All women should be screened for partner abuse, panel says

All women of childbearing age could benefit from being routinely screened for intimate partner violence, a government-appointed panel of experts said today.

Whether or not women have any signs or symptoms of abuse, they would be screened under the proposed recommendation released today by the U.S. Preventive Services Task Force.

An estimated 1.3 to 5.3 million women yearly experience violence at the hands of their partners, though these numbers are likely underestimates, because such violence often goes unreported, according to research cited by the panel.

If a screening test revealed a woman to be the victim of intimate partner violence, she should be referred for an intervention, according to the draft.

The new recommendation would be a change from the panel's previous statement on the topic. In 2004, the panel said it found insufficient evidence to recommend for or against routinely screening women for intimate partner violence. In recommending any routine screening, the panel considers evidence of the potential benefits and harms.

Intimate partner violence brings many health risks for women, including injury and death, the panel said.  Over the long term, victims of this violence are at an increased risk of sexually transmitted diseases and unintended pregnancy, along with chronic pain, neurological disorders, gastrointestinal disorders and migraine headaches. Mental health risks include depression, posttraumatic stress disorder, anxiety disorders, substance abuse and suicidal behavior.

Babies born to women experiencing partner violence are at higher risk of preterm birth and low birth weight.

In making its 2004 recommendation, the panel said there was no direct evidence that screening for intimate partner violence led to decreased disability or premature death, and no studies showed that screening tools were accurate at identifying such violence. Also, there was limited evidence showing that interventions reduced harm to victimized women, once they had been identified by screening.

Now, evidence shows a number of available tests accurately screen for intimate partner violence, including tests that consist of a health care provider asking three or four questions to a woman during an office visit. Moreover, randomized trials show that interventions — including counseling, home visits, and referrals to community services — reduce the physical and mental harms to women who are victims of partner violence.

The panel considered the potential harms of routine screening and interventions for women experiencing this type of abuse — including causing women to feel stigmatized or distressed, or escalating the abuse — but concluded that studies show that such harms are unlikely to come about.

The 2004 recommendation also applied to screening older adults or their caregivers for elder abuse. In today's statement, the panel said there was still insufficient evidence to assess the balance of benefits and harms of screening all elderly or vulnerable adults (physically or mentally dysfunctional) for abuse and neglect, so routine screening of that group is not being recommended.

The draft of their recommendation is now open for public comment, and will undergo further review before the panel votes on whether to approve it.

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