Table 8Summary of Evidence for Screening for Intimate Partner Violence

Number of studiesDesignLimitationsConsistencyApplicabilityOverall qualityFindings
Key Question 1. Does screening asymptomatic women in health care settings for current, past, or increased risk for IPV reduce exposure to IPV, physical or mental harms, or mortality?
1RCTHigh attrition rates, differential loss to followup, Hawthorne effect* among control participants.Not relevantHighFairWomen in both groups had reductions in IPV recurrence, PTSD symptoms, and alcohol problems, as well as improvements in scores for quality of life, depression, and mental health, but no between-group differences.
Key Question 2. How effective are screening techniques in identifying asymptomatic women with current, past, or increased risk for IPV?
15 studies of 13 instruments for identifying IPV in heath care settingsDiagnostic accuracy studies with cross-sectional and prospective dataEnrollment of dissimilar groups at baseline, high attrition rates, unclear application of the reference standard.ConsistentHighFair to good6 instruments with 1 to 8 items demonstrated sensitivity and specificity >80% in clinical populations of asymptomatic women: HARK, HITS (English and Spanish versions), modified CTQ-SF, OVAT, STaT, and WAST.
Key Question 4. For screen-detected women with current, past, or increased risk for IPV, how well do interventions reduce exposure to IPV, reduce physical or mental harms, or mortality?
6RCTEnrollment of dissimilar groups at baseline, high and/or differential loss to followup, recall bias, missing data, Hawthorne effect among control participants.ConsistentSome trials used narrowly defined populations that may limit applicability.Fair to good1 trial of counseling vs. usual care during pregnancy reported decreased IVP and improved birth outcomes with counseling. 2 trials of home visitation vs. none for young mothers resulted in improved IVP outcomes with visitation. Counseling resulted in decreased pregnancy coercion and resolution of unsafe relationships vs. usual care in 1 trial. 2 trials showed improved outcomes in intervention and control groups without differences (counseling vs. referral cards, nurse management vs. usual care in pregnancy).
Key Questions 3 and 5. What are the adverse effects of screening for IPV and interventions to reduce harm from IPV?
14RCT, prospective cohort, cross-sectionalDescriptive data with variability of populations, measures, and analysis.ConsistentUnclear, most data are descriptive and come from small samples.Fair3 RCTs reported no adverse effects. Descriptive studies indicated that screening has minimal adverse effects, but some women experience discomfort, loss of privacy, emotional distress, and concerns about further abuse.

Abbreviations: HARK = Humiliation, Afraid, Rape, Kick; HITS = Hurt, Insult, Threaten, Scream; IPV = intimate partner violence; CTQ-SF = Childhood Trauma Questionnaire–Short Form; OVAT = Ongoing Violence Assessment Tool; PTSD = post-traumatic stress disorder; RCT = randomized, controlled trial; STaT = Slapped, Threatened, and Throw; WAST = Woman Abuse Screening Tool.

*

Hawthorn effect is when subjects modify an aspect of their behavior in response to the fact that they are being studied.

From: 4, DISCUSSION

Cover of Screening Women for Intimate Partner Violence and Elderly and Vulnerable Adults for Abuse
Screening Women for Intimate Partner Violence and Elderly and Vulnerable Adults for Abuse: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation [Internet].
Evidence Syntheses, No. 92.
Nelson HD, Bougatsos C, Blazina I.

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