Reviewer ’s report  
 
Title:  Mental Health, Sexual Identity, and Interpersonal Violence: Findings from the Australian 
Longitudinal Women's Health Study  
 
Version: 0 Date: 22 Jan 2017 
 
Reviewer:  Anna  Bowring  
 
Reviewer’s report:  
 
This paper looks at experience and correlates of interpersonal violence among women from a 
large national cohort. Its point of difference is looking at sexual identity with multiple categories, 
allowing for a more nuanced view of the relationship between sexual identity, interpersonal 
violence and mental health. Although I'm not convinced by its ability to answer the second study 
aim, it is nonetheless is a well written paper and a contributes strongly to the l iterature base.  
 
 
GENERAL COMMENTS  
 
The in -text referencing throughout the paper often unnecessarily employs both numbering and 
author name systems. Based on the journal referencing guidelines, the author names should not 
be needed in text.   
 
There is nothi ng to be done about this, but it may be worth noting that I associate 'IPV' with 
intimate partner violence, and it took me a while to realise that that is not what the paper was 
measuring. To my knowledge there is no way of differentiating these acronyms t hough. It was 
helpful that the acronyms were written out in full in the subheadings of the results, which quickly 
alerted me to my mistake.  
 
 
ABSTRACT  
 
It would be worth including the age range in brackets after 'young women' in the abstract.  
 
 
BACKGROUND  
 
The background is substantive, and while all relevant, could be written more tightly to avoid 
repetition.  
 
 
Currently the paragraph structure essentially reads:  
 
1 Prevalence of violence against women; 2 Relationship between violence and mental health; 3 
Violence among sexual minority women; 4 Health disparities among sexual minority women; 5 
Different patterns within subgroups of sexual minority women;; 6 Different patterns within 
subgroups of sexual minority women; 7 Mental health disparities among sexual mi nority women; 
8 Link between violence and mental health in sexual minority; 9 Study aims.  
 
For example, paragraphs 2 & 8 linking violence and mental health could be consolidated; 
paragraph 7 on mental health disparities could be combined with Para 4; Para 6  could more 
directly lead into the study aims, emphasising the literature gaps this study fills.  
 
These are not prescriptive but may help with the flow of the background.  
 
 
METHODS  
 
The age range of the analysis sample could be more clearly stated. The analysis is based on the 
youngest cohort group (18 -23yo at first survey) at the third survey, which are completed every 
three years. The resulting age of sample is 25 -30 years, but this  is only mentioned near the end of 
the methods. It would be easier for the reader if this was stated upfront (e.g. pg. 7, line 54).  
 
Is the measure of sexual identity based off a validated tool? It appears to be a modification of the 
Kinsey scale, and shou ld probably be referenced as such if so.  
 
Pg. 10 line 46 - clarify annual income  
 
Pg. 10 lines 48 -53 - I think this method of relationship classification, why standard, is 
particularly problematic when looking at a younger population. Many young women will be in a 
relationship that does not classify as de facto, but equally may object to the official classification 
of being 'single'. While obviously this cannot be changed now, I think it should be acknowledged 
as a limitation of the paper.    
 
As I refer to l ater, I am a bit concerned that the analysis is too limited, without enough variables 
other than basic sociodemographic background, to truly answer the second aim of to what extent 
the association between sexual identity and poorer mental health is account ed for by experiences 
of IPV.  
 
 
RESULTS  
 
Pg. 14 line 43 - the sentence on the weakest predictor reads strangely to me. It may not be worth 
highlighting this finding in the text, given it can be inferred from table 3.  
 
Is it possible to assess and control for  other potential mediators of mental health, such as alcohol 
and drug use? Research demonstrates a higher prevalence of problematic alcohol and drug use in 
sexual minorities, and these behavioural factors may also explain/mediate the relationships 
between sexual identity, IPV and mental health.  
 
 
DISCUSSION  
 
The discussion describes the major findings well and puts them into context with existing 
literature. Caveats around the findings and interpretation are included. The limitations - and 
particularly that the study only looked at sexual identity and not other dimensions of sexual 
orientation, are addressed. However, I have drawn attention to a few other issues which limit the 
analysis, such as the limited range of variables controlled for. This is referred to in the final 
sentence of the conclusion, but should be highlighted more clearly.  
 
Pg. 17 lines 51 -56 - I don't think it's necessary to repeat these stats in discussion  
 
A sentence or two clearly articulating the implications of the findings on ongoing re search and 
services could be added to the discussion.  
 
While the main discussion nicely explains the results, I find the emphasis in the conclusion that 
mental health outcomes are more closely associated with IPV than sexual identity somewhat 
problematic f rom a research translation point of view, as it detracts from these groups of women 
having increased need of support and services. I am not sure why one would assume that sexual 
identity is in itself causative of poor mental health. The IPV was more closel y associated with 
mental health problems than sexual identity is true in this analysis, but I'd argue that not enough 
variables have been examined to extrapolate these findings and say definitively that violence 
explains the mental health disparities exper ienced by sexual minority women.  Sexual minority 
women remain at higher risk of IPV and resulting mental health outcomes, and both violence 
prevention and mental health services targeting women with diverse sexual identities are strongly 
called for.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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