Should health professionals screen women for domestic violence? Systematic review

doi:10.1136/bmj.325.7359.314

BMJ 2002;325:314 ( 10 August )

Primary care

Should health professionals screen women for domestic violence? Systematic review

Jean Ramsay, senior research officer, ^a Jo Richardson, research fellow, ^a Yvonne H Carter, professor of general practice and primary care, ^a Leslie L Davidson, director, ^b Gene Feder, professor of primary care research and development. ^a

^a Department of General Practice and Primary Care, Barts and the London, Queen Mary's School of Medicine and Dentistry, London E1 4NS, ^b National Perinatal Epidemiology Unit, Institute of Health Sciences, Oxford OX3 7LF

Correspondence to: Gene Feder: g.s.feder{at}qmul.ac.uk

Objective: To assess the evidence for the acceptabilityand effectiveness of screening women for domestic violence inhealthcaresettings.
Design: Systematic review of published quantitativestudies.
Search strategy: Three electronic databases (Medline, Embase,and CINAHL) were searched for articles published in the Englishlanguage up to February2001.
Included studies: Surveys that elicited the attitudes of womenand health professionals on the screening of women in health settings;comparative studies conducted in healthcare settings that measuredrates of identification of domestic violence in the presence andabsence of screening; studies measuring outcomes of interventionsfor women identified in health settings who experience abuse froma male partner or ex-partner compared with abused women not receivinganintervention.
Results: 20 papers met the inclusion criteria. In foursurveys, 43-85% of women respondents found screening in healthcaresettings acceptable. Two surveys of health professionals' viewsfound that two thirds of physicians and almost half of emergencydepartment nurses were not in favour of screening. In nine studiesof screening compared with no screening, most detected a greaterproportion of abused women identified by healthcare professionals.Six studies of interventions used weak study designs and gaveinconsistent results. Other than increased referral to outsideagencies, little evidence exists for changes in important outcomessuch as decreased exposure to violence. No studies measured qualityof life, mental health outcomes, or potential harm to women fromscreeningprogrammes.
Conclusion: Although domestic violence is a common problemwith major health consequences for women, implementation of screeningprogrammes in healthcare settings cannot be justified. Evidenceof the benefit of specific interventions and lack of harm fromscreening isneeded.

What is already known on this topic
Around one quarter of women in the United Kingdom have been physically assaulted by a current or former male partner

Screening for domestic violence in healthcare settings is the policy of many health professional bodies in the United States

The Department of Health recommends that health professionals should consider "routine enquiry" of women patients about whether they have experienced domestic violence

What this study adds
Screening by health professionals increases the identification of domestic violence, and many women do not object to being asked

Most health professionals surveyed do not agree with screening of women in healthcare settings

Insufficient evidence exists to show whether screening and intervention can lead to improved outcomes for women identified as abused

Implementation of screening programmes in healthcare settings is not justified by current evidence

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