Community-based outreach may reduce mental health problems in women who experience intimate partner abuse

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Women who experience intimate partner abuse (IPA) often suffer from mental health problems as a result. Post-traumatic stress disorder (PTSD), depression and fear of further attacks are all common and understandable responses.

Despite this, there are not many longitudinal studies that follow a group of women over a period of time and assess what interventions work best to reduce the risk of these mental health problems.

A new randomised controlled trial conducted by researchers from the University of Denver explores the value of community-based outreach compared with a more traditional criminal justice system-based referral program on women’s distress and safety following police-reported intimate partner abuse.

They took a population of 827 women; all victims of non-sexual IPA by a male adult offender. Allocation was unconcealed and only 236 women were enrolled in the study.

The women were randomised to one of two interventions:

  1. Community-based outreach (confidential telephone calls and tailored support)
  2. Criminal justice system-based support (provided with basic information about existing community support, but left to make contact themselves)

The main outcomes of interest were:

  1. PTSD symptoms measured on the Post-traumatic Stress Diagnostic Scale, PDS
  2. Depression symptoms measured on the Beck Depression Inventory-II
  3. Fear symptoms measured on the Trauma Appraisal Questionnaire

Here’s what they found:

  • After 6 months, both groups saw a significant reduction in symptoms, but there was no difference between the two groups:
    • PTSD (effect size −0.29, 95% CI −0.68 to +0.11; p=0.11)
    • Depression (effect size −0.33, 95% CI −0.69 to +0.02; p=0.07)
    • Fear (no reported effect size; p=0.58)
  • Between 6-12 months, the community-based outreach saw significantly improved performance on all outcomes:
    • PTSD (effect size 0.40, 95% CI 0.04 to 0.75; p=0.03)
    • Depression (effect size 0.39, 95% CI 0.04 to 0.75; p=0.03)
    • Fear (effect size 0.40, 95% CI 0.05 to 0.76; p=0.03)

The authors concluded:

This is one of the first studies to examine community-based outreach in the context of an interdisciplinary community coordinated response to police-reported IPA. The findings suggest that community-based outreach by victim advocates results in decreased distress levels, greater readiness to leave abusive relationships, and greater perceived helpfulness of services relative to system-based referrals.

There are a few issues with this RCT. The allocation was unconcealed and the researchers who assessed outcomes were not blinded to which treatment the patients had received. Of course, the patients themselves could not be blinded to their intervention. Follow-up was reasonable though.

We know that the level of abuse suffered by women can determine whether or not they contact the police to report the crime, so the findings of this research may not always be easily applied to real-world scenarios.

Overall, this is an important piece of research that adds significantly to this complex area.

Link

DePrince AP, Labus J, Belknap J, et al. The impact of community-based outreach on psychological distress and victim safety in women exposed to intimate partner abuse. J Consult Clin Psychol 2012;80:211–21. [PubMed abstract]

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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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