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Associations of Workplace Violence and Psychological Capital With BMJ Open: first published as 10.1136/bmjopen-2018-024186 on 24 May 2019. Downloaded from PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf) and are provided with free text boxes to elaborate on their assessment. These free text comments are reproduced below. ARTICLE DETAILS TITLE (PROVISIONAL) Associations of workplace violence and psychological capital with depressive symptoms and burnout among doctors in Liaoning, China: a cross-sectional study AUTHORS sui, guoyuan; liu, guangcong; jia, lianqun; wang, lie; yang, guanlin VERSION 1 - REVIEW REVIEWER Shailesh Kumar Waikato Clinical Campus, University of Auckland Private bag 3200 Hamilton New Zealand REVIEW RETURNED 08-Aug-2018 GENERAL COMMENTS I enjoyed reading this paper. Authors have identified an important area and have done justice to the topic. The paper needs significant language review. sentences are often structured poorly and sometimes difficult to understand (e.e Page 3 line 8; page 4-lines 4- 5, 11-12 and 14-19). Page 5 why should only Chinese doctors be vulnerable - line 15 well-being spelling needs correction, I suggest authors should give a concise and clear definition of psychological http://bmjopen.bmj.com/ capital early in the paper and explain how they protected respondents' privacy and anonymity especially when they had such high response rates. I would also like to read a bit more about the impact of deleting two major items of physical violence and vicarious violence and its impact on the overall quality of the tool REVIEWER Oriol Yuguero on September 28, 2021 by guest. Protected copyright. Institut de Recerca Biomedica de Lleida REVIEW RETURNED 16-Aug-2018 GENERAL COMMENTS I think it's a very interesting article. Perhaps a shorter introduction would be fine. As a non-Chinese reader, I would like to know the situation of the professionals that may induce aggression towards them. In the Methodology section I would reduce the explanation of the sample size calculation. We already deduce that the calculation has been made correctly. The results are interesting and I think they show a situation suffered by professionals in China. Perhaps it can help to establish improvements in the health system to improve the mental health of professionals and avoid aggressions to doctors. REVIEWER Lynn Monrouxe Chang Gung Medical Education Research Centre (CG-MERC) Chang Gung Memorial Hospital, Taiwan. REVIEW RETURNED 17-Aug-2018 BMJ Open: first published as 10.1136/bmjopen-2018-024186 on 24 May 2019. Downloaded from GENERAL COMMENTS Thank you for giving me the opportunity to review the manuscript “Associations of workplace violence and psychological capital with depressive symptoms and burnout among doctors in liaoning, China: a cross-sectional study”. I have read it with great interest. The subject of physician wellbeing is of great importance. However, The Introduction does not quite set the study up adequately. I believe that some of this is to do with the English language that needs to be addressed, some to do with lack of references and some to do with the argument not building sufficiently. Workplace violence was measured via a categorical scale but other measurements were (possibly) on a continuous scale – I confess that I am not a high-level statistician but mixing nominal data with ordinal/continuous data isn’t possible is it? I suggest someone who understands statistics gives a view here – I found the analysis and results section hard to follow. In terms of the results section – some of my difficulty was with the reporting of the findings and the lack of any detail at all in the main body of the report – while I understand the authors wished to summarise their findings, it’s too brief and the reader is left wondering what was really found to be statistically significant. In the discussion section - that “psychological capital mediated the effects of workplace violence on depressive symptoms and two dimensions of burnout” is, of course, important. But then the authors go on to say that Doctors who “suffered workplace violence would be more likely to experience lower levels of psychological capital, which in turn increased the levels of depressive symptoms and burnout.” doesn’t actually follow logically. Following this the authors say “Therefore it may be a effective http://bmjopen.bmj.com/ strategy to develop some programs to increase psychological capital, thus decreasing doctors’ depressive symptoms and burnout in the long run” – again – this is too much of a claim based on the authors’ data and too simplistic to have ‘some programs to increase psychological capital’ (so many constructs involved) and then depressive symptoms and burnout are decreased – I can’t see this being the case as these are really complex mental illness phenomena. on September 28, 2021 by guest. Protected