Heidi D. Nelson, MD, MPH; Peggy Nygren, MA; Yasmin McInerney, MD; Jonathan Klein, MD, MPH
Disclaimer: The authors of this article are responsible for its contents, including clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: The authors thank members of the USPSTF and reviewers of the full evidence report for their contributions to this project; Patty Davis for conducting the library search; and Miranda Norbraten for helping prepare the manuscript.
Grant Support: This study was conducted by the Oregon Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0018, Task Order Number 2, Rockville, Maryland). Dr. McInerney was supported by the Veterans Affairs special fellowship in Health Issues of Women Veterans.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (www.preventiveservices.ahrq.gov) and through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295).
Current Author Addresses: Dr. Nelson and Ms. Nygren: Oregon Health & Science University, Mail Code BICC 504, 3181 SW Sam Jackson Park Road, Portland, OR 97201.
Dr. McInerney: 13107 Mindanao Way, #1, Marina del Rey, CA 90292.
Dr. Klein: Department of Pediatrics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642.
Family and intimate partner violence is common in the United States and is often associated with acute and chronic health problems. Although the clinician's role in identification and intervention is considered a professional, ethical, and sometimes legal responsibility, the effectiveness of screening is uncertain.
To examine evidence on the benefits and harms of screening women and elderly adults in health care settings for family and intimate partner violence.
MEDLINE, PsycINFO, CINAHL, Health & Psychosocial Instruments, AARP Ageline, Cochrane Controlled Trials Register, reference lists, and experts.
The authors selected English-language studies that included original data focusing on the performance of screening instruments (14 studies for women, 3 for elderly persons) and the effectiveness of interventions based in health care settings (2 studies for women, none for elderly persons).
Study design, patient samples and settings, methods of assessment or intervention, and outcome measures were extracted, and a set of criteria was applied to evaluate study quality.
No trials of the effectiveness of screening in a health care setting for reducing harm have been published. Several screening instruments have been developed; some have demonstrated fair to good internal consistency and some have been validated with longer instruments, but none have been evaluated against measurable violence or health outcomes. Few intervention studies have been conducted. Existing intervention studies focused on pregnant women, and study limitations restrict their interpretation.
Although the literature on family and intimate partner violence is extensive, few studies provide data on detection and management to guide clinicians.
Analytic framework and key questions (KQs).
Screening instruments for elder abuse and neglect.
Table 1. Studies of Screening Instruments about Intimate Partner Violence against Women
Table 2. Studies of Interventions for Intimate Partner Violence against Women
Table 3. Studies of Screening Instruments about Elder Abuse and Neglect
Appendix Table 1. Women's Experience with Battering Scale (WEB)
Appendix Table 2. Index of Spouse Abuse—Physical Scale (ISA-PS)
spouse abuse/or domestic violence.mp. or battered woman.mp. [mp = title, abstract, heading word, table of contents, key phrase identifiers]
(screening or identity or early detection).mp.
physicians, family/ or “family physicians”.mp.
primary health care/ or “primary care”.mp.
family practice/or “family practice”.mp.
2 or 3 or 4 or 5 or 6
1 or 7
From limit 8 to.
spouse abuse/ or domestic violence.mp. or battered women.mp.
((intimate partner or life partner or partner or wife or husband) and (violence or abuse)).mp.
1 or 2
Physicians, Family/ or family physicians.mp.
exp Primary Health Care/ or primary care.mp.
Family Practice/ or family practice.mp.
EMERGENCIES/ or emergency.mp.
exp emergency service, hospital/ or emergency department$.mp.
OBSTETRICS/ or “OBSTETRICS AND GYNECOLOGY DEPARTMENT, HOSPITAL”/ or obstetrics.mp.
4 or 5 or 6 or 7 or 8 or 9 or 10
3 and 11
pc.fs. or prevent$.mp. or intervention.mp. or assessment.mp.
exp counseling/ or counsel$.mp
(patient education or questionnaire$).mp.
interviews/ or interview$.mp.
exp clinical trials/ or clinical trial$.mp.
13 or 14 or 15 or 16 or 17 or 18
12 and 19
From limit 20 to.
from 21 keep 1–151
exp Partner Abuse/ or spouse abuse.mp.
exp Battered Females/
exp Family Violence/ or exp Victimization/ or exp Emotional Abuse/ or battered women.mp.
