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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)
AUTHORS
Validation of the Compassion Fatigue Short Scale among Chinese
Medical Workers and Firefighters: a Cross-Sectional Study
Sun, Binghai; Hu, Mengna; Yu, Shitian; Jiang, Yiru; Lou, Baona
VERSION 1 - REVIEW
REVIEWER
REVIEW RETURNED
Beth Perry
Athabasca University
Canada
06-Feb-2016
GENERAL COMMENTS
I found a few things I would change and address. I would also
recommend editing for English style, grammar etc. There are a few
instances where the English it technically correct but not common
expression. For example, page 13 line 34 the phrase might probably
is used. Page 10 line 45 "owns" professional skills is not a common
way to say this. Page 8 line 28 is not a full sentence. Sometimes the
authors use CF and sometime write out the words compassion
fatigue. The last paragraph is a since sentence which is not usual
form. I wonder if the word among in the title might be more correctly
"with." So I suggest editing by a fluent English speaker/writer. Also I
am not confident in the accuracy of the statistical analysis so would
like a specialist to do a statistical review.
REVIEWER
Gabriele Prati
Università di Bologna (Italy)
26-Feb-2016
REVIEW RETURNED
GENERAL COMMENTS
Comments to the Author
The authors developed and examined the psychometric properties
of the Chinese version of the Compassion Fatigue Short Scale
among Chinese medical workers and firefighters. Generally, I
believe the manuscript has the potential to make a very important
contribution to this literature. More critically, I am of the view that it
does not do so yet. Although the study addresses an important
applied issue and reveals some interesting results, I have some
concerns.
In general, the introduction should provide theoretical support and
assumptions for the hypotheses of the study. In other words, I would
like to see a closer linkage between the literature review and the
objectives proposed and between the objectives proposed and the
analyses. For example, although there may a connection between
social support and the well-being among rescue workers (see the
meta-analysis of Prati & Pietrantoni, 2010), in the introduction this
link is never discussed. The link between rescue workers’
Downloaded from http://bmjopen.bmj.com/ on June 17, 2017 - Published by group.bmj.com
compassion fatigue and ego-resilience or job pressure scale is less
obvious. Please provide theoretical and empirical justifications to
include these scales of social support ego-resilience and job
pressure scale. Otherwise, they should be removed from the article.
It is not clear to me how the personal trauma history and
participation in emergency rescue were measured. In the literature,
different instruments to measure the degree of exposure to critical
incidents among rescue workers have been put forward (see
Monnier, Cameron, Hobfoll, & Gribble, 2002; Prati, & Pietrantoni,
2010).
I have some concerns about the statistical procedures used.
Did the authors perform a missing data analysis? Based on the
results of this analysis, the authors should consider employing
multiple imputation procedures to deal with this problem (Graham,
2009; Schafer & Graham, 2002).
It is not clear why the authors used exploratory principal component
analysis, instead of factor analysis. By the way, principal component
analysis is different from factor analysis. Moreover, the authors
should use oblique rotation, because the scales are thought to be
related (they belong to the same instrument) (Fabrigar, Wegener,
MacCallum & Strahan, 1999). I suggest the authors to identify the
number of factors using the scree test and parallel analysis (Horn,
1965) that performs better than the Kaiser normalization method
(see Fabrigar, Wegener, MacCallum & Strahan, 1999).
I suggest to investigate the relationship with criterion scales using
structural equation modelling.
References
DeCarlo, L. T. (1997). On the meaning and use of kurtosis.
Psychological Methods, 2, 292-307. Horn, J. L. (1965). A rationale
and test for the number of factors in factor analysis. Psychometrika,
32, 179-185.
Fabrigar, L. R., Wegener, D. T., MacCallum, R. C., & Strahan, E. J.
(1999). Evaluating the use of exploratory factor analysis in
psychological research. Psychological Methods, 4, 272-299.
Graham, J. W. (2009). Missing data analysis: Making it work in the
realworld. Annual Review of Psychology, 60, 549-576.
Monnier, J., Cameron, R.P., Hobfoll, S.E., & Gribble, J.R. (2002).
The impact of resource loss and critical incidents on psychological
functioning in fire-emergency workers: A pilot study. International
Journal of Stress Management, 9(1), 11–29.
Prati, G., & Pietrantoni, L. (2010). The relation of perceived and
received social support to mental health among first responders: a
meta-analytic review. Journal of Community Psychology, 38, 403417.
Prati, G., & Pietrantoni, L. (2010). An application of the social
support deterioration deterrence model to rescue workers. Journal of
Community Psychology. Journal of Community Psychology, 38(7),
901–917.
Schafer, J.L. & Graham, J. W. (2002). Missing data: Our view of the
state of the Art. Psychological Methods, 7(2), 147–177.
VERSION 1 – AUTHOR RESPONSE
Reviewer #1
I found a few things I would change and address. I would also recommend editing for English style,
grammar etc. There are a few instances where the English it technically correct but not common
Downloaded from http://bmjopen.bmj.com/ on June 17, 2017 - Published by group.bmj.com
expression. For example, page 13 line 34 the phrase might probably is used. Page 10 line 45 "owns"
professional skills is not a common way to say this. Page 8 line 28 is not a full sentence. Sometimes
the authors use CF and sometime write out the words compassion fatigue. The last paragraph is a
since sentence which is not usual form. I wonder if the word among in the title might be more correctly
"with." So I suggest editing by a fluent English speaker/writer. Also I am not confident in the accuracy
of the statistical analysis so would like a specialist to do a statistical review.
