Screening women for intimate partner violence in healthcare settings: abridged Cochrane systematic review and meta-analysis

Abstract

Objective To examine the effectiveness of screening for intimate partner violence conducted within healthcare settings to determine whether or not screening increases identification and referral to support agencies, improves women's wellbeing, decreases further violence, or causes harm.Design Systematic review and meta-analysis of trials assessing effectiveness of screening. Study assessment, data abstraction, and quality assessment were conducted independently by two of the authors. Standardised estimations of the risk ratios and 95% confidence intervals were calculated.Data sources Nine databases searched up to July 2012 (CENTRAL, Medline, Medline(R), Embase, DARE, CINAHL, PsycINFO, Sociological Abstracts, and ASSIA), and five trials registers searched up to 2010.Eligibility criteria for selecting studies Randomised or quasi-randomised trials of screening programmes for intimate partner violence involving all women aged ≥16 attending a healthcare setting. We included only studies in which clinicians in the intervention arm personally conducted the screening, or were informed of the screening result at the time of the consultation, compared with usual care (or no screening). Studies of screening programmes that were followed by structured interventions such as advocacy or therapeutic intervention were excluded.Results 11 eligible trials (n=13 027) were identified. In six pooled studies (n=3564), screening increased the identification of intimate partner violence (risk ratio 2.33, 95% confidence interval 1.39 to 3.89), particularly in antenatal settings (4.26, 1.76 to 10.31). Based on three studies (n=1400), we detected no evidence that screening increases referrals to domestic violence support services (2.67, 0.99 to 7.20). Only two studies measured women's experience of violence after screening (three to 18 months after screening) and found no reduction in intimate partner violence. One study reported that screening does not cause harm.Conclusions Though screening is likely to increase identification of intimate partner violence in healthcare settings, rates of identification from screening interventions were low relative to best estimates of prevalence of such violence. It is uncertain whether screening increases effective referral to supportive agencies. Screening does not seem to cause harm in the short term, but harm was measured in only one study. As the primary studies did not detect improved outcomes for women screened for intimate partner violence, there is insufficient evidence for screening in healthcare settings. Studies comparing screening versus case finding, or screening in combination with therapeutic intervention for women's long term wellbeing, are needed to inform the implementation of identification policies in healthcare settings.

Domestic Violence Enhanced Perinatal Home Visits: The DOVE Randomized Clinical Trial

“…Considering the findings of a recent meta-analysis 38 that did not demonstrate improved outcomes for women who were screened for IPV, DOVE is one of the few IPV interventions 39 that has demonstrated efficacy. The home visitors who implemented the DOVE protocol had established relationships with women, which facilitated the provision of support, critical to any empowerment intervention.…”

“…It empowered women with strategies to increase their safety as well as the safety of their children and enabled them to leave the relationship safely when they deemed it appropriate. While most studies have not followed abused women over time, 38 one of the distinguishing features of our study is that we followed participants from pregnancy through 24 months postpartum. Because of this long follow-up, we provide evidence of long-term decreased IPV.…”

“It’s Always Good to Ask”: A Mixed Methods Study on the Perceived Role of Sexual Health Practitioners Asking Gay and Bisexual Men About Experiences of Domestic Violence and Abuse

“…There continues to be international debate about a policy of routine enquiry for DVA in healthcare settings due to insufficient evidence of improved outcomes (Moyer et al 2013;O'Doherty et al 2014;World Health Organization, 2013). The World Health Organization recommends that providers should be trained in how to respond to disclosures of abuse and to be aware of the indicators.…”

Toward an integrated approach in research on interpersonal violence : Conceptual and methodological challenges

“…They have however not been able to show an effect of screening in reducing exposure to violence or improving health (MacMillan, Wathen, Jamieson et al, 2009;Hegarty, O'Doherty, Taft et al, 2013;WHO, 2013;O'Doherty, Taft, Hegarty et al, 2014). It should be noted that though support for general screening of all women has not been found, it might very well be beneficial to use routine enquiry within specific subgroups of patients, for example within antenatal care Hegarty et al, 2013;Taft, O'Doherty, Hegarty et al, 2013).…”