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Uncertain benefit to intimate partner violence screening

Clinical Question:
Does screening women for intimate partner violence reduce violence and improve health outcomes?

Bottom Line:
This study found no evidence that routinely screening women for intimate partner violence (IPV) improves health outcomes. Screened women did not report increased harm compared with those not screened. (LOE = 1b-)

Reference:
MacMillan HL, Wathen CN, Jamieson E, et al, for the McMaster Violence Against Women Research Group. Screening for intimate partner violence in health care settings. A randomized trial. JAMA 2009;302(5):493-501.  [PMID:19654384]

Study Design:
Randomized controlled trial (single-blinded)

Allocation:
Unconcealed

Setting:
Outpatient (any)

Synopsis:
Although many professional organizations recommend routine screening for IPV, some clinicians are concerned that doing so may actually lead to an escalation in violence and harm. These investigators recruited women, aged 18 years to 64 years, with a male partner at some time in the last 12 months, from multiple primary care clinics, emergency departments, and women's specialty care clinics. All clinicians involved in the study received standardized training in responding to IPV, including appropriate response to disclosure, safety assessment, and information about local community resources for referral. All eligible women were taken to a private room for interviewing. Women presenting for care on the randomly designated (unconcealed allocation assignment) screening day self-completed a standardized, previously validated, 8-item abuse screening tool before seeing their clinician. The clinicians were given the completed questionnaires of the women who screened positive. Any discussion of positive findings on the questionnaire and further referrals or treatment were left to the discretion of the treating clinician. On no-screening days, women completed the same abuse screening tool after their clinical encounter. Clinicians could inquire about IPV when clinically indicated. After their visits, all women regardless of group assignment completed a longer 30-item validated research instrument selected as the criterion standard for recurrent IPV. Individuals masked to group assignment interviewed participating women using standard tools for assessing recurrent IPV and quality of life within 14 days of the initial visit and again at 6, 12, and 18 months. Complete follow-up at 18 months occurred for approximately 60% of women in each group. Unfortunately women lost to follow-up generally reported higher scores on their IPV screening tools at the index visit. The prevalence of IPV at the index visit was similar in the screened and not screened groups (13% vs 12%, respectively). Recurrence of IPV reported at 18 months was similar among screened versus not screened women (46% vs 53%, difference not significant). After statistical analysis to account for the large sample loss, quality-of-life score differences were also not significant between the 2 groups. Screened women did not report increased harm compared with not screened women.

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