Reviewer ’s report  
 
Title:  The Association Between Hope, Marital Status, Depression and Persistent Pain in Men 
and Women Following Cardiac Surgery  
 
Version: 0 Date: 11 Jul 2017 
 
Reviewer:  Karin  Humphries  
 
Reviewer’s report:  
 
This is an interesting paper that looks at sex differences in hope after cardiac surgery a s well as 
factors associated with hope. The premise of the study is that because hope is linked to 
psychosocial well being, improved physical health and positive CHD outcomes a better 
understanding of factors associated with hope may identify strategies to  increase hope.  
 
Overall this paper has some interesting findings, but the conclusions as stated are not supported 
by the actual data in the manuscript.  The results do not directly address approaches to strengthen 
hope, but instead identify factors that n eed to be addressed in order to strengthen hope.   This 
distinction needs to be made clear.   
 
On page 10, first paragraph, please summarize the highlights of Table 4.  
 
Other comments:  
 
In the abstract one of the key findings is that women who were divorce d, single, or widowed, had 
lower hope scores.  As written, 'marital status' , this is not clear.  Please reword so it is clear that 
living alone - divorced, single or widowed - and female sex are associated with lower hope.  
 
Page 6, Aim - please reword aim  2, so it is clear that you are examining hope after cardiac 
surgery and not the factors, as listed, after cardiac surgery.  Consider, '…between hope after 
cardiac surgery and the following…..'  
 
Page 8,  4th line - reference 58 is not in any way relevant t o the STATA software.  Please delete 
and provide the manufacturer and city for STATA, instead.  
 
Page 7 and 8 - there is some confusion in the definitions/categories of 'marital status'.  On page 7, 
there is a category 'living with children' that does not a ppear on page 8, when the seven 
categories were collapsed into 2 categories.  Please reconcile how you grouped 'living with 
children'.  
 
Page 8 - in the list of selected covariates, time is one of the factors.  Please make it clear that this 
refers to follow -up time.   
 
In several places you refer to valve surgery and CABG surgery, as well as CABG /valve surgery.  
It would be clearer if you referred to them as isolated valve surgery and isolated CABG surgery, 
so they are distinct from the combined CABG and Va lve surgery.  
 
Page 10 - when discussing the findings related to isolated valve surgery;, please make it clear 
that the positive association with hope is relative to isolated CAVG surgery.  Similarly, it is 
important to better describe the sex* marital status interaction .  Perhaps something like, 'while 
neither sex nor marital status, as main effects, demonstrated significant associations with hope, 
women who were divorced/widowed/single were significantly more likely to have lower hope 
scores over the study period.   
 
Table 1 - to be consistent, under marital status, change 'married' to 'married/cohabitant/partner'.  
 
Table 1 - comorbidities are discrete, not continuous.  Change from mean to either median, or 
report the proportion with 2+ comorbidities.  
 
Table 2 - title - change 'itmes' to 'items'  
 
Table 3 - title - change the title so it is clear you are modeling 'higher' Herth Hope Index scores.  
 
Table 3 - there is something wrong with the label for age.  According to the footnote, it should 
read '>65,' not '<6'  
 
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.  
 
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 that 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 -financ ial 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.  
 
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