This is a topic we do not typically cover on our site, but it is clearly an important one. The U.S. Preventive Services Task Force (USPSTF) has updated its recommendations on screening for family and intimate partner violence (IPV). These guidelines, published in the Annals of Internal Medicine, recommend that all women of reproductive age be screened for intimate partner violence. The review provides some information on which screening instruments to use and reviews interventions to reduce the risk of IPV.
Prevalence of Intimate Partner Violence
According to the review of the data published in the Annals of Internal Medicine, it is estimated that nearly 31% of women and 26% of men report experiencing some form of IPV in their lifetime. The authors point out that these estimates probably underrepresent the actual rates because of underreporting. IPV has both short- and long-term consequences.
Individuals experiencing IPV often are more vulnerable to chronic mental health conditions, including depression, posttraumatic stress disorder, anxiety disorders, and substance abuse.
Adolescents and young adults experiencing IPV are more vulnerable to substance abuse, eating disorders, obesity, risky sexual behaviors, teen pregnancy, depression, anxiety disorders, and suicidality.
Among pregnant women the prevalence of IPV is high. In a recent community-based study of first time mothers in Canada, it was estimated that approximately 30% of women reported one or more experience of interpersonal violence. In a similar study carried out in Australia, it was found that about 40% of women reporting depressive symptoms also reported IPV. Researchers estimated that women exposed to emotional abuse alone had a 2.72-fold increased risk of postpartum depression (PPD), whereas women experiencing physical abuse had a 3.94-fold increased risk of PPD.
There is ample evidence to indicate that IPV is a risk factor for depression during pregnancy and the postpartum period. In addition, there is data to indicate that intimate partner violence in women is associated with increased risk of preterm birth, low birth weight, and decreased gestational age.
Screening for Intimate Partner Violence
The article reviewed a total of 15 studies of 13 screening instruments to identify IPV in women. The six tools that achieved the highest levels of sensitivity and specificity were:
- HITS (English and Spanish versions) – 4 screening questions
- Ongoing Violence Assessment Tool (OVAT) – 4 questions
- HARK – 4 questions
- Modified Childhood Trauma Questionnaire CTQ-SF
- Woman Abuse Screening Tool (WAST)
Most of the screening tools are easy to administer and consist of only a few questions. (Copies of most of these screening tools can be found in a thorough publication on IPV screening from the Centers for Disease Control and Prevention.)
Interventions to Reduce Intimate Partner Violence
The USPSTF recommends screening women of childbearing age based on research showing high diagnostic accuracy in the detection of both current and past abuse. Current research also demonstrates improved outcomes in women receiving interventions designed to reduce exposure to abuse. These interventions include counseling, behavioral interventions, and home visitation programs.
There are various interventions which have been designed specifically for women who are pregnant and postpartum. A recent trial compared usual care with prenatal and postpartum behavioral counseling in a group of 1,044 African-American patients who were pregnant or postpartum. The counseling emphasized safety behaviors and information on community resources. Women in the intervention group had significantly fewer episodes of IPV during pregnancy and the postpartum period, as well as better birth outcomes (fewer preterm births).
Another trial evaluated a 3-year home visitation program with 685 mothers who gave birth to infants determined to be at risk for abuse. The home visitors were paraprofessionals from community agencies who focused on promoting child health and decreasing child maltreatment by linking families to community services. The intervention group had lower overall rates of IPV, although there were no reduction in sexual violence, verbal abuse, and injury.
While there is more to learn about effective interventions in various populations of reproductive aged women, screening for IPV during pregnancy may help us to identify women who are at increased risk for mood and anxiety disorders during pregnancy and the postpartum period.
Ruta Nonacs, MD PhD
Kiely M, et al. An integrated intervention to reduce intimate partner violence in pregnancy: a randomized trial. Obstet Gynecol. 2010 Feb;115:273-283.
Malta LA, et al. Influence of interpersonal violence on maternal anxiety, depression, stress and parenting morale in the early postpartum: a community based pregnancy cohort study. BMC Pregnancy Childbirth. 2012 Dec 15;12:153.
Moyer VA, et al. Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: A U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2013 Jan 22.
Taft AJ, et al. Mothers’ AdvocateS In the Community (MOSAIC)–non-professional mentor support to reduce intimate partner violence and depression in mothers: a cluster randomised trial in primary care. BMC Public Health. 2011 Mar 23;11:178.
Woolhouse H, et al. Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study. BJOG. 2012 Feb;119(3):315-323.
Centers for Disease Control (CDC) site on IPV
National Domestic Violence Hotline at 800-799-SAFE (7233) or 800-787-3224 (TDD)