Clinical Utility of an Intimate Partner Violence Screening Tool for Female VHA Patients

Abstract

OBJECTIVES: Female Veterans are at high risk for physical, sexual, and psychological forms of intimate partner violence (IPV) victimization. This study evaluated the accuracy of a brief IPV victimization screening tool for use with female Veterans Health Administration (VHA) patients. DESIGN: Participants completed a paper-and-pencil mail survey that included the four-item Hurt/Insult/ Threaten/Scream (HITS) and the 39-item Revised Conflict Tactics Scales (CTS-2). Operating characteristics, including sensitivity and specificity, were calculated using the CTS-2 as the reference standard for pastyear IPV. PARTICIPANTS: Female veterans from a roster of randomly selected female patients of the New England VA Healthcare System. Women must have reported being in an intimate relationship in the past year to be included. MAIN MEASURES: Primary measures included the HITS (index test) and the CTS-2 (reference standard). KEY RESULTS: This study included 160 women. The percentage of women who reported past-year IPV, as measured by any physical assault, sexual coercion, and/or severe psychological aggression on the CTS-2, was 28.8 %. The receiver-operator characteristic curve demonstrated that the HITS cutoff score of 6 maximizes the true positives while minimizing the false positives in this sample. The sensitivity of the optimal HITS cutoff score of 6 was 78 % (95 % CI 64 % to 88 %), specificity 80 % (95 % CI 71 % to 87 %), positive likelihood ratio 3.9 (95 % CI 2.61 to 5.76), negative likelihood ratio 0.27 (95 % CI 0.16 to 0.47), positive predictive value 0.61 (95 % CI 0.47, 0.73), and negative predictive value 0.90 (95 % CI 0.82, 0.95). CONCLUSIONS: For a low-burden screen, the HITS demonstrated good accuracy in detecting past-year IPV relative to the CTS-2 in a sample of female VHA patients with an optimal cutpoint of 6. The HITS may help VHA and other health-care providers detect past-year IPV and deliver appropriate care for female Veterans. I ntimate partner violence (IPV) refers to actual or threatened physical, sexual, and psychological abuse by a current or former intimate partner. 1 IPV is a major public health problem that causes and exacerbates physical health problems, including cardiovascular, respiratory, chronic pain, gynecological disorders, and adverse pregnancy outcomes. [2][3][4] Similarly, IPV increases risk for psychiatric conditions such as posttraumatic stress disorder (PTSD), other anxiety disorders, depression, substance misuse, eating disorders, and suicidality. [3][4][5] Relative to civilians, female veterans are at higher risk for physical and sexual forms of IPV (33.0 % vs. 23.8 % lifetime prevalence). 2 Although the reasons for elevated risk among female Veterans remain unknown, some theorize that women's exposure to violence-prone environments, such as violent childhood homes and the military, may elevate women's risk for IPV. 6,7 IPV may be particularly common among women seeking care at Veterans Health Affairs (VHA) health-care facilities. 6,8,9 Studies have found lifetime reports of IPV a...

Intimate Partner Violence and Current Mental Health Needs Among Female Veterans

“…Responses are scored on a 5-point scale from 1 ("never") to 5 ("frequently") and summed for a total score. Consistent with prior work demonstrating that a cutoff score of 6 optimizes the sensitivity and specificity of the HITS in detecting IPV among female VHA patients, 10,13 women who scored Ն6 screened positive for past-year IPV.…”

“…As described elsewhere, 10 surveys were mailed to potential participants using a modified multiple mailing strategy 11 : (1) informed consent fact sheet, survey packet, and $10 incentive; (2) 2 weeks later a thank you/reminder postcard; and (3) 4 weeks later an additional survey packet and $10 incentive to nonresponders. The local institutional review board approved all procedures.…”

“…10 Using the VHA Corporate Data Warehouse, 700 women were randomly selected from the population of female veteran VHA patients in New England: 581 with locatable addresses received a survey, 21 declined participation, 191 did not return a survey, and 369 responded (63.5% response rate). Comparisons between responders and nonresponders on demographics from administrative records revealed a difference in age: responders were slightly older (Cohen d ϭ 0.27).…”

Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care

“…14 Regional studies examining VHA users found even higher rates of IPV, with up to 28.8% of partnered women reporting past-year IPV in mail survey studies. 15,16 Understanding patient-level factors that are associated with past-year IPV may help tailor programs to patients most at risk. The USPTF cites IPV risk factors such as younger age, substance abuse, and economic hardship.…”

Screening for Intimate Partner Violence: The Time Is Now

“…In this issue of JGIM, Iverson et al 1 report on the accuracy of a brief IPV screening tool in a population of female Veterans Health Administration (VHA) patients. Participants completed a mailed survey consisting of the IPV reference "gold" standard [the 39-item Revised Conflict Tactics Scale (CTS-2)] compared with HITS, a brief screening tool consisting of four items that asks about physical hurts, insults, threats or screams over the prior 12 months.…”