Abstract
BackgroundLiving in conditions of chronic adversity renders many women more vulnerable to experiencing gender-based violence (GBV). In addition to GBV’s physical and social consequences, the psychological effects can be pervasive. Access to evidence-based psychological interventions that seek to support the mental health of women affected by such adversity is rare in low- and middle-income countries.MethodsThe current study evaluates a brief evidence-informed psychological intervention developed by the World Health Organization for adults impacted by adversity (Problem Management Plus; PM+). A feasibility randomised control trial (RCT) was conducted to inform a fully powered trial. Community health workers delivered the intervention to 70 women residing in three peri-urban settings in Nairobi, Kenya. Women, among whom 80% were survivors of GBV (N = 56), were randomised to receive five sessions of either PM+ (n = 35) by community health workers or enhanced treatment as usual (ETAU; n = 35).ResultsPM+ was not associated with any adverse events. Although the study was not powered to identify effects and accordingly did not identify effects on the primary outcome measure of general psychological distress, women survivors of adversity, including GBV, who received PM+ displayed greater reductions in posttraumatic stress disorder symptoms following treatment than those receiving ETAU.ConclusionsThis feasibility study suggests that PM+ delivered by lay health workers is an acceptable and safe intervention to reach women experiencing common mental disorders and be inclusive for those affected by GBV and can be studied in a RCT in this setting. The study sets the stage for a fully powered, definitive controlled trial to assess this potentially effective intervention.Trial registration ACTRN12614001291673, 10/12/2014, retrospectively registered during the recruitment phase.
Highlights
Living in conditions of chronic adversity renders many women more vulnerable to experiencing gender-based violence (GBV)
The study was not powered to detect clinically significant differences on outcome measures, the findings revealed that PM+ had the potential to improve mental health, a reduction in Posttraumatic stress disorder (PTSD) symptoms for women affected by adversity, including GBV
The enduring mental health impact of urban adversity and GBV is a global health concern that has been the focus of substantial commentary in the last two decades
Summary
Living in conditions of chronic adversity renders many women more vulnerable to experiencing gender-based violence (GBV). Common mental disorders contribute significantly to the global disease burden [1] This is true in lowand middle-income countries (LMICs), where exposure to adverse living conditions, such as living in slums and chronic poverty, is high. Residing in such settings makes people vulnerable to experiencing risk factors for common mental disorders, as well as gender-based violence (GBV). According to a global review by the World Health Organization (WHO), 35% of women worldwide report having experienced physical and/or sexual intimate partner violence or non-partner sexual violence [2]. The rates of different forms of violence in slums within Nairobi can be expected to be higher as having a low-income increases the risk of violence among Kenyan women [3]
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