Treating Common Mental Disorders in Women in Mozambique by Addressing Intimate Partner Violence in Couples

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Intimate partner violence (IPV), a potent risk factor for depression, anxiety, and Post-traumatic Stress Disorder (common mental disorders; CMDs), is a devastating public health problem with the highest rates occurring in sub-Saharan Africa. Mental health interventions that aim to reduce IPV often fail to include men, which could be addressed by treatment in a couple modality. Yet, couple-based treatments often exclude couples who are living with IPV. The goal of this K23 Award is to expand the candidate’s skillset and prepare her to conduct independent research on couple-based mental health interventions for CMDs that address social determinants, such as IPV, to improve mental health outcomes and sustainability of gains. The proposed training program involves mentorship from leading experts, coursework and workshops, attending and presenting at scientific conferences, and developing collaborative manuscripts for publication to develop competency in (1) engagement and mental health treatment of men; (2) adaptation of an evidence-based treatment for CMDs to address IPV in couples; (3) methods and analyses of randomized controlled trials for couples; and (4) skills for a successful career as an independent investigator. These training goals and activities will align with the aims of a research study in Mozambique, one of the poorest countries in the world with a significant mental health treatment gap. Half of women in Mozambique endorsed being exposed to IPV in the past year, and there are high prevalence rates of CMDs. The candidate is Project Director of PRIDE (Partnerships in Research to Implement and Disseminate Sustainable and Scalable EBPs, U19MH113203), a collaborative project with the Mozambique Ministry of Health that is scaling- up comprehensive mental health care across a province using Interpersonal Counseling (IPC) to treat CMDs. Scale-up, however, has not considered the coordinated treatment of CMDs and the co-occurring problem of IPV among couples. The overall goal of the research plan is to investigate the feasibility of reducing CMDs in women through a couple-based treatment that addresses CMDs and situational IPV (discord between intimate partners that escalates to physical violence). This study has three specific aims. The first aim is to identify gender roles including local contextual influences relevant to engaging men in couple-based treatment of IPV in public MH care. The second aim is to adapt IPC-C to reduce CMDs in female partners through resolution of IPV and improvement of couple functioning. The third aim is to determine acceptability and feasibility of using Interpersonal Counseling for Couples (IPC-C) to reduce CMDs in women and IPV in couples. This study has applicability for low-resource populations internationally and the US that experience couple-based violence and a mental health treatment gap. With its focus on intimate partners, the intervention also has the potential to benefit health and wellbeing of children.