A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors

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RESEARCH ARTICLE

A systematic review of intimate partner

violence interventions focused on improving social support and/ mental health outcomes of survivors

Emilomo OgbeID¹*, Stacy Harmon², Rafael Van den BerghID³, Olivier Degomme¹

1 International Centre for Reproductive Health, Ghent University, Ghent, Belgium, 2 Georgia State University Alumna, Atlanta, Georgia, United States of America, 3 Me´decins Sans Frontières-Operational Centre Brussels, Brussels, Belgium

*[email protected]

Abstract

Background

Intimate partner violence (IPV) is a key public health issue, with a myriad of physical, sexual and emotional consequences for the survivors of violence. Social support has been found to be an important factor in mitigating and moderating the consequences of IPV and improving health outcomes. This study’s objective was to identify and assess network oriented and support mediated IPV interventions, focused on improving mental health outcomes among IPV survivors.

Methods

A systematic scoping review of the literature was done adhering to PRISMA guidelines. The search covered a period of 1980 to 2017 with no language restrictions across the following databases, Medline, Embase, Web of Science, PROQUEST, and Cochrane. Studies were included if they were primary studies of IPV interventions targeted at survivors focused on improving access to social support, mental health outcomes and access to resources for survivors.

Results

337 articles were subjected to full text screening, of which 27 articles met screening criteria.

The review included both quantitative and qualitative articles. As the focus of the review was on social support, we identified interventions that were i) focused on individual IPV survivors and improving their access to resources and coping strategies, and ii) interventions focused on both individual IPV survivors as well as their communities and networks. We categorized social support interventions identified by the review as Survivor focused, advocate/case management interventions (15 studies), survivor focused, advocate/case management interventions with a psychotherapy component (3 studies), community-focused, social sup- port interventions (6 studies), community-focused, social support interventions with a a1111111111

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Citation: Ogbe E, Harmon S, Van den Bergh R, Degomme O (2020) A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors. PLoS ONE 15(6):

e0235177.https://doi.org/10.1371/journal.

pone.0235177

Editor: Nihaya Daoud, Ben-Gurion University of the Negev Faculty of Health Sciences, ISRAEL

Received: March 7, 2019 Accepted: June 9, 2020 Published: June 25, 2020

Copyright:©2020 Ogbe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability Statement: All relevant data are within the paper and its Supporting Information files.

Funding: E.O- University of Gent BOF startkrediet (BOF.STA.2016.0031.01) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

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social support and/or mental health outcomes of survivors, with little evidence of their effect on IPV reduction or increase in healthcare utilization.

Conclusion

There is good evidence of the effect of IPV interventions focused on improving access to social support through the use of advocates with strong linkages with community based structures and networks, on better mental health outcomes of survivors, there is a need for more robust/ high quality research to assess in what contexts and for whom, these interventions work better compared to other forms of IPV interventions.

Introduction

The global prevalence of intimate partner violence (IPV) has been estimated at about 30% for women aged 15 and over [1]. We define IPV within this paper as ‘any acts of physical violence, sexual violence, stalking and psychological aggression (including coercive tactics) by a current or former intimate partner’ [2]. IPV affects men and women, and men or women can be per- petrators or survivors of violence. However, women are the most affected by IPV, and men tend to perpetrate violence more than women [3]. Survivors of violence are likely to first dis- close experiences of intimate partner violence and expect informal support from a friend, family member, neighbour or other members of their social network, prior to seeking support from formal sources like health institutions and legal officers, however, the extent of disclosure differed with age, nature, ethnicity and gender [4].

IPV has been found to be associated with an increased risk of poor health, depressive symp- toms, substance use, chronic disease, chronic mental illness and injury for both men and women [5]. Social support has been found to be an important factor for mediating, buffering and improving the outcomes of survivors of violence and improving mental health outcomes [6]. Conversely, social isolation and lack of social support have been found to be linked with poor health outcomes for survivors of violence. Liang et al [6] discussed the importance, per- ception of the abuse by the IPV survivor plays on their decision to ask for help and support.

