Screening for intimate partner violence in health care settings: a randomized trial.

Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Patterson Bldg, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada.
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 09/2009; 302(5):493-501. DOI: 10.1001/jama.2009.1089
Source: PubMed

ABSTRACT Whether intimate partner violence (IPV) screening reduces violence or improves health outcomes for women is unknown.
To determine the effectiveness of IPV screening and communication of positive results to clinicians.
Randomized controlled trial conducted in 11 emergency departments, 12 family practices, and 3 obstetrics/gynecology clinics in Ontario, Canada, among 6743 English-speaking female patients aged 18 to 64 years who presented between July 2005 and December 2006, could be seen individually, and were well enough to participate.
Women in the screened group (n=3271) self-completed the Woman Abuse Screening Tool (WAST); if a woman screened positive, this information was given to her clinician before the health care visit. Subsequent discussions and/or referrals were at the discretion of the treating clinician. The nonscreened group (n=3472) self-completed the WAST and other measures after their visit.
Women disclosing past-year IPV were interviewed at baseline and every 6 months until 18 months regarding IPV reexposure and quality of life (primary outcomes), as well as several health outcomes and potential harms of screening.
Participant loss to follow-up was high: 43% (148/347) of screened women and 41% (148/360) of nonscreened women. At 18 months (n = 411), observed recurrence of IPV among screened vs nonscreened women was 46% vs 53% (modeled odds ratio, 0.82; 95% confidence interval, 0.32-2.12). Screened vs nonscreened women exhibited about a 0.2-SD greater improvement in quality-of-life scores (modeled score difference at 18 months, 3.74; 95% confidence interval, 0.47-7.00). When multiple imputation was used to account for sample loss, differences between groups were reduced and quality-of-life differences were no longer significant. Screened women reported no harms of screening.
Although sample attrition urges cautious interpretation, the results of this trial do not provide sufficient evidence to support IPV screening in health care settings. Evaluation of services for women after identification of IPV remains a priority. Identifier: NCT00182468.

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    ABSTRACT: In this review, we provide a descriptive and detailed review of intervention programs for intimate partner violence (IPV) perpetrators and survivor-victims. Given the extensive personal, interpersonal, and societal costs associated with IPV, it is essential that services being offered by the criminal justice, mental health, and medical communities have requisite empirical support to justify their implementation. The review involved a detailed summary of all studies published since 1990 using randomized or quasi-experimental designs that compared an active intervention program to a relevant comparison condition. These studies included 20 studies investigating the effectiveness of “traditional” forms of batterer intervention programs (BIPs) aimed at perpetrators of IPV, 10 studies that investigated the effectiveness of alternative formats of BIPs, 16 studies of brief intervention programs for IPV victim-survivors, and 15 studies of more extended intervention programs for IPV victim-survivors. Interventions for perpetrators showed equivocal results regarding their ability to lower the risk of IPV, and available studies had many methodological flaws. More recent investigations of novel programs with alternative content have shown promising results. Among interventions for victim-survivors of IPV, a range of therapeutic approaches have been shown to produce enhancements in emotional functioning, with the strongest support for cognitive-behavioral therapy (CBT) approaches in reducing negative symptomatic effects of IPV. Supportive advocacy in community settings has been shown to reduce the frequency of revictimization relative to no-treatment controls, although rates of revictimization remain alarmingly high in these studies. Brief interventions for victim-survivors have had more complex and less consistently positive effects. Several studies have found significant increases in safety behaviors, but enhanced use of community resources is often not found. It remains unclear whether brief safety interventions produce longer term reduction in IPV revictimization. Discussion summarizes the general state of knowledge on interventions for IPV perpetrators and victim-survivors and important areas for future research.
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