Can mental health treatments help prevent or reduce intimate partner violence in low- and middle-income countries? A systematic review

Abstract

Background 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). Methods We conducted a systematic review to identify prospective, controlled studies of mental health treatments in LMIC. We defined ‘mental health treatment’ as an intervention for individuals experiencing mental ill health (including substance misuse) including a substantial psychosocial or pharmacological component. Studies had to measure a mental health and IPV outcome. We searched across multi-disciplinary databases using a structured search strategy. Screening of title/abstracts and full-text eligibility assessments were conducted by two researchers independently, data were extracted using a piloted spreadsheet, and a narrative synthesis was generated. Results 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. The other three studies evaluated integrated interventions, in which a focus on substance misuse was part of efforts to reduce HIV/AIDS and violence against particularly vulnerable women. 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. Conclusions 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. Electronic supplementary material The online version of this article (10.1186/s12905-019-0728-z) contains supplementary material, which is available to authorized users.

An intimate partner violence prevention intervention for men, women, and couples in Ethiopia: Additional findings on substance use and depressive symptoms from a cluster-randomized controlled trial

“…For example, a trial currently underway in Congolese refugee camps in Tanzania seeks to evaluate an IPV intervention that integrates advocacy and structured psychosocial support; the authors argue that integrating this psychosocial support may render the preventive intervention more effective, vis-à-vis an intervention that focuses solely on advocacy [ 60 ]. Other recent literature has highlighted the limited evidence base around the effects of mental health interventions on the prevention and reduction of IPV [ 61 ], suggesting the potential importance of further exploring the role of targeted interventions addressing the nexus between IPV and mental health.…”

Alcohol use, depressive symptoms, and intimate partner violence perpetration: A longitudinal analysis among men with HIV in northern Vietnam

“…Systematic reviews have found that mental health treatments for common mental disorders and for alcohol misuse could effectively reduce IPV [ 75 , 76 ]. However, there is limited research on the impact of mental health treatment targeting depression on IPV perpetration instead of IPV victimization [ 75 ]. Further, there is limited evidence demonstrating the effectiveness of mental health interventions on IPV perpetration in low- and middle-income settings [ 75 , 76 ].…”

“…Alternatively, men with HIV who are concurrently using alcohol and experiencing depressive symptoms may have fatigue or reduced energy, decreasing risk of alcohol-related IPV perpetration. Previous mental health interventions aiming to reduce IPV perpetration have either targeted participants who misuse alcohol or those who screen positive for depressive symptoms [ 75 ]. This study suggests that mental health interventions for men with HIV should target both groups—those who screen positive for hazardous drinking or depressive symptoms—to effectively reduce IPV perpetration.…”

“…Incorporating mental health services addressing depression and alcohol misuse into HIV care and treatment may reduce depression, alcohol use, and IPV perpetration among men with HIV. Systematic reviews have found that mental health treatments for common mental disorders and for alcohol misuse could effectively reduce IPV [75,76]. However, there is limited research on the impact of mental health treatment targeting depression on IPV perpetration instead of IPV victimization [75].…”

“…However, there is limited research on the impact of mental health treatment targeting depression on IPV perpetration instead of IPV victimization [75]. Further, there is limited evidence demonstrating the effectiveness of mental health interventions on IPV perpetration in low-and middleincome settings [75,76]. A large proportion of the participants currently or previously injected drugs because the HIV epidemic in Vietnam is largely driven by injection drug use [44,77].…”