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针对遭受亲密伴侣暴力的女性的心理疗法。

Psychological therapies for women who experience intimate partner violence.

作者信息

Hameed Mohajer, O'Doherty Lorna, Gilchrist Gail, Tirado-Muñoz Judit, Taft Angela, Chondros Patty, Feder Gene, Tan Melissa, Hegarty Kelsey

机构信息

Department of General Practice, The University of Melbourne, Melbourne, Australia.

Faculty of Health and Life Sciences, Coventry University, Coventry, UK.

出版信息

Cochrane Database Syst Rev. 2020 Jul 1;7(7):CD013017. doi: 10.1002/14651858.CD013017.pub2.


DOI:10.1002/14651858.CD013017.pub2
PMID:32608505
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7390063/
Abstract

BACKGROUND: Intimate partner violence (IPV) against women is prevalent and strongly associated with mental health problems. Women experiencing IPV attend health services frequently for mental health problems. The World Health Organization recommends that women who have experienced IPV and have a mental health diagnosis should receive evidence-based mental health treatments. However, it is not known if psychological therapies work for women in the context of IPV and whether they cause harm. OBJECTIVES: To assess the effectiveness of psychological therapies for women who experience IPV on the primary outcomes of depression, self-efficacy and an indicator of harm (dropouts) at six- to 12-months' follow-up, and on secondary outcomes of other mental health symptoms, anxiety, quality of life, re-exposure to IPV, safety planning and behaviours, use of healthcare and IPV services, and social support. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, and three other databases, to the end of October 2019. We also searched international trials registries to identify unpublished or ongoing trials and handsearched selected journals, reference lists of included trials and grey literature. SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs and cross-over trials of psychological therapies with women aged 16 years and older who self-reported recent or lifetime experience of IPV. We included trials if women also experienced co-existing mental health diagnoses or substance abuse issues, or both. Psychological therapies included a wide range of interventions that targeted cognition, motivation and behaviour compared with usual care, no treatment, delayed or minimal interventions. We classified psychological therapies according to Cochrane Common Mental Disorders's psychological therapies list. DATA COLLECTION AND ANALYSIS: Two review authors extracted data and undertook 'Risk of Bias' assessment. Treatment effects were compared between experimental and comparator interventions at short-term (up to six months post-baseline), medium-term (six to under 12 months, primary outcome time point), and long-term follow-up (12 months and above). We used standardised mean difference (SMD) for continuous and odds ratio (OR) for dichotomous outcomes, and used random-effects meta-analysis, due to high heterogeneity across trials. MAIN RESULTS: We included 33 psychological trials involving 5517 women randomly assigned to experimental (2798 women, 51%) and comparator interventions (2719 women, 49%). Psychological therapies included 11 integrative therapies, nine humanistic therapies, six cognitive behavioural therapy, four third-wave cognitive behavioural therapies and three other psychologically-orientated interventions. There were no trials classified as psychodynamic therapies. Most trials were from high-income countries (19 in USA, three in Iran, two each in Australia and Greece, and one trial each in China, India, Kenya, Nigeria, Pakistan, Spain and UK), among women recruited from healthcare, community, shelter or refuge settings, or a combination of any or all of these. Psychological therapies were mostly delivered face-to-face (28 trials), but varied by length of treatment (two to 50 sessions) and staff delivering therapies (social workers, nurses, psychologists, community health workers, family doctors, researchers). The average sample size was 82 women (14 to 479), aged 37 years on average, and 66% were unemployed. Half of the women were married or living with a partner and just over half of the participants had experienced IPV in the last 12 months (17 trials), 6% in the past two years (two trials) and 42% during their lifetime (14 trials). Whilst 20 trials (61%) described reliable low-risk random-sampling strategies, only 12 trials (36%) described reliable procedures to conceal the allocation of participant status. While 19 trials measured women's depression, only four trials measured depression as a continuous outcome at medium-term follow-up. These showed a probable beneficial effect of psychological therapies in reducing depression (SMD -0.24, 95% CI -0.47 to -0.01; four trials, 600 women; moderate-certainty evidence). However, for self-efficacy, there may be no evidence of a difference between groups (SMD -0.12, 95% CI -0.33 to 0.09; one trial with medium-term follow-up data, 346 women; low-certainty evidence). Further, there may be no difference between the number of women who dropped out from the experimental or comparator intervention groups, an indicator of no harm (OR 1.04, 95% CI 0.75 to 1.44; five trials with medium-term follow-up data, 840 women; low-certainty evidence). Although no trials reported adverse events from psychological therapies or participation in the trial, only one trial measured harm outcomes using a validated scale. For secondary outcomes, trials measured anxiety only at short-term follow-up, showing that psychological therapies may reduce anxiety symptoms (SMD -0.96, 95% CI -1.29 to -0.63; four trials, 158 women; low-certainty evidence). However, within medium-term follow-up, low-certainty evidence revealed that there may be no evidence between groups for the outcomes safety planning (SMD 0.04, 95% CI -0.18 to 0.25; one trial, 337 women), post-traumatic stress disorder (SMD -0.24, 95% CI -0.54 to 0.06; four trials, 484 women) or re-exposure to any form of IPV (SMD 0.03, 95% CI -0.14 to 0.2; two trials, 547 women). AUTHORS' CONCLUSIONS: There is evidence that for women who experience IPV, psychological therapies probably reduce depression and may reduce anxiety. However, we are uncertain whether psychological therapies improve other outcomes (self-efficacy, post-traumatic stress disorder, re-exposure to IPV, safety planning) and there are limited data on harm. Thus, while psychological therapies probably improve emotional health, it is unclear if women's ongoing needs for safety, support and holistic healing from complex trauma are addressed by this approach. There is a need for more interventions focused on trauma approaches and more rigorous trials (with consistent outcomes at similar follow-up time points), as we were unable to synthesise much of the research.

