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Task Force Urges Routine Screening of Women for Domestic Violence
Date:1/21/2013

By Serena Gordon
HealthDay Reporter

MONDAY, Jan. 21 (HealthDay News) -- Physicians should screen all women of childbearing age for signs of domestic violence and refer them for treatment if necessary, a new recommendation from the U.S. Preventive Services Task Force says.

"Screening for intimate partner violence in women works, and there are a number of interventions that have been found to be effective," said task force member Dr. David Grossman, a senior investigator at the Group Health Research Institute in Seattle.

The new recommendation, published in the Jan. 22 issue of the Annals of Internal Medicine, applies to women with no apparent symptoms of abuse.

In the United States, nearly one-third of women and more than one-quarter of men have been victims of domestic violence, according to the U.S. Centers for Disease Control and Prevention. As many as 25 percent of women and 14 percent of men have experienced severe forms of domestic violence.

Besides risking injury and death, people who experience domestic violence may also develop sexually transmitted diseases, pelvic inflammatory disease, unintended pregnancies, chronic pain, neurological disorders, gastrointestinal disorders, depression, anxiety, post-traumatic stress disorder, substance abuse and suicidal behavior. Domestic violence in women is also linked to preterm birth and low birthweight babies.

One expert welcomed the new recommendation.

"To have the health field involved in working with women and trying to identify women who have family violence experiences is a great idea. If you can identify abuse early on, you can minimize its impact," said Hillary Haldane, an assistant professor of anthropology at Quinnipiac University in Hamden, Conn.

"People look up to doctors, and to have a well-trained doctor saying they support you is really important," she added.

To arrive at its recommendation, the task force -- an independent group of national experts -- reviewed available evidence and found a number of effective, easy-to-use screening tools for women of childbearing age. Grossman said that there wasn't enough evidence to recommend screening for men or for older women and men, and that this is an area that needs more research.

The screenings by primary care doctors may be done as written tests or as interviews, and include questions such as: In the past year, have you ever been afraid of a partner? Have you ever been in a relationship where your partner pushed or slapped you?

The screening tools aren't perfect, however. Available studies suggest that they can correctly identify between roughly 62 percent and 96 percent of women experiencing domestic violence.

Women who were screened were far more likely (44 percent) to discuss domestic violence with their doctor compared to women who weren't screened (8 percent).

Available studies assessing interventions found modest improvements in domestic violence, with no harm reported for the intervention, according to the recommendation.

Haldane cautioned that "doctors and other health-care professionals have to be robustly trained on how to speak with someone who's had family violence, and not all doctors necessarily have the bedside manner or training for this." They will also need to know where to refer patients, she said.

Grossman said physicians usually know what resources are available in their community, and he noted that under the Affordable Care Act, screening and referral services will be reimbursable.

Haldane said if you have concerns about a loved one, the most important thing you can do is support her. "It's very hard to disclose abuse, and women often won't reach out for help because they don't feel like they have support," Haldane said.

Call your local domestic violence agency, and find out how to help, she advised. "You can give your loved one the name of a lawyer who can help, and suggest that they might want to give them a call," she said.

"Then just be there for them," she added. "Just be supportive. Patience is hard, but you want to make it easier for them."

More information

Learn to spot signs of abuse in friends or family members from the National Domestic Violence Hotline.

SOURCES: David Grossman, M.D., M.P.H., USPSTF member, and senior investigator, Group Health Research Institute, Seattle, Wash.; Hillary Haldane, Ph.D., program director and assistant professor, anthropology, Quinnipiac University, Hamden, Conn.; Jan. 22, 2013, Annals of Internal Medicine


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