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An interpersonally based intervention for low-income pregnant women with intimate partner violence: a pilot study
Open accessAbstract
This study assessed the initial feasibility, acceptability, and efficacy of an intervention aimed at reducing depression and posttraumatic stress disorder (PTSD) in a sample of low-income pregnant women with recent intimate partner violence (IPV). Fifty-four women were randomly assigned to the intervention or control group. The intervention consisted of four sessions during pregnancy and one "booster" session within 2 weeks of delivery. Based on principles of Interpersonal Psychotherapy, the intervention was designed to help participants improve their interpersonal relationships, including their social support networks, and master their role transition to motherhood. Assessments were administered at four time points (intake, 5-6 weeks post-intake, 2 weeks postpartum, 3 months postpartum) to assess for depression, PTSD, and IPV. The intervention did not significantly reduce the likelihood of a major depressive episode, PTSD, or IPV during pregnancy or up to 3-month postpartum. However, we found moderate effects for the intervention in reducing symptoms of PTSD and depression during pregnancy and a large effect for PTSD symptoms from pregnancy up to 3 months postpartum. This study suggests some initial support for our intervention. Larger randomized trials are needed to further examine the intervention both during and after pregnancy.
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“Though there was a moderate change in depression and PTSD scores (reduction) between the control and intervention groups at post-intake (5–6 weeks), this difference was not sustained at the post-partum period.”
From A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors (2020) · cites this paper as [31]
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ACOG Committee on Clinical Practice Guidelines–Obstetrics (2023) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000005202 · Cited by 252
“…(15) through the use of counseling interventions, such as cognitive behavioral therapy (CBT) (eg, Mothers and Babies) (16 – 19), and interpersonal therapy (eg, the ROSE [Reach Out, Stay Strong, Essentials for mothers of newborns] program) (20 – 24), which has been shown to be cost effective (25).”
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“Zlotnick et al [31] described the use of interpersonal psychotherapy among pregnant women focused at improving social support among the survivors of violence during individual psychotherapy sessions.”
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Werner, E., Miller, M., Osborne, L. M., Kuzava, S., & Monk, C. (2015) · Archives of Women's Mental Health · doi:10.1007/s00737-014-0475-y · Cited by 212
Trabold, N., McMahon, J., Alsobrooks, S., Whitney, S., & Mittal, M. (2020) · Trauma, Violence, & Abuse · doi:10.1177/1524838018767934 · Cited by 174
“…Johnson & Zlotnick, 2006; Johnson et al., 2011; Kubany et al., 2003, 2004; Michalopoulou et al., 2015; Reed & Enright, 2006; Saftlas et al., 2014; Zlotnick et al., 2011), 7 were delivered in a group format (Cort et al., 2014; Crespo & Arinero, 2010; Iverson et al., 2011; Kaslow et al., 2010; S.…”
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A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women
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“The other four studies [17,38,42,43] did not find a significant difference in IPV between the intervention and control groups.”
Arroyo, K., Lundahl, B., Butters, R., Vanderloo, M., & Wood, D. S. (2017) · Trauma, Violence, & Abuse · doi:10.1177/1524838015602736 · Cited by 160
Preventing postpartum depression: A meta-analytic review
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“One trial provided the intervention in the antenatal period only,(160) whereas three trials initiated the intervention postnatally(159,161,162) and two trials provided the intervention across the perinatal period from pregnancy to after childbirth.(158,163) Interventions were provided by a variety of service providers.”
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Hameed, M., O'Doherty, L., Gilchrist, G., Tirado-Muñoz, J., Taft, A., Chondros, P., Feder, G., Tan, M., & Hegarty, K. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013017.pub2 · Cited by 146
Interventions for preventing or reducing domestic violence against pregnant women
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Psychological treatments for perinatal depression
Stuart, S. P., & Koleva, H. K. (2013) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2013.09.004 · Cited by 80
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ResultTirado-Muñoz, J., Gilchrist, G., Farré, M., Hegarty, K., & Torrens, M. (2014) · Annals of Medicine · doi:10.3109/07853890.2014.941918 · Cited by 72
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Bender, A. K. (2017) · Violence Against Women · doi:10.1177/1077801216658977 · Cited by 80
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“Finally, several RCTs have examined the effectiveness of IPT in reducing or preventing perinatal depression in socioeconomically disadvantaged women, many of whom reported a history of childhood abuse; however, these studies did not directly examine whether childhood trauma moderated or predicted treatment outcomes.[3…”
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Karakurt, G., Koç, E., Katta, P., Jones, N., & Bolen, S. D. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.793021 · Cited by 85
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“Settings Most interventions took place in prenatal care clinics (n =15), hospitals (n = 8), or primary care clinics (n = 5).(39,45,51,52) Some took place in midwife clinics (n = 3).”
