Reviewer ’s report  
 
Title:  Intimate partner sexual violence and risk for femicide, suicidality and substance use 
among women in antenatal care and general out -patients in Thailand  
 
Version: 0 Date: 25 Nov 2016 
 
Reviewer:  Tina Bloom  
 
Reviewer’s report:  
 
Overall, this manuscript is an interesting contribution to the research literature, and the authors 
have done very good work - they are off to a great start writing up these results.  We think this 
project has many strengths and that the paper will be of g reat interest to this journal's readership!  
Most of our comments and suggestions are relatively minor, however, we do have some thoughts 
on how to better contextualize the study and its findings within the extant IPV literature.  We 
hope our comments are helpful to strengthen the manuscript.   
 
Title: the title seems unclear about other types of IPV. However, if you use "Sexual assault and 
intimate partner violence among women in antenatal care and general outpatients in Thailand" 
would be fine.  
 
Abstract is largely complete, succinct, and clear, but a few notes:  
 
* should include the study design; it would be cross sectional design?  
 
* And please include the measures in the abstract (AAS, SVAWS, Danger assessment, 
Suicidal behavior).  
 
* In additio n, for the word of "intimate partner violence" should be consistency because 
sometimes the authors used "Intimate violence partner relationships".   
 
* Please check typo in word "fiftyseven" - needs a hyphen to separate the two word parts. 
Literature revie w: A bit thin; it needs some more information.  
 
* For example, it is not insufficient information about IPV in worldwide and the important 
of IPV and sexual assault study in Thailand and to women's health. The authors showed the 
information and the prevale nce of IPV in the previous studies that conducted in Thailand, but 
they did not present the literature gap and why this study is important.  
 
* Furthermore, the aim of study focus to sexual assault in women, but the information need 
more clarify - why this is important or useful.  
 
* Finally, the second paragraph of introduction at "Globally" can move it to the first 
paragraph.  
 
* However, the previous results in Thailand about the prevalence of IPV are concrete and 
helpful.  
 
Methods: The method part needs some  revises.  
 
* It lacks a description of study design (cross sectional study?)   
 
* Were healthcare providers trained to do the screening? Do they screen all women? Was 
there a standard protocol for the screening?  Was there any assurance that providers were 
actually doing all the screening? Were women always screened in private?  
 
* Secondly, the inclusion criteria for choosing the subjects are not clear: the women that 
chose from antenatal clinic are pregnant women or any women? (any age parameters) Any 
exclus ion criteria? (do they choose some participants that they have psychological disorder or 
any problem in mental health).  
 
* Measures are generally well -chosen and translation procedures are described  - however, 
was there any validation or pilot work done w ith the translated measures?  (If not, this should be 
described later in the discussion as a limitation).  
 
* Not clear why Alcohol Use Disorder Identification Test -Consumption was included - 
please describe the rationale.   
 
* Are the measures of socioecono mic status previously validated? (i.e., the measure which 
has response options like "We have most of the important……and luxury goods"?)  
 
* Really appreciate that the authors used the Danger Assessment instrument in this study - 
the importance of this type o f risk assessment cannot be understated in my opinion - and it has 
clinical and safety planning implications.  That said - for future work - the authors will want to 
know that the 15 -item version of the DA that they used is quite old.  The more recent and better -
validated version of the DA has 20 items.  There is also a 5 -item brief version of the DA 
developed in 2015, for use in clinical settings (see 
https://www.dangerassessment.org/uploads/DA -5_2.26.15.pdf).  I think perhaps the best way to 
handle this i ssue is in the discussion -- to acknowledge that there are newer versions of the DA, 
but that the 15 -item version was previously well -validated, and that it demonstrated that some of 
these women were at significant risk - and perhaps to refer the readers t o the 5 -item version for 
use in clinical settings.   
 
* In data analysis part, the data is normal distributed or not because you wrote some 
sentences that for "non -normal distribution, non parametric test were used", please clarify more 
about because for th e table 3 you wrote Mann - Whitney U test which is non parametric test. For 
the multiple regression that you used for predicting the associated, could you check it again for 
the assumptions of regression? Although normality is not the major assumption to te st for 
multiple regression, it has to concern because your data is not normally distributed. However, if 
it is not normally, sometimes you can claim it from the size of sample.  
 
