Tol Wietse A, Greene M Claire, Likindikoki Samuel, Misinzo Lusia, Ventevogel Peter, Bonz Ann G, Bass Judith K, Mbwambo Jessie K K
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, HH863, Baltimore, MD, 21205, USA.
Department of Psychiatry, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam, Tanzania.
BMC Psychiatry. 2017 May 18;17(1):186. doi: 10.1186/s12888-017-1338-7.
BACKGROUND: Intimate partner violence (IPV) is a critical public health and human rights concern globally, including for refugee women in low-resource settings. Little is known about effective interventions for this population. IPV and psychological distress have a bi-directional relationship, indicating the potential benefit of a structured psychological component as part of efforts to reduce IPV for women currently in violent relationships. METHODS: This protocol describes a cluster randomized controlled trial aimed at evaluating an 8-session integrated psychological and advocacy intervention (Nguvu) with female adult survivors of past-year IPV displaying moderate to severe psychological distress. Outcomes are reductions in: recurrence of IPV; symptoms of anxiety, depression and post-traumatic stress (primary); and functional impairment (secondary). Hypothesized mediators of the intervention are improvements in social support, coping skills and support seeking. We will recruit 400 participants from existing women's support groups operating within villages in Nyarugusu refugee camp, Tanzania. Women's groups will be randomized to receive the intervention (Nguvu and usual care) or usual care alone. All eligible women will complete a baseline assessment (week 0) followed by a post-treatment (week 9) and a 3-month post-treatment assessment (week 20). The efficacy of the intervention will be determined by between-group differences in the longitudinal trajectories of primary outcomes evaluated using mixed-effects models. Study procedures have been approved by Institutional Review Boards in the United States and Tanzania. DISCUSSION: This trial will provide evidence on the efficacy of a novel integrated group intervention aimed at secondary prevention of IPV that includes a structured psychological component to address psychological distress. The psychological and advocacy components of the proposed intervention have been shown to be efficacious for their respective outcomes when delivered in isolation; however, administering these approaches through a single, integrated intervention may result in synergistic effects given the interrelated, bidirectional relationship between IPV and mental health. Furthermore, this trial will provide information regarding the feasibility of implementing a structured intervention for IPV and mental health in a protracted humanitarian setting. TRIAL REGISTRATION: ISRCTN65771265 , June 27, 2016.
背景:亲密伴侣暴力(IPV)是全球范围内一个重要的公共卫生和人权问题,在资源匮乏地区的难民妇女中亦是如此。对于这一人群的有效干预措施知之甚少。亲密伴侣暴力与心理困扰存在双向关系,这表明作为减少当前处于暴力关系中的女性亲密伴侣暴力行为努力的一部分,结构化心理干预可能有益。 方法:本方案描述了一项整群随机对照试验,旨在评估一项为期8节的综合心理与宣传干预措施(恩古武),干预对象为过去一年遭受亲密伴侣暴力且有中度至重度心理困扰的成年女性幸存者。干预的结果包括:亲密伴侣暴力复发率降低;焦虑、抑郁和创伤后应激症状减轻(主要结果);功能损害减轻(次要结果)。干预的假设中介因素是社会支持、应对技能和寻求支持方面的改善。我们将从坦桑尼亚尼亚鲁古苏难民营各村庄现有的妇女支持团体中招募400名参与者。妇女团体将被随机分为接受干预组(恩古武和常规护理)或仅接受常规护理组。所有符合条件的妇女将在基线(第0周)进行评估,随后在治疗后(第9周)和治疗后3个月(第20周)进行评估。干预的效果将通过使用混合效应模型评估主要结果的纵向轨迹的组间差异来确定。研究程序已获得美国和坦桑尼亚机构审查委员会的批准。 讨论:本试验将为一项旨在二级预防亲密伴侣暴力的新型综合团体干预措施的效果提供证据,该干预措施包括结构化心理干预以解决心理困扰。拟议干预措施的心理和宣传部分在单独实施时已被证明对各自的结果有效;然而,鉴于亲密伴侣暴力与心理健康之间相互关联的双向关系,通过单一综合干预措施实施这些方法可能会产生协同效应。此外,本试验将提供有关在长期人道主义环境中实施针对亲密伴侣暴力和心理健康的结构化干预措施可行性的信息。 试验注册:ISRCTN65771265,2016年6月27日。
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