Response: We thank the Reviewer for taking the time to review our manuscript. The manuscript was
proofread.
Reviewer #2
In general, the introduction should provide theoretical support and assumptions for the hypotheses of
the study. In other words, I would like to see a closer linkage between the literature review and the
objectives proposed and between the objectives proposed and the analyses. For example, although
there may a connection between social support and the well-being among rescue workers (see the
meta-analysis of Prati & Pietrantoni, 2010), in the introduction this link is never discussed. The link
between rescue workers’ compassion fatigue and ego-resilience or job pressure scale is less obvious.
Please provide theoretical and empirical justifications to include these scales of social support egoresilience and job pressure scale. Otherwise, they should be removed from the article.
Response: We thank the Reviewer for the comments. The Introduction in now, we hope, improved.
It is not clear to me how the personal trauma history and participation in emergency rescue were
measured. In the literature, different instruments to measure the degree of exposure to critical
incidents among rescue workers have been put forward (see Monnier, Cameron, Hobfoll, & Gribble,
2002; Prati, & Pietrantoni, 2010).
Response: We agree that this definition is important. We added the following statement to the
manuscript: " Workers who had experienced traumatic events were those who were under the threat
of serious injury or death in the line of duty, those who worked in settings involving multiple deaths
and injuries, those who had close contacts with burned or mutilated victims, and those who were
involved in prolonged extrication of trapped victims with life-threatening injuries [19]. These events
were assessed by self-reporting. The police records of the events were reviewed to confirm the selfreported events."
I have some concerns about the statistical procedures used.
Did the authors perform a missing data analysis? Based on the results of this analysis, the authors
should consider employing multiple imputation procedures to deal with this problem (Graham, 2009;
Schafer & Graham, 2002).
Response: Because of the small proportion of missing data (<1.5% for all variables), the missing data
estimation used in this study was based on the listwise deletion method. This was added to the
manuscript.
It is not clear why the authors used exploratory principal component analysis, instead of factor
analysis. By the way, principal component analysis is different from factor analysis. Moreover, the
authors should use oblique rotation, because the scales are thought to be related (they belong to the
same instrument) (Fabrigar, Wegener, MacCallum & Strahan, 1999). I suggest the authors to identify
the number of factors using the scree test and parallel analysis (Horn, 1965) that performs better than
the Kaiser normalization method (see Fabrigar, Wegener, MacCallum & Strahan, 1999).
I suggest to investigate the relationship with criterion scales using structural equation modelling.
Response: The KMO value was 0.849, suggesting that factor analysis should be performed. Oblique
rotation was used for the principal component analysis, and scree plot was used to extract the factors.
This was added to the manuscript.
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VERSION 2 – REVIEW
REVIEWER
REVIEW RETURNED
GENERAL COMMENTS
Beth Perry
Athabasca University, Canada
24-Apr-2016
This paper is much improved. Thank you for your hard work on
making the paper easier to read and understand. I think the paper
will be very interesting to those studying CF. There are still a few
small clarifications that would make the paper more accessible to
readers. I listed these for your consideration below. All the best in
your future study of this important topic.
Page 3 – line 14 – extra space here …5 The
Page 3 – line 21 - from regions should be for regions
Page 4 – line 25 - reduced help’s empathy to victims should be
reduced empathy for victims or helpers having reduced empathy for
victims
Page 11 – lines 23-24 – this sentence is unclear to me. As expected,
CF was positively correlated with both ST and JB, and so did ST
with JB.
Page 11 – lines 31-33 – I am not sure what “the worker has entered
to working state means.”
REVIEWER
REVIEW RETURNED
GENERAL COMMENTS
Gabriele Prati
Università di Bologna
11-Apr-2016
This is an interesting topic with potential policy applications. You
have done a good job improving the writing to make the paper more
clear. I congratulate you for your work.
VERSION 2 – AUTHOR RESPONSE
Reviewer #1
This paper is much improved. Thank you for your hard work on making the paper easier to read and
understand. I think the paper will be very interesting to those studying CF. There are still a few small
clarifications that would make the paper more accessible to readers. I listed these for your
consideration on the attachment. All the best in your future study of this important topic.
Response: We thank the Reviewer for taking the time to review our manuscript and for the comments.
We edited the manuscripts according to the new comments.
Reviewer #2
This is an interesting topic with potential policy applications. You have done a good job improving the
writing to make the paper more clear. I congratulate you for your work.
Response: We thank the Reviewer for taking the time to review our manuscript and for the comments.
Downloaded from http://bmjopen.bmj.com/ on June 17, 2017 - Published by group.bmj.com
Validation of the Compassion Fatigue Short
Scale among Chinese medical workers and
firefighters: a cross-sectional study
Binghai Sun, Mengna Hu, Shitian Yu, Yiru Jiang and Baona Lou
BMJ Open 2016 6:
doi: 10.1136/bmjopen-2016-011279
Updated information and services can be found at:
http://bmjopen.bmj.com/content/6/6/e011279
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References
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http://bmjopen.bmj.com/content/6/6/e011279#BIBL
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