The end of universal screening for intimate partner violence?BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2532 (Published 24 April 2013) Cite this as: BMJ 2013;346:f2532
Fear of violence from an intimate partner affects women’s mental health and quality of life. But universal screening followed by the offer of brief counselling by a primary care doctor didn’t improve either in a cluster randomised trial. Researchers screened unselected women by mail to identify 272 who reported fear of violence. The offer of counselling from trained primary care doctors made little difference to the women’s global mental health, quality of life, or safety planning and behaviour when compared with usual care, and a linked comment says it may be time to abandon this kind of intervention (doi:10.1016/S0140-6736(13)60584-X). Three trials in developed countries have now reported little benefit from universal screening of women followed by low intensity forms of help, although the latest Australian trial did report fewer symptoms of depression in screened and counselled women. The current trial randomised doctors, not patients.
These trials should not discourage doctors from asking women about fear of violence in specific clinical contexts, including mental health and HIV services. But they do suggest that a mail shot to nearly 20 000 asymptomatic women is neither efficient nor effective, says the editorial. The focus of research should now shift towards more intensive forms of help, offered to women in more specific settings (such as antenatal clinics). We might also develop and test relationship interventions aimed at men.
Cite this as: BMJ 2013;346:f2532