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Baas, M. A. M., van Pampus, M. G., Braam, L., Stramrood, C. A. I., & de Jongh, A. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1762310 · Cited by 53
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“A significant proportion of women dropping out of the study between the consent process and further assessment prior to randomization is another barrier associated with high attrition rates in intervention studies (Zlotnick et al., 2011).”
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Sapkota, D., Baird, K. M., Saito, A., & Anderson, D. J. (2019) · Systematic Reviews · doi:10.1186/s13643-019-0998-4 · Cited by 51
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“…et al. (2001) 35 USA No Individual Tx-control Prenatal 4 BDI 0.65 0.44 Zlotnick et al. (2006) 99 USA No Individual Tx-control Prenatal 4 BDI 0.84 0.08 Zlotnick et al. (2011) 54 USA No Individual Tx-control Prenatal 4 EPDS 0.08 0.58 Effect sizes presented here are unbiased standardized…”
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Hegarty, K., Tarzia, L., Hooker, L., & Taft, A. J. (2016) · International Review of Psychiatry · doi:10.1080/09540261.2016.1210103 · Cited by 43
“Zlotnick, Capezza, and Perker (2011) drew from primary care and private clinics and found no effectiveness for an inter-personal therapy-based intervention of five 60-min visits to enhance social support and improve overall inter-personal functioning.”
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“However, Zlotnick, Capezza, and Parker (2011) developed a primary care treatment intervention to address depression and PTSD in low-income pregnant women with recent experience of intimate partner violence.”
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“Four interventions had less than 50% of the Black women in the sample (Cocozza et al., 2005; Ghee et al., 2009; Gilbert et al., 2006; Zlotnick et al., 2011).”
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“The former [10], CBT-based, reported improvement in PTSD symptoms; the latter [11], psychotherapy-based, did not.”
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“Although there is a debate on the effectiveness of interpersonal therapy for women with a background of intimate partner violence, recent evidence outlines that persistent social maladjustment increases the risk of depression relapse and that symptoms of posttraumatic stress disorder during pregnancy and postparum in…”
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“However, to our knowledge, the few existing health care-based pilot studies of intervention outcomes (Rowe et al. 2014; Zlotnick et al. 2011)”
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Self-citationA scoping review of intimate partner violence assistance programmes within health care settings
Sprague, S., Scott, T., Garibaldi, A., Bzovsky, S., Slobogean, G. P., McKay, P., Spurr, H., Arseneau, E., Memon, M., Bhandari, M., et al. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1314159 · Cited by 18
Kiely, M., Gantz, M. G., El‐Khorazaty, M. N., & El-Mohandes, A. A. E. (2013) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12202 · Cited by 16
“INTRODUCTION Psychosocial problems among pregnant women, such as poverty, mental health problems, including depression, substance abuse, violence and social isolation, have adverse impact not only on pregnancy outcome, but also on the child’s health, behavior and development.(1,2) When women are seen for prenatal care…”
BackgroundParys, A. V., Deschepper, E., Roelens, K., Temmerman, M., & Verstraelen, H. (2017) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-017-1519-x · Cited by 17
“Compared to other studies with a similar design where most authors consider a decrease of 20% clinically relevant [45, 53, 59, 71, 72] we consider our decrease of IPVv over the course of the study pertinent.”
