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Screening women for intimate partner violence in healthcare settings: abridged Cochrane systematic review and meta-analysis

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2913 (Published 12 May 2014) Cite this as: BMJ 2014;348:g2913
  1. Lorna J O’Doherty, honorary fellow1,
  2. Angela Taft, professor2,
  3. Kelsey Hegarty, professor1,
  4. Jean Ramsay, honorary senior research fellow3,
  5. Leslie L Davidson, professor4,
  6. Gene Feder, professor5
  1. 1Department of General Practice, University of Melbourne, Carlton, Vic 3010, Australia
  2. 2Judith Lumley Centre, La Trobe University, Melbourne, Vic 3000, Australia
  3. 3Centre for Primary Health Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary College, University of London, London, UK
  4. 4Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
  5. 5Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to: L J O’Doherty lornajaneodoherty{at}hotmail.com
  • Accepted 10 April 2014

Abstract

Objective To examine the effectiveness of screening for intimate partner violence conducted within healthcare settings to determine whether or not screening increases identification and referral to support agencies, improves women’s wellbeing, decreases further violence, or causes harm.

Design Systematic review and meta-analysis of trials assessing effectiveness of screening. Study assessment, data abstraction, and quality assessment were conducted independently by two of the authors. Standardised estimations of the risk ratios and 95% confidence intervals were calculated.

Data sources Nine databases searched up to July 2012 (CENTRAL, Medline, Medline(R), Embase, DARE, CINAHL, PsycINFO, Sociological Abstracts, and ASSIA), and five trials registers searched up to 2010.

Eligibility criteria for selecting studies Randomised or quasi-randomised trials of screening programmes for intimate partner violence involving all women aged ≥16 attending a healthcare setting. We included only studies in which clinicians in the intervention arm personally conducted the screening, or were informed of the screening result at the time of the consultation, compared with usual care (or no screening). Studies of screening programmes that were followed by structured interventions such as advocacy or therapeutic intervention were excluded.

Results 11 eligible trials (n=13 027) were identified. In six pooled studies (n=3564), screening increased the identification of intimate partner violence (risk ratio 2.33, 95% confidence interval 1.39 to 3.89), particularly in antenatal settings (4.26, 1.76 to 10.31). Based on three studies (n=1400), we detected no evidence that screening increases referrals to domestic violence support services (2.67, 0.99 to 7.20). Only two studies measured women’s experience of violence after screening (three to 18 months after screening) and found no reduction in intimate partner violence. One study reported that screening does not cause harm.

Conclusions Though screening is likely to increase identification of intimate partner violence in healthcare settings, rates of identification from screening interventions were low relative to best estimates of prevalence of such violence. It is uncertain whether screening increases effective referral to supportive agencies. Screening does not seem to cause harm in the short term, but harm was measured in only one study. As the primary studies did not detect improved outcomes for women screened for intimate partner violence, there is insufficient evidence for screening in healthcare settings. Studies comparing screening versus case finding, or screening in combination with therapeutic intervention for women’s long term wellbeing, are needed to inform the implementation of identification policies in healthcare settings.

Footnotes

  • We thank the Australasian Cochrane Centre for training and support; the Cochrane Developmental, Psychosocial and Learning Problems Group for their support and assistance with searches and publication; and Cochrane Collaboration for funding support (training).

  • This article is based on a Cochrane Review12 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Database of Sytematic Reviews should be consulted for the most recent version of the review.

  • Contributors: The original search strategy was developed and executed by AT in collaboration with Liesje Toomey, Jo Abbott, and Margaret Anderson of the Cochrane Developmental, Psychosocial and Learning Problems Group. AT, LO’D, and KH selected studies; LO’D and AT extracted the data; AT undertook the analysis with the help of LO’D and KH, and drafted the original Cochrane review. All authors provided topic expertise and contributed to writing and editing the review. LO’D and AT drafted the abridged version with editing input from all authors. LO’D and AT are guarantors.

  • Funding: La Trobe University provided funding for work undertaken towards the original Cochrane Review; the university had no role in the research or its publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; Kelsey Hegarty and Gene Feder participated in the WHO guideline group on health practitioners’ response to intimate partner violence; Gene Feder chaired the programme development group of the UK NICE domestic violence and abuse guidelines; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: Further data are available from a.taft{at}latrobe.edu.au or original Cochrane review at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007007.pub2/abstract.

  • Transparency: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the systematic review being reported; that no important aspects of the review have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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