Screening for domestic violence works, but outcomes don't change

Screening instruments accurately identify women experiencing intimate partner violence, potentially boosting the chances of addressing it during a clinical exam. But improvement in health outcomes varies widely among populations, researchers found.

Fortunately, potential adverse effects such as discomfort, loss of privacy, emotional distress, and concerns about further abuse appear to have a minimal impact on most women.

The evidence showed that women assigned to screening versus usual care did not have statistically significant improvements in intimate partner violence or health outcomes. However, more women in the screened group discussed intimate partner violence with their clinician (44% vs. 8%).

Researchers reviewed English-language trials of the effectiveness of screening and interventions, diagnostic accuracy studies of screening instruments, and studies of any design about adverse effects. The review is an update for the U.S. Preventive Services Task Force recommendation on screening women for intimate partner violence and appeared online May 8 at Annals of Internal Medicine.

One large cluster randomized, controlled trial met review criteria. It looked at 6,743 women aged 18 to 64 years who were randomly assigned to screening or nonscreening groups. The primary outcomes were exposure to abuse and quality of life in the 18 months after screening.

Reviewers noted that women with positive screenings were not offered a specific intervention and few screen-positive women had discussions about intimate partner violence with their clinicians during their clinic visits. Women who were randomly assigned to the nonscreening group were provided with information cards of locally available resources for women with intimate partner violence. Women in the nonscreening group had extensive questioning about intimate partner violence over the 18 months of the trial.

The 12-month prevalence of intimate partner violence at the initial clinic visit was 13% and 12% in the screened and nonscreened groups, respectively. During follow-up, women in both groups accessed additional health care services; had reduced recurrence, post-traumatic stress disorder symptoms, and alcohol problems; and had improved scores for quality of life, depression, and mental health. None of these results were statistically significantly different between groups.

Fifteen studies evaluated the diagnostic accuracy of 13 screening instruments. Five instruments demonstrated high accuracy in identifying women with current or recent intimate partner violence, and an instrument with two questions accurately identified women with histories of childhood abuse. Positive responses on the Partner Violence Screen predicted verbal aggression and violence during the four months after screening.

Six trials evaluated interventions to reduce intimate partner violence. Results consistently showed that counseling provided benefits such as reducing intimate partner violence and improving birth outcomes for pregnant women, reducing intimate partner violence for new mothers, and reducing pregnancy coercion and unsafe relationships for women in family-planning clinics.

Few studies reported adverse effects of screening and interventions. A large randomized, controlled trial of screening indicated no differences, while descriptive studies generally indicated low levels of adverse effects related to screening.