Screening women for intimate partner violence in healthcare settings.
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ABSTRACT:
SUBMITTER: O'Doherty L
PROVIDER: S-EPMC6599831 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo 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.DesignSystematic 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 sourcesNine 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 studiesRandomised 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.Results11 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.ConclusionsThough 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.
| S-EPMC4018471 | biostudies-literature
Project description: Not available
| S-EPMC8166264 | biostudies-literature
Project description:OBJECTIVES:We studied the proportion of women who have ever been screened (ES) for intimate partner violence (IPV) in a healthcare setting, received information (RI) about relevant services, or both, and explored disparities in screening and information provision by ethnicity and other characteristics. DESIGN:In 2014-2015, we undertook a cross-sectional study, conducting interviews using a structured questionnaire among a stratified sample of 1401 Arab and Jewish women in Israel. SETTING:A sample of 63 maternal and child health clinics (MCH) clinics in four geographical districts. PARTICIPANTS:Women aged 16-48 years, pregnant or up to 6 months after childbirth. PRIMARY AND SECONDARY OUTCOME MEASURES:We used multivariable generalised estimating equation analysis to determine characteristics of women who were ES (Has anyone at the healthcare services (HCS) ever asked you whether you have experienced IPV?); RI (Have you ever received information about what to do if you experience IPV?); and both (ES&RI). RESULTS:Less than half of participants (48.8%) reported ES; 50.5% RI; and 30% were both ES&RI. Having experienced any IPV was not associated with ES or ES&RI, but was associated with RI in an unexpected direction. Women at higher risk for IPV (Arab minority women, lower education, unmarried) were less likely to report being ES, RI or both. The OR and 95% CI for not ER&RI were: 1.58 (1.00 to 2.49) among Arab compared with Jewish women; 1.95 (1.42 to 2.66) among low education versus academic education women; 1.34 (1.03 to 1.73) among not working versus working. ES, RI and both differ across districts. CONCLUSIONS:While Israel mandates screening and providing information regarding IPV for women visiting the HCS, we found inequalities, suggesting inconsistencies in policy implementation and missed opportunities to detect IPV. To increase IPV screening and information provision, the ministry of health should circulate clarification and provide support to healthcare providers to conduct these activities.
| S-EPMC6398676 | biostudies-other
Project description:Objectives Emergency Department (ED) screening for intimate partner violence (IPV) is typically nursing-initiated, often with visitors present. Since the onset of the COVID-19 pandemic, we have seen both an increase in societal stress, a known exacerbator of IPV, and the implementation of visitor restriction policies. This combination presents the need for enhanced IPV screening and the opportunity to perform screening in a controlled, patient-only environment. Our goal was to evaluate the frequency of nurse-initiated screening for IPV prior to and during the early months of the COVID-19 pandemic as well as the frequency of positive screens for IPV. Methods We conducted a retrospective cross-sectional study evaluating all adults (age >18 years) presenting to a tertiary care center ED. Patients were identified as presenting prior to the COVID-19 pandemic (June 1, 2019 to August 31, 2019) and after the COVID-19 visitor restriction policies (June 1, 2020 to August 31, 2020). Descriptive statistics were performed using chi-square and t-tests compared the demographic variables. Chi-square was used for a bivariate analysis of our primary outcomes (IPV screening performed and screening positive for IPV). Further analysis was done using a binary logistic regression model adjusting for the demographic characteristics. Results Both the odds of nursing-initiated IPV screening and the odds of verbally screening positive for IPV significantly increased (OR 1.509, 95% CI 1.432–1.600) and (OR 1.375, 95% CI 1.126–1.681) respectively following the implementation of COVID-19 visitor restriction policies. Conclusions These findings suggest that nurse-initiated IPV screening should continue to be performed with the patient privately, even after COVID-19 related ED visitor restrictions are removed. These findings also support the hypothesis that the stress related to COVID-19 is contributing to a rise in IPV.
| S-EPMC10124835 | biostudies-literature
Project description:BackgroundUganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda.MethodsWe conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis.ResultsParticipants had provided ANC services for a median (IQR) duration of 4.0 (0.1-19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients' ANC cards used to document women's medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse.ConclusionsOur findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships.
| S-EPMC8889632 | biostudies-literature
Project description: Not available
| S-EPMC7390063 | biostudies-literature
Project description:IntroductionIntimate partner violence against women is one of the most common forms of violence. Different research fields are trying to understand the cycle of violence, such as the psychological field, to understand how these women's relational patterns and intrapsychic conflict function in the cycle of violence.ObjectiveTo investigate the operationalized psychodynamic diagnosis of women victims of domestic violence, exploring the severity and experience of violence, structural functions, dysfunctional interpersonal patterns, and intrapsychic conflicts.MethodWe conducted a cross-sectional quantitative study using the OPD-2 Clinical Interviews, which were recorded and transcribed. The sample was composed by 56 women victims of domestic violence, mean age 30.07 (SD = ±9.65). Reliability was satisfactory for judges interviews(k>0,6).ResultsAccording to the OPD-2 evaluation, we found that the severity of the violence was associated with the intensity of women's subjective suffering. In the relational pattern, they stay in the relationship, leaving themselves vulnerable; perceive the partner as controlling, aggressive, offensive, and fear abandonment. As a defensive mechanism to relational discomfort and suffering victims anticipate the aggressor's desire, resulting in submissive behavior. The main psychic conflict was the "need for care versus self-sufficiency" (78.6%). And medium was the predominant structure level, in which they presented insecure internal objects, presenting difficulties in emotional regulation and perceiving reality in a distorted way. Hence, they do not recognize their limitations and needs. We found that 78.6% of the cases had some psychiatric disorder: MDD, PTSD.ConclusionThis study provides empirical evidence on clinical observations on the psychological functioning of this population and the issues that make up the maintenance of domestic violence against women. The understanding of internalized patterns, structural functions, and motivational tensions are fundamental for the prevention of re-victimization and improving coping mechanisms, as well as promoting greater adherence to treatment.
