USPSTF recommends physicians screen pregnant, postpartum women for domestic violence

Key takeaways:

• Behavioral interventions effectively reduced domestic violence in postpartum and pregnant women.
• HCPs should use their judgment when deciding to screen for caregiver abuse in older and vulnerable adults.

The U.S. Preventive Services Task Force recommended that clinicians screen for intimate partner violence in postpartum or pregnant people and women of reproductive age.

The B-grade draft recommendation also advocated that clinicians provide or refer women who screen positive to ongoing services that provide behavioral, emotional or social support.

The task force additionally issued an I-level recommendation statement, declaring that there is insufficient evidence on using screening tools for caregiver abuse of older or vulnerable adults.

Both statements are consistent with the USPSTF’s 2018 recommendations on screening for elder abuse and intimate partner violence.

“People experiencing intimate partner violence may not tell others about their abuse or ask for help,” USPSTF member David Chelmow, MD, said in a press release. “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.”

According to data from the National Domestic Violence Hotline, 35.6% of women and 28.5% of men in the United States. have experienced sexual assault, physical violence or stalking by an intimate partner in their lifetime.

In the draft evidence report, the researchers examined 35 studies (n = 18,358) that analyzed either screening tools or interventions for intimate partner violence.

They noted that screening tools could reasonably identify women experiencing intimate partner violence, but the tools did not lead to reductions in intimate partner violence or improvement in quality of life.

According to the task force, support services found to be the most effective included those with multiple sessions, such as at-home visits, and those that addressed both intimate partner violence and factors that contribute to the risk for violence.

Specifically, one randomized controlled trial showed that women with one or more risk factors in a clinic-based behavioral counseling intervention had fewer recurrent episodes of intimate partner violence during pregnancy and postpartum (OR = 0.48; 95% CI, 0.29-0.8) and fewer preterm neonates.

No studies examined the benefits or harms of screening tools or interventions for caregiver abuse of adults aged 60 years or older or adults who are unable to care for themselves due to a disability, age or both.

The USPSTF noted that there are several screening tools that can be used in primary care, most of which are brief questionnaires that assess recent or current abuse.

The task force added that intimate partner violence is also a serious issue in men, but further studies on screening and interventions in this population — as well as women no longer of reproductive age — are needed.

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

Comments on the draft recommendation can be submitted here from Oct. 29 through Nov. 25.

References:

• Domestic violence statistics. Available at: https://www.thehotline.org/stakeholders/domestic-violence-statistics/. Accessed Oct. 29, 2024.
• Screening for intimate partner violence and caregiver abuse of older and vulnerable adults: An evidence review for the U.S. Preventive Services Task Force. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/intimate-partner-violence-abuse-older-vulnerable-adults. Published Oct. 29, 2024. Accessed Oct. 29, 2024.
• Screening for intimate partner violence and caregiver abuse of older or vulnerable adults: U.S. Preventive Services Task Force draft recommendation statement. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/intimate-partner-violence-abuse-older-vulnerable-adults. Published Oct. 29, 2024. Accessed Oct. 29, 2024.
• U.S. Preventive Services Task Force issues draft recommendation statement on screening for intimate partner violence and caregiver abuse of older or vulnerable adults. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/ipv-abuse-bulletin.pdf. Published Oct. 29, 2024. Accessed Oct. 29, 2024.