Screening for intimate partner violence in health care settings. JAMA: J Am Med Assoc

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: 35.29). 09/2009; 302(5):493-501. DOI: 10.1001/jama.2009.1089
Source: PubMed


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.

Download full-text


Available from: Barbara Lent, Oct 14, 2014
  • Source
    • "However, so far, the effect of systematic screening for DV has remained somewhat unclear. Randomized controlled trials have shown that there is insufficient evidence to recommend routine screening for DV [22, 23]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to examine possible changes from 2008 to 2012 in the skills of health care staff in identifying and intervening in domestic violence (DV). A longitudinal descriptive study design with volunteer samples (baseline; n = 68 , follow-up; n = 100 ) was used to acquire information regarding the present state and needs of the staff in practices related to DV. The results of the baseline survey were used as a basis for planning two interventions: staff training and drafting practical guidelines. Information was collected by questionnaires from nurses, physicians, and social workers and supplemented by responses from the interviews. The data were analysed using both quantitative and qualitative methods. A chi-square test was used to test the statistical significance of the data sets. In addition, participants’ quotes are used to describe specific phenomena or issues. The comparison showed that overall a small positive change had taken place between the study periods. However, the participants were aware of their own shortcomings in identifying and intervening in DV. Changes happen slowly, and administrative support is needed to sustain such changes. Therefore, this paper offers recommendations to improve health care providers’ response to DV. Moreover, there is a great need for evaluating the training programme used.
    Full-text · Article · Apr 2014
  • Source
    • "The findings of this study also support calls in favor of routine screening in health care settings for better identification and quantification of violence victims. It should be noted, nonetheless, that while several studies indicate that routine screening helps identify victims of violence (Abbott, Johnson, Koziol-McLain, & Lowenstein, 1995; McCloskey et al., 2005), there is little evidence to support that it is useful to improve the outcome of the abused (MacMillan et al., 2009; Moracco & Cole, 2009). The selective conventional perception of abuse and the reactive normalization of violence observed indicate the necessity for culturally informed interventional strategies to complement screening. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Occurrence of intimate partner violence (IPV) against women in the Lebanese society has been largely ignored by local legal and religious authorities. Our aim is to estimate the prevalence of IPV among married Lebanese women, and investigate perception of abuse, referral patterns, and measures taken to deal with abusive situations. In this cross-sectional study, married women aged 20 to 65 presenting to the American University of Beirut Medical Center for gynecological care were interviewed on various forms of IPV. Out of 100 women invited to participate, 91 consented to take part in the survey of whom 37 (40.67%) gave a history of physical abuse, 30 (33.0%) of sexual abuse, 59 (64.8%) of verbal abuse, and 17 (18.7%) of emotional abuse. Spouse-imposed social isolation was reported in 20 (22.0%) women, and economic abuse in 30 (33.0%). Reasons for deciding to stay in an abusive relationship were "lack of any family or social support" (40.5%), "lack of financial resources" (40.5%), and "fear that the partner may take away the children" (37.8%). Women expressed satisfaction with their spouse's treatment irrespective of the existence of various forms of violence. A significant increase in the risk of weapon use against wife was correlated with decreased monthly income of the household, whereas a protective effect was conferred by an increased number of children. This study highlights the need for routine screening in health care settings for better identification of victims of violence. The selective conventional perception of abuse and the reactive normalization of violence observed indicate the necessity for culturally informed interventional strategies to complement screening.
    Full-text · Article · Feb 2014 · Journal of Interpersonal Violence
  • Source
    • "In 2009, in the Journal of the American Medical Association (JAMA), the results of a multi-site Canadian randomized controlled trial (RCT) were published indicating that universal screening for IPV did not significantly reduce women’s exposure to violence, or improve health outcomes or quality of life [24] (hereafter referred to as ‘the IPV screening trial’ or ‘the trial’). This was accompanied by an editorial recommending that until screening is shown to have measurable benefits for abused women, a case-finding approach, as defined above, is the best clinical response [25]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Significant emphasis is currently placed on the need to enhance health care decision-making with research-derived evidence. While much has been written on specific strategies to enable these “knowledge-to-action” processes, there is less empirical evidence regarding what happens when knowledge translation (KT) processes do not proceed as planned. The present paper provides a KT case study using the area of health care screening for intimate partner violence (IPV). Methods A modified citation analysis method was used, beginning with a comprehensive search (August 2009 to October 2012) to capture scholarly and grey literature, and news reports citing a specific randomized controlled trial published in a major medical journal on the effectiveness of screening women, in health care settings, for exposure to IPV. Results of the searches were extracted, coded and analysed using a multi-step mixed qualitative and quantitative content analysis process. Results The trial was cited in 147 citations from 112 different sources in journal articles, commentaries, books, and government and news reports. The trial also formed part of the evidence base for several national-level practice guidelines and policy statements. The most common interpretations of the trial were “no benefit of screening”, “no harms of screening”, or both. Variation existed in how these findings were represented, ranging from summaries of the findings, to privileging one outcome over others, and to critical qualifications, especially with regard to methodological rigour of the trial. Of note, interpretations were not always internally consistent, with the same evidence used in sometimes contradictory ways within the same source. Conclusions Our findings provide empirical data on the malleability of “evidence” in knowledge translation processes, and its potential for multiple, often unanticipated, uses. They have implications for understanding how research evidence is used and interpreted in policy and practice, particularly in contested knowledge areas.
    Full-text · Article · Apr 2013 · Health Research Policy and Systems
Show more