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High sensitivity and specificity screening for clinically significant intimate partner violence.

ABSTRACT: The U.S. Preventive Services Task Force has recommended that clinicians screen patients for intimate partner violence (IPV). This article aims to develop and test the first screeners for clinically significant physical and psychological IPV (i.e., acts meeting criteria in the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2019) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). The goal was to derive screeners that (1) are maximally brief, while still achieving high sensitivity and specificity; (2) assess perpetration and victimization when either men or women are reporting; and (3) use ICD-11/DSM-5 criteria as the reference standard. Random samples of active duty service members at 82 installations worldwide were obtained via e-mail invitation (2006: N = 54,543; 2008: N = 48,909); their response rates were excellent for long general population surveys with no payment (2006: 44.7%, 2008: 49.0%). The population of spouses at the participating installation was invited by mailed postcard (2006: N = 19,722; 2008: N = 12,127; response rates-2006: 12.3%, 2008: 10.8%). Clinically significant physical intimate partner violence can be effectively screened with as few as four items, with sensitivities > 90% and specificities > 95%; clinically significant psychological intimate partner violence can be screened with two items. Men and women can be screened with equivalent accuracy, as can those committing the violence and those victimized by it. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

SUBMITTER: Heyman RE

PROVIDER: S-EPMC7906486 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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High sensitivity and specificity screening for clinically significant intimate partner violence.

Heyman Richard E RE Baucom Katherine J W KJW Xu Shu S Slep Amy M Smith AMS Snarr Jeffery D JD Foran Heather M HM Lorber Michael F MF Wojda Alexandra K AK Linkh David J DJ

Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43) 20200716 1

The U.S. Preventive Services Task Force has recommended that clinicians screen patients for intimate partner violence (IPV). This article aims to develop and test the first screeners for clinically significant physical and psychological IPV (i.e., acts meeting criteria in the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2019) and the <i>Diagnostic and Statistical Manual of Mental Disorders</i> (5th ed.; DSM-5; American Psychiatric Association, 2013). The ...[more]

PMID: 32673030

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Project description:BackgroundGlobally, almost 30% of women report experiencing intimate partner violence. In Australia, intimate partner violence is estimated to affect 2.0% to 4.3% of pregnant women. Those who experience intimate partner violence during pregnancy have poorer perinatal and maternal outcomes, including preterm birth, low birth weight, preterm prelabor rupture of membranes, perinatal death, miscarriage, antepartum hemorrhage, maternal trauma, and death.ObjectiveThis study aimed to evaluate the maternal and perinatal outcomes among women who reported intimate partner violence in a tertiary Australian hospital.Study designThis was a retrospective observational study conducted between January 2017 and December 2021 at the Mater Mother's Hospital in Brisbane, Australia. The study cohort included pregnant women who completed a prenatal intimate partner violence questionnaire. Exclusion criteria included infants with known major congenital or chromosomal abnormalities.ResultsOf the total study cohort comprising 45,177 births, 3242 births (7.2%) were among women who were exposed to intimate partner violence. Those who identified as Indigenous or had refugee status experienced significantly higher rates of intimate partner violence. Women exposed to intimate partner violence had greater odds of having a small for gestational age infant (adjusted odds ratio, 1.17; 95% confidence interval, 1.04-1.33), preterm birth (adjusted odds ratio, 1.21; 95% confidence interval, 1.07-1.37), preterm prelabor rupture of membranes (adjusted odds ratio, 1.23; 95% confidence interval, 1.05-1.45), and an infant with severe neonatal morbidity (adjusted odds ratio, 1.21; 95% confidence interval, 1.08-1.35). Women who reported intimate partner violence also had higher odds of acute presentation to the obstetrical assessment unit (adjusted odds ratio, 1.71; 95% confidence interval, 1.58-1.85) and admission to hospital (adjusted odds ratio, 1.44; 95% confidence interval, 1.30-1.61). When compared with non-Indigenous women exposed to intimate partner violence, Indigenous women had worse outcomes with significantly higher rates of preterm prelabor rupture of membranes, extreme preterm birth, lower gestational age at birth, low birth weight, and higher rates of infants with birth weight <fifth percentile for gestation.ConclusionIntimate partner violence is associated with increased risks for poor perinatal outcomes, particularly among those who identify as Indigenous and those with refugee status. Our results reinforce the importance of purposefully screening for intimate partner violence during pregnancy and emphasize that mitigating this risk may improve pregnancy outcomes.