Menon, B., Stoklosa, H., Dommelen, K. V., Awerbuch, A. W., Caddell, L., Roberts, K., & Potter, J. E. (2018) · Trauma Violence & Abuse · doi:10.1177/1524838018809729 · Cited by 16
Sprague, S., McKay, P., Madden, K., Scott, T., Tikasz, D., Slobogean, G. P., & Bhandari, M. (2016) · Trauma Violence & Abuse · doi:10.1177/1524838016641667 · Cited by 15
Feltner, C., Peat, C. M., Asher, G. N., Wright, S., Vaughan, J., Middleton, J., & Jonas, D. E. (2025) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.2025.2449 · Cited by 13
Preventive interventions for perinatal mood and anxiety disorders: A review of selected programs
Werner, E. A., Le, H., Babineau, V., & Grubb, M. D. (2024) · Seminars in Perinatology · doi:10.1016/j.semperi.2024.151944 · Cited by 13
“53 In an adaptation of ROSE for adolescent mothers ≤ 17 years of age, the REACH (Relaxation, Encouragement, Appreciation, Communication, Helpfulness) intervention was tailored extensively and refined to be more culturally appropriate and appealing to teens from diverse racial and ethnic…”
Eficacia de un programa de tratamiento psicológico individual para mujeres maltratadas por su pareja
Matud, M. P., Marichal, D. F., & Medina, L. (2014) · Psychosocial Intervention · doi:10.1016/j.psi.2014.06.001 · Cited by 13
Interventions for intimate partner violence during the perinatal period: A scoping review
Mercier, O., Fu, S. Y., Filler, R., Leclerc, A., Sampsel, K., Fournier, K., Walker, M. C., Wen, S. W., & Muldoon, K. A. (2024) · Campbell Systematic Reviews · doi:10.1002/cl2.1423 · Cited by 13
Marais, A., Kuo, C., Julies, R. F., Stein, D. J., Joska, J. A., & Zlotnick, C. (2018) · Violence Against Women · doi:10.1177/1077801218802640 · Cited by 11
“By providing psycho-education, decreasing isolation and enhancing support, women experiencing IPV during pregnancy could be more likely to access appropriate resources (Zlotnick et al., 2011), and be better equipped to make decisions during the childbearing cycle (Rose et al.”
BackgroundSelf-citationAdverse Childhood Experiences and Mental Health among Women Experiencing Intimate Partner Violence
Li, Y., Herbell, K., Bloom, T., Sharps, P. W., & Bullock, L. (2020) · Issues in Mental Health Nursing · doi:10.1080/01612840.2020.1731636 · Cited by 15
Psychological prevention of postpartum depression for expectant parents
Bjertrup, A. J., Rasmussen, K. H., & Miskowiak, K. W. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.02.077 · Cited by 9
Burnette, C. E., & Sanders, S. (2017) · Journal of Ethnic & Cultural Diversity in Social Work · doi:10.1080/15313204.2016.1272029 · Cited by 9
Jones, K., Freijah, I., Brennan, S., McKenzie, J. E., Bright, T. M., Fiolet, R., Kamitsis, I., Reid, C. J., Davis, E. C., Andrews, S., et al. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014874.pub2 · Cited by 11
Violence During Pregnancy and the Postpartum Period
Martin, S. L., Arcara, J., Pollock, M. D., & Davis, L. (2012) · Cited by 9
Eficacia de un programa de intervención para mujeres maltratadas por su pareja
Matud, M. P., Padilla, V., Medina, L., & Marichal, D. F. (2016) · Terapia psicológica · doi:10.4067/s0718-48082016000300004 · Cited by 9
RELATIONSHIP BETWEEN FAMILY VIOLENCE AND POST-TRAUMATIC STRESS DISORDER
de Souza, C. M., Vizzotto, M. M., & Gomes, M. B. (2018) · Psicologia Saúde & Doenças · doi:10.15309/18psd190205 · Cited by 9
Ragucci, F., Dragan, M., Cuomo, A., Fagiolini, A. M., & Pozza, A. (2024) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2024.100802 · Cited by 11
Bird, K. L. S., Stokes, N., & Rivas, C. A. (2025) · Campbell Systematic Reviews · doi:10.1002/cl2.70026 · Cited by 9
Johnson, D. M., Wernette, G. T., Miller, T. R., Muzik, M., Raker, C., & Zlotnick, C. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106011 · Cited by 8
Self-citationReid, C. J., McKenzie, J. E., Brennan, S., Bennetts, S. K., Clark, Y., Mensah, F. K., Hokke, S., Ralph, N., Brown, S., Gee, G., et al. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014874 · Cited by 7
Psychosocial interventions for violence exposed youth – A systematic review
Lindert, J., Jakubauskienė, M., Natan, M., Wehrwein, A., Bain, P. A., Schmahl, C. G., Kamenov, K., Carta, M. G., & Cabello, M. (2020) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2020.104530 · Cited by 12
Shrestha, R., Sapkota, D., Mehra, D., Ekström, A. M., & Deuba, K. (2023) · JMIR Research Protocols · doi:10.2196/45917 · Cited by 7
“IPV interventions ideally incorporate the development of a safety plan for women to rescue themselves from difficult situations of violence [11,19,20].”
