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An intervention intended to increase empowerment among Chinese female victims of intimate partner violence failed to decrease depression appreciably more than did usual community services, according to a randomized, controlled trial published Aug. 4 in JAMA.
Women in both the experimental and control groups achieved substantial reduction in depression scores, as measured by the Chinese version of the Beck Depression Inventory II (C-BDI-II). Mean scores of 38-39 placed the women in the “severe depression” category at baseline. At the end of the 12-week intervention, mean scores declined to 24-26 in both groups, corresponding to “moderate depression.” Six months later, mean scores declined to 16-18, corresponding to “mild depression” (JAMA 2010;304:536-43).
After the researchers adjusted for differences in baseline scores, Agnes Tiwari, Ph.D., of the University of Hong Kong, and her colleagues found a 2.7-point difference between the groups in C-BDI-II scores at the final follow-up. Although that difference achieved statistical significance, it did not achieve the 5-point difference needed for meaningful clinical significance.
The study involved 200 women, aged 18 years and older, who screened positive for intimate partner violence (IPV) at a community center in Hong Kong between 2007 and 2009. They were randomly assigned to experimental and control groups. Participants in the control group received usual community services, including childcare, health care, health promotion, and recreation.
Women in the experimental group received an intervention consisting of two components: empowerment and social support. The empowerment component, delivered by a research assistant in a 30-minute one-to-one interview, aimed to increase women’s safety through recognition of danger and use of a safety plan. They learned about the cycle of violence, facts and options, community resources, and legal interventions. The social support component consisted of 12 weekly telephone calls with a research assistant and 24-hour access to a hotline.
None of the women were lost to follow-up during the course of the 9-month study. A total of 88 of the 100 women in the experimental group received all 12 weeks of telephone support, and the remaining 12 all received 10 or 11 weeks, indicating a very high level of adherence to the experimental protocol.
While the differences in depression scores between the groups were not clinically meaningful, women in the experimental group were significantly more likely than were controls to say that the intervention was “useful to extremely useful” in improving their intimate relationships (94% vs. 82%) and in helping them resolve conflicts with their intimate partners (98% vs. 84%).
The study was supported by the Food and Health Bureau of the Hong Kong Government. The authors of the study said they had no financial relationships to disclose.
Intimate partner violence (IPV) is estimated to be the leading contributor to the global burden of mental health problems among women of reproductive age. There is an increasing urgency for rigorous, good-quality evidence about what is effective in preventing or ameliorating such harm in community and health care settings. A recent Cochrane review of partner violence advocacy trials found only two trials conducted in community settings and overall concluded that evidence of health benefit is scarce in any setting. . . .
The findings of this study raise three main issues for researchers and clinicians: the expectations for clinically meaningful improvements in depressive symptoms and other outcomes following brief interventions; the specification of study outcomes that have clinical or social meaning for study participants; and the generalizability of the study findings for women with different subtypes and severity of abuse and across countries, cultures, and clinical settings.
In mental health practice, the most clinically meaningful outcome for depressed patients is recovery from depression. While there is evidence that the less severe the abuse, the better a woman’s mental health becomes, there is no evidence about how long depression recovery may take or about the most effective form of intervention to achieve this goal.
In the study by Tiwari et al. . . . even the modest study outcome of reduction in depression symptoms was not achieved, suggesting that brief social support of the kind tested here may not be an effective treatment for depression in women experiencing psychological aggression. . . .
Cultural beliefs around abuse and mental illness differ widely, and systems of care vary enormously across countries. Therefore, transferability of interventions may be difficult unless cultural differences and system readiness are taken into account when researchers are planning complex IPV interventions.
In conclusion, designing, implementing, and evaluating interventions for women experiencing varying types of abuse at different stages of psychosocial readiness to change and across cultures remains a current challenge. . . . The results of the study by Tiwari et al. do not support the use of brief interventions delivered by social workers for women experiencing depressive symptoms associated with IPV as defined by the World Health Organization, but the rigorous methods of this trial will help to inform future studies of this pervasive, global threat to women’s health and well-being.
Excerpted from an editorial published in JAMA by Angela J. Taft, Ph.D., of La Trobe University, Melbourne, and Kelsey I Hegarty, Ph.D., of the University of Melbourne. The authors stated they had no financial disclosures to report.