| S-EPMC7529253 | biostudies-literature
Project description:PurposeViolence against women during pregnancy is a serious public health concern due to its significant adverse health consequences for both the mother and the baby. This study aims to systematically identify common health problems and synergistic health correlates of intimate partner violence (IPV) that specifically affect pregnant women.MethodsWe mine large-scale electronic health record (EHR) data from the IBM Explorys database to identify health problems that are prevalent in both IPV and pregnancy populations, as well those that are synergistically associated with the presence of IPV during pregnancy. For this purpose, we develop methods that enhance the statistical reliability of identified patterns by constructing confidence intervals that take into account systematic bias and measurement errors in addition to the variance in estimation.ResultsWe identify with high confidence 668 and 2750 terms that are respectively prevalent in respectively IPV and pregnancy populations. Of these terms, 279 are common. We also identify 16 synergistic health correlates with high confidence. Our results suggest that mental health, substance abuse, and genitourinary complications are prevalent among pregnant women exposed to IPV. The synergistic terms we identify reveal potential conditions that can be direct consequences of trauma (e.g., tibial fracture), long-term health consequences (e.g., chronic rhinitis), markers associated with the demograhics of affected populations (e.g., acne), and risk factors that potentially increase vulnerability during pregnancy (e.g., disorders of attention and motor control).ConclusionsOur results indicate that IPV significantly affects the well-being of pregnant women in multiple ways. The findings of this study can be useful for screening of IPV in pregnant women. Finally, the methodology presented here can also be useful for investigating the synergy between other medical conditions using EHR databases with privacy constraints.
| S-EPMC7561659 | biostudies-literature
Project description:At least half a million women are victims of intimate partner violence in the United States annually, resulting in substantial harm. However, the etiology of violence to intimate partners is not well understood. Witnessing such violence in childhood has been proposed as a principal cause of adulthood perpetration, yet it remains unknown whether the association between witnessing intimate partner violence and adulthood perpetration is causal.We conducted a propensity-score analysis of intimate partner violence perpetration to determine whether childhood witnessing is associated with perpetration in adulthood, independent of a wide range of potential confounding variables, and therefore might be a causal factor. We used data from 14,564 U.S. men ages 20 and older from the 2004-2005 wave of the National Epidemiologic Survey on Alcohol and Related Conditions.Nearly 4% of men reported violent behavior toward an intimate partner in the past year. In unadjusted models, we found a strong association between childhood witnessing of intimate partner violence and adulthood perpetration (for witnessing any intimate partner violence, risk ratio [RR] = 2.6 [95% confidence interval = 2.1-3.2]; for witnessing frequent or serious violence, 3.0 [2.3-3.9]). In propensity-score models, the association was substantially attenuated (for witnessing any intimate partner violence, adjusted RR = 1.6 [1.2-2.0]; for witnessing frequent or serious violence, 1.6 [1.2-2.3]).Men who witness intimate partner violence in childhood are more likely to commit such acts in adulthood, compared with men who are otherwise similar with respect to a large range of potential confounders. Etiological models of intimate partner violence perpetration should consider a constellation of childhood factors.
| S-EPMC3108188 | biostudies-literature
Project description:In 2013, the United States Preventive Services Task Force recommended routine intimate partner violence (IPV) screening for reproductive-age women. Given the increased attention paid to IPV on a national scale, and broader recognition of its social and physical implications, we sought to characterize the discussions resulting from routine IPV screening-specifically regarding provider response and patient perceptions. In a cross-sectional analysis, we implemented a survey to examine outcomes of IPV screening, including use of guideline-concordant discussion topics and interventions, as well as patient perception of the encounters. Women aged 18-65 with lifetime history of IPV and a past-year healthcare appointment were recruited from clinics and women's shelters in Pennsylvania. Data collection took place from May 2014-January 2015. Of 253 women, 39% were screened for IPV at a healthcare visit in the year prior to survey administration. Of women who were screened, guideline-concordant discussion topics were employed in 70% of encounters and guideline-concordant interventions were offered in 72% of encounters. 58% of women reported being "extremely" or "very satisfied," and 53% reported being "extremely" or "very comfortable" with IPV-related discussions. The low rate of screening in this population reiterates the importance of focusing efforts on educating providers on the importance of screening, promoting the availability of community resources, and developing systems-based practices that foster IPV screening, discussion, and referral following disclosure.
| S-EPMC5683665 | biostudies-literature