Project description:BackgroundIntimate partner violence (IPV) including physical, sexual and emotional violence, causes short and long term ill-health. Brief questions that reliably identify women experiencing IPV who present in clinical settings are a pre-requisite for an appropriate response from health services to this substantial public health problem. We estimated the sensitivity and specificity of four questions (HARK) developed from the Abuse Assessment screen, compared to a 30-item abuse questionnaire, the Composite Abuse Scale (CAS).MethodsWe administered the four HARK questions and the CAS to women approached by two researchers in general practice waiting rooms in Newham, east London. Inclusions: women aged more than 17 years waiting to see a doctor or nurse, who had been in an intimate relationship in the last year.Exclusionswomen who were accompanied by children over four years of age or another adult, too unwell to complete the questionnaires, unable to understand English or unable to give informed consent.ResultsTwo hundred and thirty two women were recruited. The response rate was 54%. The prevalence of current intimate partner violence, within the last 12 months, using the CAS cut off score of >or=3, was 23% (95% C.I. 17% to 28%) with pre-test odds of 0.3 (95% C.I. 0.2 to 0.4). The receiver operator characteristic curve demonstrated that a HARK cut off score of >or=1 maximises the true positives whilst minimising the false positives. The sensitivity of the optimal HARK cut-off score of >or=1 was 81% (95% C.I. 69% to 90%), specificity 95% (95% C.I. 91% to 98%), positive predictive value 83% (95% C.I. 70% to 91%), negative predictive value 94% (95% C.I. 90% to 97%), likelihood ratio 16 (95% C.I. 8 to 31) and post-test odds 5.ConclusionThe four HARK questions accurately identify women experiencing IPV in the past year and may help women disclose abuse in general practice. The HARK questions could be incorporated into the electronic medical record in primary care to prompt clinicians to ask about recent partner violence and to encourage disclosure by patients. Future research should test the effectiveness of HARK in clinical consultations.

Project description:Lifelong brain health consequences of traumatic brain injury (TBI) include the risk of neurodegenerative disease. Up to one-third of women experience intimate partner violence (IPV) in their lifetime, often with TBI, yet remarkably little is known about the range of autopsy neuropathologies encountered in IPV. We report a prospectively accrued case series from a single institution, the New York City Office of Chief Medical Examiner, evaluated in partnership with the Brain Injury Research Center of Mount Sinai, using a multimodal protocol comprising clinical history review, ex vivo imaging in a small subset, and comprehensive neuropathological assessment by established consensus protocols. Fourteen brains were obtained over 2 years from women with documented IPV (aged 3rd-8th decade; median, 4th) and complex histories including prior TBI in 6, nonfatal strangulation in 4, cerebrovascular, neurological, and/or psychiatric conditions in 13, and epilepsy in 7. At autopsy, all had TBI stigmata (old and/or recent). In addition, white matter regions vulnerable to diffuse axonal injury showed perivascular and parenchymal iron deposition and microgliosis in some subjects. Six cases had evidence of cerebrovascular disease (lacunes and/or chronic infarcts). Regarding neurodegenerative disease pathologies, Alzheimer disease neuropathologic change was present in a single case (8th decade), with no chronic traumatic encephalopathy neuropathologic change (CTE-NC) identified in any. Findings from this initial series then prompted similar exploration in an expanded case series of 70 archival IPV cases (aged 2nd-9th decade; median, 4th) accrued from multiple international institutions. In this secondary case series, we again found evidence of vascular and white matter pathologies. However, only limited neurodegenerative proteinopathies were encountered in the oldest subjects, none meeting consensus criteria for CTE-NC. These observations from this descriptive exploratory study reinforce a need to consider broad co-morbid and neuropathological substrates contributing to brain health outcomes in the context of IPV, some of which may be potentially modifiable.

