Behavioral intervention for mental health of pregnant women experiencing domestic violence: a randomized controlled trial

TL;DR

A behavioral intervention combining yoga and skill-building improved mental health and quality of life for pregnant Indian women experiencing domestic violence.

Contribution

The study introduces and evaluates a novel Behavioral Intervention Package (BIP) for pregnant women facing domestic violence in India.

Findings

The BIP significantly improved quality of life, reduced anxiety, depression, PTSD, and domestic violence in pregnant women.

Participants showed better coping strategies and increased social support after the intervention.

The BIP was effective in a low- and middle-income setting where standardized interventions were previously lacking.

Abstract

The intersection of domestic violence (DV) during pregnancy has multiple detrimental effects on the mother and family, resulting in mental health impairment. In a cognizant effort to empower pregnant women who have experienced DV, a Behavioral Intervention Package (BIP) was developed and used. The BIP incorporates yoga-based techniques for self-development, interpersonal skill development, and awareness sessions. The study aims to assess the effect of a BIP on the quality of life (QOL), DV, anxiety, depression, PTSD and coping mechanisms of Indian women experiencing violence during pregnancy.

This randomized controlled trial (RCT) involving pregnant women experiencing DV and attending antenatal care (ANC) was conducted at Lok Nayak (LN) Hospital in New Delhi. It is a tertiary care government hospital that provides free maternal healthcare services and primarily caters to individuals from low and middle socio-economic status. Based on the inclusion criteria, 921 participants were screened, and finally, 211 women were randomly assigned to either the intervention group (n = 105) or the control group (n = 106). The intervention consisted of two components: (A) a BIP and (B) standard care. The intervention group received both A and B, while the control group received only B. The BIP, delivered over 11 sessions, aimed to empower women to attain better physical and mental health. Over the seven-month period, each participant in both groups attended 11 sessions to receive the full intervention package.

The mean age of women in the intervention group was 25.3 years, and in the control group, it is 24.5 years. The intervention group showed significant improvements in QOL, with increases in physical (6.933 vs. −3.121) and mental health scores (7.802 vs. −3.623). Anxiety decreased (effect size 9.979), and there were significant reductions in depression scores (8.882), PTSD, and DV. Improvements in coping strategies (MD = 1.1, 95% CI = −1.47, −0.71) and social support (MD = 1.57) were also observed.

The BIP can positively impact the mental health of pregnant women experiencing DV and attending ANC in India. As no standardized intervention exists for this population attending ANC in a hospital in India, integrating the BIP as an intervention during ANC is recommended.

Identifier, CTRI/2019/01/017009. https://ctri.nic.in/Clinicaltrials/advsearch.php.

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