Title: Health and suffering are associated with social support – a cross-sectional study of women
and mothers with exhaustion and pain
Version: 1 Date: 24 May 2021
Reviewer's report:
General comments
The authors present an interesting cross-sectional study of women and mothers with exhaustion
and pain, identifying the association between health and suffering and social support; I believe
this will be of interest to the readers of BMC Women’s Health. The main issue with the study
is that the authors focus on and discuss maternal and parental exhaustion, but the mothers with
exhaustion and pain in this study include women who do not have role as parents or work (e.g.,
those whose children are adults, those not living with their children, and those who are retired).
Authors need to explain this issue and reconsider their Introduction and Discussion section.
Major comments
1. Abstract - page 2, line 3: Regarding “musculoskeletal disorders”, it is better for the authors to
explain “behavior, mental, and musculoskeletal disorders” like the phrase on page 3, line 10 in
Introduction. If the authors want to focus on musculoskeletal disorders, it is recommended that
they provide an in-depth explanation of these disorders and their relationship with exhaustion
and chronic pain, with references.
2. Introduction - The authors focus on and discuss maternal and parental exhaustion and long-
lasting pain, social support in relation to motherhood, and a double burden of family and working
life. However, the study sample—“mothers with exhaustion and pain”—comprises women are
much older than the other groups, 9.3% of them are retired, and the children of more than half
of them are either adults or do not live at home. Therefore, I wonder if this group of women
suffers from fatigue and pain caused by age-related diseases, and not by parental and work
duties. Considering the results of the analysis of the current target population, the authors need
to revise the Introduction.
3. Methods - Page 6, lines 8 to 9: Regarding the patient sample, please clarify the eligibility
criteria. Did the authors select those patients who participate in the 10-week rehabilitation
program at a rehabilitation clinic for exhaustion and chronic pain? I wonder if there were any
other patients who visit the hospital and receive other treatments.
4. Results – Table 1 & 3, study sample “Mothers with exhaustion and pain” are much older, 9.3%
are retired, and the children of more than half of them are either adults or do not live at home. As
mentioned above, I wonder if this group of women suffers from fatigue and pain caused by age-
related diseases, and not by parental and work duties. Why did the authors include these women
in the study sample? Is this population appropriate to meet the research objectives? Why did the
authors consider this group of women comparable to the others in the study sample?
5.Discussion - The authors focus on and discuss maternal and parental exhaustion and chronic
pain, social support in relation to motherhood, and the double burden of family and a working
life. However, I wonder whether the sample is appropriate for this study.
- On page 19, lines 10-11: The authors state that “mothers’ chosen social network is vulnerable
in itself or deficient.” In the case of women whose children are adults, those who do not live
with their children, and those who are retired, some of them may have fewer social networks
now than that they are done raising their children or working.
6. Conclusion– page 21, lines 2 to 3 - The first sentence of the conclusion is a bit of a leap
considering the results. While this study revealed a low level of social support, measured using
MSPSS, it did not clarify loneliness or isolation using scales. It is true that low social support
is related to loneliness and isolation, but the authors have neither mentioned loneliness and
isolation in the Introduction nor used scales that measure the two concepts. Therefore, from the
results of this study, it is difficult to conclude that mothers with lower social support experience
loneliness and isolation.
Minor comments
1. Methods: page 6, line 23: I suggest that the authors provide the full names of the scales HSS,
KEDS and MSPSS.
2. Results – Table 5 & 6 and page 14- 16, for example, page 14, line 11: I suggest that the
authors add annotations for b and # at the bottom of the tables—is b an unadjusted value and
# an adjusted value?