Advocacy Intervention Fails to Improve Depression in Abused Chinese Women

An intervention intended to increase empowerment among Chinese female victims of intimate partner violence failed to decrease depression appreciably more than did usual community services, according to a randomized, controlled trial published Aug. 4 in JAMA.

Women in both the experimental and control groups achieved substantial reduction in depression scores, as measured by the Chinese version of the Beck Depression Inventory II (C-BDI-II). Mean scores of 38-39 placed the women in the “severe depression” category at baseline. At the end of the 12-week intervention, mean scores declined to 24-26 in both groups, corresponding to “moderate depression.” Six months later, mean scores declined to 16-18, corresponding to “mild depression” (JAMA 2010;304:536-43).

After the researchers adjusted for differences in baseline scores, Agnes Tiwari, Ph.D., of the University of Hong Kong, and her colleagues found a 2.7-point difference between the groups in C-BDI-II scores at the final follow-up. Although that difference achieved statistical significance, it did not achieve the 5-point difference needed for meaningful clinical significance.

The study involved 200 women, aged 18 years and older, who screened positive for intimate partner violence (IPV) at a community center in Hong Kong between 2007 and 2009. They were randomly assigned to experimental and control groups. Participants in the control group received usual community services, including childcare, health care, health promotion, and recreation.

Women in the experimental group received an intervention consisting of two components: empowerment and social support. The empowerment component, delivered by a research assistant in a 30-minute one-to-one interview, aimed to increase women’s safety through recognition of danger and use of a safety plan. They learned about the cycle of violence, facts and options, community resources, and legal interventions. The social support component consisted of 12 weekly telephone calls with a research assistant and 24-hour access to a hotline.

None of the women were lost to follow-up during the course of the 9-month study. A total of 88 of the 100 women in the experimental group received all 12 weeks of telephone support, and the remaining 12 all received 10 or 11 weeks, indicating a very high level of adherence to the experimental protocol.

While the differences in depression scores between the groups were not clinically meaningful, women in the experimental group were significantly more likely than were controls to say that the intervention was “useful to extremely useful” in improving their intimate relationships (94% vs. 82%) and in helping them resolve conflicts with their intimate partners (98% vs. 84%).

The study was supported by the Food and Health Bureau of the Hong Kong Government. The authors of the study said they had no financial relationships to disclose.