Screening women for intimate partner violence in healthcare settings

Background Intimate partner violence (IPV) damages individuals, their children, communities, and the wider economic and social fabric of society. Some governments and professional organisations recommend screening all women for IPV rather than asking only women with symptoms (case‐finding). Here, we examine the evidence for whether screening benefits women and has no deleterious effects. Objectives To assess the effectiveness of screening for IPV conducted within healthcare settings on identification, referral, re‐exposure to violence, and health outcomes for women, and to determine if screening causes any harm. Search methods On 17 February 2015, we searched CENTRAL, Ovid MEDLINE, Embase, CINAHL, six other databases, and two trial registers. We also searched the reference lists of included articles and the websites of relevant organisations. Selection criteria Randomised or quasi‐randomised controlled trials assessing the effectiveness of IPV screening where healthcare professionals either directly screened women face‐to‐face or were informed of the results of screening questionnaires, as compared with usual care (which could include screening that did not involve a healthcare professional). Data collection and analysis Two authors independently assessed the risk of bias in the trials and undertook data extraction. For binary outcomes, we calculated a standardised estimation of the odds ratio (OR). For continuous data, either a mean difference (MD) or standardised mean difference (SMD) was calculated. All are presented with a 95% confidence interval (CI). Main results We included 13 trials that recruited 14,959 women from diverse healthcare settings (antenatal clinics, women's health clinics, emergency departments, primary care) predominantly located in high‐income countries and urban settings. The majority of studies minimised selection bias; performance bias was the greatest threat to validity. The overall quality of the body of evidence was low to moderate, mainly due to heterogeneity, risk of bias, and imprecision. We excluded five of 13 studies from the primary analysis as they either did not report identification data, or the way in which they did was not consistent with clinical identification by healthcare providers. In the remaining eight studies (n = 10,074), screening increased clinical identification of victims/survivors (OR 2.95, 95% CI 1.79 to 4.87, moderate quality evidence). Subgroup analyses suggested increases in identification in antena