Behaviour within an intimate relationship which causes psychological, physical or sexual harm to either party is known as intimate partner violence (IPV). This violence is perpetrated by both men and women, but significant injuries are more commonly sustained by women. Consequently, IPV is a major public health concern as it contributes majorly to mortality in women of child-bearing age.
Given that IPV is a concern, it is important to try to improve the situations of women in a harmful relationship. GPs are often the first professional that women may approach following IPV so these doctors are in a strong position to offer help. In particular, professionals in primary care may be able to identify women (through screening) who have suffered IPV, and so offer help earlier. However, there is little existing evidence to guide what help should be provided to women; the few studies that have been conducted suggest that existing interventions have little effect, especially for women identified through screening.
A new RCT published in the Lancet (Hegarty et al, 2013) aimed to investigate the effects of counselling on women who have screened positive for IPV, in order to provide more evidence on possible interventions and whether screening is worthwhile in the case of IPV.
GPs were recruited first for the study, with one GP each being invited from a list of practices. To be included in the study, GPs had to practice for more than 3 hours per week and not have too many non-English speaking patients.
Once GPs were selected, women aged 16-50 who had seen the doctors within the last 12 months were sent a questionnaire, including an IPV screening item. If a woman screened positive for IPV and spoke good English, she was sent an invitation to take part in the study and a survey.
This survey measured several possible outcomes related to IPV, including depression or a number of safety planning behaviours.
The survey was returned by a total of 272 women. Their GPs (52 in total) were then allocated to either control or intervention groups.
Both control and intervention GPs received an IPV education pack. In addition, the intervention consisted of the GP being trained to provide some counselling and developing such skills as active listening. Women under intervention GPs were invited by their doctor to 1-6 counselling sessions within a 6 month period, with the number of sessions offered dependent on the needs of the woman.
The survey sent out to all the women at the start of the study was re-sent after this 6 months had passed, and again at 12 months, to see the effects of the intervention on IPV-related outcomes.
Although counselling was the intervention aimed at the women involved in the study, there was a low take-up of counselling in the intervention group. The majority of the women did not attend any counselling. Of those who did attend, a median of one session of counselling was used.
Even though take-up was low, there were some differences between the control and intervention women at 6 and 12 months, which were not present at baseline:
- Women in the intervention group had lower depression scores post-intervention
- In the intervention group, 36% of women had a HADS depression score of over 8 at 6 months, compared with 46% of women in the control group – an odds ratio of 0.4 (p = .05)
- Similarly at 12 months, 41% of women in the intervention group had a high depression score compared with 58% of women in the control group, an odds ratio of 0.3 (p = .005)
- Women in the intervention group also reported greater numbers of enquiries from their doctors about their own, and their children’s safety, compared with women in the control group
- No significant differences were found at 6 or 12 months between the intervention and control women on anxiety scores, reported comfort to discuss IPV fears with their doctor, quality of life, mental health status or safety behaviours and planning
The authors concluded that:
Family doctors should be trained to ask about safety of women and children and provide counselling…as counselling reduced depressive symptoms.
The authors also found no support for the use of postal screening for IPV, as women in the study did not seem to take up the intervention unless they felt it was needed.
There are some possible limitations of the paper:
- The women who participated in the study were generally well-educated and spoke good English. The study’s findings may therefore not be generalisable to other populations where IPV is a concern, such as in women’s shelters.
- The GPs included in the study had different characteristics to the wider GP population. The greatest difference was that female GPs were over-represented in the study population. Gender of healthcare professional may have an effect on women’s responses to IPV intervention
Hegarty K, O’Doherty L, Taft A, Chondros P, Brown S, Valpied J, Astbury J, Taket A, Gold L, Feder G, Gunn J. Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial. The Lancet – 20 July 2013 ( Vol. 382, Issue 9888, Pages 249-258 ). DOI: 10.1016/S0140-6736(13)60052-5 [PubMed abstract]