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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Screening for Family Violence: Recommendations from the U.S. Preventive Services Task Force
2 March 2004 | Volume 140 Issue 5 | Page I-70
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full reports titled "Screening for Family and Intimate Partner Violence: Recommendation Statement" and "Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force." They are in the 2 March 2004 issue of Annals of Internal Medicine (volume 140, pages 382-386 and 387-396). The first report was written by the U.S. Preventive Services Task Force; the second report was written by H.D. Nelson, P. Nygren, Y. McInerney, and J. Klein.
What is the U.S. Preventive Services Task Force?
The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.
What is the problem and what is known about it so far?
Domestic abuse or violence and family violence refer to situations where a person is physically, sexually, or emotionally abused or physically neglected by a family member or an intimate partner. Victims of family violence are most often children, women, and older adults. In older adults, abuse can also include financial exploitation and neglect. Studies estimate that over 1000 children died of abuse in 1999, almost 1 out of every 3 women report that they were subject to abuse at some point in their lives, and more than half a million older adults were abused in 1996. Harmful outcomes of family violence include physical injury, long-term psychological problems, and death. Some things that should make doctors and other health care providers suspect family violence are repeated or unusual injuries, depression, and unexplained symptoms or absences from school or work. When such things are present, doctors should ask patients about family violence. However, it is unclear whether doctors should screen all patients for family violence as part of routine health care. Screening is looking for a condition in patients who have no symptoms or signs of that condition.
How did the USPSTF develop these recommendations?
The USPSTF reviewed published research about the benefits and harms of screening for family violence. Potential benefits would be decreased disability, injury, or premature death. Potential harms would be an increase in abuse when the victim or others confront the abuser.
What did the USPSTF find?
The USPSTF found no studies examining the use of screening questionnaires by clinicians to detect family violence and improve health in children, women, or older adults in the general population. The USPSTF found evidence that interventions in families at higher risk for abuse can reduce harm to children. However, the few available studies in women and older adults that examined whether interventions were effective are inadequate. No available studies directly measured the potential harms of screening for family violence.
What does the USPSTF suggest that patients and doctors do?
Patients and clinicians must be aware that there have been no studies on the effectiveness of screening for family violence as a routine part of health care. Clinicians must be familiar with the symptoms and signs of family violence. They should look for family violence when these symptoms and signs are present and should know what to do when they learn that a patient is a victim of family violence. Appropriate actions include documenting the abuse, making sure that the patient receives appropriate treatment for injuries and psychological problems, and giving the patient information about protective services. Asking the patient about this issue during future office visits would also be appropriate.
What are the cautions related to these recommendations?
Recommendations may change as new studies become available. Some other organizations do recommend including questions about family violence as a routine part of health care visits. Health care providers should know that reporting child and elder abuse is mandatory in all states and that some states require reporting of domestic partner violence.
Related articles in Annals:
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  K. V. Rhodes, R. M. Frankel, N. Levinthal, E. Prenoveau, J. Bailey, and W. Levinson "You're Not a Victim of Domestic Violence, Are You?" Provider Patient Communication about Domestic Violence Ann Intern Med, November 6, 2007; 147(9): 620 - 627. [Abstract] [Full Text] [PDF]
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 A. L. Coker, V. C. Flerx, P. H. Smith, D. J. Whitaker, M. K. Fadden, and M. Williams Partner Violence Screening in Rural Health Care Clinics Am J Public Health, July 1, 2007; 97(7): 1319 - 1325. [Abstract] [Full Text] [PDF]
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 U. Pikarinen, T. Saisto, B. Schei, K. Swahnberg, and E. Halmesmaki Experiences of Physical and Sexual Abuse and Their Implications for Current Health Obstet. Gynecol., May 1, 2007; 109(5): 1116 - 1122. [Abstract] [Full Text] [PDF]
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 S. B. Plichta Interactions Between Victims of Intimate Partner Violence Against Women and the Health Care System: Policy and Practice Implications Trauma Violence Abuse, April 1, 2007; 8(2): 226 - 239. [Abstract] [PDF]
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 N. El-Bassel, L. Gilbert, E. Wu, M. Chang, C. Gomes, D. Vinocur, and T. Spevack Intimate partner violence prevalence and HIV risks among women receiving care in emergency departments: implications for IPV and HIV screening Emerg. Med. J., April 1, 2007; 24(4): 255 - 259. [Abstract] [Full Text] [PDF]
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 C. A. Walsh, J. Ploeg, L. Lohfeld, J. Horne, H. MacMillan, and D. Lai Violence Across the Lifespan: Interconnections Among Forms of Abuse as Described by Marginalized Canadian Elders and their Care-givers Br. J. Soc. Work, April 1, 2007; 37(3): 491 - 514. [Abstract] [Full Text] [PDF]
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 A. E. Bonomi, M. L. Anderson, R. J. Reid, D. Carrell, P. A. Fishman, F. P. Rivara, and R. S. Thompson Intimate Partner Violence in Older Women Gerontologist, February 1, 2007; 47(1): 34 - 41. [Abstract] [Full Text] [PDF]
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 H. L. MacMillan, C. N. Wathen, E. Jamieson, M. Boyle, L.-A. McNutt, A. Worster, B. Lent, M. Webb, and for the McMaster Violence Against Women Research G Approaches to screening for intimate partner violence in health care settings: a randomized trial. JAMA, August 2, 2006; 296(5): 530 - 536. [Abstract] [Full Text] [PDF]
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 E. A. Edwardsen and D. Morse Intimate Partner Violence Resource Materials: Assessment of Information Distribution. J Interpers Violence, August 1, 2006; 21(8): 971 - 981. [Abstract] [PDF]
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 P. Janssen, H. Dascal-Weichhendler, and M. McGregor Assessment for intimate partner violence: where do we stand? J Am Board Fam Med, July 1, 2006; 19(4): 413 - 415. [Full Text] [PDF]
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S. L. Wenzel, J. S. Tucker, K. Hambarsoomian, and M. N. Elliott Toward a more comprehensive understanding of violence against impoverished women. J Interpers Violence, June 1, 2006; 21(6): 820 - 839. [Abstract] [PDF]
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 K. V. Rhodes, M. Drum, E. Anliker, R. M. Frankel, D. S. Howes, and W. Levinson Lowering the threshold for discussions of domestic violence: a randomized controlled trial of computer screening. Arch Intern Med, May 22, 2006; 166(10): 1107 - 1114. [Abstract] [Full Text] [PDF]
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G. S. Feder, M. Hutson, J. Ramsay, and A. R. Taket Women Exposed to Intimate Partner Violence: Expectations and Experiences When They Encounter Health Care Professionals: A Meta-analysis of Qualitative Studies Arch Intern Med, January 9, 2006; 166(1): 22 - 37. [Abstract] [Full Text] [PDF]
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 P.-H. Chen, S. Rovi, M. Vega, A. Jacobs, and M. S Johnson Screening for domestic violence in a predominantly Hispanic clinical setting Fam. Pract., December 1, 2005; 22(6): 617 - 623. [Abstract] [Full Text] [PDF]
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W. C. Holmes and M. D. Sammel Brief Communication: Physical Abuse of Boys and Possible Associations with Poor Adult Outcomes Ann Intern Med, October 18, 2005; 143(8): 581 - 586. [Abstract] [Full Text] [PDF]
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H. L. MacMillan and C. N. Wathen Family Violence Research: Lessons Learned and Where From Here? JAMA, August 3, 2005; 294(5): 618 - 620. [Full Text] [PDF]
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T. Zink and F. Putnam Intimate Partner Violence Research in the Health Care Setting: What Are Appropriate and Feasible Methodological Standards? J Interpers Violence, April 1, 2005; 20(4): 365 - 372. [Abstract] [PDF]
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P. A. Janssen, T. L. Nicholls, R. A. Kumar, H. Stefanakis, A. L. Spidel, and E. M. Simpson Of Mice and Men: Will the Intersection of Social Science and Genetics Create New Approaches for Intimate Partner Violence? J Interpers Violence, January 1, 2005; 20(1): 61 - 71. [Abstract] [PDF]
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 Other articles noted Evid. Based Med., September 1, 2004; 9(5): e5 - e5. [Full Text] [PDF]
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C. Nicolaidis and the American Medical Women's Association and The P Screening for Family and Intimate Partner Violence Ann Intern Med, July 6, 2004; 141(1): 81 - 82. [Full Text] [PDF]
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 Other articles noted: 06 Feb 2004 to 16 Apr 2004 Evid. Based Nurs., July 1, 2004; 7(3): e3 - e3. [Full Text] [PDF]
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 Screening for Family and Intimate Partner Violence: Insufficient Evidence Journal Watch (General), March 26, 2004; 2004(326): 2 - 2. [Full Text]
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 L. E Ferris Intimate partner violence BMJ, March 13, 2004; 328(7440): 595 - 596. [Full Text] [PDF]
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M. S. Lachs Screening for Family Violence: What's an Evidence-Based Doctor To Do? Ann Intern Med, March 2, 2004; 140(5): 399 - 400. [Full Text] [PDF]
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 U.S. Preventive Services Task Force Screening for Family and Intimate Partner Violence: Recommendation Statement Ann. Fam. Med, March 1, 2004; 2(2): 156 - 160. [Full Text] [PDF]
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P. Nygren, H. D. Nelson, and J. Klein Screening Children for Family Violence: A Review of the Evidence for the US Preventive Services Task Force Ann. Fam. Med, March 1, 2004; 2(2): 161 - 169. [Abstract] [Full Text] [PDF]
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