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Violence against women in resource-limited settings: A WHO behavioral intervention

PLOS

A randomized controlled trial has shown that a brief behavioral treatment delivered by community lay workers significantly reduced psychological distress in women exposed to gender-based violence. In a study published in PLOS Medicine, Richard A. Bryant of the University of New South Wales, Australia, and colleagues tested the five-session intervention on 421 women in Kenya.

Gender-based violence, which includes actual or threatened sexual or nonsexual violence committed by an intimate partner or others, has been experienced by more than a third of women worldwide. Its adverse impacts on physical and mental health make it a global health issue. The World Health Organization has developed Problem Management Plus (PM+) as a brief 5-session intervention to treat people experiencing psychological distress following adversity. Because lay community health workers can be trained to deliver PM+, it is particularly applicable in resource-limited settings.

This study, in a peri-urban area of Nairobi, Kenya, randomly assigned 421 women who displayed distress and impaired functioning to receive either 5 individual sessions of PM+ or enhanced usual care (EUC). The primary outcome was psychological distress as measured by total score on the 12-item General Health Questionnaire (GHQ-12) assessed at 3 months after treatment. Assessments by investigators who were blind to the treatment assignment indicated that women who received PM+ reported significantly less psychological distress, with a moderate effect relative to EUC. The difference between PM+ and EUC in the change from baseline to 3 months on the GHQ-12 was 3.33 (95% CI 1.86 - 4.79, P = 0.001) in favour of PM+.

Further study is needed to evaluate the sustainability of PM+ in the community so that survivors of gender-based violence can be safely identified and treated without stigma. Limitations of the study include no long-term follow-up and a reliance on self-report rather than structured interview data. The PM+ manual is available for dissemination at the WHO website.

In an accompanying Perspective, Alexander C. Tsai of Harvard Medical School, USA, says: "The potential widespread deployment of PM+ stands at the intersection of two vital issues relevant to women's health: mental health and interpersonal violence. Until the large-scale structural forces that give rise to health disparities affecting vulnerable populations can be eliminated ... the health system will continue to play a key role in the multisectoral response to violence against women in resource-limited settings."

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Research Article

Funding:

This study was supported by Grand Challenges Canada #0368-04 to JU & AS, World Vision Canada to JU, and World Vision Australia to AS. 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.

Citation:

Bryant RA, Schafer A, Dawson KS, Anjuri D, Mulili C, Ndogoni L, et al. (2017) Effectiveness of a brief behavioural intervention on psychological distress among women with a history of gender-based violence in urban Kenya: A randomised clinical trial. PLoS Med 14(8): e1002371. https://doi.org/10.1371/journal.pmed.1002371

Author Affiliations:

School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
Westmead Institute for Medical Research, Sydney, New South Wales, Australia
World Vision International, Monrovia, California, United States of America
World Vision Kenya, Nairobi, Kenya
Psychosocial Support Centre, Nairobi, Kenya
Vrije Universiteit, Amsterdam, Netherlands
World Vision Canada, Mississauga, Ontario, Canada
Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002371

Perspective Article

Funding:

No specific funding was received to support the writing of this Perspective. ACT acknowledges salary support through US National Institutes of Health K23MH096620. The funder had no role in the decision to publish or the preparation of the manuscript.

Competing Interests:

ACT receives a stipend as a specialty consulting editor for PLOS Medicine and serves on the journal's editorial board.

Citation:

Tsai AC (2017) Lay worker-administered behavioral treatments for psychological distress in resource-limited settings: Time to move from evidence to practice? PLoS Med 14(8): e1002372. https://doi.org/10.1371/journal.pmed.1002372

Author Affiliations:

Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston,
Massachusetts, United States of America
Harvard Medical School, Boston, Massachusetts, United States of America
Mbarara University of Science and Technology, Mbarara, Uganda
MGH Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002372

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