Review: Wounded Healers as Agents of Change: A Comparative Study on Stress and Work Satisfaction of Nepali Accompaniers {under peer review}

 

Reviewer: Dr. Zyed Achour

 

Completed: 21-09-2025 18:25

 

Recommendation: Revisions Required

 

 

	Yes	No	N/A
Is the research question clearly defined?	+
Are the methods appropriate and sufficiently detailed?		+
Is the data analysis robust and replicable?		+
Are the conclusions supported by the results?		+
Is the manuscript well organised and clearly written?	+
Are tables, figures, and supplementary material informative and necessary?	+
Is the abstract an accurate summary of the study?		+
Does the manuscript contribute meaningfully to the field?	+
Is it relevant to the field of mental health or related disciplines that are connected to the scope of the Journal?	+
Are ethical approvals and participant consents adequately described?		+
Have competing interests, funding, and data availability been transparently declared?		+

 

Comments for the authors:

 

This study aims to assess whether “wounded healers”—family members of missing persons in Nepal who serve as psychosocial support providers—experience higher levels of stress compared to their colleagues who are not related to the missing.

Its main originality lies in the empirical validation of the “wounded healer” concept in a humanitarian context.

I present below some remarks and suggestions which, in my view, could strengthen the current version of the article and enhance its impact.

1.      Title: It could be made more precise by specifying that the study focuses specifically on families of missing persons.

2.     Abstract: While it broadly reflects the content, it would benefit from more contextual precision (e.g., reference to the Nepalese armed conflict). Moreover, the conclusion remains general and does not specify the concrete implications for humanitarian programs.

3.     Introduction:

The innovative positioning is noteworthy: the idea of recruiting victims as care providers is presented convincingly. However, the introduction would be strengthened by including epidemiological data (e.g., the total number of missing persons in Nepal) as well as more detailed information on the scale of the problem faced by affected families.

4.     Literature Review:

The article discusses key concepts (wounded healer, task-shifting, empowerment) with appropriate references. However, it lacks a true synthesis. Each section presents studies descriptively without critical analysis, and the article fails to clearly position the study within prior research. The transition from the abstract Jungian concept to its practical applications would benefit from greater theoretical rigor.

5.     Methodology:

The mixed-methods approach is well justified, and the combination of quantitative and qualitative methods is appropriate for this type of research. However, several critical methodological shortcomings seriously compromise the validity of the conclusions:

-       Sampling not documented: no information is provided on the participant selection process.

-       Unvalidated instrument: the locally developed “perceived-impact” scale lacks psychometric validation (reliability, validity, internal consistency).

-       Inadequate statistical analysis: no statistical tests are used to compare groups.

-       Major selection bias: all participants are employees of the evaluated program, creating a potential conflict of interest.

-       Unjustified imbalance in the sample composition (32% men vs. 68% women).

These methodological shortcomings require major revision, including the validation of measurement tools, the implementation of appropriate statistical tests, and the adoption of rigorous sampling strategies before the conclusions can be considered reliable for guiding humanitarian practice.

6.     Conclusion and Recommendations:

The conclusion should be rewritten to:

-       Explicitly acknowledge the major limitations, notably the risk of social desirability bias (employees evaluating their own program), which may compromise the reliability of the findings.

-       Moderate the claims by avoiding overinterpretation of results and by presenting the conclusions as exploratory, requiring further validation.

Overall, while this study addresses an important and innovative topic, it requires substantial methodological revision.