(PS8-77) Are We Serving Our Highest Risk Patients? Exploring Diversity in IPA Treatment Trials

Background: Intimate partner aggression (IPA) has seen several decades of treatment development leading to efficacious treatments for the use of IPV (Karakurt et al., 2016, 2019). However, clients who use IPA often present substantial clinical complexity. IPA use is associated with a range of risk factors including suicide, substance use disorders (SUDs), post-traumatic stress disorders and mood disorders. Additionally, IPA rates are higher among LGBTQ populations and parenting couples. Therefore, IPA treatments can only be maximally effective by accounting for this diversity and complexity. The current method review sought to explore how previous IPV trials accounted for the diversity of their samples, including examining (1) specific inclusion and exclusion criteria and (2) the degree to which they report on these central concerns.

Methods: We downloaded articles from PubMed and Academic Search Complete through August 2023. Following the strategy used in Karakurt et al. (2019), we searched for articles that had one term addressing IPA use (e.g., "domestic violence", "perpetrator") and one term addressing treatment (e.g., “therapy”, “educational”, “program”). To this list of records, we applied the following Population-Intervention-Comparison-Outcome-Time, Setting criteria (PICOTS; Higgins & Green, 2011) to identify studies that (1) recruited samples of adults that used physical or sexual IPA, (2) explored an active educational or therapeutic intervention, (3) had at least one pre-post comparison and (4) used a self-report measure of IPA. We did not set any limitations based on Time or Setting. We then descriptively categorized each study’s sample and recruitment strategy along with inclusion exclusion criteria and reported descriptives for the four clinical risk factors and two demographic risk factors (e.g., child in home & LGBTQ status).

Results: We identified 1,854 unique records that met our initial search criteria. Applying our PICOTS criteria led to a final list of 36 studies. A significant minority of studies had explicit inclusion criteria focused on SUDs and a larger proportion of studies reported on SUD rates. Although mood disorders were rarely used as inclusion/exclusion criteria, they were occasionally reported on. Suicidal thoughts/behaviors and PTSD were rarely evaluated at recruitment or in descriptives (with the rare exception of treatments that have a specific PTSD focus). When reported, parents tended to be half of the sample. The rare mentions of LGBTQ predominantly noted their samples were entirely heterosexual.

Discussion: Our results highlight an important gap in addressing suicidality and PTSD, both of which have strong links to aggression and can complicate treatment even in broad-based IPA programs. Similarly, a large focus on treating heterosexual, cisgendered patients may limit the generalizability of our treatments to sexual and gender minorities. We discuss recommendations to advance the literature including increased monitoring for risk concerns, attention to equity both in recruitment and reporting. Research that attends to these considerations can drive adaptations to address clinical complexity, cultural sensitivity, and layered challenges (e.g., IPA and child maltreatment).