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
Autoři:
Jessica Leight aff001; Negussie Deyessa aff002; Fabio Verani aff004; Samuel Tewolde aff005; Vandana Sharma aff006
Působiště autorů:
International Food Policy Research Institute, Washington, DC, United States of America
aff001; Ethiopian Public Health Association, Addis Ababa, Ethiopia
aff002; Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
aff003; CARE, New York, United States of America
aff004; EngenderHealth, Addis Ababa, Ethiopia
aff005; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
aff006
Vyšlo v časopise:
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. PLoS Med 17(8): e32767. doi:10.1371/journal.pmed.1003131
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pmed.1003131
Souhrn
Background
Intimate partner violence (IPV) is linked to substance use by male perpetrators and is associated with an increased risk of depression for women who experience violence. Unite for a Better Life (UBL) is a gender-transformative intervention delivered to men, women, and couples in Ethiopia; previous evidence demonstrated the intervention significantly reduced experience of and perpetration of IPV when delivered to men and led to more equitable household task-sharing when delivered to men and couples. The aim of this analysis is to assess engagement in the UBL intervention and to examine the relationship between random assignment to the intervention and men’s past-year substance use and women’s reported depressive symptoms as measured at the individual level.
Methods and findings
A sample of 64 villages in Gurague zone, Ethiopia, was randomly allocated to 4 arms (men’s UBL, women’s UBL, couples’ UBL, or control). In each village, 106 households were randomly sampled, and households in the intervention arms were invited to participate in UBL, consisting of 14 sessions delivered by trained facilitators. Households in the control arm were offered a short educational session on IPV. Descriptive data on participant engagement in the intervention are reported, and outcomes assessed in an intention-to-treat (ITT) analysis include male use of substances (alcohol and khat) and women’s depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9). Results from both adjusted and unadjusted specifications are reported, the latter adjusting for baseline covariates including age, education level, marriage length, polygamy, socioeconomic status, months between intervention and endline, and the baseline level of the outcome variable. The baseline sample includes 6,770 respondents surveyed in 2014–2015, and follow-up data were available from 88% of baseline respondents surveyed in 2017–2018; the majority of respondents report no education, and 61% are Muslim. Respondents reported high attendance rates and engagement in the intervention. In addition, there was evidence of a significant reduction in frequent past-year alcohol intoxication self-reported by men (adjusted odds ratio [AOR] = 0.56, 95% CI 0.36–0.85, p = 0.007), and a significant increase in the probability of frequent khat use self-reported by men (AOR = 3.09, 95% CI 1.37–6.96, p = 0.007), both observed in the couples’ UBL arm at 24 months’ follow-up relative to the control arm. There was a significant increase in symptoms of moderate depression among women in the women’s UBL arm only (AOR = 1.65, 95% CI 1.13–2.41, p = 0.010), again relative to the control arm. There was no evidence of shifts in symptoms of mild or severe depression. The primary limitation of this study is the reliance on self-reported data around sensitive behaviors.
Conclusions
The findings suggest that the UBL intervention was associated with a reduction in men’s use of alcohol when delivered to couples, but there was no evidence of a decrease in reported symptoms of depression among women in any experimental arm, and some evidence of an increase in symptoms of moderate depression in the women’s UBL arm. Further research should explore how to optimize IPV prevention interventions to target related risks of mental health and substance use.
Trial registration
Clinicaltrials.gov NCT02311699; Socialscienceregistry.org AEARCTR-0000211.
Klíčová slova:
Alcohol consumption – Depression – Ethiopia – Intimate partner violence – Intoxication – Khat – Medical risk factors – Mental health and psychiatry
Zdroje
1. Campbell JC. Health consequences of intimate partner violence. Lancet. 2002;359: 1331–36. doi: 10.1016/S0140-6736(02)08336-8 11965295
2. Garcia-Moreno C, Jansen HA, Ellsberg M, Heise L, Watts CH. WHO Multi-Country Study on Women’s Health and Domestic Violence against Women. Geneva: World Health Organization; 2005.
3. Abramsky T, Watts CH, Garcia-Moreno C, Devries K, Kiss L, Ellsberg M, et al. What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women’s health and domestic violence. BMC Public Health. 2011;11:109. doi: 10.1186/1471-2458-11-109 21324186
4. Jewkes R. Intimate partner violence: Causes and prevention. Lancet. 2002;359: 1423–1429. doi: 10.1016/S0140-6736(02)08357-5 11978358
5. Leonard K. Alcohol and intimate partner violence: when can we say that heavy drinking is a contributing cause of violence? Addiction. 2005;100:422–425. doi: 10.1111/j.1360-0443.2005.00994.x 15784050
6. Langenderfer L. Alcohol use among partner violent adults: reviewing recent literature to inform intervention. Aggress Violent Behav. 2013;18:152–128.