Intimate partner violence (IPV) is estimated to be the leading contributor to the global burden of mental health problems among women of reproductive age. There is an increasing urgency for rigorous, good-quality evidence about what is effective in preventing or ameliorating such harm in community and health care settings. A recent Cochrane review of partner violence advocacy trials found only two trials conducted in community settings and overall concluded that evidence of health benefit is scarce in any setting. . . .
The findings of this study raise three main issues for researchers and clinicians: the expectations for clinically meaningful improvements in depressive symptoms and other outcomes following brief interventions; the specification of study outcomes that have clinical or social meaning for study participants; and the generalizability of the study findings for women with different subtypes and severity of abuse and across countries, cultures, and clinical settings.
In mental health practice, the most clinically meaningful outcome for depressed patients is recovery from depression. While there is evidence that the less severe the abuse, the better a woman’s mental health becomes, there is no evidence about how long depression recovery may take or about the most effective form of intervention to achieve this goal.
In the study by Tiwari et al. . . . even the modest study outcome of reduction in depression symptoms was not achieved, suggesting that brief social support of the kind tested here may not be an effective treatment for depression in women experiencing psychological aggression. . . .
Cultural beliefs around abuse and mental illness differ widely, and systems of care vary enormously across countries. Therefore, transferability of interventions may be difficult unless cultural differences and system readiness are taken into account when researchers are planning complex IPV interventions.
In conclusion, designing, implementing, and evaluating interventions for women experiencing varying types of abuse at different stages of psychosocial readiness to change and across cultures remains a current challenge. . . . The results of the study by Tiwari et al. do not support the use of brief interventions delivered by social workers for women experiencing depressive symptoms associated with IPV as defined by the World Health Organization, but the rigorous methods of this trial will help to inform future studies of this pervasive, global threat to women’s health and well-being.
Excerpted from an editorial published in JAMA by Angela J. Taft, Ph.D., of La Trobe University, Melbourne, and Kelsey I Hegarty, Ph.D., of the University of Melbourne. The authors stated they had no financial disclosures to report.
Intimate partner violence (IPV) is estimated to be the leading contributor to the global burden of mental health problems among women of reproductive age. There is an increasing urgency for rigorous, good-quality evidence about what is effective in preventing or ameliorating such harm in community and health care settings. A recent Cochrane review of partner violence advocacy trials found only two trials conducted in community settings and overall concluded that evidence of health benefit is scarce in any setting. . . .
The findings of this study raise three main issues for researchers and clinicians: the expectations for clinically meaningful improvements in depressive symptoms and other outcomes following brief interventions; the specification of study outcomes that have clinical or social meaning for study participants; and the generalizability of the study findings for women with different subtypes and severity of abuse and across countries, cultures, and clinical settings.
In mental health practice, the most clinically meaningful outcome for depressed patients is recovery from depression. While there is evidence that the less severe the abuse, the better a woman’s mental health becomes, there is no evidence about how long depression recovery may take or about the most effective form of intervention to achieve this goal.
In the study by Tiwari et al. . . . even the modest study outcome of reduction in depression symptoms was not achieved, suggesting that brief social support of the kind tested here may not be an effective treatment for depression in women experiencing psychological aggression. . . .
Cultural beliefs around abuse and mental illness differ widely, and systems of care vary enormously across countries. Therefore, transferability of interventions may be difficult unless cultural differences and system readiness are taken into account when researchers are planning complex IPV interventions.
In conclusion, designing, implementing, and evaluating interventions for women experiencing varying types of abuse at different stages of psychosocial readiness to change and across cultures remains a current challenge. . . . The results of the study by Tiwari et al. do not support the use of brief interventions delivered by social workers for women experiencing depressive symptoms associated with IPV as defined by the World Health Organization, but the rigorous methods of this trial will help to inform future studies of this pervasive, global threat to women’s health and well-being.
Excerpted from an editorial published in JAMA by Angela J. Taft, Ph.D., of La Trobe University, Melbourne, and Kelsey I Hegarty, Ph.D., of the University of Melbourne. The authors stated they had no financial disclosures to report.
An intervention intended to increase empowerment among Chinese female victims of intimate partner violence failed to decrease depression appreciably more than did usual community services, according to a randomized, controlled trial published Aug. 4 in JAMA.
Women in both the experimental and control groups achieved substantial reduction in depression scores, as measured by the Chinese version of the Beck Depression Inventory II (C-BDI-II). Mean scores of 38-39 placed the women in the “severe depression” category at baseline. At the end of the 12-week intervention, mean scores declined to 24-26 in both groups, corresponding to “moderate depression.” Six months later, mean scores declined to 16-18, corresponding to “mild depression” (JAMA 2010;304:536-43).
