Is intimate partner violence an effect modifier for psychosocial interventions for women’s mental health in low and middle-income countries (LMICs)?
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2 June 2020 — adopted November 2019 • completing October 2021
Is intimate partner violence an effect modifier for psychosocial interventions for women’s mental health in low and middle-income countries (LMICs)?
Intimate partner violence (IPV) is behaviour by a partner or ex-partner causing physical, sexual or psychological harm. It is common around the world and negatively affects the physical and mental health of women and their children. Depression in pregnancy is also a common problem worldwide, which negatively affects women’s and children’s physical and mental health.
lifetime prevalence of IPV exposure among women in rural Ethiopia (Deyessa, Berhane et al., 2009)
In low-income countries like Ethiopia, IPV is particularly common during pregnancy. Pregnancy is also the time that women are most likely to receive healthcare — making antenatal care an ideal opportunity to offer women mental health treatment that is adapted to address the impacts of IPV.
IPV in Ethiopia is most prevalent during pregnancy and increases the risk of child mortality associated with maternal depression (Deyessa et al., 2010), reinforcing the importance of antenatal intervention.
Background
IPV in Ethiopia is associated with emotional distress (García-Moreno, 2005) and depression (Tadegge, 2008). International goals to improve maternal health and reduce maternal mortality mean that pregnancy is the commonest time for Ethiopian women to access healthcare.
Undetected and untreated maternal mental health problems are associated with a range of adverse outcomes. In Ethiopia, antenatal depression is correlated with:
Increased emergency presentations in pregnancy (Bitew et al., 2016)
Increased perinatal complications (Bitew, Hanlon et al., 2017)
Prolonged labour (Hanlon, Medhin et al., 2009)
Increased use of emergency delivery care (Bitew, Hanlon et al., 2017)
About the research study
This research investigates whether IPV moderates women’s response to psychosocial interventions for common mental disorders (CMDs) in LMICs. It tests whether adapting a psychological intervention to explicitly address IPV — and its recruitment, randomisation, implementation, follow-up and evaluation — is feasible and acceptable to perinatal women and health workers in rural Ethiopia.
Study aims
To review published evidence from studies of talking therapies delivered in LMICs — finding out whether women who report IPV respond better or worse than women who don’t report IPV to treatments for common mental health problems including depression, anxiety and PTSD
To interview women with experience of IPV and/or depression and healthcare workers about their perspectives, use the results to adapt a brief talking therapy to address women’s experiences of IPV in rural Ethiopia, and then test whether the adapted intervention is acceptable and practical to deliver
How the research will be carried out
Accepted for publication in The Lancet Psychiatry
21 interviews conducted at time of publication
Testing the adapted IPV-focused intervention against standard talking therapy and information-only control
How patients and the public are involved
The King’s College London Section of Women’s Mental Health Patient and Public Involvement group provided feedback on the research project prior to its commencement
A Community Advisory Board (CAB) comprising community members, government and healthcare workers based in Sodo, Ethiopia, participated in a Theory of Change workshop at the inception of the study in July 2017, and continues to be consulted at each stage of research progress and dissemination
A diverse group of healthcare workers (midwives, nurses and health extension workers) active in antenatal care participated in a Theory of Change workshop to refine the intervention in October 2018
As there are no community groups representing women experiencing IPV in this region, the experiences and perspectives of this group are being captured through qualitative interviews
How this research addresses the needs of people in south London
Although this research is focused on the needs of pregnant women living in rural Ethiopia, the research team believe it will provide important information relevant to pregnant women in south London. This is because:
IPV and depression are common in south London too
South London is a diverse region in which many pregnant women face cultural, language and educational barriers to receiving help for both their mental health and IPV
Brief, low-cost mental health interventions integrated into antenatal care that meet the needs of pregnant women experiencing IPV could be trialled in south London in future if found to be effective
Potential benefits of the project
This project will yield new meta-analytic, qualitative and feasibility study research results on IPV and perinatal mental health in LMICs. These outputs will form the foundations for a post-doctoral randomised controlled trial of the adapted intervention to investigate its efficacy, scalability and cost-effectiveness.
This work will benefit the primary healthcare sector in rural Ethiopia and the research community investigating IPV and perinatal mental health in LMICs. Longer term, the resulting intervention could be adapted for other settings, improving perinatal mental health in diverse contexts worldwide.
Funded by a King’s College London clinician investigator scholarship (Dr Roxanne Keynejad) and a Wellcome Trust DELTAS / AMARI postdoctoral fellowship (Dr Tesera Bitew), and a fellowship from the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa. Adopted by ARC South London November 2019. Completing October 2021.
Project leads
|
TB
Assistant professor (PhD) in mental health epidemiology, Addis Ababa University (AAU), Ethiopia |
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Maternity and perinatal mental health research at ARC South London
Original source: arc-sl.nihr.ac.uk — NIHR ARC South London legacy content archived May 2026.