Data from PATH trial (03-2018)

Design: Pragmatic parallel group individually randomized controlled trial of normal DVA
advocacy vs. advocacy + psychological intervention.
Setting: specialist DVA agencies; two UK cities.
Participants: Women aged 16 years
and older accessing DVA services.
Intervention: Eight specialist psychological advocacy (SPA) sessions
Primary outcomes at 12 months: depression symptoms (PHQ-9) and psychological
distress (CORE-OM).
Primary analysis: intention to treat regression model.
Secondary analyses: pre-specified subgroup analyses; multiple imputation by
chained equation models (mice); complier-average
causal effects (CACE) using instrumental variables
Results: 263 women recruited (78 in shelter/refuge, 185 in community), 3 withdrew (2
community, control group; 1 intervention, refuge group), 130 in intervention and 130 in
control groups. Recruitment ended June 2013. 12-month follow up: 65%.
Primary outcomes
At 12-month follow up, greater improvement in mental health of women in the
intervention group. Difference in average CORE-OM score between intervention and
control groups: -3.3 points (95% CI -5.5 to -1.2). Difference in average PHQ-9 score
between intervention and control group: -2.2 (95% CI -4.1 to -0.3). At 12 months, 35%
of the intervention group and 55% of the control group were above the CORE-OM
clinical threshold (OR 0.32, 95% CI 0.16 to 0.64); 29% of the intervention group and
46% of the control group were above the PHQ-9 clinical threshold (OR 0.41, 95% CI
0.21 to 0.81).
Conclusions
This study provides evidence that DVA advocacy can be enhanced in relation to
mental health outcomes by relatively brief training of advocates in psychological
methods. An eight-session psychological intervention delivered by DVA advocates
produced clinically relevant improvement in mental health outcomes compared with
normal advocacy care for female survivors of domestic violence.