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: 07 Dec 2016 
 
Reviewer:  Sheila  Sprague  
 
Reviewer’s report:  
 
This study aimed to assess the prevalence and correlates of sexual assault victimization by an 
intimate partner among adult women attending outpatient and antenatal clinics who screen 
positive for intimate partner violence (IPV) within the past 12 months.  This study focuses on an 
important women's right issue.   
 
Overall:  
 
 The authors use sexual assault and sexual violence interchangeably.  Using one term 
consistently would add clarity.   
 
 The authors should explicitly state at the beginning of the manuscript that the study is 
investigating sexual assault by intimate partners specifically, as opposed to sexual assault 
by anyone.  
 
 There are a number of typos and grammatical errors througho ut the manuscript.   
 
 The 12 month prevalence seems very low.  Previous studies of 12 month prevalence rates 
of IPV in women attending health care services have reported much higher prevalence 
rates ranging from 12% to 26% (e.g. references 1 -3 below).  Ad ditionally, reference 4 
below which comes from the data collected as part of the WHO multicentre study cited 
by the authors indicates that the 12 month prevalence of the Thai sample is 21.3% and 
22.9% for the two Thai samples.  The authors should cite some  of these articles in their 
discussion and provide more detailed exploration about why their reported prevalence is 
so much lower.  The authors should address the possibility of selection bias in their 
results interpretation and explore potential reasons w hy many women may not have 
disclosed?  Without this discussion the results may make readers think that IPV is a 
problem experienced by very few women in Thailand.  
 
Background:  
 
 Paragraph 1: In the sentence that reads "According to the World Health Organiz ation 
(WHO) multi -countr HUy study on women's health and domestic violence against women 
in Thailand [2], 23% of ever -partnered women in Bangkok and 34% in Nakhonsawan 
reported physical violence by their intimate partner at some time in their life, and 30% in  
Bangkok and 29% in Nakhonsawan reported that they had experienced sexual violence 
by an intimate partner", the authors should clarify if the 30% and 29% of women who 
report experiencing sexual violence by an intimate partner is all women, or 30 and 29% 
of women who reported experiencing some form of IPV.  
 
 Paragraph 1: In the sentence that reads "Physical violence by a partner during pregnancy 
was 4% of women who had ever been pregnant in both Bangkok and Nakhonsawan" 
there appears to be a typo.  Should it  read "Physical violence by a partner during 
pregnancy was reported by 4% of women who had ever been pregnant in both Bangkok 
and Nakhonsawan"?  
 
 Paragraph 1: In the sentence that reads "Other local surveys found of 475 pregnant Thai 
women, 13.1% report ev er been abused, whereas 4.8% reported physical abuse during 
pregnancy and 4.8% sexual violence in the past 12 months…" there is tense 
inconsistency.  "13.1% report" should be "13.1% reported".  
 
 Paragraph 2 - it is better to cite original sources as oppose d to siting secondary sources.  
Strongly suggest that paragraph two is revised to site the original sources cited in 
reference 7, as opposed to citing "as reviewed in [7]".  
 
 Paragraph 2: The authors state that 40 -68% of women have experienced both physica l 
and sexual violence.  Is that lifetime exposure?   
 
 Has any previous research been done looking at the 12 month prevalence rate of IPV in 
Thai women?  Is so this should be referenced and if not this should be stated as 
justification for the need for thi s study.  
 
 Include rationale for conducting this study within a health care setting specifically. E.g. is 
there a reason to expect higher prevalence in this setting, or is identifying the prevalence 
important for identifying a need for IPV screening and as sistance programs in these 
settings?  
 
Methods:  
 
 The following sentence is not clearly written: "The health care provider would inform the 
woman who has screened positive on the Abuse Screen for intimate partner (i.e., 
spouse/common -law, ex -spouse/ex -commo n-law, boyfriend/girlfriend, or ex -boyfried/ex -
girlfriend) physical or sexual abuse occurring within the preceding 12 months about the 
study and referred to a female research assistant."  Also appear to me missing words (e.g. 
Abuse Screen should be Abuse A ssessment Screen and "intimate partner" should be 
"intimate partner violence" and "boyfriend" is misspelled in one instance.  
 
