Interventions in health settings for male perpetrators or victims of intimate partner violence
Metrics details. Epidemiological research suggests an interrelationship between mental health problems and the re occurrence of intimate partner violence IPV. However, little is known about the impact of mental health treatments on IPV victimization or perpetration, especially in low- and middle-income countries LMIC. We conducted a systematic review to identify prospective, controlled studies of mental health treatments in LMIC. Studies had to measure a mental health and IPV outcome.SEE VIDEO BY TOPIC: Domestic Violence: Living in Fear - NPT Reports
SEE VIDEO BY TOPIC: Assessing and Intervening in the Home with Victims of Intimate Partner ViolenceContent:
Metrics details. Epidemiological research suggests an interrelationship between mental health problems and the re occurrence of intimate partner violence IPV. However, little is known about the impact of mental health treatments on IPV victimization or perpetration, especially in low- and middle-income countries LMIC.
We conducted a systematic review to identify prospective, controlled studies of mental health treatments in LMIC. Studies had to measure a mental health and IPV outcome. We searched across multi-disciplinary databases using a structured search strategy. We identified seven studies reported in 11 papers conducted in five middle-income countries.
With the exception of blinding, studies overall showed acceptable levels of risk of bias. Four of the seven studies focused on dedicated mental health treatments in various populations, including: common mental disorders in earthquake survivors; depression in primary care; alcohol misuse in men; and alcohol misuse in female adult sex workers.
The dedicated mental health treatments targeting depression or alcohol misuse consistently reduced levels of these outcomes. The two studies targeting depression also reduced short-term IPV, but no IPV benefits were identified in the two alcohol-focused studies.
In contrast to the dedicated mental health interventions, the integrated interventions did not consistently reduce mental ill health or alcohol misuse compared to control conditions. Too few studies have been conducted to judge whether mental health treatments may provide a beneficial strategy to prevent or reduce IPV in LMIC.
Key future research questions include: whether promising initial evidence on the effects of depression interventions on reducing IPV hold more broadly, the required intensity of mental health components in integrated interventions, and the identification of mechanisms of IPV that are amenable to mental health intervention.
Peer Review reports. Intimate partner violence IPV is a critical human rights and public health concern. IPV refers to behavior within an intimate relationship that causes, or has the potential to cause, physical, sexual, or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse, and controlling behaviors [ 1 ].
Consequences of IPV include physical, reproductive, and mental health issues [ 3 , 4 , 5 ] and in severe cases, the resulting injuries can be fatal [ 6 ]. Knowledge is accruing on how to best prevent and reduce IPV [ 7 ]. Research from low- and middle-income countries LMIC has more frequently focused on preventive interventions, and has shown promising benefits of group training for men and women e. With regard to efforts to reduce IPV once detected, evidence mainly from high-income countries suggests that women-centered care, advocacy, and home-visitation programs can reduce the risk of further victimization [ 8 , 9 ].
Although treatment of mental ill health or substance abuse may strengthen efforts to prevent and reduce IPV [ 10 ] relatively little research has focused on this topic. There are several reasons to think that treatment of mental disorders and substance abuse problems may be an effective strategy for prevention and reduction of IPV in LMIC either through targeting perpetrators or victims. Hazardous alcohol use [ 11 , 12 , 13 , 14 ], common mental disorders posttraumatic stress disorder [PTSD], depression, anxiety [ 12 , 13 , 14 , 15 , 16 ], and anger dysregulation [ 17 ] are known correlates of IPV perpetration.
Duluth interventions tend to focus on gender reeducation aimed at addressing the patriarchal factors underlying male perpetration of IPV. Evaluations of traditional batterer intervention programs based on this model, commonly in high-income countries, have shown conflicting results [ 18 ].
Mental health interventions may also reduce further risk for victimization by treating mental health problems among IPV survivors [ 23 , 24 , 25 ]. Longitudinal studies suggest that the relationship between IPV and mental ill health may in fact be cyclical: mental health impacts of IPV put women at increased risk for further abuse [ 26 , 27 , 28 , 29 ].