They mentioned how cultural factors including stigma and shame around disclosing IPV, per- ception of the incident as a personal problem and awareness of resources available, play a determining factor on types of resources accessed, especially for IPV survivors with a migrant background or of a low socioeconomic status. IPV survivors who perceive the abuse to be a personal problem were more likely to use placating and avoidant strategies before seeking external support [6].

In this study, we make use of Shumaker and Brownell’s definition of social support, and define it as any provision of assistance, which may be financial or emotional, that is recognized by both the beneficiary and provider as advantageous to the beneficiary’s welfare. ‘[7]. IPV interventions that involve the use of social support, have the potential to improve the health seeking behaviour, access to resources and mental health outcomes of IPV survivors. Com- monly cited types of social support interventions include but are not limited to the use of peer support, family support and the use of ‘remote interventions like the use of internet or tele- phones as sources of social support from trained counsellors, as well as information about resources’ [8]. Goodman and Smyth [9] discussed the importance of using a ‘network oriented’

approach to provision of domestic violence services that takes into account the value of

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well-being of the survivor and sustain some of the benefits of the intervention over time.

Given the existing gap in evidence on the effect of different IPV interventions on social support and/ mental health outcomes of IPV survivors, this study aimed to address the evidence gap, by assessing the effects of these different IPV interventions, and network oriented approaches on improving access to social support and improved mental health outcomes for IPV survivors. This is of added benefit, as access to social support improves the mental health outcome of survivors of violence. More evidence of different types of social support interventions targeted at different groups of people, that are effective in addressing mental health outcomes of survivors, are needed.

Methods

The systematic review was developed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines. The methods used to screen the studies and define eligibility are described below:

Eligibility criteria

Studies meeting the following criteria were included: Primary research (original articles excluding systematic reviews), targeted at IPV survivors, describing interventions focused on improving access to resources and mental health outcomes for IPV survivors. The interventions had to use a social support or network-oriented approach. There were no restrictions on gender, but most of the studies identified focused on female survivors of violence (See Table 1). We defined ‘IPV as physical, sexual and psychological abuse directed against a per- son, by a current or ex-partner’ [10].

Studies had to address the following outcomes: intimate partner violence, social support, mental health outcomes and quality of life. Other outcomes that were also included were those associated with access to resources, utilisation of health services, and safety-promot- ing behaviours, if they were assessed in addition to the outcomes mentioned earlier. No restrictions were placed on study design or language, to allow for inclusion of all relevant studies.

Information sources

Between May and July 2017, we conducted a search across 5 databases: Medline, Embase, Web of Science, Cochrane and PROQUEST, for studies published between 1980 and 2017. We decided to include studies from the 1980’s because some of the pioneering publications on the use of advocacy and social support, for example, Sullivan et al’s work were published in the late 80’s and early 1990’s and we wanted our review to include some of these publications. Even though the review eventually included only primary studies, we included studies from COCHRANE to allow us to identify additional articles. We did not conduct a separate search for grey literature, as the PROQUEST database also included scholarly journals, newspapers, reports, working papers, and datasets along with e-books. Retrieved references were imported to Endnote and Mendeley and were then transferred to a systematic review software called Co- evidence [11]. In January 2019, another search was done to update and ensure new articles or information could be included in the review.Table 1provides an overview and summary of the studies selected, as well as the evidence ranking of the studies.

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Table1.Summaryofstudiesselected. TitleofstudyAuthorsTypeofinterventionYearTypeofstudy designTargetpopulation/ control/numberof participants

InterventionMainfindingsGrading (EPPHP) 1.Theimpactofcommunity- basedoutreachonpsychological distressandvictimsafetyin womenexposedtointimate partnerabuse

DePrince etalCommunityfocused supportintervention2012Randomized controltrial236Femaleadult Intimatepartner violencesurvivors (non-sexualIPV) Useofasystemsbasedadvocate (Referral)comparedtoa communitycoordinated/based advocate(Outreach)using telephonecalls

