Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force
- Heidi D. Nelson, MD, MPH;
- Peggy Nygren, MA;
- Yasmin McInerney, MD; and
- Jonathan Klein, MD, MPH
- From Oregon Health & Science University and Veterans Affairs Medical Center, Portland, Oregon; and University of Rochester, Rochester, New York.
Abstract
Background: Family and intimate partner violence is common in the United States and is often associated with acute and chronic health problems. Although the clinician's role in identification and intervention is considered a professional, ethical, and sometimes legal responsibility, the effectiveness of screening is uncertain.
Purpose: To examine evidence on the benefits and harms of screening women and elderly adults in health care settings for family and intimate partner violence.
Data Sources: MEDLINE, PsycINFO, CINAHL, Health & Psychosocial Instruments, AARP Ageline, Cochrane Controlled Trials Register, reference lists, and experts.
Study Selection: The authors selected English-language studies that included original data focusing on the performance of screening instruments (14 studies for women, 3 for elderly persons) and the effectiveness of interventions based in health care settings (2 studies for women, none for elderly persons).
Data Extraction: Study design, patient samples and settings, methods of assessment or intervention, and outcome measures were extracted, and a set of criteria was applied to evaluate study quality.
Data Synthesis: No trials of the effectiveness of screening in a health care setting for reducing harm have been published. Several screening instruments have been developed; some have demonstrated fair to good internal consistency and some have been validated with longer instruments, but none have been evaluated against measurable violence or health outcomes. Few intervention studies have been conducted. Existing intervention studies focused on pregnant women, and study limitations restrict their interpretation.
Conclusion: Although the literature on family and intimate partner violence is extensive, few studies provide data on detection and management to guide clinicians.
Article and Author Information
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Disclaimer: The authors of this article are responsible for its contents, including clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
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Acknowledgments: The authors thank members of the USPSTF and reviewers of the full evidence report for their contributions to this project; Patty Davis for conducting the library search; and Miranda Norbraten for helping prepare the manuscript.
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Grant Support: This study was conducted by the Oregon Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0018, Task Order Number 2, Rockville, Maryland). Dr. McInerney was supported by the Veterans Affairs special fellowship in Health Issues of Women Veterans.
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (http://www.preventiveservices.ahrq.gov) and through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295).
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Current Author Addresses: Dr. Nelson and Ms. Nygren: Oregon Health & Science University, Mail Code BICC 504, 3181 SW Sam Jackson Park Road, Portland, OR 97201.
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Dr. McInerney: 13107 Mindanao Way, #1, Marina del Rey, CA 90292.
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Dr. Klein: Department of Pediatrics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642.
- Copyright ©2004 by the American College of Physicians
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