Trauma Mental Health Screening Cash Transfer Timing and Post-Traumatic Stress Disorder Symptom Persistence Among Malawian Intimate Partner Violence Survivors: A Target-Trial Emulation of Economic Independence Thresholds

Intimate partner violence (IPV) survivors in Malawi face high rates of post-traumatic stress disorder (PTSD), and cash transfer programmes are increasingly proposed as a mental health intervention. However, the timing of cash transfers relative to trauma mental health screening may condition their effectiveness, and the threshold of economic independence required to sustain PTSD symptom reduction is unknown. Because no observational data are available, the study characterises the operating characteristics of a before-after-control-impact (BACI) design under a declared variance structure (between-cluster SD = 6.0, residual SD = 4.5, intraclass correlation = 0.64). Power was estimated across 2000 design cells for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. The analysis indicates that 52 clusters are required to detect a 5-percentage-point effect at 80% power. The findings inform the design of future evaluations and highlight the importance of cluster-level variance in economic independence thresholds.