Screening Women for Intimate Partner Violence: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation

Nelson, Heidi D; Bougatsos, Christina; Blazina, Ian

doi:10.7326/0003-4819-156-11-201206050-00447

Cited by 302 publications

(255 citation statements)

References 64 publications

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“…The HITS screening tool 13 comprises the following four items: "Over the last 12 months, how often did your partner: (1) physically hurt you, (2) insult you or talk down to you, (3) threaten you with harm, and (4) scream or curse at you?" Responses are scored on a 5-point scale from 1 ("never") to 5 ("frequently") and summed for a total score (range [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Findings support the concurrent validity of this instrument.…”

Section: Methodsmentioning

confidence: 90%

“…IPV screening programs can have benefits for women's health and safety, 11 but no extant IPV screening tool has yet been rigorously evaluated in a published study of female VHA patients. It is important to establish the validity of an IPV screening tool with female VHA patients prior to implementation of such a tool in the VHA setting because some aspects of diagnostic accuracy, such as sensitivity and specificity, can vary by characteristics of patient populations, such as prevalence.…”

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confidence: 99%

“…12 The four-item Hurt/Insult/ Threaten/Scream (HITS) tool 13 is one of the more efficient and sensitive validated screens in the broader literature. 11 It can be administered within a couple of minutes, is easy to score, and has demonstrated sensitivity and specificity. [14][15][16] The HITS includes items assessing psychological IPV, as well as physical aggression, a component of IPV that is lacking in other screens.…”

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confidence: 99%

“…The CTS-2 is the most widely used comprehensive measure of IPV in the social science and medical literature 22 and is the most commonly applied reference standard for evaluating IPV screening tools. 11,17 Because the HITS does not include an item assessing sexual IPV, a secondary aim of this study was to evaluate the accuracy of the HITS in detecting past-year sexual IPV.…”

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confidence: 99%

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Clinical Utility of an Intimate Partner Violence Screening Tool for Female VHA Patients

et al. 2013

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OBJECTIVES: Female Veterans are at high risk for physical, sexual, and psychological forms of intimate partner violence (IPV) victimization. This study evaluated the accuracy of a brief IPV victimization screening tool for use with female Veterans Health Administration (VHA) patients. DESIGN: Participants completed a paper-and-pencil mail survey that included the four-item Hurt/Insult/ Threaten/Scream (HITS) and the 39-item Revised Conflict Tactics Scales (CTS-2). Operating characteristics, including sensitivity and specificity, were calculated using the CTS-2 as the reference standard for pastyear IPV. PARTICIPANTS: Female veterans from a roster of randomly selected female patients of the New England VA Healthcare System. Women must have reported being in an intimate relationship in the past year to be included. MAIN MEASURES: Primary measures included the HITS (index test) and the CTS-2 (reference standard). KEY RESULTS: This study included 160 women. The percentage of women who reported past-year IPV, as measured by any physical assault, sexual coercion, and/or severe psychological aggression on the CTS-2, was 28.8 %. The receiver-operator characteristic curve demonstrated that the HITS cutoff score of 6 maximizes the true positives while minimizing the false positives in this sample. The sensitivity of the optimal HITS cutoff score of 6 was 78 % (95 % CI 64 % to 88 %), specificity 80 % (95 % CI 71 % to 87 %), positive likelihood ratio 3.9 (95 % CI 2.61 to 5.76), negative likelihood ratio 0.27 (95 % CI 0.16 to 0.47), positive predictive value 0.61 (95 % CI 0.47, 0.73), and negative predictive value 0.90 (95 % CI 0.82, 0.95). CONCLUSIONS: For a low-burden screen, the HITS demonstrated good accuracy in detecting past-year IPV relative to the CTS-2 in a sample of female VHA patients with an optimal cutpoint of 6. The HITS may help VHA and other health-care providers detect past-year IPV and deliver appropriate care for female Veterans. I ntimate partner violence (IPV) refers to actual or threatened physical, sexual, and psychological abuse by a current or former intimate partner. 1 IPV is a major public health problem that causes and exacerbates physical health problems, including cardiovascular, respiratory, chronic pain, gynecological disorders, and adverse pregnancy outcomes. [2][3][4] Similarly, IPV increases risk for psychiatric conditions such as posttraumatic stress disorder (PTSD), other anxiety disorders, depression, substance misuse, eating disorders, and suicidality. [3][4][5] Relative to civilians, female veterans are at higher risk for physical and sexual forms of IPV (33.0 % vs. 23.8 % lifetime prevalence). 2 Although the reasons for elevated risk among female Veterans remain unknown, some theorize that women's exposure to violence-prone environments, such as violent childhood homes and the military, may elevate women's risk for IPV. 6,7 IPV may be particularly common among women seeking care at Veterans Health Affairs (VHA) health-care facilities. 6,8,9 Studies have found lifetime reports of IPV a...

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Section: Methodsmentioning

confidence: 90%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Clinical Utility of an Intimate Partner Violence Screening Tool for Female VHA Patients

et al. 2013

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“…3 Additionally, women who are experiencing IPV may be more likely change contact information, making them more difficult to reach. 4 This analysis highlights the significant relationship between socioeconomic hardship and IPV. Nearly 40 % of homeless women reported past-year IPV.…”

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confidence: 88%

Capsule Commentary on Kimerling et al., Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care

Thomas

2016

J GEN INTERN MED

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T he authors used a nationally representative sample (N = 6287) of women receiving primary care through the Veterans Health Administration (VHA) to (1) assess prevalence of intimate partner violence (IPV) in the past 12 months and (2) identify patient demographic, military, and health services utilization factors associated with pastyear IPV. Prevalence of past-year IPV was 18.5 %. Factors associated with IPV included economic hardship, sexual minority status, being a parent/guardian, past military sexual trauma, fewer years of military service, use of VHA as usual provider, higher health services utilization, and poorer continuity of care. 1 The authors achieved a response rate of 84 % and performed sensitivity analyses for non-response. They used a well-validated screening tool and included important covariates. Limitations include lack of data on veterans not using VHA and use of a telephone interview. Additionally, in studies estimating past-year rates, telescoping can result in inaccuracies. 2 In contrast to prior studies, rates of past-year IPV among female veterans were similar to the general population. This analysis may underestimate true prevalence. This survey only included women who had at least one primary care visit in the prior year; women experiencing IPV may be less likely to seek care. 3 Additionally, women who are experiencing IPV may be more likely change contact information, making them more difficult to reach. 4 This analysis highlights the significant relationship between socioeconomic hardship and IPV. Nearly 40 % of homeless women reported past-year IPV. Financial stressors may make it more difficult for these women to distance themselves from an abusive partner, yet providers may not be aware of a patient's socioeconomic situation. It is important for VHA to identify socioeconomic risk factors, screen for IPV among these at-risk women, and provide supportive services to help women safely leave abusive situations.Women using VHA as a usual provider, as well as women with more frequent visits, were more likely to report IPV. This means VHA has frequent opportunities to screen and provide services. VHA should work to build trusting relationships between patients and providers, as trust is a major factor in whether women who are screened disclose IPV. 5

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Health Care's Response to Women Exposed to Partner Violence

Wathen¹,

MacMillan²

2012

JAMA

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Screening Women for Intimate Partner Violence: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation

Abstract: Agency for Healthcare Research and Quality.

Cited by 302 publications

References 64 publications

Clinical Utility of an Intimate Partner Violence Screening Tool for Female VHA Patients

Clinical Utility of an Intimate Partner Violence Screening Tool for Female VHA Patients

Capsule Commentary on Kimerling et al., Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care

Health Care's Response to Women Exposed to Partner Violence

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