Author's response to reviews Title: Prevalence of sexual, physical and emotional abuse in the Norwegian Mother and Child Cohort Study Authors: Marie F Sorbo (marie.flem.sorbo@ntnu.no) Hilde Grimstad (hilde.grimstad@ntnu.no) Johan H Bjorngaard (johan.h.bjorngaard@ntnu.no) Berit Schei (berit.schei@ntnu.no) Mirjam Lukasse (mirjam.lukasse@ntnu.no) Version: 3 Date: 6 February 2013 Author's response to reviews: see over
Cover letter Manuscript reference number: MS: 2031674796844064 Title: Prevalence of sexual, physical and emotional abuse in the Norwegian Mother and Child Cohort Study Authors: Marie Flem Sørbø Hilde Grimstad Johan Håkon Bjørngaard Berit Schei Mirjam Lukasse marie.flem.sorbo@ntnu.no hilde.grimstad@ntnu.no johan.h.bjorngaard@ntnu.no berit.schei@ntnu.no mirjam.lukasse@npeu.ox.ac.uk Version: 3, Date: 6 th. of Feb. 2013 1
Authors`s response to reviews Manuscript reference number: MS: 2031674796844064 Dear Editor, Please find enclosed the revised manuscript: 290113_MS: 2031674796844064 Prevalence of sexual, physical and emotional abuse in the Norwegian Mother and Child Cohort Study Marie F Sorbo, Hilde Grimstad, Johan H Bjorngaard, Berit Schei and Mirjam Lukasse Thank you for the reviews and for your comments on our manuscript. We are pleased that you and the reviewers found the paper valuable, and that you are willing to consider a revised draft. We hope this revised manuscript addresses your concerns. We found the comments constructive and useful and believe that their impact have improved the paper. A detailed description of how we have addressed the issues raised by you and the reviewers follows below. Response to editors comments: Ensuring that the manuscript meets the journals manuscript structure will help to speed the production process if your manuscript is accepted for publication. We will conduct the formatting changes in the best way we can to meet the demands of the journal. 1. Copyediting: After reading through your manuscript, we feel that the quality of written English needs to be improved before the manuscript can be considered further. Before submitting the manuscript the first time we asked the Edanz Group Ltd. to perform Expert Scientific Review (ESR ) service to correct our document. It was performed by MD, MPH Thomas Laage, and the language is changed accordingly to the suggestions. In addition we have now seeked assistance from a native English speaking researcher (John.Walmsley@sintef.no). We hope this now will meet your demand of the quality of written English. 2
2. Please change the title 'Introduction' to 'Background'. We have changed the title to background. 3. Competing interests: Manuscripts should include a?competing interests? section. This should be placed after the Conclusions/Abbreviations. Please consider the following questions and include a declaration of competing interests in your manuscript: Financial competing interests? In the past five years have you received reimbursements, fees, funding, or salary from an organization that may in any way gain or lose financially from the publication of this manuscript, either now or in the future? Is such an organization financing this manuscript (including the article-processing charge)? In the Disclosure of interests section, which is placed after Acknowledgements in our document, we now additionally declare our financial interests. See last paragraph page15. 4. Tables as additional files: We notice that you have included tables as additional files. If you want the tables to be visible within the final published manuscript please include them in the manuscript in a tables section following the references. Alternatively, please cite the files as Additional file 1 etc., and include an additional files section in the manuscript. We have now included the tables to the manuscript following the references. 5. Figure titles: All figures must have a figure title listed after the references in the manuscript file. The figure file should not include the title or number (e.g. Figure 1... etc.). The figures are numbered automatically in the order in which they are uploaded. For more information, see the instructions for authors: http://www.biomedcentral.com/info/ifora/figures. A list of the figures are provided after the tables, see page 20. 6. Figure cropping: It is important for the final layout of the manuscript that the figures are cropped as closely as possible to minimise white space around the image. For more information, see the instructions for authors: http://www.biomedcentral.com/info/ifora/figures. We have changed this in accordingly to your request. On behalf of the authors, sincerely yours Marie Flem Sørbø MD, PhD candidate 6th of Feb. 2013 3
Comments from reviewer 1, Sadik Khuder The authors present interesting findings on prevalence of sexual, physical and emotional abuse in women using data from a large cohort of pregnant women in Norway. Abuse in women is an important public health issue and the manuscript should be of great interest to the readers. However, the manuscript is not well written and the discussion section would probably need to be revised. I have few comments: Before submitting the manuscript the first time we asked the Edanz Group Ltd. to perform Expert Scientific Review (ESR ) service to correct our document. It has been performed by MD, MPH Thomas Laage, and the language is changed accordingly to the suggestions. In addition we have now seeked assistance from a native English speaking researcher (John.Walmsley@sintef.no). We hope this now will meet your demand of the quality of written English. -The reported percentages of abuse (32% lifetime, 20% adult, 19% child, 6% both) are a little bit confusing. I suggest reporting the percentages similar to those in table 1. In the revised version of the manuscript we have made an attempt to make this paragraph clearer. We have added, in brackets, a description of any lifetime abuse, which we think will make it easier to interpret the other numbers presented. In addition we will replace the