perhaps in future, the authors would like to consider using the CTS2 which
seems superior in many ways than the WHO questionnaire or the variant the
authors used.
See for example, Reliability, validity, and prevalence of partner violence
measured by the conflict tactics scales in male-dominant nations by Murray A.
Straus & Ethel L. Mickey (2012).
b. It remains unclear for me what exactly such items (crying, sadness, lack of
interest in usual activities) capture. Instead of distress, it would have been better
to speak about despondency, depressed mood etc. In any case, they seem to
differ from what is described in the WHO questionnaire regarding the part on
GENERAL HEALTH.
Allow me the suggestion
b1. Perhaps in future, the authors would like to consider using well-established
measures of mental health.
FINAL COMMENTS
The main interest of this manuscript, in my opinion, pertains to that there are not
much data concerning IPV in Iraq, particularly in the Kurdistan region. In any
case, I suggest a major revision before acceptance.
1. Is the question posed by the authors well defined?
Answer: Can be improved by a more clear specification of the aims of the study.
2. Are the methods appropriate and well described?
Answer: Can be improved by re-writing the part on methods and adding lacking
information.
3. Are the data sound?
Answer: The operationalization of the various components of the IPV assessed is
problematic. Some given analyses were not conducted.
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition?
Answer: To some extent, yes. Some given analyses were not conducted.
5. Are the discussion and conclusions well balanced and adequately supported
by the data?
Answer: Questions can be raised whether findings are discussed. Conclusions
can be improved.
6. Are limitations of the work clearly stated?
Answer: Not sufficiently.
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished?
Answer: It is unclear.
8. Do the title and abstract accurately convey what has been found?
Answer: The title could be changed to be more in line with what was done/aims.
The abstract conveys what was found.
9. Is the writing acceptable?
Answer: The manuscript would gain in clearity with English editing.
Level of interest: An article of limited interest
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I have no competing interests