Therewasamoderatereductionin PTSD,DepressionandFear.PTSD (Outreachconditiond:0.43(0.11,0.74), andReferralconditiond0.31(–0.08, 0.70).RCIof8.77wascalculatedbased onareliabilitysample,where Cronbach’salphaforPTSD0.93(SD 11.96),Depression(Outreach,t(206) 3.61,p.0004,d0.37(0.06,0.69),and Referral,t(210)2.26,p.02,d0.30(– 0.09,0.69),RCIof8.50wascalculated basedonareliabilitysamplewhere Cronbach’salphafordepression0.90 (SD9.76)andFear,(Outreach condition,t(205)6.92,p.0001,d0.77 (0.45,1.09),toreportgreaterreductions infearsymptomsthantheReferral condition,t(208)3.18,p.0017,d0.45 (0.06,0.85).RCIof.89wascalculated basedonareliabilitysample,where Cronbach’salphaforfear0.89(SD 0.97);forbothinterventiongroups frombaselineto12monthsafter intervention,withtheoutreachgroup withslightlyhigherscores.Other secondaryoutcomeslikeService Utilization,Outreachgroup:(19%- contactedacommunityservice,and 30%atherapistat12months),Referral group(13%-contactedacommunity service,and37%atherapistat12 months)therewerenosignificant differencesbetweenbothgroupsfor serviceutilizationandcontinuedornew experiencesofphysical,sexualand psychologicalaggression.The probabilityofhavingleftanabusive relationshipwashigherfortheoutreach group(d,t(56.60)2.07,p.04).No changesfrombaselinewerereported.

Strong (Continued

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Table1.(Continued) TitleofstudyAuthorsTypeofinterventionYearTypeofstudy designTargetpopulation/ control/numberof participants

InterventionMainfindingsGrading (EPPHP) 2.Effectofanadvocacy interventiononmentalhealthin Chinesewomensurvivorsof intimatepartnerviolence:A randomizedcontrolledtrial

TiwarietalSurvivorfocused, Advocacy/case management intervention 2010Randomized controltrial200Femaleadult ChineseIPVsurvivors (18yearsandabove)

Useofanadvocate,empowerment counsellingandweeklytelephone callsfor12weeks.Thecontrol receivedusualcommunityservices includingchildcare,healthcare andpromotionandrecreation programs

Theinterventionreduceddepression scoresintheinterventionarm comparedtothecontrol(2.66(95%CI, 0.26to5.06;P=.03)vsthecontrol)but itwasnotstatisticallysignificant,an impactwashowevernoticedin reductioninpartneraggression (psychological),At9monthspost baseline,Control(−6.4[95%CI,−7.8to −5.0]andIntervention−8.9[95%CI, −10.6to−7.2])andincreaseinsocial support,At9months,Control:12.4 [95%CI,10.5to14.3]andIntervention: 14.4[95%CI,12.7to16.1]).Participants intheinterventionarmreported improvedqualityofrelationships ((93.8%vs81.7%;between-group difference,12.1%[95%CI,2.1%to 22.0%];P=.02)andsettlingof disagreementswiththeirpartners (Intervention:97.5%vsControl:84.1%; between-groupdifference,13.4%[95% CI,4.7%to22.0%];P=.001).

Strong 3.FindingsfromtheSASA! Study:aclusterrandomized controlledtrialtoassessthe impactofacommunity mobilizationinterventionto preventviolenceagainstwomen andreduceHIVriskinKampala, Uganda.