7. Devries KM, Child JC, Bacchus LJ, Mak J, Falder G, Graham K, et al. Intimate partner violence victimization and alcohol consumption in women: a systematic review and meta-analysis. Addiction. 2014;109:379–391. doi: 10.1111/add.12393 24329907
8. Al-Hebshi NN, Skaug N. Khat (Catha edulis)–an updated review. Addict Biol. 2005;10:299–307. doi: 10.1080/13556210500353020 16318950
9. Gebissa E. Scourge of life or an economic lifeline? Public discourses on khat (Catha edulis) in Ethiopia. Subst Use Misuse. 2008;43:784–802. doi: 10.1080/10826080701738950 18473222
10. Feseha G, G/Mariam A, Gerbaba M. Intimate partner violence among women in Shimelba refugee camp, northern Ethiopia. BMC Public Health. 2012;12:125. doi: 10.1186/1471-2458-12-125 22340756
11. Lencha B, Ameya G, Baresa G, Minda Z, Ganfure G. Intimate partner violence and its associated factors among pregnant women in Bale Zone, Southeast Ethiopia: A cross-sectional study. PloS ONE. 2019;14:e0214962. doi: 10.1371/journal.pone.0214962 31042713
12. Karamagi CAS, Tumwine JK, Tylleskar T, Heggenhougen K. Intimate partner violence against women in eastern Uganda: implications for HIV prevention. BMC Public Health. 2006;6:284. doi: 10.1186/1471-2458-6-284 17116252
13. Arnold D, Gelaye B, Goshu M, Beryane Y, Williams M. Prevalence and risk factors of gender-based violence among female college students in Awassa, Ethiopia. Violence Vict. 2008;23:787–800. doi: 10.1891/0886-6708.23.6.787 19069568
14. Bekele T, Kas M, Gebremariam A, Deressa W. Sexual violence and associated factors among female students of Madawalabu University in Ethiopia. Epidemiology (Sunnyvale). 2015;5:190.
15. Gelaye B, Philpart M, Goshu M, Berhane Y, Fitzpatrick AL, Williams MA. Anger expression, negative life events and violent behaviour among male college students in Ethiopia. Scand J Public Health. 2008;36:538–545. doi: 10.1177/1403494807086916 18635735
16. Wirtz AL, Perrin NA, Desgroppes A, Phipps V, Abdi AA, Ross B, et al. Lifetime prevalence, correlates and health consequences of gender-based violence victimisation and perpetration among men and women in Somalia. BMJ Glob Health. 2018;3:e000773. doi: 10.1136/bmjgh-2018-000773 30105094
17. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, et al. Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ. 2008;337:a506. doi: 10.1136/bmj.a506 18687720
18. Gibbs A, Washington L, Abdelatif N, Chirwa E, Willan S, Shai N, et al. Stepping Stones and Creating Futures intervention to prevent intimate partner violence among young people: Cluster randomized controlled trial. J Adolesc Health. 2020;66:323–335. doi: 10.1016/j.jadohealth.2019.10.004 31784410
19. Saggurti N, Nair S, Silverman JG, Naik DD, Battala M, Dasgupta A, et al. Impact of the RHANI Wives intervention on marital conflict and sexual coercion. Int J Gynaecol Obstet. 2014;126:18–22. doi: 10.1016/j.ijgo.2014.01.015 24795094
20. Parcesepe A, L’Engle KL, Martin SL, Green S, Sinkele W, Suchindran C, et al. The impact of an alcohol harm reduction intervention on interpersonal violence and engagement in sex work among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial. Drug Alcohol Depend. 2016;161:21–28. doi: 10.1016/j.drugalcdep.2015.12.037 26872880
21. Heise L, Ellsberg M, Gottmoeller M. A global overview of gender-based violence. Int J Gynaecol Obstet. 2002;78(Suppl. 1):S5–S14.
22. Oram S, Khalifeh H, Howard LM. Violence against women and mental health. Lancet Psychiatry. 2016;4:159–70. doi: 10.1016/S2215-0366(16)30261-9 27856393
23. Ellsberg M, Jansen HAFM, Heise L, Watts CH, Garcia-Moreno C. Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study. Lancet. 2008;37: 1165–1172.