摘要

背景:针对女性的亲密伴侣暴力行为普遍存在,且与心理健康问题密切相关。遭受亲密伴侣暴力的女性经常因心理健康问题前往医疗服务机构就诊。世界卫生组织建议,遭受亲密伴侣暴力且被诊断患有心理健康问题的女性应接受循证心理健康治疗。然而,尚不清楚心理治疗对处于亲密伴侣暴力情境中的女性是否有效,以及是否会造成伤害。 目的:评估心理治疗对遭受亲密伴侣暴力的女性在6至12个月随访时的主要结局(抑郁、自我效能感和伤害指标(退出治疗))以及次要结局(其他心理健康症状、焦虑、生活质量、再次遭受亲密伴侣暴力、安全规划与行为、医疗保健及亲密伴侣暴力服务的使用情况以及社会支持)的有效性。 检索方法:我们检索了Cochrane常见精神障碍对照试验注册库(CCMDCTR)、CENTRAL、MEDLINE、Embase、CINAHL、PsycINFO以及其他三个数据库,检索截至2019年10月底。我们还检索了国际试验注册库以识别未发表或正在进行的试验,并手工检索了选定的期刊、纳入试验的参考文献列表以及灰色文献。 选择标准:我们纳入了随机对照试验(RCT)、半随机对照试验、整群随机对照试验和交叉试验,这些试验的对象为16岁及以上自我报告近期或一生中曾遭受亲密伴侣暴力的女性。如果女性还同时存在心理健康诊断或药物滥用问题,或两者皆有,我们也纳入这些试验。心理治疗包括与常规护理、无治疗、延迟或最小干预相比,针对认知、动机和行为的广泛干预措施。我们根据Cochrane常见精神障碍的心理治疗列表对心理治疗进行分类。 数据收集与分析:两位综述作者提取数据并进行“偏倚风险”评估。在短期(基线后至多6个月)、中期(6至不足12个月,主要结局时间点)和长期随访(12个月及以上)时,比较试验组和对照组干预措施之间治疗效果。对于连续性结局,我们使用标准化均数差值(SMD);对于二分结局,我们使用比值比(OR),由于各试验间异质性较高,我们采用随机效应荟萃分析。 主要结果:我们纳入了33项心理治疗试验,涉及5517名女性,她们被随机分配至试验组(2798名女性,51%)和对照组干预措施(2719名女性,49%)。心理治疗包括11种综合疗法、9种人本主义疗法、6种认知行为疗法、4种第三代认知行为疗法以及3种其他以心理为导向的干预措施。没有试验被归类为精神动力疗法。大多数试验来自高收入国家(美国19项、伊朗3项、澳大利亚和希腊各2项、中国、印度、肯尼亚、尼日利亚、巴基斯坦、西班牙和英国各1项),招募的女性来自医疗保健、社区、庇护所或避难所环境,或这些环境的任意组合。心理治疗大多以面对面方式提供(28项试验),但治疗时长(2至50节)和提供治疗的人员(社会工作者、护士、心理学家、社区卫生工作者、家庭医生、研究人员)各不相同。平均样本量为82名女性(14至479名),平均年龄37岁,66%为失业状态。一半的女性已婚或与伴侣同居,略超过一半的参与者在过去12个月内遭受过亲密伴侣暴力(17项试验),6%在过去两年内(2项试验),42%在一生中(14项试验)。虽然20项试验(61%)描述了可靠的低风险随机抽样策略,但只有12项试验(36%)描述了可靠的程序来隐藏参与者状态的分配。虽然19项试验测量了女性的抑郁情况,但只有4项试验在中期随访时将抑郁作为连续性结局进行测量。这些试验显示心理治疗在减轻抑郁方面可能具有有益效果(SMD -0.24,95% CI -0.47至-0.01;4项试验,600名女性;中等确定性证据)。然而,对于自我效能感,可能没有证据表明两组之间存在差异(SMD -0.12,95% CI -0.33至0.09;1项试验有中期随访数据,346名女性;低确定性证据)。此外,试验组或对照组干预措施中退出治疗的女性数量可能没有差异,这是无伤害的一个指标(OR 1.04,95% CI 0.75至1.44;5项试验有中期随访数据,840名女性;低确定性证据)。虽然没有试验报告心理治疗或参与试验导致的不良事件,但只有1项试验使用经过验证的量表测量伤害结局。对于次要结局,试验仅在短期随访时测量了焦虑情况,表明心理治疗可能减轻焦虑症状(SMD -0.96,95% CI -1.29至-0.63;4项试验,158名女性;低确定性证据)。然而,在中期随访中,低确定性证据显示,对于安全规划(SMD 0.04,95% CI -0.18至0.25;1项试验,337名女性)、创伤后应激障碍(SMD -0.24,95% CI -0.54至0.06;4项试验,484名女性)或再次遭受任何形式的亲密伴侣暴力(SMD 0.03,95% CI -0.14至0.2;2项试验,547名女性)这些结局,两组之间可能没有证据表明存在差异。 