 Remove the words "be" and "have" for conciseness from the following sentence: 
"Written informed consent was obtained from all stu dy participants who met the 
following inclusion criteria: (1) be female, (2) be 18 years of age and older, (3) have 
experienced IPV in the past 12 months, and willingness to give informed consent."  Also 
provision of informed consent should be its own incl usion criteria.   
 
 Were there any exclusion criteria?  If so they should be listed and if not this should be 
stated.  
 
 The authors state: "Following an informed consent procedure, the interviewer verbally 
administered a questionnaire in Thai language in a  private room without the partner or 
other individuals being present."  Were these all questionnaires included in the measures 
section?  If so "a questionnaire" should read "questionnaires" in the above sentence.  If 
not, please provide details about the q uestionnaire (e.g. questionnaire name, number of 
questions, validity, reliability and citation if an pre -existing questionnaire was  used, or 
details about what the questionnaire included if the questionnaire was developed for this 
study).  
 
 For the SVAWS and Danger Assessment Scale, the authors should clarify whether these 
questionnaires are assessing the severity of violence and danger that women experience 
specifically from intimate partner violence (as opposed to violence from other sources).  
 
Data Anal ysis 
 
 The authors should specify the specific parametric and non -parametric tests that were 
used.  
 
 P-values should be included along with ORs and CIs  
 
Results  
 
 An acronym (IPV) is used for intimate partner violence for the first time in the results 
section.  This should be used consistently throughout the paper or not at all.  
 
 The sample characteristics from Table 1 in the results text should mention the 
characteristics that are significantly different between the sexually assaulted and non -
sexually assaulted group.  
 
 The language used to describe the Danger assessment items i n the results text and Table 3 
are different.  The authors should use consistent language for clarity.  The text of the 
results section and Table 3 should include ORs, Cis, and p -values.  
 
 ORs, CIs, and p -values should also be included for the bivariate an d logistic regression 
analyses in both the text and Table 4.  
 
Discussion  
 
 Are there other studies in Thailand that screened a small sample of women for intimate 
partner violence?  If so these should be mentioned in the background section.  
 
 The authors no te that the prevalence of IPV identified in their study is much lower that 
other studies and suggest this may be due to Thai family values, however, some of the 
other studies cited with higher rates were conducted in Thai population.  Could this 
difference  be due to different reference periods (e.g. lifetime prevalence versus 12 month 
prevalence).  It may be more useful to compare to other 12 month prevalence studies in 
Thailand.  
 
 Also, it is unclear whether the authors are suggesting that Thai culture may  be more 
accepting of the abuse which explains its occurrence, or the lower than expected rate of 
IPV disclosure among women.  
 
 The authors should include a discussion of the implications of their findings (e.g. how 
can this research be used? What does it add to the existing literature? What are the 
authors recommendations for future research?)  
 
References:  
 
1. Alzahrani TA, Abaalkhail BA, Ramadan IK. Prevalence of intimate partner violence and 
its associated risk factors among Saudi female patients attendi ng the primary healthcare 
centers in Western Saudi Arabia. Saudi Med J. 2016 Jan;37(1):96 -9. doi: 
10.15537/smj.2016.1.13135.  
 
2. PRAISE Investigators, Sprague S, Bhandari M, Della Rocca GJ, Goslings JC, Poolman 
RW, Madden K, Simunovic N, Dosanjh S, Schemit sch EH. Prevalence of abuse and 
intimate partner violence surgical evaluation (PRAISE) in orthopaedic fracture clinics: a 
multinational prevalence study. Lancet. 2013 Sep 7;382(9895):866 -76.  
 
3. Xu X, Zhu F, O'Campo P, Koenig MA, Mock V, Campbell J. Preva lence of and risk 
factors for intimate partner violence in China. Am J Public Health. 2005 Jan;95(1):78 -85. 
 
4. Garcia -Moreno C, Jansen HA, Ellsberg M, Heise L, Watts CH; WHO Multi -country 
Study on Women's Health and Domestic Violence against Women Study T eam. 
Prevalence of intimate partner violence: findings from the WHO multi -country study on 
women's health and domestic violence. Lancet. 2006 Oct 7;368(9543):1260 -9. 
 
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.  
 
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:  
 
Not suitable for publication unless extensively edited  
 
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 a n 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.  
 
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