Reviewer's report
Title:The differential impact of forced sex and sexual coercion on Chinese
women's mental health: a prospective cohort study
Version:1Date:18 February 2014
Reviewer: Hanh Nguyen
Reviewer's report:
This is an interesting study on the differential impact of forced sex and sexual
coercion on Chinese women’s mental health. The research question is original
and important. The methods used are appropriate and well described. The data
appear to be sound.
Major revision:
1. The aim of the study written in the abstract is somewhat different and seems to
be wider than that in the manuscript. It includes “making distinctions between
physically forced sex and non-physical coercion” (but not only comparing their
mental health impact). If it is the exact goal of the study, it has not been reached
to. There are only a few words working on making distinctions between physically
forced sex and non-physical coercion (page 5) where non-physical coercion is
defined not very clearly (“as unwanted vaginal, oral, or anal sex after being
pressured in a non-physical way”, according to this, if a woman feel pressured
herself for not being a good wife (her husband does not do anything to make her
feel so) and has sex with her husband for this feeling but against her wish, will
that be considered non- physical sexual coercion?)
2. The participants were recruited from community centres operated by
non-governmental organizations, shelters for abused women, and the Family and
Child Protective Services Units. Could it make any kind of sampling bias? (The
organizations chosen may be special places for abused women which can raise
the percentage of the abused ones. The result shows that 29.3% are never -
abused women which mean 70.7% are abused, will that be able to represent for
Chinese women in general?)
3. When describing the 11 cases of forced sex, it seems that the definition of
forced sex that the authors have cited in page 5 is misused. While they stated
that “Physically forced sex is defined as unwanted vaginal, oral, or anal
penetration (completed or attempted) through the use of physical force or threats
to physically harm”, here they described forced sex including degradation,
publication humiliation about the woman’s poor sexual performance and other
controlling behaviors like stalking, movement restricting and financial control
(page 13).
4. It is written in the background that non-physical sexual coercion has received
limited attention from researchers. With this point, readers may look forward to
finding many new things from this study on non-physical sexual coercion. It is
also emphasized in the conclusion that differentiating between physically forced
sex and non-physical sexual coercion when conducting assessment for sexual
assault is highly needed. However, the result and the discussion show little
notice on non-physical sexual coercion. This, in turn, proves the author’s
statement that little attention has been given to non-physical sexual coercion
(even in this study).
5. The conclusion should be more focused and use fewer examples.
6. The title “The differential impact of forced sex and sexual coercion on Chinese
women’s mental health: a prospective cohort study” may bring some confusion
on the two terms “forced sex” and “sexual coercion”. In the manuscript, the
authors use the two clearly different terms “physically forced sex” and
“non-physical sexual coercion”. But in the title, the use of the abbreviation may
lead to some overlap understanding.
Minor revision:
7. The authors wrote in the abstract “Qualitative analysis also confirmed
contextual differences in the women’s sexual experiences, with those in the
forced sex group reporting their partners’ use of physical force, degrading tactics,
and controlling behaviors. Such behaviors were not reported by women in the
sexual coercion group.”. These sentences are meaningless as it is absolutely
clear that sexual coercion can not include such behaviors, otherwise they will
become forced sex.
8. In the background, page 4, the authors cited that annually 6000 women in
Hong Kong may have experienced forced sex intimate relationship. It would be
better for the readers if they may know the frequency.
9. In the qualitative findings, the respondents are divided into two groups with
forced sex and sexual coercion. In the pre-parts of the manuscript, those women
are divided into three groups, namely never-abused, physically abused without
sexual assault and physically abused with sexual assault. Which group within
these three groups can women with sexual coercion belong to?
10. The quantitative component in the Methods is somewhat long. The authors
may consider to summary more and avoid describing in great detail.
11. Abstract: The date of the survey should be added.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interest