copyright. Despite the authors admitting that their study is such that it is impossible to draw causal relationships – they continually attempt to do such a thing. Caution should be taken here. The authors have filled in the STROBE-Vet which is an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. However, their study is not an observational study in epidemiology (hence they responded ‘no’ to many items). I suggest they switch to using: Kelley K, Clark B, Brown V, Sitzia J. Good practice in the conduct and reporting of survey research. Int J Qual Health Care. 2003;15(3):261-266. I suggest the authors fond someone to English Edit their work. DETAILS OF ADDITIONAL CHANGES Abstract Please briefly define psychological capital as it is not clear. The design just says it’s a “cross sectional study” but of what kind? Many different qualitative and quantitative studies can be cross sectional – can the authors please be more specific. Also, the authors state “Psychological capital mediated the effects of workplace violence on depressive symptoms and burnout” – but in what way? For the BMJ Open: first published as 10.1136/bmjopen-2018-024186 on 24 May 2019. Downloaded from conclusion section it is going beyond the data to say that in China “most doctors encountered various types of workplace violence”: the authors are extrapolating their findings too much. Strengths and limitations “This is the first study exploring mediating role of psychological capital in the associations of workplace violence with depressive symptoms and burnout.” Is not focused on the study methods/methodology so should be revised. Introduction IBBN? Please spell out acronyms first. “In China the ratio of doctor to general population (1:735) is lower than that in western countries (1:280-1:640)” – this range is really very large and maybe not significantly higher than the top end of 1:640. I think it is sufficient to give us the figures for China and emphasise that doctors are under strain due to insufficient human resources. Lines 13 – 19 on Page 4 really needs some references. Page 5: “sample size was relative small, and results were varied” – more information on this required. Line 13; and lines 16-18 on page 5 – references please? Line 4 on Page 6 – reference please? VERSION 1 – AUTHOR RESPONSE http://bmjopen.bmj.com/ Reviewer: 1 Reviewer Name: Shailesh Kumar Institution and Country: Waikato Clinical Campus, University of Auckland, Private bag 3200 Hamilton New Zealand Q1: The paper needs significant language review. sentences are often structured poorly and sometimes difficult to on September 28, 2021 by guest. Protected copyright. understand (e.e Page 3 line 8; page 4-lines 4-5, 11-12 and 14-19). Answer: Thank you very much for your advice. We improved the quality of language in our manuscript with the assistance of an English-speaking colleague. Page 3 line 8: This study is impossible to draw causal relationship due to cross-sectional design. The revision was as followed: Due to the cross-sectional design, this survey was not able to determine causality among variables. (Page 3, Line 10-11) page 4-lines 4-5: Doctors in direct contact with patients and patients’ families may be exposed to high levels of workplace violence. The revision was as followed: It was well documented that doctors were vulnerable to suffer workplace violence. (Page 4, Line 4-5) page 4- lines 11-12: In China the ratio of doctor to general population (1:735) is lower than that in western countries (1:280-1:640), so human resources in hospital are insufficient. The revision was as followed: BMJ Open: first published as 10.1136/bmjopen-2018-024186 on 24 May 2019. Downloaded from According to China Statistical Yearbook, the number of doctors was 2.31 per 1000 persons. A study reported that human resources in Chinese hospitals were insufficient, which may make doctors under strain. (Page 4, Line 10- 12) page 4- lines 14-19: These may lead to unharmonious doctor-patient relationship. In addition, in China patients undertake huge medical costs so that they often complain about it. At the same time, doctors get low benefits from medical technology due to strictly government-controlled conditions, and some Chinese doctors may provide unreasonable treatments for patients in order to make more profit. Though government takes some measures to deal with this issue, this still causes adverse effects. The revision was as followed: And with the development of medicine, most doctors are busy with technical problems, and thus ignore patients’ inner feeling in clinical process[7]. In addition, in China patients often complain about huge medical costs[8]. Because the price of medical services is under government-controlled conditions, Chinese doctors get low benefits from medical services[9]. As a result, in order to make more profits, some doctors may provide unreasonable treatments for patients[9].
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