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Abstract
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ntimate partner violence (IPV) is a devastating public health problem that affects one in three women globally (Garcia-Moreno et al., 2006) and can lead to numerous mental health (Devries et al., 2013), physical health (Coker, 2007), socioeconomic (Adams et al., 2012), and intergenerational sequelae (Gartland et al., 2019). Reducing situational IPV - when discord and conflict in couples escalates to mild or moderate physical violence (McCollum and Stith, 2008) - and improving marital accord in couples can help address a mental health treatment gap for women with common mental disorders (depression, anxiety, and PTSD). Mozambique has extremely high prevalence rates of IPV. A national sample showed that approximately 30% of women reported experiencing physical or sexual IPV in the past 12 months (Instituto Nacional de Estatistica, 2011), and a sample from Maputo City reported a rate of∼50% for exposure to sexual, physical, or psychological IPV(Zacarias et al., 2012), consistent with other countries in sub-Saharan Africa (Garcia-Moreno et al., 2006). IPV is associated with emotional distress (Ellsberg et al., 2008), posttraumatic stress disorder and anxiety (Lagdon et al., 2014), serious mental illness (Chandan et al., 2020), suicidal ideation (Halim et al., 2018) and past attempts (Ellsberg et al., 2008), and is a potent risk factor for depression (Howard et al., 2013) - doubling or tripling women's odds of having this common mental disorder (Islam et al., 2017).
Research in high-income countries has shown that when couples choose to stay together addressing IPV in a couple modality can reduce IPV levels more than treatment of individuals (Karakurt et al., 2016). Interventions targeting IPV disproportionately focus on treating the offender or the victim and mental health sequelae of their experiences of IPV (Mootz et al., 2023). In high-income countries, mandated treatment for IPV perpetrators that involves gender-specific men-only treatment is generally ineffective (Crane et al., 2014; Dutton and Corvo, 2007) but remains widespread due to concerns of victim advocates that couple-based treatment might provoke or exacerbate violence (Armenti and Babcock, 2016). Studies have also demonstrated that couple-based treatment for IPV can be both safe and effective (Antunes-Alves and Stefano, 2014; Stith and McCollum, 2011), and with careful screening to ensure IPV is situational, rigorous training of providers, and ongoing risk assessment and safety planning, couples can reduce IPV and improve their relationship through enhanced communication and problem-solving skills (Antunes-Alves and Stefano, 2014; Armenti and Babcock, 2016; Hurless and Cottone, 2018). In a meta-analysis of RCTs of couple-based therapies for IPV, this modality showed significantly greater reductions in IPV than individual treatments and control conditions (Karakurt et al., 2016). However, these studies were all conducted in the US.
Despite decades of research establishing the ubiquity of IPV and its consequences for women's mental health, less is known about how to prevent or reduce IPV experienced by women with common mental disorders in low-and middle-income countries (LMICs). A recent review indicated that only two studies in LMICs had adapted interventions for common mental disorders in women to address IPV (with reduction in symptoms) (Keynejad et al., 2020). Another review of 11 studies in LMICs found that targeted mental health interventions performed better in reducing symptoms of mental health problems and IPV, although substance use or integrated interventions produced mixed results (Tol et al., 2019). Our team conducted a systematic review of intervention studies in LMICs that addressed family violence (IPV or child maltreatment) as well as mental health or substance use problems. From 19 studies across 13 LMICs, we found that there was a high degree of variability in effectiveness of interventions. Taken together, the reviews show the need for future research on adapting feasible, acceptable, and effective evidence-based treatments for common mental disorders that address IPV in LMICs. ...
Language: en |