Title: Domestic Violence Experienced by Women With Multiple Sclerosis: A Study from the
North-East of Iran
Version: 1 Date: 11 Apr 2022
Reviewer's report:
Comments on Domestic Violence in Women With Multiple Sclerosis: A Study from the North-
East of Iran by Elham Manouchehri et al.
General comments
The paper describes and analyzes the prevalence if domestic violence against women with
Multiple Sclerosis and find prevalences of the different subtypes of violence, in particular
economical violence and psychological violence, where more than half of the women are
exposed to a high or moderate level of violence. Further, it shows that the prevalence of violence
is dependent on both the woman´s and husband´s income and occupation and the woman´s
educational level – however with differences between the subtypes of violence. The analysis is
performed properly, and model tests are carried out. However, some information on the methods
seems to be missing, making it difficult to assess them:
- The questionnaire is very coarsely described, the number of questions but not the content of
each question. The cited reference Mohseni Tabrizi et al. (2013) seemingly not available in
English. Eventually the questions could be described in short or, better, given in a supplementary
file.
- The transformation of the total score into the categories low, moderate, and high/severe
violence is not described. How is the classification into these groups made?
- It is not clear how the ROC curves should be interpreted. I think they can be omitted.
Further, I am a little confused about who are exposed to domestic violence and who are not. My
comments are based on the assumption that “low violence” means no domestic violence and
“moderate” and “severe” both means exposed to violence.
Specific comments:
Abstract:
Abstract, results section: The percentages of the different subtypes (46.5%, 36.7 % etc.) are the
percentages with low/no violence, according to Table 2. I think the percentages instead should
be for moderate+severe violence together, e.g. 52.7 %, 62.5 % etc.
Abstract, results section: “and sexual violence (9.1%)”: I should be 5.1%, according to Table 2.
Abstract, results section: “participant’s job (P = 0.045)”: It should be P=0.036, according to
Table 3.
Abstract, results section: “and also higher than a diploma”: The sentence is unclear, should
probably be “and also higher than in participants with education above diploma”
Introduction:
p. 3 line 23 “It occurs in people in their 20s - 50s who are at their peak of sexual activity and
fertility (19, 20).” Please specify what occurs – probably the onset of MS.
p. 4 line 5 : “In fact, a decrease in the level of life satisfaction, intimacy, and marital relationship
is created in the caregiver spouse”. Please check language.
Method:
p. 4 line 6 from bottom: “using the convenience sampling method”. If possible, please describe
more detailed how the sample was obtained, e.g., were all women who fulfilled the inclusion/
exclusion criteria included in the study?
p.5 line 5: Please describe the assumptions in the sample size calculation, e.g., why s=0.16 and
d=0.05
Further, I do not understand how 246 women became 185 – is the prevalence of MS relevant
for the sample size – I assume you only recruit participants among MS patients?
p. 5 line 13: The reference 37 seems only to be available in Persian language. Is there an
English version available? Without knowing the questions, it is hard to assess the results. In my
experience, the prevalence of domestic violence depends on how questions about the violence
are formulated.
Data analysis:
Please elaborate this paragraph. In particular I miss information on how the questionnaire is
scored, and how the scores are transformed into the outcome (low/medium/severe violence).
Which cut points did you use, and how were they defined?
p. 5 line 7: Please be consistent – high violence or severe violence.
Results:
p.6, the paragraph “Demographic Characteristics”: You chose to present only the most frequent
categories, e.g. having 2 children, low income etc. Please mention this from the beginning – you
actually do this later, e.g., “Patients were mostly housewives (206, 74.9%)”
p. 6 line 17 “was less than 238 dollars per month”. Please describe in the Methods section how
these seemingly odd numbers arise.
p.6 line 21 “strong family support” Please describe how this is defined in the Methods section.
p. 6 line 3 from bottom: “Domestic violence was low”: I think this should not be mentioned,
instead it would be more relevant to mention the percentages who are exposed to violence
(moderate+severe).
p. 6 line 2 from bottom: “physical violence (66.2%, 18)” should be “physical violence (66.2%,
182)”
p.7 line 9 participant occupation (P = 0.032):  This should be P=0.023 according to Table 3.
p.7 line 12 The relation between economic violence and participant occupation (P = 0.021) seems
not the be significant, as P=0.062 in Table 3.
p. 7 line 14 Relation between physical violence and income (P = 0.001): It should be spouse
income.
p.7 line 17 Relation between sexual violence and participant occupation (P = 0.004): This is not
significant, as P=0.497.
p.7 line 21 Relation between domestic violence and participant occupation (P = 0.045): P=0.036
p. 7 line 3 from button and the next 20 lines: I would suggest that you in general wrote the
confidence interval of the OR  instead of the p-value, e.g. “OR of the moderate or high level of
psychological violence in women with diploma and over diploma was 0.43 (95% CI 0.19;0.96)
and 0.27 (95% CI 0.11;0.63) respectively, compared to women educated  under diploma (Table
4)”. I have not changed this in the comments below, but I recommend it.
p.8 line 2 and the following lines: “Probability or more likely”: You mean Odds Ratio compared
to the reference group. You do not know the probability in multivariable logistic regression, only
odds. Please change probability /more likely to odds or odds ratio everywhere in this paragraph.
p. 8 line 2. “the probability of economic violence in patients with an educational level of diploma
and above was 0.31 (P = 0.011) and with less than a diploma was 0.32 (P = 0.018).”:  You
probably mean “the OR of economic violence in patients with an educational level of diploma
and above was 0.31 (P = 0.011) and 0.32 (P=0.018), respectively, compared to patients with
educational level less than a diploma”
p. 8 line 11: “of patients with a diploma and less” should be “of patients with less than a
diploma” (because this is the reference group)
p. 8 line 12f: “Patients who were older than their spouses and also patients who were the same
age as their spouses were 5.81 times (P = 0.003) and 4.7 times (P = 0.009) more likely to have
sexual violence, respectively“:  This could be changed to “Patients who were older than their
spouses and patients who were the same age as their spouses had OR= 5.81 (P = 0.003) and
OR=4.7  (P = 0.009) for sexual violence, respectively, compared to those who were younger.”
p. 8 line 14: “Patients with strong family support were 0.33 times (P = 0.028) likely to have
sexual violence than patients without family support.”  Could be changed to:  “Patients with
strong family support had OR= 0.33 (P = 0.028) for sexual violence compared to patients without
family support.”
P. 8 line 16: “The overall rate of domestic violence decreased in patients with diploma (P =
0.014) and above diploma (P = 0.016) compared to patients with less education.”: Please present
the OR.
Discussion:
p. 8 bottom lines: “sexual violence and economic violence were the most and less common
violence experienced by women, respectively.”: According to Table 2, economical violence is
the most common (62.5%) and sexual violence the least common form of violence (20.4%).
p. 10 line 8 and following lines: You use “rate” but I think it is prevalence.
Conclusion:
p. 12 line 8 from bottom “Women experienced various forms of domestic violence throughout
their lives”: I agree, but I think your findings only leads to conclusions regarding women with
MS, and not women in general.
Availability of data and materials:
“All data generated or analyzed during this study is included in this published article”: Maybe
I misunderstand what is meant here, but in particular I miss the questionnaire. Further, are the
raw questionnaire data available?