Abramsky etalCommunity-focused socialsupport intervention 2014Pair-matched Cluster Randomized controltrial Male,females,aged 18–49four communitiesand800 respondentsperarm (100menand100 womenpersite) TheSASA!ActivistKitfor PreventingViolenceagainst WomenandHIVisacommunity mobilizationinterventionthat seekstochangecommunity attitudes,normsandbehaviours thatresultingenderinequality, violenceandincreasedHIV vulnerabilityforwomen

Therewasasignificantdecreasein socialacceptanceofIPVamongwomen (adjustedriskratio0.54,95% confidenceinterval(CI)0.38to0.79), andmen(0.13,95%CI0.01to1.15) significantlygreateracceptancethata womancandeclinetohavesexamong women(1.28,95%CI1.07to1.52),and men(1.31,95%CI1.00to1.70);lower experienceofphysicalIPV(last12 months)amongwomen,andlower levelsofexperienceofsexualIPV(last 12months)(0.76,95%CI0.33to1.72), Womenexperiencingviolencein interventioncommunitiesweremore likelytoreceivesupportivecommunity responses(2.11,0.52to8.59).Reported multiplesexualpartners(concurrent sexualpartners)bymenwas significantlylowerinintervention communitiescomparedtocontrol(0.57, 95%CI0.36to0.91).Differencesinpast yearphysical/sexualIPVbetween interventionandcontrolcommunities: RatesofsexualIPVincreasedincontrol communities,nodifferencein Interventioncommunities,andwas statisticallynon-significant.Pastyear experienceofphysicalIPVwas substantiallyloweramongintervention womencomparedtocontrolwomen (0.48,0.16to1.39),butwasstatistically non-significant.Nomentalhealth outcomeswerereported

Moderate (Continued

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Table1.(Continued) TitleofstudyAuthorsTypeofinterventionYearTypeofstudy designTargetpopulation/ control/numberof participants InterventionMainfindingsGrading (EPPHP) 4.Anadvocacyintervention programforwomenwithabusive partners:initialevaluation.

SullivanetalSurvivorfocused Advocacy/case management intervention 1992Randomized controltrial141AdultfemaleIPV survivors(battered women18yearsand above)whohadspent anightattheshelter Advocateworkedwithwomenfor 10–12weeks,Controlgroup receivedusualservices

Therewasasignificantminimal reductionindepression,fear,anxiety, locusofcontrol,self-efficacy,emotional attachmenttoassailant,physicaland psychologicalabuse,socialsupportand overallqualityoflifewithaMANOVA test[F(9,121)=1.90,p=.058]acrossboth groupsbutqualityoflife[F(2,131)=4.10, p<.05]andsocialsupport[F(2,131)= 11.71,p<.05]significantlyincreasedin theinterventiongroup.Qualityoflife scoresalsoincreasedbetweenboth groups,bothgroups(Control(51% physicalviolence,56%psychological violence)andintervention(40% physicalabuseand42%psychological violence)experiencedabusepost- shelter,thedifferencewasstatistically non-significant

Moderate 5.Aninterpersonallybased interventionforlow-income pregnantwomenwithintimate partnerviolence:Apilotstudy

ZiotnicketalSurvivorfocused Advocacy/case management interventionwitha psychotherapy component) 2011Randomized controltrial54AdultfemaleIPV survivorswhowere pregnantbetweenthe agesof18and40years ofage Interpersonaltherapyfocusedon improvingsocialsupport, consistingoffour60-min individualsessionsovera4-week periodbeforedeliveryand followedbyone60-minindividual “booster”sessionwithin2weeksof delivery.

Therewasnosignificantreductionof thelikelihoodofamajordepressive episodeF(1,44)=1.73,p=0.19or PTSDF(1,44)=1.51,p=0.23between thecontrolandinterventiongroup postpartum(2weeksand3months postpartum).Howevertherewere moderateeffectsforreducingsymptoms ofPTSDF(1,44)=7.50,p=0.009and DepressionF(1,44)=3.29,p=0.08 duringpregnancy.Theoverallgroup effectacrossthetwotimeperiodswas significantfortheDepressionandPTSD outcomes.Abusevictimizationscores betweenthecontrolandintervention groupwerenotdifferentorsignificant.

Strong 6.Effectofanin-clinicIPV advocateinterventiontoincrease helpseeking,reduceviolence,and improvewell-being.

