Clinical Question

Are psychological therapies safe and effective for women who experience intimate partner violence (IPV)?

Evidence-Based Answer

Psychological therapies decrease depressive symptoms (standardized mean difference [SMD] = 0.24; 95% CI, 0.01 to 0.47) and anxiety symptoms (SMD = 0.96; 95% CI, 0.63 to 1.29). It is unclear if they improve self-efficacy (i.e., a belief in one's own ability to cope with challenging life situations), posttraumatic stress disorder symptoms, reexposure to IPV, or safety planning. No harmful effects were identified.¹ (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

IPV describes physical assault, sexual violence, psychological harm, or stalking by a current or former partner.² One in three women reports having been a victim of IPV at some time.¹ There is a higher incidence of depression, anxiety and phobias, posttraumatic stress disorder, and alcohol use disorder in women who have been abused by their partners.³

The authors of this analysis sought to determine whether psychological therapies benefit women who have experienced IPV.¹ They included 33 randomized controlled trials (RCTs) and quasi-RCTs, with a total of 5,517 women 16 years and older; the average age of participants was 37 years. Most trials were conducted in high-income countries, including the United States (58%). The participants were recruited from health care, community, shelter, or refugee settings and had a wide range of education levels, relationship statuses, and ethnic backgrounds. An exception was socioeconomic status; 66% of participants were unemployed.

The psychological therapies in the study groups were mostly delivered face-to-face by staff with varied levels of training. The length of treatment ranged from two to 50 sessions. Control groups received usual care, which involved no treatment or delayed or minimal intervention. Depression was quantified using the Beck Depression Inventory, Center for Epidemiologic Studies Short Depression Scale, and Patient Health Questionnaire. The authors also attempted to determine whether there was significant harm, as determined by participant dropouts at six to 12 months of follow-up. Secondary outcomes were symptoms of anxiety, quality of life, reexposure to IPV, safety planning and behaviors, use of health care and IPV services, and social support. Scales for anxiety included the Beck Anxiety Inventory; the State-Trait Anxiety Inventory; and the Depression, Anxiety, and Stress Scale. The primary outcomes were depression and self-efficacy.

Depressive symptoms were improved in those treated with psychological therapies compared with those in the control groups over six to 12 months (SMD = 0.24; 95% CI, 0.01 to 0.47; n = 600). The trials showed consistent results and had low risk of bias. Two other studies (n = 528) demonstrated that psychological therapies improve depressive symptoms at six to 12 months compared with the control groups.

The reported data showed no evidence that psychological therapies have an impact on self-efficacy. There were no noted differences in dropouts. Anxiety symptoms were also improved in those treated with psychological therapies delivered for up to six months compared with the control groups (SMD = 0.96; 95% CI, 0.63 to 1.29; n = 158).

No harmful effects were demonstrated in the intervention groups. This review was limited by the various types of interventions and the various study durations. Given these limits, there is reason to believe that further studies might alter the conclusions.

Current U.S. Preventive Services Task Force guidelines recommend that clinicians screen for IPV in women of reproductive age and, for those who screen positive, provide them with or refer them to ongoing support services.⁴

The practice recommendations in this activity are available at http://www.cochrane.org/CD013017.