Reviewer's report
Title:Psychometric properties of a French scale for assessing body image in
unaffected female BRCA 1/2 mutation carriers/non carriers.
Version: 1Date:28 December 2012
Reviewer: PAGONA ROUSSI
Reviewer's report:
The paper titled “Psychometric properties of a French scale for assessing body
image in unaffected female BRCA 1/2 mutation carriers/non carriers” is based on
sound methodology and statistical analyses and adds to existing scientific
knowledge. The comments that follow address mostly the write-up, which in the
opinion of this reviewer, needs improvement.
Major Compulsory Revisions:
Introduction: It covers general information regarding body image and etiological
factors. The authors build a case that there is a gap in the literature regarding the
healthy female population. I think the Introduction would be improved if the
authors focused on the literature regarding components of body image (eg.,
value of appearance and satisfaction with appearance) and the findings for
healthy populations, as well as populations similar to the one studied here,
BRCA1/2 carriers, high risk women. The findings reported in the Lodder et al.
(2002) study need to be included. I do not think the more general discussion
regarding pathology (eating disorders) and personality traits as an etiological
factor are necessary, particularly because it is repetitive in some places.
The text is confusing and/or vague occasionally, I assume because of the
language barrier. For example, end of 1st paragraph, 2nd page of introduction,
and last paragraph of same page. This is a general comment for the whole
manuscript, which would benefit from a reading by a person whose 1st language
is english.
Method: For the description of the scale, it is unclear to me which
subscales/items were part of the Lodder scale and which ones were added by
the authors of the present study.
The description of the remaining of the questionnaires need to be part of the
instruments bubsection and not the Procedure. Also, a reference needs to be
made to the fact that the CES-D was used as a binary variable and how the
value of 23 as a cutoff point was chosen. What does it represent?
Procedure – was the 1st measurement (background information) completed at
the clinic and the 2nd (CES-D & BBIS) mailed in? Order in which they were
administered? Were there any refusals? Women who consented but never
mailed the 2nd questionnaire?
Statistical analysis – this section is too long and repetitive (to a degree) with the
results section. I think it would be equally informative if the authors had a shorter
section here about the general statistical approach.
Results: The section with the title: scores and sub-scores, covers more than just
that and its title needs to be changed so that it will reflect the relationships with
the demographic and medical variables as well as with depressive symptoms.
Some of the categorical variables had more than two levels, e.g., BMI. Were
post-hocs conducted?
Discussion: In my opinion, the Discussion is long and repetitive at times. It needs
to be shortened and the text needs to become a little “tighter”.
Also, it may help if the authors commented on the following points:
the low reliability coefficient for the satisfaction with breasts subscale
the items that had similar loading on another scale (i.e., items 12 & 8).
although the authors comment on some trends, they do not comment on the
trend indicating that there are differences between BRCA1/2 carriers and
non-carriers with regard to breast satisfaction (p=.08).
I would personally like an interpretation as to why depressive symptoms showed
a differential relationship with the various subscales.
I would not refer to the concepts included in the parentheses at the end of the 1st
paragraph of the discussion as medical and behavioral characteristics. As is the
case with the Introduction section, the text is confusing and/or vague
occasionally.
In the limitations section, I would include the fact that validity testing is limited
since there were no relationships explored with similar concepts. Also, I would
include the low reliability for the breast satisfaction scale.
In conclusion, this is a sound and interesting paper but its presentation needs
some improvement, particularly with regard to the Introduction and Discussion
sections.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests