Universal screening for intimate partner violence may provide only modest benefits

There is a lack of consensus on the issue of screening women for IPV in health care settings. Proponents support screening because of the high prevalence of IPV and associated impairment and the availability of feasible screening techniques. But organizations such as the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care have concluded that insufficient evidence exists to recommend for or against universal screening - mainly due to lack of interventions that have been proven effective for women exposed to violence and referred from health care settings. "Nevertheless, clinicians and health care organizations are being encouraged to implement IPV screening. Numerous professional societies recommend routine IPV evaluation, assessment, and/or screening as a part of standard patient care, and the standards of the Joint Commission require that hospitals have objective criteria for identifying and assessing possible victims of abuse and neglect," the authors write.

Harriet L. MacMillan, M.D., M.Sc., F.R.C.P.C., of McMaster University, Hamilton, Ontario, Canada, and colleagues examined the effectiveness of IPV screening and communication of a positive screening result to clinicians in health care settings, compared with no screening, in reducing subsequent violence and improving quality of life. The randomized controlled trial was conducted in 11 emergency departments, 12 family practices, and 3 obstetrics/gynecology clinics in Ontario, Canada, among 6,743 female patients, age 18 to 64 years.

Women in the screened group (n = 3,271; 347 positive for abuse) 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 = 3,472; 360 positive for abuse) self-completed the WAST and other measures after their visit. Women who disclosed past-year IPV were interviewed at the start of the study and every 6 months until 18 months regarding subsequent incidents of IPV and quality of life, as well as several health outcomes and potential harms of screening. The number of women who did not complete the study was high: 43 percent of screened women, and 41 percent of nonscreened women, and data analysis accounted for these losses.

The study found that:

• All women in the trial showed reductions in exposure to violence across time - these reductions were not, however, associated with screening.
  
• At 18 months, observed recurrence of IPV among screened vs. nonscreened women was 46 percent vs. 53 percent (not statistically significant).
  
• Women in the screened vs. nonscreened groups showed higher improvement in quality of life and depression, but these differences were small and not statistically significant when the analysis accounted for women lost to follow-up. There were no differences in other health outcomes.
  
• Screened and control group women had no differences in the frequency of using violence-related health and social services.
  
• Many women must be screened to identify one woman who discloses abuse.
  
• There were no harms of screening as implemented in this trial.