Keynejad Roxanne C, Hanlon Charlotte, Howard Louise M
Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; World Health Organization Collaborating Centre for Mental Health Research and Capacity-Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Lancet Psychiatry. 2020 Feb;7(2):173-190. doi: 10.1016/S2215-0366(19)30510-3.
Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs).
For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611.
Of 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0·31, 95% CI 0·04 to 0·57, I=49·4%). No differences in response to intervention were seen in women reporting intimate partner violence for PTSD (eight interventions, n=1436; dSMD 0·14, 95% CI -0·06 to 0·33, I=42·6%), depression (12 interventions, n=2940; 0·10, -0·04 to 0·25, I=49·3%), and psychological distress (four interventions, n=1591; 0·07, -0·05 to 0·18, I=0·0%, p=0·681).
Psychological interventions treat anxiety effectively in women with current or recent intimate partner violence exposure in LMICs when delivered by appropriately trained and supervised health-care staff, even when not tailored for this population or targeting intimate partner violence directly. Future research should investigate whether adapting evidence-based psychological interventions for CMDs to address intimate partner violence enhances their acceptability, feasibility, and effectiveness in LMICs.
UK National Institute for Health Research ASSET and King's IoPPN Clinician Investigator Scholarship.
关于针对同时遭受亲密伴侣暴力的患有常见精神障碍（CMD）的女性进行心理干预有效性的证据很少。我们旨在检验我们的假设，即在低收入和中等收入国家（LMIC），遭受亲密伴侣暴力会降低针对CMD的干预效果。
对于这项系统评价和荟萃分析，我们检索了MEDLINE、Embase、PsycINFO、Web of Knowledge、Scopus、CINAHL、LILACS、ScieELO、Cochrane、PubMed数据库、试验注册库、3ie、谷歌学术以及数据库建立至2019年8月16日期间发表的研究的前后向引文。纳入了所有在LMIC中针对CMD进行心理干预且测量了亲密伴侣暴力的随机对照试验（RCT），无语言或日期限制。我们与研究作者联系以获取未发表的关于报告和未报告亲密伴侣暴力的女性的汇总亚组数据。我们对焦虑、抑郁、创伤后应激障碍（PTSD）和心理困扰结局进行了单独的随机效应荟萃分析。通过随机效应荟萃分析，将随机对照试验的证据合成为症状变化的标准化均数差（SMD）之间的差异，比较报告和未报告亲密伴侣暴力的女性。使用Cochrane偏倚风险工具评估证据质量。本研究已在PROSPERO注册，注册号为CRD42017078611。
在识别出的8122条记录中，21条符合条件，15项RCT的数据可用，所有这些研究的总体偏倚风险均为低到中度。焦虑（5项干预措施，728名参与者）方面，报告亲密伴侣暴力的女性对干预的反应比未报告的女性更大（标准化均数差差异[dSMD]为0·31，95%置信区间为0·04至0·57，I² = 49·4%）。在报告亲密伴侣暴力的女性中，PTSD（8项干预措施，n = 1436；dSMD为0·14，95%置信区间为 -0·06至0·33，I² = 42·6%）、抑郁（12项干预措施，n = 2940；0·10， -0·04至0·25，I² = 49·3%）和心理困扰（4项干预措施，n = 1591；0·07， -0·05至0·18，I² = 0·0%，p = 0·681）方面，干预反应无差异。
当由经过适当培训和监督的医护人员实施时，心理干预能有效治疗LMIC中目前或近期遭受亲密伴侣暴力的女性的焦虑，即使该干预未针对该人群进行调整或直接针对亲密伴侣暴力。未来的研究应调查针对CMD的循证心理干预进行调整以解决亲密伴侣暴力问题是否会提高其在LMIC中的可接受性、可行性和有效性。
英国国家卫生研究院资产项目和国王学院IoPPN临床研究者奖学金。
