Mental health counselling for abused women Determinants of considering the session useful Logistic regression analysis was performed to ex- plore the characteristics of women who found the session to be useful and to understand which fea- tures of the session were associated with usefulness. Considering the potential over-reporting of posi- tive reaction to the session, we treated a dummy variable denoting the session either as very useful or not as the dependent variable. The independent variables included age, education of the woman and wealth index of her household, whether she considered the topic of discussion very important, whether attempt at maintaining privacy by the paramedic was highly appreciated, whether she was encouraged to be self-confident and to explore a way out of the situation, and her exposure to physi- cal and sexual violence by husband (Table 6). The results showed that the women who considered the discussion topic very important were two times more likely to rate the session as very useful. Also, women who were strongly encouraged to explore a way out of violence were almost seven times more likely to consider the session very useful. DISCUSSION It is clear from the findings of the study that the sample consisting of abused women experienced higher levels of mental stress compared to a sample representing a mixture of non-abused and abused women. Also, a large proportion of these women had suicidal ideation. This highlights the need for mental health counselling service for these wom- en. Most women were positive towards different as- pects of the counselling session. The overwhelming majority of the women considered that the timing of the session was good or very good. The average duration of the session was close to the desired du- ration. Although most women were fine with the waiting-time, some women were unhappy about it. They had competing demands on their time due to childcare and household responsibilities and were concerned about an abusive husband. Some of them told the paramedics about these problems, and some did not. Interventions such as this need to be more sensitive to such issues and try to re- solve them. The paramedics conducted the sessions in private. Most women were confident about confidential- ity. Some women who were concerned about con- fidentiality were later convinced that the concern was not justified. Women were particularly positive about the perfor- Volume 27 | Number 4 | August 2009 Naved RT et al. mance of the paramedics. Most rated their perfor- mance in conducting the session as good or very good. Every participant felt that the paramedics treated her very well. According to the women, the paramedic listened to them very carefully. Most be- lieved that the paramedics understood what they told them and considered that the paramedics had a non-judgemental attitude. The paramedics encouraged the majority of wom- en to be self-confident and encouraged more than half of the women to explore a way out of the violent situation. There is evidence in the litera- ture to the effect that short-term counselling (four sessions at best) has reduced distress levels (33). However, these findings still hold surprising given the number of sessions the women had in this case. If the reports were not biased, enhanced self- confidence might result in better coping skills of these women. The majority of the women found the session useful mostly because it offered them some relief to talk about their negative experienc- es. Women who considered discussion of violence very important were more likely to find the ses- sion very useful. This is not surprising in light of the fact that the majority of abused women in Bangladesh do not talk about their experience but it is well-known that inhibiting or holding back one’s thoughts, feelings, and behaviours is associated with long-term stress and disease (34). Actively confronting upsetting ex- periences—through writing or talking—is hypothe- sized to reduce the negative effects of inhibition, such as short-term autonomic activity (35-36) and long-term stress-related disease (37), by allowing individuals assimilate and reframe the negative ex- perience (38-40). This study also indicates that increasing efforts in exploring a way out of the violence might help make the session more useful to the women, and further intervention needs to take this into ac- count. It is important to note that these findings suggest that the first session was convenient for most wom- en. The ethical guidelines were carefully followed in implementing the intervention. The session seemed to have offered most women some hope and relief. It must be recognized that the effects of the session as reported by the women were small but significant, particularly in light of the fact that most participants attended only one session. The additional benefit of attending multiple sessions remains to be explored. 487