BackgroundWaller, B., Lee, S., Legros, N. C., Ombayo, B. K., Mootz, J. J., Green, M. C., Hankerson, S. H., Williams, S. N., Williams, J. E., & Wainberg, M. L. (2023) · Trauma Violence & Abuse · doi:10.1177/15248380231206113 · Cited by 7
“…interventions were efficacious in treating both depression and PTSD. CBT, Grady Nia and brief Interpersonal Psychotherapy (brief IPT/IPC) aimed to reduce survivors’ psychological symptoms, interpersonal problems, and social support (Iverson et al., 2011; Kaslow et al., 2010; Zlotnick et al., 2011).”
BackgroundMethodReaching Out To Women Who Are Victims of Intimate Partner Violence
Svavarsdóttir, E. K., Örlygsdóttir, B., & Guðmundsdóttir, B. (2014) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12080 · Cited by 7
Khalili, S., Faradmal, J., Mahjub, H., Moeini, B., & Rastegar, K. E. (2021) · BMC Medical Research Methodology · doi:10.1186/s12874-021-01325-7 · Cited by 7
“There are many women who may experience depression during pregnancy and the risk of it increases under IPV [4, 5].”
BackgroundAli, P. A., Allmark, P., Booth, A., McGarry, J., Woods, H. B., & Seedat, F. (2021) · Journal of Criminal Psychology · doi:10.1108/jcp-03-2021-0007 · Cited by 6
Interpersonal Psychotherapy: A Review of Theory, History, and Evidence of Efficacy
Stuart, S. P., Schultz, J. M., Molina, A. P., & Siber, S. (2024) · Psychodynamic Psychiatry · doi:10.1521/pdps.2024.52.3.370 · Cited by 5
Muñoz, M. D. L. F. R., Chrzan‐Dętkoś, M., Uka, A., García-López, H. S., Bina, R., & Le, H. (2024) · Archives of Women s Mental Health · doi:10.1007/s00737-024-01537-y · Cited by 8
Metadata
- Authors
- Zlotnick, C., Capezza, N. M., & Parker, D.
- Affiliations
- Brown University (US)
- Corresponding author
- Zlotnick, Caron
- Venue
- Archives of Women s Mental Health
- Published
- 2010-12-11
- Volume
- 14
- Issue
- 1
- Pages
- 55-65
- ISSN
- 1434-1816 (ISSN-L)
- 1435-1102
- PMC
- PMC3042850
- OpenAlex
- W2130513347
- Cited by
- 136
- References
- 109
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 8 · 2023: 7 · 2022: 7 · 2021: 9 · 2020: 15 · 2019: 8 · 2018: 11 · 2017: 9 · 2016: 8 · 2015: 6 · 2014: 16 · 2013: 9 · 2012: 6
- FWCI
- 5.96
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Archives of Women s Mental Health (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34MH075013)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Health › Intimate Partner and Family Violence
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- intimate partner violence, pregnant women, interpersonal psychotherapy, depression, post-traumatic stress disorder, low-income women, postpartum period, social support, transition to motherhood, interpersonal relationships, intervention feasibility and acceptability
- MeSH terms
- Adult, Major Depressive Disorder, Female, Humans, Interpersonal Relations, Pilot Projects, Poverty, Pregnancy, Pregnancy Complications, Psychotherapy, Social Support, Stress Disorders, Post-Traumatic, Domestic Violence, Young Adult
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