Research Article: Psychological advocacy towards healing (PATH): A randomized controlled trial of a psychological intervention in a domestic violence service setting

Date Published: November 27, 2018

Publisher: Public Library of Science

Author(s): Giulia Ferrari, Gene Feder, Roxane Agnew-Davies, Jayne E. Bailey, Sandra Hollinghurst, Louise Howard, Emma Howarth, Lynnmarie Sardinha, Debbie Sharp, Tim J. Peters, Michele Kiely.


Experience of domestic violence and abuse (DVA) is associated with mental illness. Advocacy has little effect on mental health outcomes of female DVA survivors and there is uncertainty about the effectiveness of psychological interventions for this population.

To test effectiveness of a psychological intervention delivered by advocates to DVA survivors.

Pragmatic parallel group individually randomized controlled trial of normal DVA advocacy vs. advocacy + psychological intervention. Statistician and researchers blinded to group assignment. Setting: specialist DVA agencies; two UK cities. Participants: Women aged 16 years and older accessing DVA services.

Eight specialist psychological advocacy (SPA) sessions with two follow up sessions.

Primary outcomes at 12 months: depression symptoms (PHQ-9) and psychological distress (CORE-OM). Primary analysis: intention to treat linear (logistic) regression model for continuous (binary) outcomes.

263 women recruited (78 in shelter/refuge, 185 in community), 2 withdrew (1 community, control group; 1 intervention, refuge group), 1 was excluded from the study for protocol violation (community, control group), 130 in intervention and 130 in control groups. Recruitment ended June 2013. 12-month follow up: 64%. At 12-month follow up greater improvement in mental health of women in the intervention group. Difference in average CORE-OM score between intervention and control groups: -3.3 points (95% CI -5.5 to -1.2). Difference in average PHQ-9 score between intervention and control group: -2.2 (95% CI -4.1 to -0.3). At 12 months, 35% of the intervention group and 55% of the control group were above the CORE-OM -2clinical threshold (OR 0.32, 95% CI 0.16 to 0.64); 29% of the intervention group and 46% of the control group were above the PHQ-9 clinical threshold (OR 0.41, 95% CI 0.21 to 0.81),

64% retention at 12 months

An eight-session psychological intervention delivered by DVA advocates produced clinically relevant improvement in mental health outcomes compared with normal advocacy care.

ISRCTN registry ISRCTN58561170

Partial Text

Domestic violence and abuse (DVA) is a common violation of human rights that damages physical and mental health. DVA can be physical, sexual, psychological and economic, perpetrated by a partner, ex-partner or adult family member. Intimate partner violence (IPV) is a type of DVA. Although DVA is experienced by women and men, the majority of severe, repeated and sexual assaults are on women [1]. Most DVA epidemiological research has focused on the impact of intimate partner violence (IPV), a major contributor to the global burden of disease for women of reproductive age [2]. The main long term association of IPV is mental illness, with a three-fold risk of depressive disorders, four-fold risk of anxiety disorders and a seven-fold risk of post-traumatic stress disorder (PTSD) [3]. A meta-analysis of longitudinal studies has established a causal relationship between IPV and depression and suicide attempts [4].

We report on the analysis of the primary and secondary outcomes at the primary follow up point of 12 months, between the two groups of women as randomised (ITT).

This study is the first randomized controlled trial of an intervention to improve mental health symptoms of women experiencing DVA delivered by advocates with additional training in psychological methods. The PATH intervention, unlike the majority of psychological treatments for survivors of DVA, which are delivered by psychologists or counsellors, is based on a relatively brief training of advocates already in the DVA sector with ongoing supervision by a psychologist.




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