Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London United Kingdom.
PLoS One. 2018 Nov 27;13(11):e0205485. doi: 10.1371/journal.pone.0205485. eCollection 2018.
BACKGROUND: Experience of domestic violence and abuse (DVA) is associated with mental illness. Advocacy has little effect on mental health outcomes of female DVA survivors and there is uncertainty about the effectiveness of psychological interventions for this population. OBJECTIVE: To test effectiveness of a psychological intervention delivered by advocates to DVA survivors. DESIGN, MASKING, SETTING, PARTICIPANTS: Pragmatic parallel group individually randomized controlled trial of normal DVA advocacy vs. advocacy + psychological intervention. Statistician and researchers blinded to group assignment. Setting: specialist DVA agencies; two UK cities. Participants: Women aged 16 years and older accessing DVA services. INTERVENTION: Eight specialist psychological advocacy (SPA) sessions with two follow up sessions. MEASUREMENTS: Primary outcomes at 12 months: depression symptoms (PHQ-9) and psychological distress (CORE-OM). Primary analysis: intention to treat linear (logistic) regression model for continuous (binary) outcomes. RESULTS: 263 women recruited (78 in shelter/refuge, 185 in community), 2 withdrew (1 community, control group; 1 intervention, refuge group), 1 was excluded from the study for protocol violation (community, control group), 130 in intervention and 130 in control groups. Recruitment ended June 2013. 12-month follow up: 64%. At 12-month follow up greater improvement in mental health of women in the intervention group. Difference in average CORE-OM score between intervention and control groups: -3.3 points (95% CI -5.5 to -1.2). Difference in average PHQ-9 score between intervention and control group: -2.2 (95% CI -4.1 to -0.3). At 12 months, 35% of the intervention group and 55% of the control group were above the CORE-OM -2clinical threshold (OR 0.32, 95% CI 0.16 to 0.64); 29% of the intervention group and 46% of the control group were above the PHQ-9 clinical threshold (OR 0.41, 95% CI 0.21 to 0.81). LIMITATIONS: 64% retention at 12 months. CONCLUSIONS: An eight-session psychological intervention delivered by DVA advocates produced clinically relevant improvement in mental health outcomes compared with normal advocacy care. TRIAL REGISTRATION: ISRCTN registry ISRCTN58561170 Original Research 3675/3750.
背景：家庭暴力和虐待（DVA）的经历与精神疾病有关。倡导对女性 DVA 幸存者的心理健康结果几乎没有影响，而且对于这一人群的心理干预的有效性存在不确定性。 目的：测试由倡导者为 DVA 幸存者提供的心理干预的有效性。 设计、掩蔽、设置、参与者：正常 DVA 倡导与倡导+心理干预的平行组个体随机对照试验。统计员和研究人员对分组分配不知情。设置：专门的 DVA 机构；两个英国城市。参与者：年龄在 16 岁及以上，接受 DVA 服务的女性。 干预措施：八次专门的心理倡导（SPA）会议，两次随访。 测量：12 个月时的主要结果：抑郁症状（PHQ-9）和心理困扰（CORE-OM）。主要分析：连续（二项）结果的意向治疗线性（逻辑）回归模型。 结果：共招募 263 名女性（避难所/庇护所 78 名，社区 185 名），2 名退出（1 名社区，对照组；1 名干预组，庇护所组），1 名因违反方案被排除（社区，对照组），130 名干预组和 130 名对照组。招募于 2013 年 6 月结束。12 个月随访：64%。在 12 个月时，干预组女性的心理健康有更大的改善。干预组和对照组之间 CORE-OM 平均评分的差异：-3.3 分（95%CI-5.5 至-1.2）。干预组和对照组之间 PHQ-9 平均评分的差异：-2.2（95%CI-4.1 至-0.3）。在 12 个月时，干预组有 35%的人，对照组有 55%的人在 CORE-OM-2 临床阈值以上（OR 0.32，95%CI 0.16 至 0.64）；干预组有 29%的人，对照组有 46%的人在 PHQ-9 临床阈值以上（OR 0.41，95%CI 0.21 至 0.81）。 局限性：12 个月时的保留率为 64%。 结论：与正常倡导护理相比，由 DVA 倡导者提供的八节心理干预在心理健康结果方面产生了具有临床意义的改善。 试验注册：ISRCTN 注册 ISRCTN58561170 原始研究 3675/3750。
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