Two-year follow up of a cluster randomised controlled trial for women experiencing intimate partner violence:Effect of screening and family doctor-delivered counselling on quality of life, mental and physical health, and abuse exposure

Objectives: This was a 2-year follow-up study of a primary care-based counselling intervention (weave) for women experiencing intimate partner violence (IPV). We aimed to assess whether differences in depression found at 12 months (lower depression for intervention than control participants) would be sustained at 24 months and differences in quality in life, general mental and physical health and IPV would emerge. Design: Cluster randomised controlled trial. Researchers blinded to allocation. Unit of randomisation: family doctors. Setting: Fifty-two primary care clinics, Victoria, Australia. Participants: Baseline: 272 English-speaking, female patients (intervention n=137, doctors=35; control n=135, doctors=37), who screened positive for fear of partner in past 12 months. Twenty-four-month response rates: intervention 59% (81/137), control 63% (85/135). Interventions: Intervention doctors received training to deliver brief, woman-centred counselling. Intervention patients were invited to receive this counselling (uptake rate: 49%). Control doctors received standard IPV information; delivered usual care. Primary and secondary outcome measures: Twenty-four months primary outcomes: WHO Quality of Life-Bref dimensions, Short-Form Health Survey (SF-12) mental health. Secondary outcomes: SF-12 physical health and caseness for depression and anxiety (Hospital Anxiety Depression Scale), post-traumatic stress disorder (Check List-Civilian), IPV (Composite Abuse Scale), physical symptoms (&ge;6 in last month). Data collected through postal survey. Mixed-effects regressions adjusted for location (rural/urban) and clustering. Results: No differences detected between groups on quality of life (physical: 1.5, 95% CI &minus;2.9 to 5.9; psychological: &minus;0.2, 95% CI &minus;4.8 to 4.4,; social: &minus;1.4, 95% CI &minus;8.2 to 5.4; environmental: &minus;0.8, 95% CI &minus;4.0 to 2.5), mental health status (&minus;1.6, 95% CI &minus;5.3 to 2.1) or secondary outcomes. Both groups improved on primary outcomes, IPV, anxiety. Conclusions: Intervention was no more effective than usual care in improving 2-year quality of life, mental and physical health and IPV, despite differences in depression at 12 months. Future refinement and testing of type, duration and intensity of primary care IPV interventions is needed. Trial registration number: ACTRN12608000032358.</jats:sec

Protocol for a randomised controlled trial of a web-based healthy relationship tool and safety decision aid for women experiencing domestic violence (I-DECIDE)

BACKGROUND: Domestic violence is a serious problem affecting the health and wellbeing of women globally. Interventions in health care settings have primarily focused on screening and referral, however, women often may not disclose abuse to health practitioners. The internet offers a confidential space in which women can assess the health of their relationships and make a plan for safety and wellbeing for themselves and their children. This randomised controlled trial is testing the effectiveness of a web-based healthy relationship tool and safety decision aid (I-DECIDE). Based broadly on the IRIS trial in the United States, it has been adapted for the Australian context where it is conducted entirely online and uses the Psychosocial Readiness Model as the basis for the intervention. METHODS/DESIGN: In this two arm, pragmatic randomised controlled trial, women who have experienced abuse or fear of a partner in the previous 6&nbsp;months will be computer randomised to receive either the I-DECIDE website or a comparator website (basic relationship and safety advice). The intervention includes self-directed reflection exercises on their relationship, danger level, priority setting, and results in an individualised, tailored action plan. Primary self-reported outcomes are: self-efficacy (General Self-Efficacy Scale) immediately after completion, 6 and 12&nbsp;months post-baseline; and depressive symptoms (Centre for Epidemiologic Studies Depression Scale, Revised, 6 and 12&nbsp;months post-baseline). Secondary outcomes include mean number of helpful actions for safety and wellbeing, mean level of fear of partner and cost-effectiveness. DISCUSSION: This fully-automated trial will evaluate a web-based self-information, self-reflection and self-management tool for domestic violence. We hypothesise that the improvement in self-efficacy and mental health will be mediated by increased perceived support and awareness encouraging positive change. If shown to be effective, I-DECIDE could be easily incorporated into the community sector and health care settings, providing an alternative to formal services for women not ready or able to acknowledge abuse and access specialised services. TRIAL REGISTRATION: Trial registered on 15(th) December 2014 with the Australian New Zealand Clinical Trials Registry ACTRN12614001306606

Mapping common ground: relationships between sensory-processing sensitivity, introversion-extraversion, openness to experience and intelligence