作者结论:有证据表明,对于遭受亲密伴侣暴力的女性,心理治疗可能减轻抑郁并可能减轻焦虑。然而,我们不确定心理治疗是否能改善其他结局(自我效能感、创伤后应激障碍、再次遭受亲密伴侣暴力、安全规划),且关于伤害的数据有限。因此,虽然心理治疗可能改善情绪健康,但尚不清楚这种方法是否能满足女性对安全、支持以及从复杂创伤中全面康复的持续需求。由于我们无法综合许多研究,因此需要更多侧重于创伤方法的干预措施以及更严格的试验(在相似的随访时间点有一致的结局)。

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[3]
An online healthy relationship tool and safety decision aid for women experiencing intimate partner violence (I-DECIDE): a randomised controlled trial.

Lancet Public Health. 2019-6

[4]
Moms' Empowerment Program participation associated with improved physical health among Latinas experiencing intimate partner violence.

Rev Panam Salud Publica. 2018-3-30

[5]
"Like Opening Up Old Wounds": Conceptualizing Intersectional Trauma Among Survivors of Intimate Partner Violence.

J Interpers Violence. 2021-9

[6]
Counselling-based psychosocial intervention to improve the mental health of abused pregnant women: a protocol for randomised controlled feasibility trial in a tertiary hospital in eastern Nepal.

BMJ Open. 2019-4-23

[7]
Effect of a Qigong Intervention on Telomerase Activity and Mental Health in Chinese Women Survivors of Intimate Partner Violence: A Randomized Clinical Trial.

JAMA Netw Open. 2019-1-4

[8]
Women's experiences of a randomised controlled trial of a specialist psychological advocacy intervention following domestic violence: A nested qualitative study.

PLoS One. 2018-11-27

[9]
Psychological advocacy towards healing (PATH): A randomized controlled trial of a psychological intervention in a domestic violence service setting.

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[10]
The effect of training problem-solving skills for pregnant women experiencing intimate partner violence: a randomized control trial.

Pan Afr Med J. 2018-5-29

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