SUMMARIES FOR PATIENTS

Screening for Family Violence: Recommendations from the U.S. Preventive Services Task Force

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The summary below is from the full reports titled "Screening for Family and Intimate Partner Violence: Recommendation Statement" and "Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force." They are in the 2 March 2004 issue of Annals of Internal Medicine (volume 140, pages 382-386 and 387-396). The first report was written by the U.S. Preventive Services Task Force; the second report was written by H.D. Nelson, P. Nygren, Y. McInerney, and J. Klein.

What is the U.S. Preventive Services Task Force?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Domestic abuse or violence and family violence refer to situations where a person is physically, sexually, or emotionally abused or physically neglected by a family member or an intimate partner. Victims of family violence are most often children, women, and older adults. In older adults, abuse can also include financial exploitation and neglect. Studies estimate that over 1000 children died of abuse in 1999, almost 1 out of every 3 women report that they were subject to abuse at some point in their lives, and more than half a million older adults were abused in 1996. Harmful outcomes of family violence include physical injury, long-term psychological problems, and death. Some things that should make doctors and other health care providers suspect family violence are repeated or unusual injuries, depression, and unexplained symptoms or absences from school or work. When such things are present, doctors should ask patients about family violence. However, it is unclear whether doctors should screen all patients for family violence as part of routine health care. Screening is looking for a condition in patients who have no symptoms or signs of that condition.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research about the benefits and harms of screening for family violence. Potential benefits would be decreased disability, injury, or premature death. Potential harms would be an increase in abuse when the victim or others confront the abuser.

What did the USPSTF find?

The USPSTF found no studies examining the use of screening questionnaires by clinicians to detect family violence and improve health in children, women, or older adults in the general population. The USPSTF found evidence that interventions in families at higher risk for abuse can reduce harm to children. However, the few available studies in women and older adults that examined whether interventions were effective are inadequate. No available studies directly measured the potential harms of screening for family violence.

What does the USPSTF suggest that patients and doctors do?

Patients and clinicians must be aware that there have been no studies on the effectiveness of screening for family violence as a routine part of health care. Clinicians must be familiar with the symptoms and signs of family violence. They should look for family violence when these symptoms and signs are present and should know what to do when they learn that a patient is a victim of family violence. Appropriate actions include documenting the abuse, making sure that the patient receives appropriate treatment for injuries and psychological problems, and giving the patient information about protective services. Asking the patient about this issue during future office visits would also be appropriate.

What are the cautions related to these recommendations?

Recommendations may change as new studies become available. Some other organizations do recommend including questions about family violence as a routine part of health care visits. Health care providers should know that reporting child and elder abuse is mandatory in all states and that some states require reporting of domestic partner violence.