An Integrated Intervention to Reduce Intimate Partner Violence in Pregnancy A Randomized Controlled Trial
An Integrated Intervention to Reduce Intimate Partner Violence in Pregnancy A Randomized Controlled Trial
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DOI：
10.1097/aog.0b013e3181cbd482
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发表时间：
2010-02-01
影响因子：
7.2
通讯作者：
Gantz, Marie G.
中科院分区：
文献类型：
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作者：
Kiely, Michele;El-Mohandes, Ayman A. E.;Gantz, Marie G.
目的：评估心理行为干预在减少非裔美国女性怀孕期间和产后亲密伴侣暴力复发以及改善分娩结局方面的功效。方法：我们开展了一项随机对照试验，招募了 1,044 名女性。妇女被随机分配接受干预（n=521）或常规护理（n=523）。个性化定制的咨询课程改编自针对亲密伴侣暴力和其他风险的循证干预措施。使用逻辑回归来模拟亲密伴侣暴力受害复发情况，并预测轻微、严重、身体和性亲密伴侣暴力。结果：随机分配到干预组的女性遭受亲密伴侣暴力受害复发的可能性较小（比值比 [OR] 0.48，95% 置信区间 [CI] 0.29-0.80）。遭受轻微亲密伴侣暴力的女性在怀孕期间（OR 0.48，95% CI 0.26-0.86，OR 0.53，95% CI 0.28-0.99）和产后（OR 0.56，95% CI 0.34-0.93）经历进一步发作的可能性显着降低。与常规护理组相比，需要治疗的人数分别为 17、12 和 22。遭受严重亲密伴侣暴力的女性产后发作次数显着减少（OR 0.39，95% CI 0.18-0.82）；需要治疗的人数为 27 人。经历过亲密伴侣身体暴力的女性在第一次随访（OR 0.49，95% CI 0.27-0.91）和产后（OR 0.47，95% CI 0.27-0.82）时表现出显着减少；需要治疗的人数分别为18人和20人。干预组中妇女的极早产新生儿显着减少（干预组为 1.5%，常规护理组为 6.6%；P=.03），平均孕龄增加（干预组为 38.2+/-3.3，常规护理组为 36.9+/-5.9；P=.016）。 结论：妊娠期间相对短暂的干预对亲密伴侣暴力和妊娠结局具有明显影响。强烈建议筛查亲密伴侣暴力以及其他社会心理和行为风险，并在产前护理中纳入类似的干预措施。
OBJECTIVE: To estimate the efficacy of a psycho-behavioral intervention in reducing intimate partner violence recurrence during pregnancy and postpartum and in improving birth outcomes in African-American women.METHODS: We conducted a randomized controlled trial for which 1,044 women were recruited. Women were randomly assigned to receive either intervention (n=521) or usual care (n=523). Individually tailored counseling sessions were adapted from evidence-based interventions for intimate partner violence and other risks. Logistic regression was used to model intimate partner violence victimization recurrence and to predict minor, severe, physical, and sexual intimate partner violence.RESULTS: Women randomly assigned to the intervention group were less likely to have recurrent episodes of intimate partner violence victimization (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.29-0.80). Women with minor intimate partner violence were significantly less likely to experience further episodes during pregnancy (OR 0.48, 95% CI 0.26-0.86, OR 0.53, 95% CI 0.28-0.99) and postpartum (OR 0.56, 95% CI 0.34-0.93). Numbers needed to treat were 17, 12, and 22, respectively, as compared with the usual care group. Women with severe intimate partner violence showed significantly reduced episodes postpartum (OR 0.39, 95% CI 0.18-0.82); the number needed to treat was 27. Women who experienced physical intimate partner violence showed significant reduction at the first follow-up (OR 0.49,95% CI 0.27-0.91) and postpartum (OR 0.47,95% CI 0.27-0.82); the numbers needed to treat were 18 and 20 respectively. Women in the intervention group had significantly fewer very preterm neonates (1.5% intervention group, 6.6% usual care group; P=.03) and an increased mean gestational age (38.2+/-3.3 intervention group, 36.9+/-5.9 usual care group; P=.016).CONCLUSION: A relatively brief intervention during pregnancy had discernible effects on intimate partner violence and pregnancy outcomes. Screening for intimate partner violence as well as other psychosocial and behavioral risks and incorporating similar interventions in prenatal care is strongly recommended.