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One of the original reviewers has viewed your revised submission and made some suggestions for minor revisions. If you are able to address the editorial changes below, then there is a good likelihood your article will eventually be accepted (although this can never be guaranteed).
The article is very much improved. Minor changes are indicated only, as attached.
Experimental design is appropriate as previously discussed
The findings are appropriate
Depression, anxiety, and stress in partners of Australian combat veterans and military personnel: A comparison with Australian population norms, #9599
The manuscript is very much improved. Small grammatical and spelling corrections are provided below:
Abstract
Line 31 – ‘…comparative analysis of the mental…’
Line 39 – ‘Samples 1 and 2 comprised….veterans who reported…’
Line 45 – ‘sample 4 and then it is possibly due….with frequent deployment.’
Introduction
Line 62 – ‘The majority….compared the partners of veterans who have PTSD….that of partners without... Thus, no research to date…’
Line 91 – ‘There is also……among partners….’
Line 95 – ‘into…..and families, over…lifespan of the relationships….therefore, more research is needed to examine the possible negative…loop between family factors that affect the combat….’
Line 102-106 – ‘of veterans…..military (samples 1 and 2)…..(SASR) (sample 3)…..partners of non-SASR veterans (sample 4). A description of the sample……suggest that a greater number…in turn, may have a negative impact on the partners’….’
Line 107 – ‘Although…deployment is currently…..suggests that SASR personnel experience more…..military staff.’
Method
Participants
Line 119 – ‘basis…way to support and air any problems the partners may…’
Line 135 – ‘Ten…deployments.’
Line 137 – ‘convenience sample’
Line 140 – Clarify what is meant by ‘Deployment varied for the partners’ veterans’
Line 145 – ‘convenience sample’
Procedure
Line 174 - ‘convenience sample’
Discussion
Line 253 - ‘different…no comparison of mental….symptomatology relative to….’
Line 255 – ‘groups…..snapshot of the psychological…..’
Line 267 – ‘been….of the psychological….’
Line 268 – Please consider that there are two differences between samples 1, 3, and 4, based on age and work status (i.e. veterans vs. military personnel), so the latter point should also be considered.
Line 272 – ‘2009), and the results may……for the partners…veterans. For example, preventative….’
Line 279 – add full stop after ‘move’
Line 285 – ‘in this cohort reported….could reflect….hyperarousal in the partners, which reflects the issues and problems they experience in meeting….’
Line 289 – ‘First, only….was used to examine mental health symptoms.’
Thank you for your submission, which has now been reviewed. You will see that both reviewers have wondered about the purpose of sample 2 and noted the need for further analyses. Please ensure you address these concerns satisfactorily.
While I can appreciate that this is an important study, I think that the introduction of the article needs more work. In particular, there is a lack of clarity in the writing and some structural issues that make it hard for the reader to separate out past research findings relating to partners of veterans vs. those relating to the partners of currently serving military. This is, I believe, an important aspect of your study, particularly when it comes to interpreting your results.
As such, I suggest that you make it clear upfront that you are interested in investigating psychological distress in these two different types of partners and then present the past research for each in turn. Further, to facilitate the readers' ability to distinguish, refer to each group differently (e.g., 'veterans' partners' and 'serving military partners' or similar).
I was somewhat confused by the fact that your study did not investigate any of the reasons provided in the introduction for why the samples of interest may have higher levels of psychological distress than the general population. This was compounded by the reporting of deployment information in the method section, but no following analysis involving this data, and also the mention of participants' careers in the discussion (lines 235) without this information being included in the method.
I was also unsure about the purpose of Sample 2 - why did you randomly select this group of participants and then run it separately from the original Sample 1? Furthermore, it is unclear why you only compared each sample to norms and not to each other.
The difficulty I find is that, while your findings indicate that the samples differ from norms, there is no evidence to support that these differences have anything at all to do with the fact that the participants are partners of veterans or currently serving military personnel. To demonstrate this, you would need to include additional analyses examining the impact of variables specific to these samples (e.g., deployments, relocations, partner's PTSD, etc.) and determine if they explained at least some of the variance in scores.
Furthermore, without testing the differences between samples (e.g., psychological distress, demographics, partner variables, etc.), it is not clear if the majority of the significant findings are a function of partner differences (i.e., veteran, SASR, non-SASR) or if they are related to other differences, such as age, parenting, career, etc.
On the basis of these issues, I do not feel that the conclusions drawn are appropriate.
Overall, I feel that the paper could be much improved with some reworking and additional analyses, after which it will be a valuable addition to the literature.
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Peer J #9599, Depression, anxiety, and stress in partners of Australian combat veterans and military personnel: a comparison with Australian population norms
Abstract
The results as detailed in the abstract are unclear, especially the reference made to ‘poorer symptoms of depression’, and ‘poorer symptomatology’, and the results for partners of SASR personnel are different than those that appear in the results section. Please correct the presentation of results in this section.
