Reviewer ’s report  
 
Title:  Mental Health, Sexual Identity, and Interpersonal Violence: Findings from the Australian 
Longitudinal Women's Health Study  
 
Version: 0 Date: 15 Jan 2017 
 
Reviewer:  James  Morandini  
 
Reviewer’s report:  
 
The present study was based on a secondary analysis of data on young women from the 
Australian Longitudinal Study on Women's Health, examining the link between sexual identity, 
interpersonal violence, and mental health outcomes in mostl y heterosexual, bisexual, and lesbian 
women. Key findings were that, controlling for demographics, mostly heterosexual and bisexual 
women were significantly more likely to report physical, sexual, and emotional abuse then 
exclusively heterosexual women; mo stly heterosexual women were more likely to report severe 
physical abuse and being in a violent relationship in the past 3 years, and all sexual minority 
women were 2 -3 times more likely to have experience harassment. Bisexual women reported 
higher levels of adverse mental health outcomes than all other groups. IPV predicted poorer 
mental health in lesbian and bisexual women. This manuscript makes an important contribution 
to the literature - in particular in examining IPV and mental health in mostly hetero sexual 
women (a group typically overlooked in the sexual minority literature).  
 
 
Below I suggest some minor issues to be addressed:  
 
1) A clear operational definition of IPV is needed in the opening paragraphs. It is not until the 
description of measures i n methods that the authors are explicit in exactly what they mean by 
IPV.  
 
2) IPV is measured based on 5 items reflecting distinct domains (physical, severe physical, 
emotional, sexual, harassment). Is there a literature supporting IPV as constituting these specific 
domains, and could this info be incorporated into the introducti on and/or description of measures 
in the methods.  
 
3) Was the Anxiety Symptoms measure a single item? Need to clarify.  
 
4) No info on the internal consistency of the Mental Health Index in methods - although IC is 
included for other measures.  
 
5) Table 3 : Emotional violence - replace " ---" with "***"  
 
6) Fifth paragraph of discussion: The authors may wish speculate as to why IPV fully explains 
increased mental health issues in lesbians, but not bisexual or mainly heterosexual women. What 
additional facto rs may explain elevated MH in bisexual/mainly heterosexual women (after 
controlling for IPV). Social isolation? Lack of community connectedness? Individual difference 
variables (personality factors) which may be linked to both bisexual/mainly heterosexual 
identification and MH outcomes? Obviously this will need to framed in a way which does not 
pathologise non -monosexual women - but need to provide some potential explanations for your 
findings.  
 
7) Check paragraph 3 - You state that greater reported violen t relationships in mainly 
heterosexual/bisexual women may be explained by the fact that their partners are more likely to 
be male - but then in the next sentence, provide evidence with of similar rates of IPV in same -sex 
and opposite partners. I think your  original assertion seems defensible based on the data you 
provide, and cross -cultural data of sex differences in violent behaviour generally (and in sexual 
relationships generally). Moreover - your sentence on rates of IPV in same -sex and opposite -sex 
relationship is not convincing - you don't clarify whether these studies are comparing male AND 
female same -sex vs. opposite -sex relationships, or just comparing within gender. If the former, it 
seems possible that the male -male relationships are driving this  effect. Again, obviously this is a 
politically sensitive topic - so I understand the motivation to tread carefully. Nevertheless, I don't 
think this should come at the expense of providing a clear potential account of your data.   
 
8) Examination of coeff icients of the link between type of IPV and MH (Table 3), show that 
"emotional violence" is by far the strongest predictor of MH outcomes. This also looks to be the 
most subjective component of IPV measured (i.e., the others tend to reference specific, tim e-
limited objective events, whereas being "bullied" or "critizied" involve a strong evaluative 
component on behalf of the respondent). It might be worth mentioning this issue of causation in 
the discussion - i.e., it might be that emotional violence leads to MH outcomes, but also, that 
those with elevated MH difficulties, may also perceive more emotional violence (thus explaining 
why this facet is so strongly linked to MH outcomes relevant to other facets measured).  
 
9) A potential discussion point also may  be whether it is reasonable to assume that mainly 
heterosexual women experience the same type/severity of minority stress as faced by bisexual or 
lesbian women. At this point exactly who adopts this label and why - is still poorly understood. 
As you indic ate - without data collected on sexual behaviour (past or present), it's unclear 
whether "mainly heterosexual" women in your sample simply represent otherwise heterosexual 
women who acknowledge the potential to be attracted to women (or are open -minded to the 
potential of such attraction in the future) in the absence of past/present behaviour or even 
intention to act on this attraction. Whether increased MH difficulties in this group (relative to 
exclusive heterosexuals) can be explained by > sexual minorit y stress is still unclear.  
 
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 am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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3. Do you hold or are you currently applying for any patents relating to the content of the 
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