Should primary care clinicians screen adult women for intimate partner violence and/or screen older or vulnerable adults for abuse?

In this updated 2018 review, the U.S. Preventive Services Task Force (USPSTF) concludes there is sufficient evidence to recommend screening for intimate partner violence (IPV) in women of reproductive age where ongoing support services are available (B recommendation). The USPSTF concludes that there is insufficient evidence to recommend screening for abuse and neglect in older or vulnerable adults (I statement). These recommendations are unchanged from the 2013 USPSTF recommendations. (LOE = 2c)

US Preventive Services Task Force. Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults. US Preventive Services Task Force recommendation statement. JAMA 2018;320(16):1678-1687.  [PMID:30357305]

Practice guideline

Government

Population-based

In this updated 2018 version, the task force analyzed 3 randomized controlled trials (RCTs) that compared IPV screening with no screening and found no direct improvement in patient-oriented outcomes when screening was followed only by brief counseling or referral. Two of these RCTs reported on harms of screening and found none. Nine studies assessed screening tools, with sensitivities ranging from 64% to 87% and specificities ranging from 80% to 95%. Eleven RCTs evaluated interventions for women with screen-detected IPV or at high risk for IPV, and the most effective trials for IPV outcomes involved ongoing support services. Such services included multiple visits, with behavioral and social interventions addressing other pregnancy-related risk factors in addition to IPV, including smoking, depression, and tobacco exposure. Of the 3 RCTs that enrolled pregnant women and evaluated a counseling intervention, 2 found benefit. No studies evaluated screening or interventions for elder abuse and neglect. The American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American Academy of Pediatrics recommend screening for IPV. The Canadian Task Force on Preventive Health Care and the World Health Organization do not recommend screening for IPV on the basis of insufficient evidence of direct benefit.