McMaster University

McMaster University

Faculty of
Health Sciences

Universal screening in health-care settings for intimate partner violence shows no significant benefit for women

By Laura Thompson
Published: August 5, 2009
Harriet MacMillan
Harriet MacMillan, professor of psychiatry and behavioural neurosciences

Universal screening in health-care settings for intimate partner violence does not result in significant reductions in subsequent violence, nor does it lead to significant improvements in quality of life, a new McMaster University study has found.

The study, published in the August 5, 2009 edition of the Journal of the American Medical Association (JAMA), was led by Harriet MacMillan, a professor of psychiatry and behavioural neurosciences and pediatrics in the Michael G. DeGroote School of Medicine, in collaboration with researchers from the McMaster Violence Against Women Research Group.

The research was supported by Echo: Improving Women’s Health in Ontario, an agency of the Ontario Ministry of Health and Long-Term Care.

The researchers examined the effectiveness of screening along with communication of a positive screening result to clinicians in health-care settings, compared with no screening, in reducing subsequent violence and improving quality of life.

"We conclude, although sample attrition urges cautious interpretation, that these results do not provide sufficient evidence to support universal intimate partner violence screening in health-care settings at this time," said MacMillan, a pediatrician and psychiatrist. "Further research is essential."

Women who disclosed violence in the past year were interviewed at the start of the study and every six months for 18 months about subsequent incidents of intimate partner violence and quality of life, as well as their health.

The study also found that:

  • All women in the trial showed reductions in exposure to violence across time – these reductions were not, however, associated with screening.
  • At 18 months, observed recurrence of intimate partner violence among screened vs. non-screened women was 46 per cent vs. 53 per cent, which is not statistically significant.
  • Women in the screened vs. non-screened groups showed higher improvement in quality of life and depression, but these differences were small and not statistically significant when the analysis accounted for women lost to follow-up. There were no differences in other health outcomes.
  • Screened and control group women had no differences in the frequency of using violence-related health and social services.
  • Many women must be screened to identify one woman who discloses abuse.
  • There were no harms of screening as implemented in this trial.

Pat Campbell, CEO of Echo, said that the results of the study help to shed light on the issue of screening women for intimate partner violence in health-care settings.

"While this study indicates there is insufficient evidence to support universal intimate partner violence screening in health-care settings, it underscores the need for effective treatments and services to improve the health status of women who are exposed to violence," she said.

The randomized controlled trial was conducted in 11 emergency departments, 12 family practices, and three obstetrics/gynecology clinics in Ontario among 6,743 female patients aged 18 to 64 years. The women were screened, using a written, self-completed questionnaire, for emotional, physical and sexual violence by an intimate partner.

The authors also concluded that evidence of effective interventions for women experiencing intimate partner violence is urgently required. They recommended that further research be undertaken to evaluate such treatments and services, which may include counselling, shelters and other clinical and social services.

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