For example, depression may be associated with self-blame for IPV victimization, reduced self-esteem, and hopelessness. Mental health interventions therefore may reduce IPV re-victimization by targeting mental ill health in survivors [ 21 ]. Consistent with this hypothesis, a randomized controlled trial from the United States, providing cognitive behavioral therapy to interpersonal violence survivors reduced IPV re-victimization [ 30 ]. Both for survivors and perpetrators, mental health treatments may have additional indirect benefits for IPV reduction by conferring psychological and social skills - strengthening communication, stress management, and anger management skills, and reducing social isolation — that may reduce IPV incidence [ 31 ].
To date, less attention has been placed on some of the individual-level factors e. We note that interventions addressing the mental health of survivors need to be mindful of the risk of victim blaming, i. We also highlight the wider constellation of risk and protective factors for IPV [ 33 ] noting both family- and community-level factors e. We examine individual-level factors, in particular mental health, without diminishing the importance of these broader social and structural influences. Research findings from high-income countries may not generalize to LMIC because of differences in the distribution of determinants of violence; socio-cultural context; resources available to respond to IPV; notions of mental illness; and characteristics of mental health systems.
Given the potential of mental health interventions to address IPV and the gap in knowledge on this topic in LMIC, in this systematic review we synthesize findings from controlled trials of mental health interventions conducted in LMIC that included IPV as a primary or secondary outcome. Low and middle-income countries were defined using the latest World Bank income classifications, including both lower- and upper-middle income countries.
An intervention was considered a mental health treatment if it met all of the following criteria: 1 included a mental health component, i. We excluded studies where violence was measured as occurring between: people in the general community; paying sexual partners; or family members that were not intimate partners i.
We did not set any restrictions by year of publication. Trials with all types of inactive control conditions were considered for inclusion, including placebo, waitlist, no treatment, treatment as usual, or treatment without an active mental health component. We also included studies with only one treatment arm that adequately controlled for unobserved confounding in design and analysis e. We excluded studies that compared two or more active treatments without a control condition.
We excluded non-peer reviewed literature e. We excluded studies that did not have an abstract in English. If an article had an abstract in English but was written in any other language, the article was still eligible for inclusion. Our search strategy combined terms aimed at identifying studies that: 1 were conducted in LMIC; and 2 evaluated mental health treatments i.
To identify studies focused on mental health treatments, search terms included names of mental disorders, categories of disorders, and commonly abused substances, as well as general terms for mental ill health e.
A search strategy was initially developed by selecting multiple medical subject headings MeSH terms and subheadings relevant to mental health problems e. Together with a university librarian, this search was iteratively refined by examining search strategies from relevant reviews e. In addition, we hand-searched the following regional databases, trial, and funding registries: Cochrane Central Register of Controlled Trials, ClinicalTrials.
Additional hand searching included the reference list of any relevant systematic reviews or published trial protocols found through this search process, as well as forward and backward citation checks on any article eligible for inclusion.
We also reached out to all authors of included articles to ask if they, as experts in this area, knew of any articles that we had missed in our search process.
Search results from all databases and registries were compiled and duplicates eliminated by a single researcher using Covidence software. Two researchers then independently: 1 screened titles and abstracts, and 2 screened the full text of any article that was found to be potentially eligible. In the case of conflicting decisions on eligibility, the two reviewers SM, LS discussed the discrepancy and their rationale.
If consensus could not be reached, a third party WT, JB was consulted for a final decision. One author LS extracted information from eligible full texts into a piloted, structured Excel spreadsheet. A second author SM checked all the extracted information, and consulted a third reviewer WT, JB as necessary when her interpretation of an article varied substantially from the first reviewer or the information provided in the manuscript was unclear.
The data extraction spreadsheet included entries for: sample and population characteristics e. This tool included the following dimensions: selection bias sequence generation; allocation concealment ; performance bias blinding of participants and personnel ; detection bias blinding of outcome assessment ; attrition bias incomplete outcome data ; and reporting bias selective outcome reporting.
We planned to conduct a narrative synthesis and, if a sufficient number of high-quality trials were identified with sufficient homogeneity, meta-analysis using aggregate data. We screened the titles and abstracts of unique records see Fig. Of these, we reviewed the full-texts of 56 papers for potential inclusion. Of the 56 papers, eight were determined to meet all study criteria.