* In addition, it is confusing that how sexual assault and danger come topic co me from 
because looked at the Table 3, it seems like descriptive analysis, how the authors got Odds ratio 
and CI, this comes from regression analysis?  
 
* Finally, it would be great to analysis and clear if the authors can show the results that 
separate fro m participants from antenatal clinic and general out -patient. We realize the numbers 
are too small to present statistical subanalyses by these clusters, but it would be useful if the text 
in the results began with some descriptive results of where particip ants came from (e.g., how 
many from which settings).   
 
Discussion: In discussion part, it needs more discussion about the results.   
 
* For the first paragraph that discussed about the lower rate of sexual assault of current 
study than previous study, it w ould be informative and stronger if the authors can find more 
studies to discuss, and another variable or any factor in demographic data that can explain about 
this such as socio economic that seems high.  
 
* In second paragraph, for the last sentence that " this finding highlights the important of 
mental health management…. Of sexual assault" It seems not clear for who is managing or 
manage to who.  
 
The most problematic issue related to interpreting the findings of this study is the extremely low 
prevalence  of IPV (0.02%) - but this is an important finding in and of itself.  
 
* This should be talked about in the discussion.  
 
* Because the prevalence found in this study was so, so low, and so very different from 
other research studies, it is most likely that t he actual prevalence rate is much higher than 0.02% 
-- and this should be clearly stated.  Since the healthcare providers were in essence the 
"gatekeepers" doing all the screening -- it seems likely that what was happening here that 
resulted in low prevale nce is that women were not disclosing IPV to the providers - and this 
should also be clearly stated.   
 
* I think that it also makes it very hard to assume that the women that DID disclose IPV 
were typical of abused Thai women - it is a skewed sample. This should also be clearly stated 
and should be addressed in the discussion section as a limitation.  
 
* BUT  it does suggest that these providers were not doing the greatest job screening 
patients and/or that there are significant barriers to Thai women to disclosing IPV when asked in 
a healthcare setting (it's probably both).  This is actually a very important finding in and of itself.  
 
* There is a large body of research that demonstrates that healthcare providers don't 
routinely screen for IPV, are not comfortable asking about it, are not well -trained about IPV, and 
often have negative attitudes and stereotype s about IPV.  These findings should be grounded in 
this literature.   
 
* There is also relevant research regarding women's barriers to disclosing IPV to healthcare 
providers and others - which should also be worked into the discussion.   
 
* it is not clear i f - when the authors talk about Buddhist principles/Thai cultural factors at 
the start of the discussion - do they mean that these factors might have kept women from 
disclosing violence? Or from experiencing IPV in the first place?  
Please include recommen dations for future research, policy, and practice based on the findings.   
 
Conclusion: The conclusion needs revise again by including the rational problems and important 
results and future research. The authors wrote about "the study found the moderate ra te of sexual 
assault in intimate partner violence, but it has not seen where the results show the moderate rate 
of IPV. The authors also wrote the helpful of study but lack of the future of research.   
 
Minor/grammatical: The consistency of terms related to  intimate partner violence is needed 
because sometimes the authors used intimate violence partner relationships in study.  
 
English is quite good overall, but there are some typographical errors here and there.   
 
Another thing to revise and update is the ref erences in discussion.  
 
 
Sincerely,  
 
 
Tipparat  Udmuangpia  
Doctoral Nursing Student  
Sinclair School of Nursing  
University of Missouri  
573-529-7039  
tuhk3@mail.missouri.edu  
tipparatudmuangpia@gmail.com  
P.E.O. International Peace Scholarship (2016 -2017)  
  
And  
 
Tina Bloom, PhD, MPH, RN  
Associate Professor  
Robert Wood Johnson Foundation Nurse Faculty Scholar 2011 -14 
University of Missouri  
S421 Sinclair School of Nursing  
Columbia, MO 65211  
(573) 207 -9510  
bloomt@missouri.edu  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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 am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees,  funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  My doctoral student Tipparat Udmuangpia also 
helped with this review; she als o has no competing interests to declare.  
 
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