Introduction
Although this section is generally well written, the language is rather imprecise, especially in describing the partners of veterans and military personnel. In particular, reference is made to ‘the military and veteran couple’ (line 77), ‘partners of the military and combat veterans’ (line 78), ‘partners of the military and veterans’ (line 80), ‘partners of non-military and veterans’ (line 81), and ‘partners of the Australian military’ (line 86). Do you mean to infer that the participants are married to the military, or did you mean to write ‘partners of military- and combat-veterans’? Please also correct the following to include the word in parentheses ‘currently serving military [personnel]’ (line 87). Further, on line 84, reference was made to: ‘partners of veterans and military personnel (from now on referred to as veterans).’ Do you mean that all current and ex-military staff will be referred to as veterans, or just the latter? In addition, parents who are in a marital relationship, whether or not they shoulder all of the burden of caring for children, are not single parents (line 70), rather, the latter are obviously parents who raise children on their own, without the financial or other supportive assistance of a spouse.
Method
On line 93, it was mentioned that sample 1 participants were mostly members of the PVA – who are the other participants, and how were they recruited? Or do you mean that all the participants in group 1 were recruited via the PVA newsletter, whether or not they were members? On line 94, reference was made to ‘all partners of current and former partners’ - this requires revision. On the following lines, the word ‘while’ should be replaced with ‘whereas’ (line 104, 117, 138, 140, 228). On line 104, reference is made to ‘Of those who indicated that they had been deployed….’- I thought that the partners of veterans/personnel (and not the servicemen themselves) filled in this questionnaire? In addition, no mention was made of the number of veterans who were deployed only once, or were their no servicemen in this position?
In sample 2, random selection of the participants evidently did not occur, since selecting the first 50 participants in a sample is a non-random selection criterion, and this requires correction throughout the manuscript (also line 153). On line 121, by ‘contemporary’ do you mean ‘current’? Why was the treatment of participants different in sample 4 (i.e. ‘survey….following meetings discussing their issues.’)? Could this have biased the results obtained in sample 4, that is, could they have been inadvertently biased by the interview?
In regards to the study measures (line 133), the sentence starting: ‘It is a 21-item self report yielding..’ – are you referring to a self-report scale, and also three subscales? It would be helpful if you detailed what the subscales actually are. In addition, ‘each subscale (not scale) consists of seven items’, and the subscales should again be referred to on line 142. The anxiety subscale of the DASS measures ANS symptoms and fear-related cognitions rather than ‘situational anxiety’. On line 143, the sentence should read: ‘..of the DASS-42 and referenced to the normative data…’. The Cronbach’s alphas for the DASS subscales in sample 3 were much lower than for other three samples, but this was not addressed, not even as a study limitation in the discussion.
In the procedure, it is unclear why sample 2 exists at all, especially since you were not comparing values between the samples, rather comparing the results to normed values? A justification of this second sample is therefore required. Further, it is not clear why different recruitment methods were used to recruit each sample, especially since this may alternately explain the different profile of study results in each sample.
Results & tables
The t-tests were conducted without making any Bonferroni-type adjustments, and this is required here. What exactly was the missing data? This was not specified. On line 164, reference should have been made to Australian normed values rather than ‘normative levels’. The results for partners of SASR personnel (line 166) appear to be different from those presented in the abstract. The sentence running from lines 167-170 is unclear and requires further clarification. No mention is made of the slightly different mean values obtained for samples 1 and 2, especially the stress values which were higher in sample 2. On line 176, the sentence should read: ‘(sample 4) reported values in the non-clinical range…’. Further, the results related to samples 3 and 4 do not support the assertion that psychological distress occurred in the partners of military personnel, either SASR or non-SASR, except for the stress value in the latter group, and this should be properly discussed.
Discussion
Reference should be made to ‘major symptoms of psychosocial dysfunction [or distress] on line 214, not ‘symptoms of psychological functioning’. On line 215, it is untrue that the results were compared to ‘norms for partners of current and past serving Australian combat veterans’, and this requires correction. On line 220, start the sentence with ‘Many’ otherwise, it does not make sense, and on line 223, the sentence should read: ‘health of partners relative to Australian normative data’. What is ‘poorer symptomatology’? Do you mean that the symptoms were greater or lesser, or higher or lower?
It is entirely possible that the different results for each of the four samples are attributable to age, rather than whether the servicemen were veterans or military personnel. Although comparisons are made with respect to Australian normed values (rather than between samples), it is necessary to control for age in each of the analyses. Further, it needs to be clarified that the study results may only be generalizable to partners of army personnel who fought in the Vietnam war, since only a few participants were partners of air force or navy veterans or those who fought in other conflicts in sample 1. On line 102, the sentence should read: ‘veterans who attended different conflict zones….’ On line 231, refer to ‘effect sizes’ not effects.
Why is there a discussion comparing the results of samples 3 and 4, when they were compared to Australian normed values, not each other, and in most cases the values were similar to the normed values? Although interesting, the related discussion is not really relevant, whereas there is very little discussion of the importance of the results of samples 1 and 2, which had much higher values than the normed values. Other study limitations (as mentioned above) require mention in the study limits section. Finally, in the conclusion, the authors should restate the main study results, not discuss issues that are beyond the scope of this study (e.g. partners needing immediate and adequate support to care for their veteran). The sentence on line 250, starting ‘partners of veterans and military members constitute a population at risk’ is not supported by the results of this study, in samples 3 and 4, except for the higher stress value in sample 4, and this should be corrected.
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