24. Bacchus LJ, Ranganathan M, Watts C, Devries K. Recent intimate partner violence against women and health: a systematic review and meta-analysis of cohort studies. BMJ Open. 2018;8:e019995. doi: 10.1136/bmjopen-2017-019995 30056376
25. Devries KM, Mak JY, Bacchus LJ, Child JC, Falder G, Petzold M, et al. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. Plos Med. 2013;10: e1001439. doi: 10.1371/journal.pmed.1001439 23671407
26. Coker AL, Smith PH, Thompson MP, McKeown RE, Bethea L, Davis KE. Social support protects against the negative effects of partner violence on mental health. J Womens Health Gend Based Med. 2002;11:465–76. doi: 10.1089/15246090260137644 12165164
27. Mburia-Mwalili A, Clements-Nolle K, Lee W, Shadley M, Yang W. Intimate partner violence and depression in a population-based sample of women: Can social support help? J Interpers Violence. 2010;25:2258–78. doi: 10.1177/0886260509354879 20051589
28. Bourey C, Williams W, Bernstein EE, Stephenson R. Systematic review of structural interventions for intimate partner violence in low- and middle-income countries: organizing evidence for prevention. BMC Public Health. 2015;15: 1165. doi: 10.1186/s12889-015-2460-4 26597715
29. Deda Ogum A, Addo-Lartey AA, Chirwa ED, Sikweyiya Y, Coker-Appiah D, Jewkes R, et al. Evaluation of the rural response system intervention to prevent violence against women: findings from a community randomised controlled trial in the Central Region of Ghana. Glob Health Action. 2020;13:1711336. doi: 10.1080/16549716.2019.1711336 31935166
30. Sharma V, Leight J, Verani F, Tewolde S, Deyessa N. Effectiveness of a culturally appropriate intervention to prevent intimate partner violence and HIV transmission among men, women, and couples in rural Ethiopia: Findings from a cluster-randomized controlled trial. PLoS Med. 2020;17(8): e1003274 doi: 10.1371/journal.pmed.1003274
31. Central Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF; 2016.
32. Deyessa N, Berhana Y, Alem A, Ellsberg M, Emmelin M, Hogberg U, et al. Intimate partner violence and depression among women in rural Ethiopia: a cross-sectional study. Clin Pract Epidemiol Mental Health. 2009;5:8.
33. World Health Organization. Putting women first: ethical and safety recommendations for research on domestic violence against women. Geneva: WHO; 2001.
34. Gelaye B, Williams M, Seblewengel L, Deyessa N, Bahretibeb Y, Shibre T, et al. Validity of the patient health questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013;210:653–661. doi: 10.1016/j.psychres.2013.07.015 23972787
35. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x 11556941
36. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.
37. Pronyk P, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C, et al. Effect of a structural intervention for the prevention of intimate partner violence and HIV in rural South Africa: a cluster randomized trial. Lancet. 2006;368:1973–83. doi: 10.1016/S0140-6736(06)69744-4 17141704
38. Hossain M, Zimmerman C, Kiss L, Abramasky T, Kone D, Bakayoko-Topolska M, et al. Working with men to prevent intimate partner violence in a conflict-affected setting: A pilot cluster randomized controlled trial in rural Cote d’Ivoire. BMC Public Health. 2014;14:339. doi: 10.1186/1471-2458-14-339 24716478
39. Gupta J, Falb JL, Lehmann H, Kpebo D, Xuan Z, Hossain M, et al. Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Côte d’Ivoire: a randomized controlled pilot study. BMC Int Health Human Rights. 2013;13:46.
40. Abramsky T, Devries K, Kiss L, Nakuti J, Kyegombe N, Starmann E, et al. Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Med. 2014;12:122. doi: 10.1186/s12916-014-0122-5 25248996
41. Doyle K, Levtov RG, Barker G, Bastian GG, Bingenheimer JB, Kazimbaya S, et al. Gender-transformative Bandebereho couples' intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: Findings from a randomized controlled trial. PLoS ONE. 2018;13:e0192756. doi: 10.1371/journal.pone.0192756 29617375
42. Hunt M, Auriemma J, Cashaw AC. Self-report bias and underreporting of depression on the BDI-II. J Pers Assess. 2003;80:26–30. doi: 10.1207/S15327752JPA8001_10 12584064
43. Rodrigues M, Patel V, Jaswal S, de Souza N. Listening to mothers: Qualitative studies on motherhood and depression from Goa, India. Soc Sci Med. 2003;57:1797–1806. doi: 10.1016/s0277-9536(03)00062-5 14499506
44. Ugarriza DN. Group therapy and its barriers for women suffering from postpartum depression. Arch Psychiatr Nurs. 2004;18:39–48. doi: 10.1053/j.apnu.2004.01.002 15106134
45. De PK, Murshid NS. Associations of intimate partner violence with screening for mental health disorders among women in urban Bangladesh. Int J Public Health. 2018;63:913–921. doi: 10.1007/s00038-018-1139-x 29974130
46. Soboka M., Tesfaye M, Feyissa GT, Hanlon C. Alcohol use disorders and associated factors among people living with HIV who are attending services in south west Ethiopia. BMC Res Notes. 2014;7:828. doi: 10.1186/1756-0500-7-828 25417542
47. Teferra S, Medhin G, Selamu M, Bhana A, Hanlon C, Fekadu A. Hazardous alcohol use and associated factors in a rural Ethiopian district: a cross-sectional community survey. BMC Public Health. 2016;16:218. doi: 10.1186/s12889-016-2911-6 26940221
48. Zewdu S, Hanlon C, Fekadu A, Medhin G, Solomon T. Treatment gap, help-seeking, stigma and magnitude of alcohol use disorder in rural Ethiopia. Subst Abuse Treat Prev Policy. 2019;14:4. doi: 10.1186/s13011-019-0192-7 30658659
49. Molla GL, Sebhat HM, Hussen ZN, Mekonen AB, Mersha WF, Yimers TM. Depression among Ethiopian adults: cross-sectional study. Psychiatry J. 2016.
