Descriptive statistics (n = 755).

Mental health and intimate partner violence (IPV) are urgent public health problems in the perinatal period. We examined whether a Cognitive Behavioral Therapy (CBT) intervention designed to lower prenatal anxiety led to differing risk of perinatal IPV between the intervention and control arms. We investigated if social support or spousal relationship quality in the third trimester mediated this association. The analysis included 755 pregnant Pakistani women with at least mild anxiety participating in a randomized clinical trial, which was conducted from April 2019 to October 2022. Intervention arm participants received up to six CBT-based treatment sessions (and up to five booster sessions), while controls received enhanced usual care. After implementing multivariate imputation using chained equations (MICE), we conducted log binomial regression analyses to assess the risk ratios (RRs) for any, physical, and emotional IPV in the intervention versus control arms. We assessed the mediating roles of spousal relationship and social support in the third trimester through causal mediation analyses. 27.7% of participants experienced any perinatal IPV. Compared to women in the control group, those in the intervention arm had significantly lower risk of reporting any IPV (adjusted risk ratio (aRR)=0.73, 95% confidence interval (CI): 0.58-0.91), physical IPV (aRR = 0.63, 95% CI:0.45-0.89), and emotional IPV (aRR = 0.74, 95% CI:0.56-0.93). These associations were partially mediated by spousal relationship quality and social support available in the third trimester. Receipt of a CBT intervention aiming to reduce anxiety was inversely associated with risk of perinatal IPV, likely through improving social relationships during the pregnancy.