Czech and Slovak Members of Religious Institutes: Their Health in Comparison to the General Population

Round 1

Reviewer 1 Report

This paper examines its proposed question in a thorough and transparent manner.  The discussion of study limitations is a very adequate presentation of key issues which need attention into the future.  The only significant omission may be a reference to the effects of colonisation on health - particularly when there is a comparison of findings with the health of CP in the USA>

Author Response

Response to Reviewer 1 Comments

Point 1: The only significant omission may be a reference to the effects of colonisation on health - particularly when there is a comparison of findings with the health of CP in the USA.

RESPONSE: Thank you for your comment and suggestions. We agree, that there might be some influence of the process of colonisation and creating the “melting pot” population on the health of the US inhabitants. Also, the comparison with the much more homogenous population of the Central Europe countries, which do not have bigger experience of mixing races and nationalities, would be interesting. However, we did not find any adequate references concerning this topic, except of articles about the effects of colonisation on indigenous people in the USA. We also consider this topic not essential for this article, as we compared Czech/Slovak CP with the general population in CZ/SK and referred to the results of the comparison of US CP with the general US population. In both cases, CP seem to show different tendencies in their health compared to the population of their own country. The comparison of CP among the countries remains the subject of the future research. Nevertheless, we agree that this fact has not been clarified enough, so we have added a more detailed text into the Discussion (the new text has been italicised):

Discussion

When comparing Czech and Slovak CP with the representative Czech sample regarding general health, we found a significantly higher risk of having worse general health for CP. Moreover, these findings are supported by a trend, however insignificant, that could be observable in most of the chronic diseases in our study. These findings correspond to our hypothesis that comparing to the results from USA [22,24], there are more negative health-effecting factors in CP in CZ and SK. In both cases, the comparison was carried out between CP and the general population of the same country, therefore this cannot be seen as a possible result of different general health conditions in these two parts of the world, connected e.g. with certain effects of colonization and “melting pot” society on health in the USA. Rather, it seems to be connected with a different mentality and lifestyle of CP in the USA and in CZ/SK, which may be influenced by the major society and the historical, cultural and ecclesiastical background. The delayed and only partial reception of post-conciliar changes after Vaticanum II, in particular, causes a higher level of conservativism in religious communities, which is typical for the post-communist countries [49,50]. Czech/Slovak CP still seem to tend to the traditional performance-oriented lifestyle characterized by strict self-denial [51]. Thus, possible reasons for the worse general health in Czech/Slovak CP could be overwork, stress and a lack of active and passive rest caused by the stereotyped regime of the communities unadapted to their actual situation and not giving enough space for leisure and relaxation of individuals. Perhaps the higher incidence of psychosomatic problems should also be considered. All of these hypotheses are for future research.

Reviewer 2 Report

The authors are to be commended for focussing on consecrated persons in post-communist countries and, originally, on the difference between "owls" and "larks". However, it is a weakness of the article that only the comparison with the nun-study in the USA is used. I would suggest to consider results from other countries and regions. Perhaps in this way there will be further insights regarding the assumption that post-communist countries offer more difficult living conditions for CPs.

Author Response

Response to Reviewer 2 Comments

Point 1: However, it is a weakness of the article that only the comparison with the nun-study in the USA is used. I would suggest to consider results from other countries and regions. Perhaps in this way there will be further insights regarding the assumption that post-communist countries offer more difficult living conditions for CPs.

RESPONSE: Thank you for your comment. We are aware of the lack of comparison with the results from other countries. However, USA is the only country with more or less systematic research in CP and health. During our bibliographic search, we did not find any other results regarding the general health of CP. Now we have carried out another search with the same conclusion: we found some more studies of the US provenience but nearly nothing from other countries. The other studies we quoted, coming from Germany, Poland and Italy, are oriented mostly on issues related to the mental health of CP and not on their health in general. We can conclude, this kind of research worldwide is very deficient. In our research project, we concentrate on collecting data from more countries, so that it will be possible to provide such comparisons. Nevertheless, we agree that this fact has not been clarified enough, so we have added a more detailed text into the Introduction (the new text has been italicised):

Introduction

However, the existing results cannot be fully generalized because there is a need for more data from different countries and social-political contexts. So far, most of the previous studies were carried out in the USA, which is the only country with somehow systematic research in CP and with results regarding the general health of CP.  Some of the above quoted studies come from Poland, Germany and Italy but they are oriented mostly on issues related to the mental health of CP and not on their health in general. In all these countries, despite the advanced secularization in some of them, the presence and social engagement of religious institutes have an established tradition and a high level of public credit, which seems to play an important role [14]. On the contrary, data from secular post-communist countries and many other European countries are missing, as are data from African, Asian or South American communities. We presume there is also some other biases to consider, such as a high level of social desirability and non-representative samples, because all community members rarely complete the voluntary questionnaires and the healthier and more active persons are more likely to participate.