Three additional eligible articles were identified through cross-referencing. The final group consisted of seven studies, reported in 11 papers. Studies were published between and and were conducted in five countries two in India, two in South Africa, and one each in China, Kenya and Mongolia.
Two studies [ 38 , 40 , 41 ] had effective sample sizes of less than i. Two of the seven studies [ 40 , 41 , 43 , 44 ] specifically focused on female sex workers, and two studies were conducted with disadvantaged communities, i. Two studies [ 45 , 46 , 47 , 48 ] were conducted in Indian primary care, and one study [ 39 ] included earthquake survivors in China. One study screened in on the basis of meeting criteria for PTSD, depression, or both, using a structured psychiatric diagnostic interview [ 39 ].
One study applied a brief eligibility screening questionnaire to assess drug use eligibility criteria confirmed with biological testing [ 42 ]. One study reported all types of IPV combined using one measure [ 39 ]. None of the studies specifically noted that IPV was a primary outcome, and one study [ 38 ] did not distinguish primary vs secondary outcomes. Rather, studies commonly used single-item survey questions e. All of these studies used the Alcohol Use Disorders Identification Test AUDIT to assess alcohol use, except Wechsberg and colleagues [ 42 ] who screened for alcohol use with a brief questionnaire and confirmed other drug use through biological testing on urine samples.
Selective reporting did not appear to be a significant concern in any of the included studies: authors summarized results based on all included outcomes.
Two studies focused on common mental disorders. IPT was delivered by trained local personnel to individuals over 12 sessions. The intervention was delivered by lay counselors over six to eight sessions and consisted of psychoeducation; behavioral assessment; activity monitoring, structuring, and scheduling; activation of social networks; and problem solving.
Two studies focused on substance abuse. The intervention was based on the WHO Brief Intervention for Alcohol Use and consisted of six min sessions of individual counseling, delivered approximately monthly by nurse counselors trained in motivational interviewing. Treatment was delivered individually by lay counsellors and included motivational interviewing, problem-solving, and general counselling strategies e.
The sexual risk reduction intervention was based on social cognitive and ecological theory [ 51 , 52 ] and consisted of four sessions with a relationship focus the relationship with the paying sexual partner.
It included information on how to protect oneself from violence not IPV-specific. This intervention was tested with and without two wrap-around sessions of motivational interviewing aimed at reducing harmful alcohol use. Stepping Stones is based on participatory learning approaches, including critical reflection, role play, and drama. It consists of 10 3-h sessions with single-sex groups, who come together to discuss learning on more gender equitable relationships and improved communication.
Participants also discuss motivations for behavior, including influences of alcohol and poverty. Of the four 1-h modules, one is focused on information about drug use and risks. Sessions also focus on skills to negotiate condom use and avoiding potentially violent situations. Mental health benefits and reduction in alcohol misuse were consistently found across the dedicated mental health treatments, but reductions in IPV were inconsistently identified.
Two of the dedicated mental health treatments focused on depression. Second, Patel, [ 45 ] Weobong [ 46 ] and coworkers found that behavioral activation was associated with reductions on depression symptom severity and remission at both 3- and month assessments in primary care centers in India. Although physical IPV victimization in women was reduced in the treatment arm at three months adjusted mean difference [aMD] 0.
The other two dedicated mental health treatments focused on alcohol misuse.
Intimate Partner Violence
These interventions approach violence as a learned behavior; thus, according to the CBT model of psychology, nonviolence can also be learned by domestic violence perpetrators. Physically abusive men are encouraged to think about and change their understanding of violence, examine the circumstances surrounding their violence, and disrupt the cognitive chain that leads to their commission of violent acts of domestic abuse. Target Population The target population of CBT for domestic violence almost exclusively comprises male batterers.
