Interventions for intimate partner violence – Authors' reply

Abstract

The WEAVE study assessed the effectiveness of family doctors providing brief counselling for women exposed to intimate partner violence.1Hegarty K O'Doherty L Taft A et al.Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial.Lancet. 2013; 382: 249-258Summary Full Text Full Text PDF PubMed Scopus (154) Google Scholar Importantly, no case-control differences were shown for any of the three primary outcomes of quality of life, safety planning, and mental health. Therefore, it is reasonable to conclude that there is no empirical evidence to support the effectiveness of counselling by family doctors to address the core problems faced by women experiencing intimate partner violence, which is the the point that we and others have made in previous Correspondence.2Rees S Silove D Why primary health-care interventions for intimate partner violence do not work.Lancet. 2014; 384: 229Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 3Jewkes R Intimate partner violence: the end of routine screening.Lancet. 2013; 382: 190-191Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar Kelsey Hegarty and colleagues confound this important message by referring to studies that differ fundamentally from WEAVE.1Hegarty K O'Doherty L Taft A et al.Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial.Lancet. 2013; 382: 249-258Summary Full Text Full Text PDF PubMed Scopus (154) Google Scholar Specifically, they refer to the success of the IRIS study, which focused solely on training doctors to detect and refer women experiencing intimate partner violence to specialist services.4Feder G Davies RA Baird K et al.Identification and Referral to Improve Safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: a cluster randomised controlled trial.Lancet. 2011; 378: 1788-1795Summary Full Text Full Text PDF PubMed Scopus (221) Google Scholar In addition, they refer to a meta-analysis that showed positive effects for interventions by non-medical professionals who commonly referred women to specialist services.5Bair-Merritt MH Lewis-O'Connor A Goel S et al.Primary care—based interventions for intimate partner violence: a systematic review.Am J Prev Med. 2014; 46: 188-194Summary Full Text Full Text PDF PubMed Scopus (126) Google Scholar These studies provide no evidence to support family doctors playing a central part as counsellors to address intimate partner violence; instead, the evidence they offer underscores the importance of specialist community services in providing comprehensive assistance for women experiencing intimate partner violence.2Rees S Silove D Why primary health-care interventions for intimate partner violence do not work.Lancet. 2014; 384: 229Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar It is always risky to resort to secondary measures when primary outcomes of randomised controlled trials do not show any effects. The authors claim that WEAVE had a beneficial effect on the secondary outcome of depression. Self-report questionnaires of depression such as the Hospital Anxiety and Depression Scale (HADS) tend to be oversensitive, detecting mild and transient cases that can fluctuate over time, raising doubts about the clinical significance of the slight difference in depression in the intervention group (46% at baseline, 41% at 12 months). Also of concern is that the primary mental health measure, the Short-Form (SF)-12, which is a robust proxy measure of depression, showed no change.6Vilagut G Forero CG Pinto-Meza A et al.The mental component of the Short-Form 12 Health Survey (SF-12) as a measure of depressive disorders in the general population: results with three alternative scoring methods.Value in Health. 2013; 16: 564-573Summary Full Text Full Text PDF PubMed Scopus (152) Google Scholar Finally, controls showed remarkable flux in their HADS depression scores over time (52% positive at baseline, 46% at six months, 58% at 12 months), raising questions about whether that group represented a valid comparator for the intervention group who received counselling. Given these concerns, it is premature to claim that brief counselling by family doctors can have a clinically significant and lasting effect on depression in women experiencing intimate partner violence. To declare unambiguously that a high-quality study has produced a negative finding is of great value to the field because it can provide the impetus to search for and test novel models of intervention.7Marks JS Cassidy EF Does a failure to count mean that it fails to count? Addressing intimate partner violence.Am J Prev Med. 2006; 30: 530-531Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar By contrast, to obscure this finding and draw inferences from secondary measures will only confuse researchers and practitioners, risking the perpetuation of ineffective practices. We declare no competing interests. Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trialOur 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. Full-Text PDF Open AccessInterventions for intimate partner violenceWe disagree with Susan Rees and Derrick Silove's Correspondence1, which states that primary care interventions do not work for intimate partner violence. Full-Text PDF