Two-year follow up of a cluster randomised controlled trial for women experiencing intimate partner violence: effect of screening and family doctor-delivered counselling on quality of life, mental and physical health and abuse exposure.
OBJECTIVES
This was a 2-year follow-up study of a primary care-based counselling intervention (weave) for women experiencing intimate partner violence (IPV). We aimed to assess whether differences in depression found at 12 months (lower depression for intervention than control participants) would be sustained at 24 months and differences in quality in life, general mental and physical health and IPV would emerge.


DESIGN
Cluster randomised controlled trial. Researchers blinded to allocation. Unit of randomisation: family doctors.


SETTING
Fifty-two primary care clinics, Victoria, Australia.


PARTICIPANTS
Baseline: 272 English-speaking, female patients (intervention n=137, doctors=35; control n=135, doctors=37), who screened positive for fear of partner in past 12 months. Twenty-four-month response rates: intervention 59% (81/137), control 63% (85/135).


INTERVENTIONS
Intervention doctors received training to deliver brief, woman-centred counselling. Intervention patients were invited to receive this counselling (uptake rate: 49%). Control doctors received standard IPV information; delivered usual care.


PRIMARY AND SECONDARY OUTCOME MEASURES
Twenty-four months primary outcomes: WHO Quality of Life-Bref dimensions, Short-Form Health Survey (SF-12) mental health.


SECONDARY OUTCOMES
SF-12 physical health and caseness for depression and anxiety (Hospital Anxiety Depression Scale), post-traumatic stress disorder (Check List-Civilian), IPV (Composite Abuse Scale), physical symptoms (≥6 in last month). Data collected through postal survey. Mixed-effects regressions adjusted for location (rural/urban) and clustering.


RESULTS
No differences detected between groups on quality of life (physical: 1.5, 95% CI -2.9 to 5.9; psychological: -0.2, 95% CI -4.8 to 4.4,; social: -1.4, 95% CI -8.2 to 5.4; environmental: -0.8, 95% CI -4.0 to 2.5), mental health status (-1.6, 95% CI -5.3 to 2.1) or secondary outcomes. Both groups improved on primary outcomes, IPV, anxiety.


CONCLUSIONS
Intervention was no more effective than usual care in improving 2-year quality of life, mental and physical health and IPV, despite differences in depression at 12 months. Future refinement and testing of type, duration and intensity of primary care IPV interventions is needed.


TRIAL REGISTRATION NUMBER
ACTRN12608000032358.
['Hegarty|Kelsey|K|', 'Valpied|Jodie|J|0000-0001-8793-0427', 'Taft|Angela|A|0000-0002-6350-843X', 'Brown|Stephanie Janne|SJ|0000-0001-9812-0067', 'Gold|Lisa|L|', 'Gunn|Jane|J|', "O'Doherty|Lorna|L|"]
D003376:Counseling D005260:Female D005500:Follow-Up Studies D006801:Humans D000066511:Intimate Partner Violence D011788:Quality of Life D014739:Victoria
primary care mental health clinical trials general medicine (see internal medicine) medical education & training