Clinicians should screen patients for intimate partner violence and caregiver abuse

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The US Preventative Services Task Force (USPSTF) posted a draft recommendation statement on clinician screenings for intimate partner violence and caregiver abuse of older/vulnerable adults in primary care settings. The USPSTF recommends that clinicians screen pregnant and postpartum people and women of reproductive age for signs of intimate partner violence, in what the Task Force considers a “B” grade recommendation. The USPSTF determined that there is insufficient evidence to recommend for or against screening for caregiver abuse of older/vulnerable adults—an “I” level statement.

Intimate partner violence

“People experiencing intimate partner violence may not tell others about their abuse or ask for help,” David Chelmow, MD, USPSTF member, said in the USPSTF Bulletin. “The good news is clinicians can make a real difference for women of reproductive age and pregnant and postpartum people by screening them for intimate partner violence and connecting those who need it to support services.”

The USPSTF recommends that screenings begin with a brief questionnaire to assess current or recent abuse. Some recommended screening instruments are the “Humiliation, Afraid, Rape, Kick (HARK); Hurt, Insult, Threaten, Scream (HITS); and Woman Abuse Screening Tool (WAST). Patients who screen positive should be referred to ongoing support services that provide emotional, social and behavioral support.

The most effective support services include multiple sessions, like frequent at-home visits, addressing intimate partner violence in addition to other related issues which can contribute to the risk of abuse, including physical and mental health, family and social needs, rather than addressing intimate partner violence by itself. According to the USPSTF, brief interventions were not found to be effective. They also note that there is a lack of research into effective screening and intervention methods for male victims, calling for more studies into the demographic, as well as women no longer in reproductive age.

Intimate partner violence, or domestic violence, affects millions of people across the United States. According to the US Centers for Disease Control and Prevention’s (CDC’s) National Intimate Partner and Sexual Violence Survey (NISVS), roughly 41% of women and 26% of men in the US have experienced intimate partner violence during their lifetime and reported a related impact.

Intimate partner violence can include physical violence, sexual violence, psychological aggression or stalking by a partner. Effects of intimate partner violence can vary drastically from case to case, ranging from physical and emotional trauma to death. Data from US crime reports have found that roughly half of female homicide victims are killed by current or former male intimate partners.

Survivors of intimate partner violence may experience serious health conditions affecting the heart, muscles and bones, digestive, reproductive and nervous systems, many of which are chronic. Specific effects may include bruises, broken bones, pain, anxiety, depression, post-traumatic stress disorder (PTSD), sexual transmitted infections and unintended pregnancy.

Anybody can be a victim of intimate partner violence, but women are at a higher risk than men and groups that have been marginalized, including those in racial and ethnic minority groups, are at a higher risk.

An economic study reports that the lifetime cost associated with medical services related to intimate partner violence, lost productivity from paid work and criminal justice, among other factors, is $3.6 trillion. Individually, as of 2018, the cost of intimate partner violence over a victim’s lifetime was $103,767 for female victims and $23,414 for male victims.

Caregiver abuse

After a thorough review of past research, the USPSTF did not find enough evidence to confidently recommend for or against screening for caregiver abuse of older/vulnerable adults. In the USPSTF Bulletin, the Task Force defines caregiver abuse as, “when a trusted person harms an older adult (age 60 or older) or a vulnerable adult (one who is unable to care for themselves due to age, disability or both).” The USPSTF explained that abuse of older/vulnerable adults can include physical, sexual, emotional or financial abuse, and could also involve neglect or abandonment. They note that further research into the pros and cons of screening for caregiver abuse.

“In the absence of evidence, primary care clinicians should use their best judgement when deciding whether or not to screen older and vulnerable adults for caregiver abuse,” said Tumaini Coker, MD, MBA, USPSTF member. “Health care professionals should evaluate any individual with signs of abuse or who expresses concerns about caregiver abuse so they can give the help they need.”