Reviewer ’s report  
 
Title: Psychological symptoms among hospital nurses i n Taiwan: a cross sectional study  
 
Version: 1 Date: 23 Feb 2017  
 
Reviewer: Natalia Stanulewicz  
 
Reviewer's report:  
 
The article that I reviewed examined an important issue of health outcomes in nurses. The design 
of the study and the analyses seemed  appropriate for the aims of the paper, however there are 
certain issues with the paper, which I will describe below.  
 
 
First, parts of the paper are not clear, and thus require some language related modification to 
attain better clarity. Similarly jargon s hould be eliminated from the paper (e.g., finding their feet) 
and the words used should be chosen more carefully (sometimes psychological symptoms are 
referred to as psychological disorders).  
 
 
Second, the paper contains errors that need correcting, for ex ample, it is stated that p value had to 
be below .25 (p.8, line142), which is incorrect; similarly category "excellent health" that was 
mentioned in the text as being collapsed with "good health" appears inconsistently in the tables 
presenting the results.   
 
 
Third, it is not explained what were the criteria for choosing the list of the health problems that 
nurses could choose from, that should be addressed.  
 
 
Fourth, I am not certain how reliable is the 1 -item measure of health, some information regarding 
its reliability (e.g., from other studies) should be provided.  
 
 
Next, the cut off point for psychological symptoms is said to be 5/6… Is it 5 or 6? Or someth ing 
in between? This is not clear. Similarly, in regard with the cut off for these symptoms it should 
be described how the cut off was determined, this information is missing.  
 
 
In regard with the results, it is stated that nurses younger than 30 years old should be especially 
supported as they are at significant risk of health problems, but I do not understand why do the 
authors ignore the fact that there was a trend (p=.064) for those aged 30 -39? Should they not be 
given more support, especially that they seem to be at increased risk?  
 
In the discussion, it seems problematic and simplistic to suggest that offering higher education 
opportunities to nurses might help with their psychological symptoms. What about the additional 
stress and time -burden that such  an undertaking would require, especially for those already 
working in a high -strain job? Moreover, the authors suggest that future studies should look into 
association between health check -up utilization and psychological symptoms. I am not sure what 
is the basis of that suggestion, as the authors report no significant relation between the two, and 
there is no literature used to support this suggestion.  
 
 
Also, the authors mention that using BSRS -5 is a limitation of the study, but they do not provide 
any information how appropriate the psychometric characteristics this scale has, for example in 
this and other studies. This should help with assessing how strong this limitation is. Finally, is 
the score of 5 not used in the BSRS -5? The table 1 suggests that this is the case, but this seems 
incorrect.  
 
Thank you for the opportunity to review this paper.  
 
 
 
 
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 t he 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  
additi onal statistical review?  
If an additional statistical review is recommended, please speci fy 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 l anguage in the manuscript:  
 
Not suitable for publication unless extensively edited  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the follow ing 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 s tocks 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 compe ting 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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