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: 6.03). 04/2013; 4(4):CD007007. DOI: 10.1002/14651858.CD007007.pub2
Source: PubMed


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),, 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.

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    • "There have been several systematic reviews of partner violence interventions, predominantly targeted at individuals, for example, using advocacy [4] or using clinician practices such as screening for partner violence in healthcare settings [5]. Such reviews have also found the evidence base to be small. "
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    ABSTRACT: Intimate partner violence is a serious global problem that damages the health and prosperity of individuals, their families, community, and society. WHO endorses an ‘ecological model,’ which states that there are multi-level intersecting factors enabling perpetration and victimization of violence. Intervention science to prevent or reduce the problem is in its infancy, and the few existing intervention studies have been targeted at the individual level. In a recent study published in BMC Medicine, Abramsky et al. bring innovation to the field, targeting their intervention trial “SASA!” in Kampala Uganda at all ecological levels, but particularly at the community level. Recruiting and training both male and female community leaders and activists who enabled group and media discussions, the authors focused on the beneficial and abusive detrimental uses of power rather than commencing with the central issue of gender inequality. SASA! successfully reduced community attitudes to tolerance of violence and inequality, men’s sexual risk behaviors, and women’s experience of physical violence. The study also improved the communities’ response to victimized women. SASA! has promise for adaptation and replication in low, middle and high income countries. Please see related article:
    Full-text · Article · Oct 2014 · BMC Medicine
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    • "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. "
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    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.
    Full-text · Article · Sep 2014 · Psychological Medicine
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    • "A Cochrane review shows that screening for women exposed to IPV in health care settings is likely to increase detection rates, but evidence is still lacking concerning the long-term benefits for the violence-exposed women. Further, no study has compared the benefits of universal screening versus selective screening for high risk groups, such as pregnant women [19]. Another Cochrane review showed insufficient evidence regarding the effectiveness of interventions for domestic violence in relation to pregnancy outcomes [20]. "
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    ABSTRACT: Background Intimate partner violence (IPV) during pregnancy is a serious matter which threatens maternal and fetal health. The aim of this study was to develop a grounded theoretical model of women’s experience of IPV during pregnancy and how they handle their situation. Method Ten interviews with women who had experience of being exposed to IPV during pregnancy were analyzed using the grounded theory approach. Results The core category ‘Struggling to survive for the sake of the unborn baby’ emerged as the main concern of women who are exposed to IPV during pregnancy. The core category also demonstrates how the survivors handle their situation. Also, three sub-core categories emerged, ‘Trapped in the situation’ demonstrates how the pregnant women feel when trapped in the relationship and cannot find their way out. ‘Exposed to mastery’ demonstrates the destructive togetherness whereby the perpetrator’s behavior jeopardizes the safety of the woman and the unborn child. ‘Degradation process’ demonstrates the survivor’s experience of gradual degradation as a result of the relationship with the perpetrator. All are properties of the core category and part of the theoretical model. Conclusion The theoretical model “Struggling to survive for the sake of the unborn baby” highlights survival as the pregnant women’s main concern and explains their strategies for dealing with experiences of violence during pregnancy. The findings may provide a deeper understanding of this complex matter for midwives and other health care providers. Further, the theoretical model can provide a basis for the development and implementation of prevention and intervention programs that meet the individual woman’s needs.
    Full-text · Article · Aug 2014 · BMC Pregnancy and Childbirth
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