Project description:ImportanceThe practice of screening women for intimate partner violence (IPV) in health care settings has been a critical part of responding to this major public health problem. Yet, IPV prevention would be enhanced with detection efforts that extend beyond screening for IPV experiences to identifying those who use violence in relationships as well.ObjectiveTo determine rates of IPV experiences and use (ie, among perpetrators of IPV) and factors associated with disclosures among adult patients seeking mental health services at the Veterans Health Administration.Design, setting, and participantsThis cross-sectional study used electronic medical record data drawn from a quality improvement initiative at 5 Veterans Health Administration medical centers conducted between November 2021 and February 2022 to examine IPV disclosures following concurrent screening for IPV experience and use. Participants included patients engaged in mental health services. Data were analyzed in April and May 2023.ExposureMental health clinicians were trained to screen for IPV experience and use concurrently and instructed to screen all patients encountered through routine mental health care visits during a 3-month period.Main outcomes and measuresOutcomes of interest were past-year prevalence of IPV use and experience, sociodemographic characteristics, and clinical diagnoses among screened patients.ResultsA total of 200 patients were offered IPV screening. Of 155 participants (mean [SD] age, 52.45 [15.65] years; 124 [80.0%] men) with completed screenings, 74 (47.7%) denied past-year IPV experience and use, 76 (49.0%) endorsed past-year IPV experience, and 72 (46.4%) endorsed past-year IPV use, including 67 participants (43.2%) who reported IPV experience and use concurrently; only 9 participants (5.8%) endorsed unidirectional IPV experiences and 5 participants (3.2%) endorsed unidirectional IPV use. Patients who reported past-year IPV experience and use were younger than those who denied IPV (experience: mean difference, -7.34 [95% CI, 2.51-12.17] years; use: mean difference, -7.20 [95% CI, 2.40-12.00] years). Patients with a posttraumatic stress disorder diagnosis were more likely to report IPV use (43 patients [59.7%]) than those without a posttraumatic stress disorder diagnosis (29 patients [40.3%]; odds ratio, 2.14; [95% CI, 1.12-4.06]). No other demographic characteristics or clinical diagnoses were associated with IPV use or experience.Conclusions and relevanceIn this cross-sectional study of IPV rates and associated factors, screening for IPV found high rates of both IPV experience and use among patients receiving mental health care. These findings highlight the benefit of screening for IPV experience and use concurrently across gender and age. Additionally, the associations found between PTSD and IPV use underscore the importance of strengthening and developing additional targeted treatment for IPV.

Project description:IntroductionBetween 38 and 59 percent of women presenting to health care professionals have experienced intimate partner violence. Consequently, multiple intimate partner violence identification or screening programs within health care settings have been developed; however, substantial variations in program content and interpretation of program effectiveness has resulted in conflicting practice guidelines. The purpose of our scoping review is to broadly identify and synthesize the available literature evaluating intimate partner violence identification programs within health care settings to identify key areas for potential evidence-based recommendations and to focus research priorities in the field.Materials and methodsWe conducted a search of MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and psycINFO. We used broad eligibility criteria to identify studies that evaluated intimate partner violence identification programs in health care settings. We completed all screening and data extraction independently and in duplicate. We used descriptive statistics to summarize all data.ResultsWe identified 59 eligible studies evaluating intimate partner violence identification programs within health care settings. The most commonly reported outcome themes were IPV disclosure (69%, n = 35), number of patients screened (39%, n = 20), HCP opinions towards screening (37%, n = 19), and patient opinions towards screening (29%, n = 15). The majority of studies (36 studies (70.6%)) reported positive program evaluation results.DiscussionThe majority of studies reported positive program evaluation results. This may suggest that many different intimate partner violence identification programs are beneficial for identifying victims of abuse, however, it remains unknown as to whether identification programs prevent future episodes of abuse. Additionally, the substantial heterogeneity of the intervention characteristics, study methodology, and outcome measures assessed limits the ability to make clear recommendations as to the optimal method(s) of screening.

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High sensitivity and specificity screening for clinically significant intimate partner violence.

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High sensitivity and specificity screening for clinically significant intimate partner violence.

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