A randomized controlled trial of a Multi-component family Intervention to Lower depression and Address intimate Partner violence (MILAP) among young women in Nepal - PROJECT SUMMARY Intimate Partner Violence (IPV) is a major public health problem in low- and middle-income countries (LMICs). Globally, an estimated 30% of women report physical or sexual violence by an intimate partner in their lifetime. IPV is a well-established social driver of mental health problems and doubles the rate of depression and PTSD. Interventions like cognitive behavioral therapy (CBT) can improve depression after women experiencing IPV exit abusive relationships. However, despite ongoing violence, many young women in LMICs are less likely to divorce or separate from their husband. But ongoing IPV severely limits mental health recovery and increases the risks of suicide. Another important factor in many LMICs is that young women often live in extended, multi-generational households, where studies have shown that mother-in-laws (MILs) play a critical role in young daughter-in-laws (DILs) autonomy and freedom of movement, substantially affecting her mental health. The pathways via which multiple family members and ongoing IPV affect young women’s mental health in LMICs is very poorly understood. There is an urgent need to study interventions that: a) improve mental health and reduce IPV; b) engage husbands and MILs, and not just women experiencing IPV; and c) elucidate pathways via which IPV-related drivers affect mental health. Our Nepal- US collaborative team has pilot-tested a novel Multi-component family Intervention to Lower depression and Address intimate Partner violence (MILAP, meaning unity and reconciliation in Nepali) among young women in Nepal. MILAP’s first component engages DILs and their MILs by establishing them as allies in addressing IPV and improving DIL’s empowerment and freedom of movement. In MILAP’s second component, the DIL and her husband participate in behavioral couple’s therapy (BCT) to improve communication skills, increase caring behaviors, and enhance trust in the marital relationship. This approach was acceptable, feasible, and safe. It resulted in substantial reduction in proportion of people with moderate depression (PHQ-9>9) (baseline: 46%, 3 months: 4%). Based on this pilot study (n=75; 25 triads), we now propose to conduct a fully- powered RCT of MILAP to: a) establish effectiveness by conducting a 12-month RCT with 300 triads (young women reporting IPV, their husbands, and their MILs), b) understand mechanism of intervention impact, and c) conduct a costing analysis. Our team has a 16-year history of successful global health collaborative research in Nepal. If successful, this study will deliver an effective family intervention and a better understanding of its mechanism to address two complex challenges (IPV and depression) that lead to a massive public health burden among young women living in Nepal, other LMICs, and other regions where women live in multi- generational households and have limited options to leave abusive relationships.