CokeretalSurvivorfocused Advocacy/case management intervention 2012Quasi experimental studywith randomization FemaleadultIPV survivors,with experiencesofIPV,in the2yearspriortothe study,andchildren betweentheagesof4 and6 TheMEPinterventionprovides psychoeducationaboutviolence anditseffectsonwomenand children,identifiesandassistswith advocacyneeds,andteaches importantskillsforpromoting goodmentalhealth,whileworking withadvocates

Therewasanincreaseinuseofsupport services(legalandsocialsupport) amongtheinterventiongroupinthe studycomparedtothecontrolgroup(p =.003)andmorelikelyinthefirst6 months.Therewasalsoagreaterdecline ofIPVamongtheresearchparticipants intheinterventiongroupcomparedto thecontrolgroup.IPVscoresinthe interventionclinicsreducedovertime relativetothecontrolarmScoresfor depressivesymptomsandsuicidal ideationweresignificantlylowerover timeforIPV+womeninthe interventionclinicsrelativetotheusual carearms.Therewerenodifferences betweenbothgroupsinself-perceived physicalhealth

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InterventionMainfindingsGrading (EPPHP) 7.Theprocessthroughwhichan advocacyinterventionresultedin positivechangeforbattered womenovertime.

BybeeetalSurvivorfocused Advocacy/case management intervention 2002Randomized controltrialAdultfemaleIPV survivorsAdvocacy/Socialsupport intervention,mediatingand interventioneffectsassessedat12 and24monthsfollowup

Thepresenceofsocialsupportand resourceswerefoundtobesignificant mediatorsof‘qualityoflife’scoresinthe ‘control’and‘intervention’groups. Socialsupporthadmoreinfluenceon outcomes(asamediatingfactor)than accesstoresourcesfortheresearch participants(p=0.003).Howeverthis effectwasnotsustainedover24months. Atthistime,socialsupportplayedless ofaninfluentialroleinoutcomes,and accesstoresourceshadasignificant effect.Womenintheinterventionarm (whoworkedwithadvocates)had positiveoutcomessustainedupto24 months(qualityoflife,socialsupport, accesstoresourcesanddeclinein experiencesofrepeatedabuse).

Moderate 8.TheFramingSafetyProject: photographsandnarrativesby batteredwomen.

LisaFrohmanCommunity-focused socialsupport intervention

2005Ethnographic QualitativestudyAdultmigrantfemale IPVsurvivors,TheFramingSafetyProjectisa therapeutictool,acommunity educationandactionstrategy, participatoryactionresearchfor womentoexploretheir experienceslivinginand extricatingthemselvesfroma batteringrelationship,andameans ofinformingothersaboutthe realitiesoftheseexperiences,using photography.

Thestudyreportedanincreasedfeeling ofempowermentamongwomenwho participatedintheproject.Thefactthe interventionoccurredwithinasupport groupcontext,seemedtomakea differencefortheparticipants,asthis wasasourceofsupportandconfidence. Theyweremorewillingtosharetheir experiencesofIPVwithapublic audience(usinganexhibition)andbe advocatesforIPVprevention.

Moderate 9.ProjectWINGS(Women InitiatingNewGoalsofSafety):A randomisedcontrolledtrialofa screening,briefinterventionand referraltotreatment(SBIRT) servicetoidentifyandaddress intimatepartnerviolence victimisationamongsubstance- usingwomenreceiving communitysupervision.

GilbertetalSurvivorfocused Advocacy/case management intervention 2015Randomized controltrial191Adultwomen, withanintimate relationshipwitha historyofsubstance abuseinthelast6 months

TheWINGSinterventionisguided bySocialCognitiveTheory,it enablessubstance-usingwomento identifyanddiscloseIPV,provide feedbackontheirrisksforIPV, developself-efficacytoprotect themselvesfromIPV,raise awarenessofdrug-relatedtriggers forIPV,developsafetyplans consideringsubstance-relatedrisks forIPVandenhancesocial supportsandlinkagestoIPV services,whileworkingwithcase managers.

