School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27705, USA.
Duke Global Health Institute, Duke University, Durham, NC, USA.
BMC Public Health. 2021 Nov 4;21(1):2010. doi: 10.1186/s12889-021-12121-9.
Diverse intervention efforts are implemented to address intimate partner violence (IPV) against women. Via a syndemics theory lens and emerging empirical evidence, mental health interventions demonstrate promise to partially ameliorate IPV. However, the mechanisms of change underlying many IPV interventions are not well understood. These gaps impede our efforts to strengthen or integrate effective components into the current mental health resources, especially in low- and middle-income countries (LMICs). This study aims to examine the impact of a maternal mental health intervention called Integrated Mothers and Babies Course & Early Childhood Development (iMBC/ECD) on IPV and whether social support and/or couple communication mediates the intervention effects among women in rural, Northern Ghana.
The current study is a secondary data analysis of a cluster randomized controlled trial. IPV was measured at baseline and 8 months post-intervention (~ 19 months post-baseline). At baseline, 84.8% of the women enrolled in the study (n = 374) reported some type of IPV in the past 12 months. Logistic regression models and multiple mediation analyses were used to address the study aims.
iMBC/ECD did not reduce IPV in the intervention group compared to the control group. Social support and couple communication did not mediate the intervention effects on IPV as indicated by the indirect effects of the multiple mediation models. However, increase in social support reduced women's odds of experiencing emotional violence by 7%, odds ratio (OR) = 0.93, p = 0.007; b = - 0.07, 95% confidence interval (CI) = (- 0.13, - 0.02), and improvement in couple communication demonstrated promise in reducing women's odds of experiencing controlling behaviors by 7%, OR = 0.93, p = 0.07; b = - 0.07, CI = (- 0.14, 0.005), though the improvements were not due to the intervention.
This maternal mental health intervention did not reduce IPV; however, the findings extend our knowledge about the impact of such interventions on IPV and the potential mechanisms of change via social support and couple communication. Future research evaluating the impact of mental health interventions on IPV and mechanisms of change is essential for the development of effective interventions. Future programs addressing IPV in LMICs should consider risk factors beyond relationship level (e.g. poverty and gender inequity).
ClinicalTrials.gov # NCT03665246 , Registered on August 20th, 2018.
针对针对妇女的亲密伴侣暴力（IPV）问题，实施了各种干预措施。通过综合征理论视角和新出现的实证证据，心理健康干预显示出部分缓解 IPV 的希望。然而，许多 IPV 干预措施的变化机制尚不清楚。这些差距阻碍了我们努力加强或整合有效的组成部分到当前的心理健康资源中，尤其是在中低收入国家（LMICs）。本研究旨在探讨一种称为综合母婴课程和儿童早期发展（iMBC/ECD）的产妇心理健康干预措施对 IPV 的影响，以及社会支持和/或夫妻沟通是否在加纳农村地区的女性中调节干预效果。
本研究是一项针对群组随机对照试验的二次数据分析。在基线和干预后 8 个月（约 19 个月后基线）测量 IPV。在基线时，研究中纳入的 84.8%的女性（n=374）报告在过去 12 个月内经历过某种类型的 IPV。逻辑回归模型和多重中介分析用于解决研究目的。
与对照组相比，iMBC/ECD 并未减少干预组的 IPV。社会支持和夫妻沟通并没有像多重中介模型的间接效应所表明的那样调节干预对 IPV 的影响。然而，社会支持的增加降低了女性经历情感暴力的几率 7%，优势比（OR）=0.93，p=0.007；b=-0.07，95%置信区间（CI）=-0.13，-0.02），夫妻沟通的改善有希望降低女性经历控制行为的几率 7%，OR=0.93，p=0.07；b=-0.07，CI=-0.14，0.005），尽管这些改善不是由于干预所致。
这种产妇心理健康干预并没有减少 IPV；然而，这些发现扩展了我们对这种干预对 IPV 的影响以及通过社会支持和夫妻沟通的潜在变化机制的认识。评估心理健康干预对 IPV 影响和变化机制的未来研究对于有效干预措施的发展至关重要。未来在 LMICs 中解决 IPV 的方案应考虑关系层面以外的风险因素（例如贫困和性别不平等）。
ClinicalTrials.gov # NCT03665246，于 2018 年 8 月 20 日注册。
