Title: Magnitude of psychological distress and associated factors among war survivor women
in Northern, Ethiopia, 2022: A community-based cross- sectional survey
Version: 2 Date: 04 Oct 2023
Reviewer's report:
As a general suggestion the researcher did the area need evidence for intervention which is
appreciated, many females are suffering since they are at high risk with their children, however,
females included in the study who are pregnant and have children are less in number I feel the
high-risk women overlooked.
I have reviewed and put my suggestion for each title as follows
Abstract part :
Background: the sentence “Civilian war and internal conflicts increase mental health conditions
among war survivors”. Not clear whether mental health condition means enhanced or lower.
Method part:  mention study participant and sampling method
As a result part, the term “being separate” from what?? , farmer and housewife how the authors
separate especially during data collection they make clear
The conclusion is not drawn from the result, the distress is due to war? The study design is not
comparative
Introduction part
The introduction is not focused on female survivor after being exposed to war, the gap was not
well-addressed and need updating
Line 4: PTSD correct as post-traumatic stress disorder
In the last paragraph, it says “These highly complex settings need an integral to establish
psychosocial rehabilitation to reduce levels of physical and emotional traumas and improve
social functioning through individual and community interventions” to address the gap before
recommendation for intervention evidence should be generated, the gap should be based on the
availability of information. The authors need to address a clear gap.
Method part
The census sampling technique is not clear and needs to be described further
When conceptualizing the outcome variable, with Suicidal behaviors that variably affect the
other, multicollinearity checked between suicidal behavior and PTSD, can the authors mention
the result and say on the assumption for logistic regression?
I am not clear why the English version tool was used for data collection, or how the proposal
obtained ethical approval.
Validation of the tool done in the Ethiopian context? If so what is the importance of calculating
Cronbach’s alpha again?
The term “For women, a cut-point of 4 resulted in many false negatives. The data were collected
following the end of the war in the area. As a result, a cutoff point of 3 and above was considered
to minimize the false negative” are not clear
Result part
For age in Table 1, mean and SD are not properly specified
Classification of maternal education as able to read and write and education primary and above
can overlap, how the data collected, it seems to overlap of information, and how this can affect
the assumption of logistic regression, the authors need to give further information or description
Married females were 85.2% while those having no under-five children were 70.5% can the
author explain this?
For suicidal behaviors what action was taken, since suicide is an emergency in psychiatry?
The selection of variables and interpretation of the logistic output need further work
Discussion
The discussion part needs further work example if different measurement tools, and study
designs, can we compare the results?
Language edition through the document needs further work