Disclosureratesweresimilarforthe intervention-(Computerised:77.7%)and controlarm(Casemanager77.3%), Therewerenosignificantdifferences betweenbotharmsinaccesstosocial support,reductionindruguseand utilizationofIPVservices.Inbotharms, therewereimprovedscoresacrossall outcomes:ReceivedIPVservices:Case Manager,Baseline(N=148):3(4.0%),3 months(N=130)11(16.2%),ORIRR 7.72�(p<0.05),CI[95%]=[1.51,39.45] Differenceofchangebetweencase managerandcomputer0.51[0.07,3.92], Computer:Baseline:6(8.3%),3months: 12(19.4%)OR:3.94�(p<0.05)CI[95%] [1.01,15.38].

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InterventionMainfindingsGrading (EPPHP) 10.RespondingEffectivelyto WomenExperiencingSevere Abuse:IdentifyingKey ComponentsofaBritish AdvocacyIntervention

Howarthand RobinsonSurvivorfocused Advocacy/case management intervention 2016Retrospective quantitativestudy (Interruptedtime series) Adultdomestic violencesurvivorswho usedanIndependent domesticviolence advisor,2,427(Time 1),1,167(Time2)

TheIDVArolewasestablishedin Britainin2005,specificallyto provideadviceandsupportto survivorsdeemedtobeathighrisk ofharmfromfurtherabuse.The IDVAmodelofinterventionis designedtobedeliveredfromthe pointofcrisisoverarelatively shortperiodoftimeandisfocused onaddressingimmediaterisksto safetyandbarrierstoservice utilization,beforereferringvictims tootherservices

Womenwhohadmoreinteractionwith theadvocateswerelesslikelyto experienceabuse,reportedsignificant reductionsintheoccurrenceofall formsofabuse,sexualabuse:% reportingsexualabuse(13.1vs.14.0) T1,24.5T2,5.0��(p<0.01),%reporting perpetrator’sjealous/controlling behaviour(5.4vs.26.9)T1,87.2t2, 26.9��(p<0.01)%reportinganyformof severeabuseT1,79.2T2,19.2�� (p<0.01)%reportinganyescalationin severityorfrequencyofabuseT1,60.6 T2,4.2��(p<0.01)andimportantlymost felttosomedegreesafer.1.4%of womenreportedtoIDVAsthattheyfelt significantlysaferand23.5%felt somewhatsafer.Althoughwomenliving separatelyfromtheabuseratTime1 weremorelikelytoreportpositive outcomesatTime2

Weak 11.SecondaryPreventionof IntimatePartnerViolenceA RandomizedControlledTrial

McFarlane etalSurvivorfocused Advocacy/case management intervention 2006Randomized controlledtrialPregnantIPV survivorswithchildren 5yearsoryounger Theinterventiontestedtheadded benefitofanursecase management,inadditiontothe useofanabuseassessmentanda referralcard,basedonthe‘March ofDimes’protocol

Therewerenosignificantdifferences betweengroupsacrossalloutcomes,i.e. Noaddedbenefitofusinganursecase manager.Twoyearsfollowing treatment,bothtreatmentgroupsof womenreportedsignificantly(p<.001) reducedexperiencesofabusethreats, assaults,harassmentatworkandrisksof homicidebuttherewerenosignificant differencesbetweengroups.Compared tobaseline,bothgroupsofwomen adoptedsignificantly(p<.001)more safetybehavioursby24months (however,communityresourceuse declinedsignificantly(p<.001)for bothgroups.Therewerenosignificant differencesbetweengroups.

Moderate 12.PreventingAbusetoPregnant Women:Implementationofa ’MentorMother’Advocacy Model

McFarlaneet WilstSurvivorfocused Advocacy/case management intervention 1997Preandpost evaluation100PregnantIPV survivorsleaving shelters Theinterventionfocusedonthe effectivenessofthementormother modelinimprovingeffective referrals Theprogrammewaseffectivein improvingthenumberofreferrals amongthewomenwhousedthe advocacyservices,andwasreportedto beeffective‘inofferingsocialsupport, educationandassistancewithneeded communityresources’.