3 and (women or females).mp.
((intimate partner$ or life partner$ or partner or wife or husband) and (violence or abuse)).mp.
1 or 2 or 4 or 5
exp Family Physicians/ or family physicians.mp.
exp Family Physicians/ or family practice.mp.
exp emergency services/ or emergenc$.mp.
exp OBSTETRICS/ or obstetrics.mp.
exp GYNECOLOGY/ or gynecology.mp.
7 or 8 or 9 or 10 or 11 or 12 or 13 15. 6 and 14
(prevent$ or intervention or assessment).mp.
exp counseling/ or counsel$.mp.
exp Client Education/ or patient education.mp.
questionnaires/ or questionnaire$.mp.
exp interviews/ or interview$.mp.
exp at risk populations/ or cohort study$.mp.
(domestic violence or family violence).mp.
(elder$ or aged or old or ageing).mp.
(vulnerable or disabled or handicapped).mp.
(2 or 4) and 3
1 or 5
mass screening/ or screening.mp.
questionnaires/ or questionnaire$.tw.
interview/ or interview$.tw.
7 or 8 or 9
6 and 10
From limit 11 to.
from 12 keep 1–1009
((family or domestic) and (abuse or violence)).mp.
(elder$ or old or ageing or aging or aged or geriatric).mp.
2 and 3
1 or 4
(internal medicine or geriatrics or family physicians or family practice).mp.
(primary care or emergency or emergency services).mp.
1 or 4 or 5
GERIATRICS/ or geriatrics.mp.
Internal Medicine/ or internal medicine.mp.
Family Practice/ or family practice.mp
exp Emergency Service, Hospital/ or emergency department.mp.
7 or 8 or 9 or 10 or 11 or 12 or 13
6 and 14
From limit 15 to.
exp COUNSELING/ or counseling.mp.
INTERVIEWS/ or interviews.mp.
17 or 18 or 19 or 20 or 21 or 22 or 23
16 and 24
from 25 keep 1–129
(elder$ or aged or aging or ageing or old or geriatric).mp.
3 or 4
2 and 5
1 or 6
exp GERIATRICS/ or geriatrics.mp.
internal medicine.mp. or exp Physicians/
exp Family Physicians/ or exp General Practitioners/ or family practice.mp.
exp emergency services/ or emergency$.mp.
8 or 9 or 10 or 11 or 12 or 13
7 and 14
prevention/ or prevent$.mp. or intervention.mp. or assessment.mp.
exp counseling/ or counsel$.mp. or assess$.mp.
exp at risk populations/ or exp cohort analysis/ or cohort stud$.mp.
from 25 keep 1–36
6 or 7
5 and 8
from 9 keep 1–75
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Adrian A Boyle
August 13, 2004
Screening women for domestic violence
The article by Nelson et al (1) concludes that intervention studies fail to show any benefit for women suffering domestic violence. They have only considered interventions based in health care and have ignored an extensive literature from psychologists, sociologists and criminologists. There are well conducted controlled trials which show some benefit. (2) (3) Women suffering domestic violence do not only present to physicians but are likely to involve the police and voluntary agencies. Considering interventions based only in healthcare alone is artificial, since this is unlikely to represent the experience of the victim. (4) Though including these studies would probably not have changed the overall conclusions of this review, it is important that researchers in this field consider the wider sources of information before making recommendations.
(1) Nelson HD, Nygren P, McInerney Y, Klein J. Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine 2004; 140(5):387-396.
(2) Sullivan CM, Bybee D, I. Reducing violence using community-based advocacy for women with abusive partners. J Consult Clin Psychol 1999; 67(1):43-53.
(3) Sherman L, Berk RA. The specific deterrent effects of arrest for domestic assault. American Sociological Review 1984; 49(2):262-272.
(4) Mirrlees-Black C. Domestic violence: findings from a new British crime survey self completion questionnaire. 1-136. 1999. Home Office Publications.
Nelson HD, Nygren P, McInerney Y, Klein J. Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140:387–396. doi: 10.7326/0003-4819-140-5-200403020-00015
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Published: Ann Intern Med. 2004;140(5):387-396.
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