Reviewer ’s report  
 
Title:  Factors mediating the impacts of child abuse and intimate partner violence on chronic 
pain: A cross -sectional study  
 
Version: 0 Date: 16 Jul 2018 
 
Reviewer:  Catherine  Cerulli  
 
Reviewer’s report:  
 
Overall: Thank you for the opportunity to review this study. It is an important contribution to the 
literature - not just for Saudi women but  healthcare providers globally. So little is known about 
the issues you discuss.  
 
I have provided some comments in the hope that you can edit your paper to make it even 
stronger. First, I will provide some general global recommendations:  
 
Consider removing "in order to" throughout the paper. It isn't necessary and distracts the reader. 
Try to avoid the language "predictive" as this is a cross -sectional study based on self -report only. 
While you note that in the limitations, throughout the a bstract, etc. it is speckled throughout. Try 
to use the first person - I highlight in some places below.  
 
Title: Nicely stated.  
 
Abstract: This is a nice summary of the article. Please rewrite it in the active voice. It will require 
less words. With the ex tra space, please add the period of time the data was collected and a little 
about how they completed the measures: interview, computer, etc.  
 
Introduction: Please add other forms of violence facing women including sexual trafficking 
violence and violence  and rape as a war strategy. While they are not as common, the impact of 
these forms of violence throughout the world is noteworthy. Please add to your definition that 
prior partners can engage in abuse too. So it is current or former partner, engaging in abuse. For 
your study - it may be different - current partner only. You can also add economic abuse, abuse 
of pets, etc. Also, the sentence which begins with "defined" (p.6, line 12) is incomplete. Perhaps 
use the WHO definition in the multi -country survey . Line 22, p 6 - please explore the literature 
more. The ACEs literature is actually divided on whether it increases perpetration and 
victimization risk. It is worth adding a few more sentences to show the complexity of the field. 
Line 34, p 6, see line of  work by Toth et al., Cort et al., who have an extensive body of literature 
on the interactive effects of previous abuse. Extra space line 29, pg.9. Please note the specific 
goals of the paper - and or hypothesis following line 19, page 10. Guide the reade r to why your 
work is important, simply stated in one line that you will fill the gap that currently exists, then 
your specific goals. Your aims are currently in the methods - simply move them up.  
 
Methods: Cross -sectional studies traditionally do not use the word predictive - but rather 
correlational. You can delete "in order to" line 58, p.10. Given your use of SEM, I am curious 
that you ran the model twice with PTSD and depression rather than run it with a latent variable 
"mental health" as currently dep icted in your figure. The SEM approach would let you have a 
latent variable with two highly correlated variables. Please note in the methods why you chose to 
separate them out. You note it later in the article - but perhaps move it up.  
 
Setting and Sample:  Please rewrite in active voice. Please indicate whether the interviews took 
place at the same time as informed consent or at a later date. I am guessing same day since you 
had no attrition. Also - please discuss safety protocols and guidelines. This may b e helpful to 
other researchers in your country. Did you back translate the survey instruments before using 
them - or using ones previously used - were they back translated? If so - please note. Can you 
speak more to the question omitted regarding sexual ab use and how you think this may have 
changed the outcome?  
 
Analysis: Can you speak in this section why you omitted the sociodemographic factors from the 
SEM? It seems that such variables may have played a role in the dependent variable given your 
range in a ge and other variables: economics, education, etc.  
 
Results: The diagrams and tables are clearly presented. A few questions. How does the 
distribution impact your results? With so many individuals having PTSD and Depression, it 
seems these distributions mi ght impact the outcome.  
 
Analysis: Very nice description of the SEM approach. You walk the novice reader through this 
with a way that will aid to them being able to understand the paper. You complement this 
discussion of the approach with nice, clear diag rams.  
 
Discussion: Nice job on the discussion. However, you may be able to take this further. Can you 
reduce the "findings" reiterated in the discussion to give room to tell the readers what you think? 
Can you perhaps flesh this out a bit more? While you n ote the current recommendations by 
WHO et al regarding screening for IPV, can you discuss those more - what are they, do they 
have any evidence base? Etc. What is the current practice in your primary care settings? Did it 
change as a result of this study? Did you have any respondent verification sessions? Did you 
present the data back to the clinics? Were they surprised?  
 
Conclusion: This is where you can take it home - can you describe an approach or intervention 
that takes into account the personal lived experience of the patient, coupled with their current 
living situation, to offer social support to reduce isolation and safety planning to reduce future 
violence? What might some possibilities be?  
 
References: The references are well done with the exceptio n of exploring some articles noted 
above. However - they are out of order. 18, Why does it jump from 38 to 51? Also - there are 
some typos:  
 
1. Reference 19 - not cited in the article.  
 
2. Reference 8 - what is this - a report? Presentation, etc?  
 
3. Referenc e 31 - same, no journal noted.  
 
4. Reference 71 - same, no journal noted - if this is a report - spell out the acronymns.  
 
5. Typo number 9, 18, 29, 65  
 
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.  
 
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  
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 -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.  
 
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