Weak (Continued

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Table1.(Continued) TitleofstudyAuthorsTypeofinterventionYearTypeofstudy designTargetpopulation/ control/numberof participants InterventionMainfindingsGrading (EPPHP) 13.ATrialofTelephoneSupport ServicestoPreventFurther IntimatePartnerViolence

StevensetalSurvivorfocused Advocacy/case management intervention 2015Randomized controltrial300AdultIPV survivorswithpartial orfullcustodyofa paediatricpatientat theemergency department

Theadvocacyintervention consistedofempowermentand telephonesocialsupport,basedon theDutton’sempowermentmodel andCohen’sSocialSupport Theory.Theformercomponent wasprovidedatthebeginningof theinterventionandtookabout30 minutes.Itincludedprotection andenhancedchoice-makingand problem-solvingskills.Thelatter wasprovidedvia12scheduled weeklytelephonecallsand24-hour accesstoahotline.Womeninthe controlgroupreceivedtheusual communityservicesprovidedby thecommunitycentreincluding health,social,educational,and recreationalservices.

Thestudyfoundhigherperceivedlevels ofsocialsupportatbaselineand3 monthswasmildlyrelatedtoreduced reportingofexperiencesofviolence (CASscores)and,andtherewere significantreductionsinIPV victimizationacrossallgroups,no differencesbetweengroupsorother outcomeswerenoted.

Strong 14.Theprocess,outcomes,and challengesoffeasibilitystudies conductedinpartnershipwith stakeholders:ahealth interventionforwomensurvivors ofintimatepartnerviolence

WuestetalCommunity-focused socialsupport interventions 2015Pre-poststudy52AdultIPV survivors,whoare livingapartfromtheir abusivepartnersfor3 months

Theprotocolisusedduring12to 14individualsessionswithan interventionistoverasix-month period.Thesixcomponentsofthe iHEALareaddressedinthree phases.Ingettinginsync, interventionistsandwomenbegin tobuildmutualtrustbydiscussing thewoman’spriorities,thesurvival context,andthenatureofthe iHEALandtheSCLItheory,as planningtheorderoftheirwork oncomponents.Inworking together,foreachcomponent, womenaresupportedtoframe theirpersonalexperiencesof intrusioninlightofwhatisknown aboutothersurvivors’intrusion experiences,usingpaper-based toolsorexercisesdevelopedfor thispurpose.

Preliminaryeffectsshowimprovement inthequalityoflifeandmentalhealth oftheIPVsurvivors.Therewasalsoa reductioninsymptomsofdepression andPTSD

Moderate 15.Community-basedPTSD treatmentforethnicallydiverse womenwhoexperiencedintimate partnerviolence:afeasibility study.

KellyetalCommunity-focused socialsupport interventionwitha psychotherapy component 2014Preandpost study12AdultIPVSpanish immigrantwomen withsymptomsof PTSD

Theinitialinterventionconsisted of6–10-sessionweekly psychotherapygroups,usinga synthesisofsupportive psychotherapy,includingpsycho- educationandself-carestrategies. SpecifictopicsincludedPTSD101; relationshipswithself,children, andothers;sleephygiene,mindful eating,therelaxationresponse,and exercise;faithandfamily.The interventionwasconductedbytwo advancedpracticepsychiatric nurses(PMHCNSandPMHNP), withexperienceintreating survivorsofIPVwithPTSD.

SymptomsofPTSDdecreasedat6 monthspost-intervention,from59.00to 44.13,respectively(n=15;p=0.003). SymptomsofMDDdecreased significantlyatallpost-intervention time-points.Theonlystatistically significantdifferenceinselfratingof generalhealthwasfrombaseline(3.06) to6-monthfollow-up(2.63;p=0.048). Self-reportedmentalhealth-relatedQoL alsoimprovedsignificantlyatalltime- points,withanearly50%(p=0.013) and66%improvement(p=0.003)at3- and6-monthfollow-up,respectively. Self-efficacyscoresimprovedatalltime- points,reachingstatisticalsignificance (p=0.020)at6-monthfollow-up