WOMEN & DOMESTIC VIOLENCE

Screening Women for Domestic Violence Could Help Prevent Abuse

Review shows benefits of routine checks at clinics, in doctors' offices.

Routine screening of women for domestic violence could reduce cases of abuse and injuries, a new analysis indicates.The review of recent studies, which was commissioned by the U.S. Preventive Services Task Force (USPSTF), also found that general screening for domestic violence did not appear to harm women.

The task force will use the review to decide whether to update its 2004 guidelines, which state that there is not enough evidence about the benefits and harms of domestic violence screening to recommend it to doctors.The task force will probably make a final decision on new guidelines within a few weeks of the current review, which was published online May 7 in Annals of Internal Medicine, said review author Dr. Heidi Nelson, a clinical epidemiologist at the Oregon Evidence-based Practice Center in Portland.

"It's definitely a stronger set of studies than we looked at before," said Nelson, who was involved in the review that informed the 2004 guidelines.The current review evaluated all the studies that have looked at the effects of domestic violence screening in clinics, the treatments that screening led to, and the effectiveness of screening methods that had been published since the review for the 2004 guidelines."The task force recommendations are not mandates, but often a strong recommendation by the task force leads to a standard of care and insurance coverage," Nelson said.

Several organizations for medical professionals, including the Institute of Medicine (IOM), already support the routine screening of patients for domestic violence."The USPSTF recommendations tend to be more rigorous, and more user-friendly [and] accessible, so I think they are more used than IOM's," said Dr. Adam Zolotor, a family physician in the University of North Carolina School of Medicine. Zolotor has concerns about the idea of general screening."The issue is you have got a busy family practice, and doctors screen these women and women get emotional and then you don't have anything to offer them," he said. There could also be a big risk that a woman's abuse gets worse because her boyfriend or husband finds resources that the doctor gave her, such as numbers to call for support, and beats her, Zolotor explained.

However, "there is a really important new piece of evidence that screening works that is one of the most important questions for moving the needle on screening," Zolotor noted. This evidence comes from six studies included in the review that evaluated the effect of interventions to help women who screen positive for domestic violence. One study in particular screened more than 1,000 pregnant black women in the D.C. area during their prenatal care visits. It gave half of the women experiencing abuse counseling sessions before and after they gave birth. The study found that women who received therapy had less domestic violence during and after pregnancy and also gave birth to healthier babies.

"I think the ultimate recommendation from the task force ought to be something like we should screen and/but we need to develop adequate resources to refer women to for interventions," Zolotor said. The studies of interventions in the review offered structured help, such as sessions with a therapist or home visits, but not all areas have these resources. "In my area, I might be able to give you a telephone number to call for help when you are having problems," Zolotor said.

However, every state has a domestic violence coalition and programs with domestic violence advocates who can help women with a number of issues, such as planning safe ways to get out of an abusive situation, getting child care and finding a job, said Fern Gilkerson, a health education specialist with the Pennsylvania Coalition Against Domestic Violence in Harrisburg.

"I absolutely think that universal screening could be helpful; there's no harm at all in asking," Gilkerson said. Even if there are not a lot of resources in place, "screening itself is an intervention," Gilkerson said. "Screening lets them know that there's help when they're ready to get it. Someone may need to be asked seven or eight times." Many of the studies in the review screened women who were either pregnant or new moms because they are accessing health care, Nelson said, "but women who come in for a routine physical or pelvic exam might float under the radar."

Zolotor said that certain times might be the most appropriate to screen, such as when a doctor or clinic sees a patient for the first time or when a patient becomes pregnant. As of August 2012, the Affordable Care Act is requiring that insurance covers domestic violence screening every year, as well as counseling, as part of preventive health services.

Between 1.3 million and 5.3 million women in the United States experience domestic violence each year, and between 22 percent and 39 percent of women experience abuse at some point in their lives, according to the review.

More information

To learn more about domestic violence, visit Helpguide.org .

(SOURCES: Heidi Nelson, M.D., M.P.H. clinical epidemiologist, Oregon Evidence-based Practice Center, Oregon Health & Science University, research professor, medical informatics, clinical epidemiology and medicine, Portland, Ore.; Adam Zolotor, M.D., M.P.H., family physician, assistant professor, family medicine, University of North Carolina School of Medicine, Chapel Hill, N.C.; Fern Gilkerson, health education specialist, Pennsylvania Coalition Against Domestic Violence, Harrisburg, Pa.; May 7, 2012, Annals of Internal Medicine, online)