50. Bitew T, Hanlon C, Kebede E, Medhin G, Fekadu A. Antenatal depressive symptoms and maternal health care utilization: a population-based study of pregnant women in Ethiopia. BMC Pregnancy Childbirth. 2016;16: 301. doi: 10.1186/s12884-016-1099-1 27724876
51. Hailemariam S, Tessema F, Asefa M, Tadeese H, Tenkolo G. The prevalence of depression and associated factors in Ethiopia: findings from the National Health Survey. Int J Ment Health Syst. 2012;6: 23. doi: 10.1186/1752-4458-6-23 23098320
52. Hussien G, Tesfaye M, Hiko D, Fekadu H. Assessment of prevalence and risk factors of depression among adults in Gilgel Gibe Field Research Center, South West Ethiopia. J Depress Anxiety. 2017;6: 260.
53. Bitew T. Prevalence and risk factors of depression in Ethiopia: A review. Ethiop J Health Sci. 2014;24:2.
54. Sweetland AC, Belkin GS, Verdeli H. Measuring depression and anxiety in sub-saharan Africa. Depress Anxiety. 2014;31:223–232. doi: 10.1002/da.22142 23780834
55. Kane JC, Murray SM, Vinikoor MJ, Greene MC, Fine SL, Paul R, et al. Concordance of self‐ and partner‐reported alcohol consumption among couples experiencing intimate partner violence in Zambia. Alcohol Clin Exp Res. 2019;43:2568–2577. doi: 10.1111/acer.14205 31557344
56. Kadden RM, Litt MD, Kabela-Cormier E, Petry NM. Increased drinking in a trial of treatments for marijuana dependence: substance substitution? Drug Alcohol Depend. 2009;105:168–71. doi: 10.1016/j.drugalcdep.2009.05.024 19608353
57. Reiman A. Cannabis as a substitute for alcohol and other drugs. Harm Reduct J. 2009;6:35. doi: 10.1186/1477-7517-6-35 19958538
58. Copersino ML, Boyd SJ, Tashkin DP, Huestis MA, Heishman SJ, Dermand JC, et al. Quitting among non‐treatment‐seeking marijuana users: reasons and changes in other substance use. Am J Addict. 2006;15:297–302. doi: 10.1080/10550490600754341 16867925
59. Jeffrey DB. Treatment evaluation issues in research on addictive behaviors. Addict Behav. 1975;1:23–36. doi: 10.1016/s0306-4603(75)80015-3 826130
60. Tol W, Greene MG, Likindikoki S, Misinzo L, Ventevogel P, Bonz AG, et al. An integrated intervention to reduce intimate partner violence and psychological distress with refugees in low-resource settings: study protocol for the Nguvu cluster randomized trial. BMC Psychiatry. 2017;17:186. doi: 10.1186/s12888-017-1338-7 28521751
61. Tol WA, Murray SM, Lund C, Bolton P, Murray LK, Davies T, et al. Can mental health treatments help prevent or reduce intimate partner violence in low and middle-income countries? A systematic review. BMC Womens Health. 2019;19:34. doi: 10.1186/s12905-019-0728-z 30764813
Článek vyšel v časopise
PLOS Medicine
2020 Číslo 8
- S diagnostikou Parkinsonovy nemoci může nově pomoci AI nástroj pro hodnocení mrkacího reflexu
- Proč při poslechu některé muziky prostě musíme tančit?
- Chůze do schodů pomáhá prodloužit život a vyhnout se srdečním chorobám
- „Jednohubky“ z klinického výzkumu – 2024/44
- Je libo čepici místo mozkového implantátu?
Nejčtenější v tomto čísle
- Social distancing to slow the US COVID-19 epidemic: Longitudinal pretest–posttest comparison group study
- Coming together to improve access to medicines: The genesis of the East African Community’s Medicines Regulatory Harmonization initiative
- Age and the association between apolipoprotein E genotype and Alzheimer disease: A cerebrospinal fluid biomarker–based case–control study
- A clinical algorithm for same-day HIV treatment initiation in settings with high TB symptom prevalence in South Africa: The SLATE II individually randomized clinical trial