Intervening with perpetrators of intimate partner violence: A global perspective
The causes of partner violence by intimates remain only partially clear and are often debated. Two theories have heavily influenced intimate partner etiology research; social learning theory, or the idea that violence may be transmitted from one generation to the next, and feminist theory, or the idea that male dominance in society affects interpersonal relationships. The theory that stress may contribute to intimate violence perpetration has also been postulated Jewkes, Moreover, the majority of available research has defined intimate partner violence narrowly — as including only physical violence or in some cases, physical and sexual assault. Nonetheless, several factors have been found to be consistently associated with the physical assault of intimate partners, and as a result they are widely believed to play some causal role. In response to the problem of intimate partner violence, most nations have developed legal, medical and social resources to support victims and their children. Rape kits, one-stop centres, sexual assault response teams, special examination centres and sexual assault nurse examiner programmes, as well as sensitivity training for healthcare professionals, have been implemented in developing and developed nations alike. Psychological counselling centres, legal literacy programmes, self-help groups, specialized shelters, supportive telephone hotlines, and peer advocacy programmes for intimate partner violence victims have been replicated in a wide variety of settings. While the growth of victim advocacy and support services is an achievement, intervention with the perpetrators of intimate partner violence has received comparatively little attention from non-governmental, governmental and academic organizations outside the USA and Canada. Given that many abusers continue to terrorize their victims even after the relationship ends Hart, ; Browne, , providing support services to victims in the absence of intervention for perpetrators is a questionable practice.
Interventions in Health Settings for Male Perpetrators or Victims of Intimate Partner Violence.
The information and resources listed here can be easily adapted to other groups and settings. It is vital for all staff employed by health, behavioral health, and integrated care organizations to understand the nature and impact of trauma and how to use principles and practices that can promote recovery and healing: Trauma-Informed Approaches. In addition to information and resources on IPV, this page provides links to resources on Trauma and Trauma-Informed Approaches , as well as Suicide Prevention , that we encourage you to explore.
Intimate Partner Violence in Treatment Seeking Problem Gamblers
Сьюзан поворачивалась то влево, то вправо. Она услышала шелест одежды, и вдруг сигналы прекратились. Сьюзан замерла.SEE VIDEO BY TOPIC: Domestic Violence PowerPoint (8 minutes)
Она принялась нажимать кнопки безжизненной панели, затем, опустившись на колени, в отчаянии заколотила в дверь и тут же замерла. За дверью послышалось какое-то жужжание, словно кабина была на месте. Она снова начала нажимать кнопки и снова услышала за дверью этот же звук. И вдруг Сьюзан увидела, что кнопка вызова вовсе не мертва, а просто покрыта слоем черной сажи. Она вдруг начала светиться под кончиком пальца.
Звон колоколов оглушал, эхо многократно отражалось от высоких стен, окружающих площадь. Людские потоки из разных улиц сливались в одну черную реку, устремленную к распахнутым дверям Севильского собора. Беккер попробовал выбраться и свернуть на улицу Матеуса-Гаго, но понял, что находится в плену людского потока. Идти приходилось плечо к плечу, носок в пятку. У испанцев всегда было иное представление о плотности, чем у остального мира.
Это совсем не обрадует коммандера Стратмора. Клушар приложил руку ко лбу. Очевидно, волнение отняло у него все силы.
Это не так важно, - горделиво заявил Клушар. - Мою колонку перепечатывают в Соединенных Штатах, у меня отличный английский. - Мне говорили, - улыбнулся Беккер.
ГЛАВА 33 Токуген Нуматака смотрел в окно и ходил по кабинету взад-вперед как зверь в клетке. Человек, с которым он вступил в контакт, Северная Дакота, не звонил. Проклятые американцы. Никакого представления о пунктуальности.
Он вызвал скорую. Мы решили уйти. Я не видела смысла впутывать моего спутника, да и самой впутываться в дела, связанные с полицией. Беккер рассеянно кивнул, стараясь осмыслить этот жестокий поворот судьбы.
У нас нет причин ему не верить. - Это прозвучало как сигнал к окончанию разговора. Он отпил глоток кофе. - А теперь прошу меня извинить. Мне нужно поработать.
Как ты не понимаешь, что я ко всему этому непричастен. Развяжи. Развяжи, пока не явились агенты безопасности.