Reviewer's report
Title:Cross-sectional and longitudinal risk of physical impairment in a cohort of
postmenopausal women who experience physical and verbal abuse
Version:1Date:30 March 2015
Reviewer: Lori Weeks
Reviewer's report:
Major Compulsory Revisions
1. Study Justification and Literature Review: Starting on line 86, the main
justification for this study appears to be that no studies have prospectively
investigated the potential association of abuse exposure with accelerated decline
in physical functioning in older women. The hypotheses state that women who
experience physical and/or verbal abuse will have lower levels of physical
functioning in the short and long-term.
There is some review of prior research about the risk of abuse exposure for older
women starts on line 71, but there are additional sources of data to draw on to
provide more complete picture of our knowledge of abuse experienced by older
women, and more information from cited studies could be included. For example,
the cited study by Zinc and colleagues (2005) provides additional information on
health outcomes for older abused women. Based on studies cited in this
manuscript, and others not cited, the unique knowledge, or even confirmatory
knowledge, that this study will add is not clear. Much more literature needs to be
added and more clarity is needed about what this study contributes to our
knowledge. I included some additional sources below that could be included. The
introduction should also include a rationale for focusing on physical and verbal
abuse in particular.
Bonomi, A. E., Anderson, M. L., Reid, R. J., Carrell, D., Fishman, P. A., Rivara,
F. P., Thompson, R. S. (2007). Intimate partner violence in older women. The
Gerontologist, 47(1), 34-41.
Loxton, D., Schofield, M., Hussain, R., Mishra, G. (2006). History of domestic
violence and physical health in midlife. Violence against Women, 12(8), 715-731.
Mouton, C. P., Rovi, S., Furness, K., & Lasser, N. L. (1999). The associations
between health and domestic violence in older women: results of a pilot study.
Journal of Women’s Health & Gender-Based Medicine, 8, 1173-1179.
McGarry, J. (2010). How domestic abuse affects the wellbeing of older women.
Nursing Older People, 22(5), 33-37.
Rennison, C., & Rand, M. R. (2003). Non-lethal intimate partner violence against
women: A comparison of three age cohorts. Violence against Women, 9(12),
1417-1428.
2. Methods: While a reference to a protocol paper is included in the methods
section, it would be helpful to include how the questions were asked of the
women. Was it a face-to-face interview or a mailed survey for example? How the
data was collected will help to interpret the results, especially given that we know
that many women will not disclose abuse in studies such as this.
3. Study Limitations: The specific abuse questions are included, which is helpful.
It is clear that the questions will detect domestic violence in that the abuser is a
close family member or friend. The questions do not detect intimate partner
violence as the type of abusive relationship is not known. We also do not know
the gender of the abuser, and there is also no information collected on intensity,
frequency, or duration of abuse. Of course, the researchers can do nothing about
how the questions were asked, but these are serious limitations that influence the
significance of the results. These limitations need to be more clearly discussed.
4. Covariates: You include a section on covariates, beginning on line 159 in the
methods section. It is not clear why you define these as covariates or how this
fits with the purpose and hypothesis of your study. Is one of your purposes to
determine the characteristic of older women who experience different forms of
abuse? It appears that you included various sociodemographic characteristics
that are associated with abuse. Associated in what way? In Table 1, you include
the results of the characteristics for the whole sample and then the 3 categories
of abuse. You indicated in a note that the differences between abuse exposure
groups were statistically significant for every characteristic. You did not indicate
the statistical procedures used to determine this in the methods or in the table. In
some instances in the table, participants with the same characteristic
experienced different forms of abuse in the same proportion, or very similar
proportions. For example, the characteristics for those not experiencing abuse
and verbal abuse are often quite similar. The narrative presented for Table 1 in
the results section is not clear. Focus on the key findings. For example, women
who experience verbal abuse were more likely to be married than those who did
not experience abuse.
5. Longitudinal Nature of the Study: I believe that the data presented in tables 1-3
are baseline data only. The analysis presented in table 4 is unclearly described in
the methods or in the table. It appears that you compared the three age groups
of women and the type of abuse experienced, but was this done at baseline
only? The longitudinal nature of this analysis needs to be clarified. If this is a
longitudinal study, the characteristics of the women should be included for
whatever data points you are analyzing in this study.
Minor Essential Revisions:
1. In the abstract define the acronym WHI.
2. I believe that notes are needed for Table 2
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.