© 2018 Dr. Jodie ValpiedSensory-processing sensitivity encompasses the overlapping characteristics of low sensory threshold, heightened awareness of and reactivity to sensory stimuli, heightened top-down inhibitory processes, and deep processing of sensory information. Both introversion and openness to experience (also encompassing the narrower facet of intellect) have been separately linked to markers of sensory-processing sensitivity, even though introversion and openness/intellect are usually negatively correlated with each other. Introversion and openness/intellect have rarely been included simultaneously in analyses of relationships with sensory-processing sensitivity. Including these two personality factors simultaneously in analyses is important, given the negative bivariate relationship between introversion and openness/intellect can obscure positive relationships with other variables, through statistical suppression effects. The Highly Sensitive Person Scale is a self-report measure of sensory-processing sensitivity of potential utility for further researching relationships between sensory-processing sensitivity, introversion and openness/intellect. However, there is lack of clarity regarding the factor structure of the Highly Sensitive Person Scale, with different studies reporting different factor solutions. There are several methodological issues that may have contributed to these discrepancies, and concerns that neuroticism or negative affect could contribute to spurious factors emerging for this scale. However, no known prior studies have addressed these potential issues. A series of studies were undertaken as part of this thesis, investigating the factor structure of the Highly Sensitive Person Scale, and relationships between these factors and introversion, openness/intellect, and intellectual giftedness. The final study in this thesis then sought to test whether introversion, openness/intellect or cognitive reasoning ability were related to non-invasive, physiological markers of sympathetic and parasympathetic responsivity: low frequency and high frequency heart rate variability. Studies undertaken for this thesis employed robust structural equation modelling techniques with data from a range of new or existing adult samples recruited through the community and online. All analyses controlled for neuroticism or subjective wellbeing, and for other variables where relevant, and included introversion and openness/intellect simultaneously in analyses. Results of these analyses showed that the Highly Sensitive Person Scale is best represented by three factors, Low Sensory Threshold, Situational Sensitivity and Aesthetic Sensitivity. This factor structure was unaffected by neuroticism or emotional wellbeing, and was replicated across three samples. Low Sensory Threshold was consistently, positively related to both introversion and openness/intellect. This relationship was mediated by Situational Sensitivity for introversion and by Aesthetic Sensitivity for openness/intellect. Both introversion and openness/intellect were also positively related to intellectual giftedness, when including both of these personality variables simultaneously in the model. However, contrary to expectations, there were no significant relationships between Highly Sensitive Person Scale factors and intellectual giftedness. Both introversion and openness/intellect were positively related to low frequency heart rate variability during some conditions, and openness/intellect was positively related to high frequency heart rate variability under most conditions. Cognitive reasoning had a positive relationship with low frequency heart rate variability for males, and a negative relationship with high frequency heart rate variability for females. The above findings suggest that heightened sensory-processing sensitivity may be accompanied by feeling potentially overactivated by external stimuli or by a desire to engage with aesthetic or cognitively interesting stimuli. The former is associated with introversion and the latter with openness/intellect. Some highly sensitive individuals may experience both Situational Sensitivity and Aesthetic Sensitivity aspects of sensory-processing sensitivity, given the pattern of relationships found. Common ground shared between introversion, openness/intellect and correlates such as intelligence may have important implications for further understanding these personality variables, especially given the current interest by personality theorists in mechanisms shared by extraversion and openness/intellect. The model of relationships found in this thesis could provide a useful framework for future research, and for practitioners who work in areas relevant to sensory-processing sensitivity

The Genesis of reading ability : what helps children learn letter-sound correspondences?

Knowledge of letter–sound correspondences underpins successful reading acquisition, and yet little is known about how young children acquire this knowledge and what prior information they bring to the learning process. In this study, we used an experimental training design to examine whether either prior letter awareness or prior phonemic awareness directly assists preliterate children in subsequently learning letter–sound correspondences. Here 76 preschoolers received 6 weeks of training in either letter awareness, phonemic awareness, or control tasks and then received a further 6 weeks of training in either letter–sound correspondences or control tasks. There was limited evidence that prior training in either phoneme or letter awareness directly assisted learning of letter–sound correspondences, although phonemically trained children appeared to show some advantage on recognition tasks. Overall, the data suggest that there is little value in training preschoolers in either letter forms or sounds in isolation in advance of providing instruction on the links between the two.21 page(s

Sexual violence associated with poor mental health in women attending Australian general practices

Abstract Objective: Sexual violence (SV) against adult women is prevalent and associated with a range of mental health issues. General practitioners could potentially have a role in responding, however, there is little information to help guide them. Data around prevalence of all forms of adult SV (not just rape) is inconsistent, particularly in clinical samples, and the links between other forms of SV and mental health issues are not well supported. This study aimed to address these gaps in the knowledge base. Methods: A descriptive, cross‐sectional study was conducted in Australian general practice clinics. Two hundred and thirty adult women completed an anonymous iPad survey while waiting to see the doctor. Results: More than half the sample had experienced at least one incident of adult SV. Most commonly, women reported public harassment or flashing, unwanted groping and being coerced into sex. Women who had experienced adult SV were more likely to experience anxiety than women who had not, even after controlling for other factors. Women who had experienced adult SV were more likely to feel down, depressed or hopeless than women who had not; however, this association disappeared after controlling for childhood sexual abuse. Conclusions: The findings support the association between SV and poor mental health, even when ‘lesser’ incidents have occurred. Implications for public health: General practitioners should consider an experience of SV as a possible factor in otherwise unexplained anxiety and depressive symptoms in female patients

