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Systematic review and meta-analysis
A move beyond screening is required to ensure adequate healthcare response for women who experience intimate partner violence
  1. Heidi Stöckl
  1. Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to: Dr Heidi Stöckl, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK; heidi.stoeckl{at}lshtm.ac.uk

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Context

Intimate partner violence (IPV) is an important health and human rights issue and its impact on mortality and morbidity warrants greater engagement from the health sector.1 ,2 Screening for IPV has therefore been recommended, alongside screening for smoking, depressive disorders and other health-related issues, within healthcare settings.3

It has been acknowledged that when women disclose violence perpetrated by a partner, screening should be followed by interventions such as advocacy, social support, structured clinician support and other therapeutic interventions. However, the evidence on these interventions is still limited. Screening is therefore often implemented on its own with healthcare providers informing abused women about onsite or external services.

This systematic review and meta-analysis examines the effectiveness of screening for IPV within healthcare settings when not followed by an intervention. The review aims to establish the impact of screening on the identification of IPV, referral to support agencies, improvements in women's well-being and reduction in instances of further violence, while also assessing any harm that may be caused by screening.

Methods

The authors assessed heterogeneity and publication bias, and clearly stated the question they addressed, their search strategy, study selection, assessment of study quality, data extraction and synthesis. As the review was based on a recently published Cochrane review, it adhered to recognised protocols for systematic reviews and meta-analyses from The Cochrane Collaboration and PRISMA. Eleven randomised controlled trials were eligible for inclusion, reporting on 13 027 women. The review results are reported as relative risk (RR) estimates and CIs.

Findings

Six of the studies, reporting on 2564 women, found that screening increased identification of IPV (RR=2.33, 95% CI 1.39 to 3.89), with higher rates detected in antenatal care settings (RR=4.26, 95% CI 1.76 to 10.31). No evidence was found on whether screening leads to referrals in the three studies that measured it (RR=2.67, 95% CI 0.99 to 7.20), while the two studies investigating the effect of screening on IPV 3–18 months after screening found no reductions. One study established that screening does not cause harm.

Commentary

This review provides necessary evidence to the ongoing debate on screening for IPV in healthcare settings.4 Despite this debate and recommendations for universal screening, O'Doherty and colleagues could only identify 11 trials of necessary quality for inclusion, with only three trials assessing referrals. This is concerning, as it has been established that women and healthcare providers only endorse screening if disclosure is followed by an adequate response, at a minimum, by referrals to onsite or external services.4 ,5 Another concern is the quality of screening that is currently taking place; the review found fairly low identification rates of screening compared to prevalence rates estimations in the population.

To screen women effectively for IPV, it is necessary to create a confidential, safe and supportive environment.6 This environment can only be created if the healthcare system as a whole, especially the high-level administration, endorses screening and dedicates budget and staff time to training, screening and referral processes. The findings of this systematic review err away from recommending screening as an effective intervention on its own. Further research must look beyond screening to identify and test interventions that can feasibly be provided in healthcare settings to abused women. Screening can be an effective tool to identify abused women; however, it is not an effective standalone intervention.

References

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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