abbreviations according the different types of abuse (AAA, ACA, etc.) in the text in the result section, which we hope will clarify the content. Table 1 presents the numbers of the women exposed to only adult abuse, only child abuse etc., whilst the numbers in the text refers to adult abuse (which includes possibly child abuse), child abuse (which includes possibly adult abuse) and so on. These groups are very similar, and we think that adding another table could be confusing due to the similarity of the groups, and we hope that clarifying the text improves the understanding of the paragraph. -There is no justification for using age 30-34 as reference point in the logistic regression analysis. We wanted to compare with the largest age group hence we chose the age group 30-34 as reference. This is clarified in the revised manuscript (see page 6, in the Other variables section). -Page 8 first paragraph of discussion: change any adult abuse to any lifetime abuse We agree with the reviewer, and have changed the sentence accordingly. -Page 8 second paragraph of discussion: remove the word unselected We have removed the word from the sentence. 4
-Page 12 second paragraph: clarify the sentence drinking alcohol might be a cause of exposure to abuse as well as a risk factor for being exposed to abuse. We agree with the reviewer that this sentence might be confusing. In the revised version of the manuscript we have deleted the sentence. Page 13 first paragraph line 4: change the sentence was less associated with... to was associated with less.... In our opinion the suggested change will not convey our meaning. In the revised version of the manuscript we have rephrased this sentence in order to clarify the content. See page 13, in the last paragraph. Comments from reviewer 2, Helen Fisher Reviewer's report: This manuscript provides descriptive data on the prevalence of child and adult abuse amongst a large sample of Norwegian women. The results add to the existing body of literature in this area and have potentially important public health implications. The major limitation of this manuscript is the low response rate (38.5%) which detracts substantially from the generalizability of the findings as does the exclusive focus on pregnant women. Some revisions would be useful to improve this manuscript: Major Compulsory Revisions 1. Given that the authors raise in the introduction the problems of comparing prevalence rates from different studies due to differing methodologies, it would be useful if they could comment on how their choice of abuse measure is comparable to previous prevalence studies conducted in other countries. In the revised version of the manuscript we have in the Abuse variables section in the Methods chapter provided more background information about our choice of abuse measures, see page 5. Furthermore, in the Strengths and limitation section we have intended to discuss our choice of measurements and their comparability to other prevalence studies, see page 8. 2. Please provide psychometric properties of the abuse questionnaire that was employed in this study in the Methods section along with a description of how the questions were selected and justification if their use. The physical abuse question in particular is extremely subjective and many good alternatives are available in well-validated questionnaires that been utilised in previous studies over the past decade. 5
To our knowledge there has been a huge development the past decade in improving and acknowledging the importance of using validated instruments for research in this field. In the revised version of the manuscript we have provided more information regarding the reliability and validity of our abuse measures (see page 9), and a broader background for our choices (see pages 8 and 9. We agree with the reviewer that the question on physical abuse in our study gives room for subjective interpretation. A discussion about the choice of our questions is provided under the heading Strengths and limitations. 3. The discussion section should focus more on the public health implications of the findings which are important to the readers of this journal and less on comparisons with previous research which are unnecessarily extensive. We think it is of public health interest in itself to present prevalence rates, as information of prevalence is required to estimate the size of a problem, which also is important when strategies to prevent abuse is considered. These are important reasons why we chose this to be a prevalence article. This is also why we wanted to perform a thoroughly comparison of the published literature and suggest reasons for differences, as we think there is a gap to fill. At the same time we agree with you that focusing on public health implications of the findings are of great interest and important to provide information about, and we have therefor added a complementary paragraph in the discussion section. See page 14 in the Public health section. We have also attempted to reduce the discussion and comparison of the results and previous research. 4. It would also be helpful if the authors could include under the limitations section some discussion of the issues relating to retrospective reporting of abuse - given that the women were pregnant and potentially in a more emotionally unstable state it would be worth mentioning briefly the potential impact of depression on recall of early experiences. In the revised version of the manuscript we have provided a discussion about this limitation (see page 10, last paragraph). Minor Essential Revisions 1. It would be useful if the authors could include percentages in Figure 4 to aid the reader in determining the proportion of overlap between the different forms of abuse. We agree with the reviewer and have changed this accordingly. 2. The last sentence of the results section should read: "The results of the unadjusted logistic regression were in the main confirmed by the adjusted results. This is corrected accordingly. 6