Article

Screening women for intimate partner violence in healthcare settings. The Cochrane Database of Systematic reviews. 4

Mother and Child Health Research, La Trobe University, 215 Franklin Street, Melbourne, Victoria, Australia, 3000.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 04/2013; 4(4):CD007007. DOI: 10.1002/14651858.CD007007.pub2
Source: PubMed

ABSTRACT Intimate partner violence (IPV) damages individuals, their children, communities, and the wider economic and social fabric of society. Some governments and professional organisations recommend screening all women for intimate partner violence rather than asking only women with symptoms (case-finding); however, what is the evidence that screening interventions will increase identification, and referral to support agencies, or improve women's subsequent wellbeing and not cause harm?
To assess the effectiveness of screening for intimate partner violence conducted within healthcare settings for identification, referral to support agencies and health outcomes for women.
We searched the following databases in July 2012: CENTRAL (2012, Issue 6), MEDLINE (1948 to September Week June Week 3 2012), EMBASE (1980 to Week 28 2012), MEDLINE In-Process (3 July 2012), DARE (2012, Issue 2), CINAHL (1937 to current), PsycINFO (1806 to June Week 4 2012), Sociological Abstracts (1952 to current) and ASSIA (1987 to October 2010). In addition we searched the following trials registers: metaRegister of Controlled Trials (mRCT) (to July 2012), and International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Australian New Zealand Clinical Trials Registry and the International Standard Randomised Controlled Trial Number Register to August 2010. We also searched the reference lists of articles and websites of relevant organisations.
Randomised or quasi-randomised trials assessing the effectiveness of IPV screening where healthcare professionals screened women face-to-face or were informed of results of screening questionnaires, compared with usual care ( which included screening for other purposes).
Two review authors independently assessed the risk of bias in the trials and undertook data extraction. For binary outcomes, we calculated a standardised estimation of the risk ratio (RR) and for continuous data, either a mean difference (MD) or standardised mean difference (SMD). All are presented with a 95% confidence interval (CI).
We included 11 trials that recruited 13,027 women overall. Six of 10 studies were assessed as being at high risk of bias.When data from six comparable studies were combined (n = 3564), screening increased identification of victims/survivors (RR 2.33; 95% CI 1.40 to 3.89), particularly in antenatal settings (RR 4.26; 95% CI 1.76 to 10.31).Only three studies measured referrals to support agencies (n = 1400). There is no evidence that screening increases such referrals, as although referral numbers increased in the screened group, actual numbers were very small and crossed the line of no effect (RR 2.67; 95% CI 0.99 to 7.20).Only two studies measured women's experience of violence after screening (one at three months, the other at six, 12 and 18 months after screening) and found no significant reduction of abuse.Only one study measured adverse effects and data from this study suggested that screening may not cause harm. This same study showed a trend towards mental health benefit, but the results did not reach statistical significance.There was insufficient evidence on which to judge whether screening increases take up of specialist services, and no studies included economic evaluation.
Screening is likely to increase identification rates but rates of referral to support agencies are low and as yet we know little about the proportions of false measurement (negatives or positives). Screening does not appear to cause harm, but only one study examined this outcome. As there is an absence of evidence of long-term benefit for women, there is insufficient evidence to justify universal screening in healthcare settings. Studies comparing screening versus case finding (with or without advocacy or therapeutic interventions) for women's long-term wellbeing would better inform future policies in healthcare settings.

Download full-text

Full-text

Available from: Gene Feder, Aug 26, 2015
2 Followers
 · 
114 Views
  • Source
    • "Psychological Medicine, Page 1 of 12. © Cambridge University Press 2014 doi:10.1017/S0033291714001962 are primarily based on evidence obtained from general population and primary-care samples (Feder et al. 2013; Taft et al. 2013), but findings may not generalize to psychiatric populations, where the nature and/or impact of violence may differ. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Domestic and sexual violence are significant public health problems but little is known about the extent to which men and women with severe mental illness (SMI) are at risk compared with the general population. We aimed to compare the prevalence and impact of violence against SMI patients and the general population.Method Three hundred and three randomly recruited psychiatric patients, in contact with community services for ≥1 year, were interviewed using the British Crime Survey domestic/sexual violence questionnaire. Prevalence and correlates of violence in this sample were compared with those from 22 606 general population controls participating in the contemporaneous 2011/12 national crime survey.Results Past-year domestic violence was reported by 27% v. 9% of SMI and control women, respectively [odds ratio (OR) adjusted for socio-demographics, aOR 2.7, 95% confidence interval (CI) 1.7-4.0], and by 13% v. 5% of SMI and control men, respectively (aOR 1.6, 95% CI 1.0-2.8). Past-year sexual violence was reported by 10% v. 2.0% of SMI and control women respectively (aOR 2.9, 95% CI 1.4-5.8). Family (non-partner) violence comprised a greater proportion of overall domestic violence among SMI than control victims (63% v. 35%, p < 0.01). Adulthood serious sexual assault led to attempted suicide more often among SMI than control female victims (53% v. 3.4%, p < 0.001).Conclusions Compared to the general population, patients with SMI are at substantially increased risk of domestic and sexual violence, with a relative excess of family violence and adverse health impact following victimization. Psychiatric services, and public health and criminal justice policies, need to address domestic and sexual violence in this at-risk group.
    Psychological Medicine 09/2014; 45(04):1-12. DOI:10.1017/S0033291714001962 · 5.43 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: Millennium Development Goal 5 calls for increasing proportions of deliveries assisted by skilled health personnel to reduce maternal mortality. This study aims to identifying the implication of exposure to intimate partner violence on these proportions. Methodology: This study used domestic violence modules data of Demographic and Health Surveys of six countries from 2005 to 2007. Proportions of assisted deliveries were examined by sociodemographic characteristics and exposure to intimate partner violence in the studied countries. Influence on the proportion was examined against exposure to intimate partner violence through odds ratio and 95% of logistic regression analysis after controlling for women age, residence (urban/ rural), household wealth level, economic level of country, educational level and working status of women and their husbands/ partners. Results: Data sets of 18,507 participants over 20 years of age showed that almost three-quarters (73%) of women had deliveries assisted by skilled health personnel. One-third of the women were ever exposed to intimate partner violence (37%) and 9% of them to the severe level. Exposure to intimate partner violence statistically significantly lowered this proportion to 69% (odds ratio: 0.73; 95% confidence interval: 0.67–0.78) meanwhile severe violence lowered it to 65% (odds ratio 0.64; 95% confidence interval: 0.58–0.72). When running multiple regression analysis, exposure to intimate partner violence retained its statistically significant decreasing influence on proportions and was not biased by the other stronger socioeconomic characteristics. Conclusion and recommendations: Intimate partner violence has an independent influence on reducing assisted deliveries by skilled health personnel. Programs working for increasing proportions of assisted deliveries by skilled health personnel are recommended to integrate protection women from violence.
    Open Medicine 01/2013; DOI:10.1177/2050312113508388
  • JAMA The Journal of the American Medical Association 08/2013; 310(5):479-80. DOI:10.1001/jama.2013.167453 · 30.39 Impact Factor
Show more