Title: GASTROINTESTINAL SYMPTOMS IN ABUSED NONPATIENT WOMEN
Version: 2 Date: 21 Oct 2024
Reviewer's report:
The study is a  comparative/exploratory study which aims at understanding gastrointestinal
symptoms in abused women. It uses a questionnaire for the assessment of physical and sexual
abuse before and after thirteen years of age. Further, the number of gastrointestinal (GI)
symptoms belonging to different subgroups are reported in a self-rating questionnaire.
Two groups are studied; 67 women in anti-violence shelters (V), and 46 controls, referred to a
lawyer for legal assistance, but assumedly not because of ongoing abuse (LC).
There are no other rating scales administered, such as measures for PTSD and related morbidity.
The results are that among the “control” cases, 65 % experienced previous sexual and/or physical
abuse. The severity scores were much lower in the control group, however. Further, both groups
reported high rates of GI symptoms, within in the “V” group, the higher the abuse severity
measure, the more symptoms, which is statistically significant. An unexpected finding is that
the “V” subjects reported an extremely high incidence of traffic accidents, very significantly
different from the control group. This is not overstated but just mentioned,
Is the paper technically sound?
The focus for this study is stated as in the following way; “It remains a subjects of considerable
debate whether the abuse-symptom relationship varies with different life, social, and community
conditions and among the different types of abuse the role of severity”.
No doubt the paper studies these questions, and the results add to the existing literature by
detailing the abuse history in a relevant way. However the power to assess differences or specific
symptom patterns is not very high.
One of the possible criticisms is the choice of control group. Why not females from the general
population? Why were they “referred” to lawyers? Is that to obtain some kind of similarity? And
why not a higher number of participants?
The control LC group is much older than the V group, and they have a higher educational status.
It is of course desirable that the non-patient violence-exposed women under consideration could
be matched with demographically comparable controls from the general population (and maybe
more controls).
This said, that might be be difficult or expensive in the real world, but it is a critical point.
The next criticism is the lack of data on PTSD and related (dissociation, anxiety etc) symptoms,
given the risk implied in the previous abuse and the on-going threat. Much of that points to a
high incidence of PTSD in the “V” group that might explain some of the findings.
Are the claims fully supported by the experimental data? Yes, with the limitations mentioned
above. And the results are certainly relevant from the vantage point of Women’s health.
If not, what further evidence is needed? See above.
Is the statistical analysis of the data sound? I am not a statistician (but a psychiatrist with an
interest in stress and psychotraumatology). I think the data are presented clearly and easy to read,
with the exception of table 5 and 6.; are they necessary? In that case maybe further explanation is
needed to eludicate their importance.  There is no report of a power calculation, maybe because it
is an exploratory study. It would be important with a final statement of how a future study could
be carried out in order to improve the knowledge about the association between GI symptoms,
abuse, and psychological trauma.
Does the availability of data adhere to the expected standards of your research community? The
authors state that the data can be accessed if reasonable, which is a bit ambiguous.
Are the claims appropriately discussed in the context of previous literature? Yes. Presumably
the literature on GI symptoms of a “functional” nature is.
Could the manuscript be revised to address any potential limitations? They are mentioned in
great detail, so probably not.
The language must be checked once more.