After the researchers adjusted for differences in baseline scores, Agnes Tiwari, Ph.D., of the University of Hong Kong, and her colleagues found a 2.7-point difference between the groups in C-BDI-II scores at the final follow-up. Although that difference achieved statistical significance, it did not achieve the 5-point difference needed for meaningful clinical significance.
The study involved 200 women, aged 18 years and older, who screened positive for intimate partner violence (IPV) at a community center in Hong Kong between 2007 and 2009. They were randomly assigned to experimental and control groups. Participants in the control group received usual community services, including childcare, health care, health promotion, and recreation.
Women in the experimental group received an intervention consisting of two components: empowerment and social support. The empowerment component, delivered by a research assistant in a 30-minute one-to-one interview, aimed to increase women’s safety through recognition of danger and use of a safety plan. They learned about the cycle of violence, facts and options, community resources, and legal interventions. The social support component consisted of 12 weekly telephone calls with a research assistant and 24-hour access to a hotline.
None of the women were lost to follow-up during the course of the 9-month study. A total of 88 of the 100 women in the experimental group received all 12 weeks of telephone support, and the remaining 12 all received 10 or 11 weeks, indicating a very high level of adherence to the experimental protocol.
While the differences in depression scores between the groups were not clinically meaningful, women in the experimental group were significantly more likely than were controls to say that the intervention was “useful to extremely useful” in improving their intimate relationships (94% vs. 82%) and in helping them resolve conflicts with their intimate partners (98% vs. 84%).
The study was supported by the Food and Health Bureau of the Hong Kong Government. The authors of the study said they had no financial relationships to disclose.
An intervention intended to increase empowerment among Chinese female victims of intimate partner violence failed to decrease depression appreciably more than did usual community services, according to a randomized, controlled trial published Aug. 4 in JAMA.
Women in both the experimental and control groups achieved substantial reduction in depression scores, as measured by the Chinese version of the Beck Depression Inventory II (C-BDI-II). Mean scores of 38-39 placed the women in the “severe depression” category at baseline. At the end of the 12-week intervention, mean scores declined to 24-26 in both groups, corresponding to “moderate depression.” Six months later, mean scores declined to 16-18, corresponding to “mild depression” (JAMA 2010;304:536-43).
After the researchers adjusted for differences in baseline scores, Agnes Tiwari, Ph.D., of the University of Hong Kong, and her colleagues found a 2.7-point difference between the groups in C-BDI-II scores at the final follow-up. Although that difference achieved statistical significance, it did not achieve the 5-point difference needed for meaningful clinical significance.
The study involved 200 women, aged 18 years and older, who screened positive for intimate partner violence (IPV) at a community center in Hong Kong between 2007 and 2009. They were randomly assigned to experimental and control groups. Participants in the control group received usual community services, including childcare, health care, health promotion, and recreation.
Women in the experimental group received an intervention consisting of two components: empowerment and social support. The empowerment component, delivered by a research assistant in a 30-minute one-to-one interview, aimed to increase women’s safety through recognition of danger and use of a safety plan. They learned about the cycle of violence, facts and options, community resources, and legal interventions. The social support component consisted of 12 weekly telephone calls with a research assistant and 24-hour access to a hotline.
None of the women were lost to follow-up during the course of the 9-month study. A total of 88 of the 100 women in the experimental group received all 12 weeks of telephone support, and the remaining 12 all received 10 or 11 weeks, indicating a very high level of adherence to the experimental protocol.
While the differences in depression scores between the groups were not clinically meaningful, women in the experimental group were significantly more likely than were controls to say that the intervention was “useful to extremely useful” in improving their intimate relationships (94% vs. 82%) and in helping them resolve conflicts with their intimate partners (98% vs. 84%).
The study was supported by the Food and Health Bureau of the Hong Kong Government. The authors of the study said they had no financial relationships to disclose.
Major Finding: Compared to women receiving standard social services for intimate partner violence, those receiving advocacy intervention scored 2.7 points lower on the Chinese version of the Beck Depression Inventory II at 12 months. While this difference was statistically significant, it was below the 5-point difference required for clinical significance.
Data Source: Randomized controlled trial of 200 female victims of intimate partner violence in Hong Kong.
Disclosures: The study was supported by the Food and Health Bureau of the Hong Kong Government. The authors stated they had no financial relationships to disclose.