Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial
Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial
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DOI：
10.1016/s0140-6736(13)60052-5
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发表时间：
2013-07-20
期刊：
影响因子：
168.9
通讯作者：
Gunn, Jane
中科院分区：
文献类型：
--
作者：
Hegarty, Kelsey;O'Doherty, Lorna;Gunn, Jane
背景 为帮助在医疗机构中筛查出亲密伴侣暴力 (IPV) 呈阳性的女性而采取干预措施的益处的证据有限。我们评估了接受过针对通过IPV筛查发现的女性的培训的家庭医生的简短咨询是否会提高女性的生活质量、安全计划和行为以及心理健康。方法在这项整群随机对照试验中，我们招募了来自澳大利亚维多利亚州诊所的家庭医生及其女性患者（年龄16-50岁），这些患者在过去12个月内因对伴侣的恐惧而在健康和生活方式调查中筛查呈阳性。研究干预措施包括以下内容：培训医生、通知医生因害怕伴侣而筛查呈阳性的女性，以及邀请女性参加一对六的关系和情感问题咨询。我们使用计算机生成的随机序列来分配医生进行控制（标准护理）或干预，根据每位医生的执业地点（城市与农村）进行分层，每个层内的随机排列块大小为 2 和 4。数据是通过邮政调查在基线以及邀请后 6 个月和 12 个月（2008-11）收集的。研究人员对治疗分配情况不知情，但参与试验的女性和医生则不然。主要结局是 12 个月时的生活质量（WHO 生活质量-BREF）、安全计划和行为、心理健康（SF-12）。次要结局包括抑郁和焦虑（医院焦虑和抑郁量表；截止值 >= 8）；妇女关于医生询问她们及其孩子的安全的报告；以及与医生讨论恐惧的舒适度（李克特五点量表）。分析是根据治疗意向进行的，考虑了缺失的数据，并且报告的估计值根据医生位置和基线结果评分进行了调整。该试验已在澳大利亚新西兰临床试验登记处注册，编号为 ACTRN12608000032358。 结果 我们将 52 名医生（以及 272 名符合纳入条件并返回基线调查的女性）随机分配到干预组（25 名医生，137 名女性）或对照组（27 名医生，135 名女性）。干预组 137 名女性（见 23 名医生）中的 96 名（70%）和对照组 135 名女性（见 26 名医生）中的 100 名（74%）完成了 12 个月的随访。我们在 12 个月时发现生活质量、安全计划和行为或心理健康 SF-12 没有差异。对于次要结局，我们发现 12 个月时的焦虑或 6 个月时讨论恐惧的舒适度没有组间差异，但与对照组相比，干预组在 12 个月时的抑郁情况有所改善（比值比 0.3, 0.1-0.7；p=0.005），6 个月时医生对女性安全性的询问也是如此（5.1, 1.9-14.0；p=0.002），儿童安全（5.5、1.6-19.0；p=0.008）。我们没有记录到任何不良事件。 解释 我们的研究结果可以为在初级保健机构中向披露亲密伴侣暴力的妇女提供简短咨询的进一步研究提供信息，但不支持使用邮寄筛查来识别这些患者。然而，我们建议家庭医生应该接受培训，询问妇女和儿童的安全，并为遭受虐待的妇女提供支持性咨询，因为我们的研究结果表明，尽管我们发现生活质量没有改善，但咨询可以减少抑郁症状。
Background Evidence for a benefit of interventions to help women who screen positive for intimate partner violence (IPV) in health-care settings is limited. We assessed whether brief counselling from family doctors trained to respond to women identified through IPV screening would increase women's quality of life, safety planning and behaviour, and mental health.Methods In this cluster randomised controlled trial, we enrolled family doctors from clinics in Victoria, Australia, and their female patients (aged 16-50 years) who screened positive for fear of a partner in past 12 months in a health and lifestyle survey. The study intervention consisted of the following: training of doctors, notification to doctors of women screening positive for fear of a partner, and invitation to women for one-to-six sessions of counselling for relationship and emotional issues. We used a computer-generated randomisation sequence to allocate doctors to control (standard care) or intervention, stratified by location of each doctor's practice (urban vs rural), with random permuted block sizes of two and four within each stratum. Data were collected by postal survey at baseline and at 6 months and 12 months post-invitation (2008-11). Researchers were masked to treatment allocation, but women and doctors enrolled into the trial were not. Primary outcomes were quality of life (WHO Quality of Life-BREF), safety planning and behaviour, mental health (SF-12) at 12 months. Secondary outcomes included depression and anxiety (Hospital Anxiety and Depression Scale; cut-off >= 8); women's report of an inquiry from their doctor about the safety of them and their children; and comfort to discuss fear with their doctor (five-point Likert scale). Analyses were by intention to treat, accounting for missing data, and estimates reported were adjusted for doctor location and outcome scores at baseline. This trial is registered with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358.Findings We randomly allocated 52 doctors (and 272 women who were eligible for inclusion and returned their baseline survey) to either intervention (25 doctors, 137 women) or control (27 doctors, 135 women). 96 (70%) of 137 women in the intervention group (seeing 23 doctors) and 100 (74%) of 135 women in the control group (seeing 26 doctors) completed 12 month follow-up. We detected no difference in quality of life, safety planning and behaviour, or mental health SF-12 at 12 months. For secondary outcomes, we detected no between-group difference in anxiety at 12 months or comfort to discuss fear at 6 months, but depressiveness caseness at 12 months was improved in the intervention group compared with the control group (odds ratio 0.3, 0.1-0.7; p=0.005), as was doctor enquiry at 6 months about women's safety (5.1, 1.9-14.0; p=0.002) and children's safety (5.5, 1.6-19.0; p=0.008). We recorded no adverse events.Interpretation Our findings can inform further research on brief counselling for women disclosing intimate partner violence in primary care settings, but do not lend support to the use of postal screening in the identification of those patients. However, we suggest that family doctors should be trained to ask about the safety of women and children, and to provide supportive counselling for women experiencing abuse, because our findings suggest that, although we detected no improvement in quality of life, counselling can reduce depressive symptoms.