Task force says quiz all women about abuse
Be sure to screen all women between the ages of 14 and 46 for intimate partner violence (IPV), advises new research.1 The U.S. Preventive Services Task Force has issued draft guidance based on the new evidence, noting that such strategies as having women fill out a questionnaire in the waiting room or clinicians asking a few brief questions during a check-up are effective for spotting those who are facing partner violence.2
Based on the evidence, the task force, in a draft recommendation, calls for healthcare professionals to screen all women between ages 14 and 46 for IPV and provide or refer women who have experienced abuse to programs and support. Final guidance will be issued after the task force reviews comments submitted during the comment period of June 10, 2012, through July 11, 2012.
Why is it so important that clinicians include such screening in their encounters with women? Because intimate partner violence, which includes a range of abusive behaviors perpetrated by someone who is or was involved in an intimate relationship with the victim, is common, says Heidi Nelson, MD, MPH, a research professor in the Departments of Medical Informatics and Clinical Epidemiology and Medicine at Oregon Health & Science University in Portland. Approximately 1.3 to 5.3 million women in the United States experience such violent acts each year3-4, notes Nelson, who served as lead author of the new research.
"The National Intimate Partner and Sexual Violence Survey indicated that 30% of women experience physical violence, 9% rape, 17% sexual violence other than rape, and 48% psychological aggression from their intimate partners over their lifetimes," says Nelson.
In addition to social problems, intimate partner violence causes important health problems that are relevant to effective patient care and healthcare delivery, says Nelson. These problems include immediate health effects, such as injuries and death from physical and sexual assault; sexually transmitted infections including HIV; pelvic inflammatory disease; unintended pregnancy; and psychological distress.
Women who are assaulted during pregnancy might see adverse effects in their own health as well as their newborns, states Nelson. Intimate partner violence is associated with preterm birth, low birth weight, and decreased mean gestational age.5-7
Intimate partner violence can have long-lasting repercussions, Nelson comments. Long-term physical and mental health conditions associated with IPV include chronic pain, neurologic disorders, gastrointestinal disorders, migraine headaches, post-traumatic stress disorder, depression, anxiety disorders, substance abuse, and suicide.
Signs not always clear
Not all signs of abuse are obvious, says Susan Sorenson, PhD, a professor in the School of Social Policy & Practice at the University of Pennsylvania and director of the Evelyn Jacobs Ortner Center on Family Violence in Philadelphia. Some abusers hit their victims in the abdomen, which is usually covered with clothing. Others inflict damage onto the head, which is usually covered with hair, and some use strangulation, which can be difficult to detect visually, particularly on women with dark skin, notes Sorenson.
"So, the most straightforward approach is to begin, as we do with other health problems, by asking the patient," states Sorenson. "We have screening instruments that can identify current and past abuse or increased risk for abuse, and the task force is to be commended for encouraging clinicians to use them with all women of childbearing age."
Women of childbearing age are not the only ones who are abused by a partner, observes Sorenson. However, the task force recommendation is a "good start," she notes.
What works?
Screening instruments that include one or more brief questions about IPV are accurate in identifying women at risk for intimate partner violence, says Nelson. Her team's review of 15 studies published since 2002 evaluated 13 screening instruments; of these, six instruments were considered highly accurate (sensitivity and specific greater than 80%). Counseling interventions for women exposed to IPV resulted in reduced IPV and improved health outcomes, Nelson states. (To read the full article, published in the Annals of Internal Medicine, go to http://bit.ly/LkItsG. Also watch a Centers for Disease Control and Prevention (CDC) Public Health Grand Rounds presentation, "Breaking the Silence: Public Health's Role in Intimate Partner Violence Prevention," at http://bit.ly/MrSJiG. Use a CDC IPV fact sheet with patients; download it from http://1.usa.gov/AmcbVW. )
"Our review of four trials of counseling reported reduced IPV and improved birth outcomes for pregnant women, reduced IPV for new mothers, and reduced pregnancy coercion and unsafe relationships for women in family planning clinics," she notes. "Adverse effects of IPV screening were minimal for most women when evaluated in 14 studies, although some women experienced discomfort, loss of privacy, emotional distress, and concerns about further abuse."
References
- Nelson HD, Bougatsos C, Blazina I. Screening women for intimate partner violence: a systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med 2012; 156(11):796-808.
- U.S. Preventive Services Task Force. Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: Draft Recommendation Statement. AHRQ Publication No. 12-05167-EF-2.
- Tjaden P, Thoennes N. Full Report Of The Prevalence, Incidence, And Consequences Of Violence Against Women: Findings From The National Violence Against Women Survey. Rockville, MD: National Institute of Justice, U.S. Department of Justice; 2000.
- National Center for Injury Prevention and Control. Costs of Intimate Partner Violence Against Women In The United States. Atlanta: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2003.
- El-Mohandes AA, Kiely M, Gantz MG, et al. Very preterm birth is reduced in women receiving an integrated behavioral intervention: a randomized controlled trial. Matern Child Health J 2011; 15:19-28.
- Kiely M, El-Mohandes AA, El-Khorazaty MN, et al. An integrated intervention to reduce intimate partner violence in pregnancy: a randomized controlled trial. Obstet Gynecol 2010; 115:273-283.
- Shah PS, Shah J; Knowledge Synthesis Group on Determinants of Preterm/ LBW Births. Maternal exposure to domestic violence and pregnancy and birth outcomes: a systematic review and meta-analyses. J Womens Health (Larchmt) 2010; 19:2,017-2,031.
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