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.