Health service use by same-sex attracted Australian women for alcohol and mental health issues: a cross-sectional study

Background: Same-sex attracted women (SSAW) have higher rates of alcohol and mental health problems than heterosexual women, but utilisation of and satisfaction with treatment is limited. Aim: This study investigated the influences on health service use for alcohol and mental health problems among SSAW. Design & setting: The Gelberg-Andersen behavioural model of health service utilisation was used to generate outcome variables. Method: A convenience sample of 521 community-connected Australian SSAW completed an online survey. Health service use according to sexual identity was compared using χ2 analysis. Binary logistic regression examined associations between the independent variables with treatment utilisation. Results: Reports of alcohol treatment were very low. Only 41.1% of participants with service need had utilised mental health and alcohol treatment. Bisexual women (adjusted odds ratio [AOR] = 2.76) and those with ‘other’ identities (AOR = 2.38) were more likely to use services than lesbian women. Enablers to service use were having a regular GP (AOR = 3.02); disclosure of sexuality to the GP (AOR = 2.42); lesbian, gay, bisexual and transgender (LGBT) community-connectedness (AOR = 1.11); and intimate partner violence ([IPV] AOR = 2.51). Social support was associated with a reduction in treatment use (AOR = 0.97). Significant access barriers included not feeling ready for help, and previous negative experiences related to sexual identity. Conclusion: Disclosing sexual identity to a regular, trusted GP correlated with improved utilisation of alcohol and mental health treatment for SSAW. The benefits of seeking help for alcohol use, and of accessing LGBT-inclusive GPs to do so, should be promoted to SSAW

Sustainability of identification and response to domestic violence in antenatal care: The SUSTAIN Study

This project set out to understand and support the integration of evidence-based, effective screening, risk assessment and first-line response to domestic violence (DV) into the complex system of antenatal care. It built on existing resources and research to focus on women assessed as currently in lower risk situations, who are often not in contact with DV services but attended health services for pregnancy

Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial

SummaryBackgroundEvidence for a benefit of interventions to help women who screen positive for intimate partner violence (IPV) in health-care settings is limited. We assessed whether brief counselling from family doctors trained to respond to women identified through IPV screening would increase women's quality of life, safety planning and behaviour, and mental health.MethodsIn this cluster randomised controlled trial, we enrolled family doctors from clinics in Victoria, Australia, and their female patients (aged 16–50 years) who screened positive for fear of a partner in past 12 months in a health and lifestyle survey. The study intervention consisted of the following: training of doctors, notification to doctors of women screening positive for fear of a partner, and invitation to women for one-to-six sessions of counselling for relationship and emotional issues. We used a computer-generated randomisation sequence to allocate doctors to control (standard care) or intervention, stratified by location of each doctor's practice (urban vs rural), with random permuted block sizes of two and four within each stratum. Data were collected by postal survey at baseline and at 6 months and 12 months post-invitation (2008–11). Researchers were masked to treatment allocation, but women and doctors enrolled into the trial were not. Primary outcomes were quality of life (WHO Quality of Life-BREF), safety planning and behaviour, mental health (SF-12) at 12 months. Secondary outcomes included depression and anxiety (Hospital Anxiety and Depression Scale; cut-off ≥8); women's report of an inquiry from their doctor about the safety of them and their children; and comfort to discuss fear with their doctor (five-point Likert scale). Analyses were by intention to treat, accounting for missing data, and estimates reported were adjusted for doctor location and outcome scores at baseline. This trial is registered with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358.FindingsWe randomly allocated 52 doctors (and 272 women who were eligible for inclusion and returned their baseline survey) to either intervention (25 doctors, 137 women) or control (27 doctors, 135 women). 96 (70%) of 137 women in the intervention group (seeing 23 doctors) and 100 (74%) of 135 women in the control group (seeing 26 doctors) completed 12 month follow-up. We detected no difference in quality of life, safety planning and behaviour, or mental health SF-12 at 12 months. For secondary outcomes, we detected no between-group difference in anxiety at 12 months or comfort to discuss fear at 6 months, but depressiveness caseness at 12 months was improved in the intervention group compared with the control group (odds ratio 0·3, 0·1–0·7; p=0·005), as was doctor enquiry at 6 months about women's safety (5·1, 1·9–14·0; p=0·002) and children's safety (5·5, 1·6–19·0; p=0·008). We recorded no adverse events.InterpretationOur 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.FundingAustralian National Health and Medical Research Council