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Feltner C, Wallace I, Berkman N, et al. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: An Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Oct. (Evidence Synthesis, No. 169.)
Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: An Evidence Review for the U.S. Preventive Services Task Force [Internet].
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Appendix G Table 1IPV KQ 1: Results of included randomized, controlled trials
| Author, Year Study Design Quality | Setting Group (N) | IPV Outcome Measure (tool) Results | QOL Measure Results | Other Eligible Outcomes Measure (Tool) Results |
|---|---|---|---|---|
| Klevens et al, 201257,
60
Good | Primary Care
G1: Computerized screening followed by brief intervention for screen-positive women and IPV resource list (909) G2: IPV resource list only (893) G3: Control (898) | IPV exposure at 1 year (18 questions adapted from the National Violence Against Women Survey), G1 vs. G2
N events/N analyzed G1: 96/909 G2: 101/893 G3: 83/898 OR, (95% CI): G1 vs. G2: 1.2 (0.9 to 1.6) G1 vs. G3 1.0 (0.8 to 1.4) G2 vs. G3: 1.1 (0.8 to 1.5) Recurrence of IPV at 1 year among women reporting IPV in the year prior to enrollment N events/N analyzed G1: 38/120 G2: 33/116 G3: 40/110 OR, (95% CI): G1 vs. G2: 0.8 (0.5 to 1.4) G1 vs. G3: 1.2 (0.7 to 2.2) G2 vs. G3: 1.4 (0.8 to 2.5) | SF-12 PCS at 1 year* (mean, 95% CI)
G1: 46.8 (46.1 to 47.4) G2: 46.4 (45.8 to 47.1) G3: 47.2 (46.5 to 47.8) P=0.21 (across all groups) SF-12 MCS at 1 year (mean, 95% CI): G1: 48.3 (47.5 to 49.1) G2: 47.9 (47.2 to 48.7) G3: 47.8 (47 to 48.5) p=0.51 (across all groups) SF-12 at 1 year among women reporting IPV in the year prior to enrollment SF-12 PCS (mean, 95% CI): G1: 47.4 (46.1 to 48.8) G2: 47.1 (45.7 to 48.4) G3: 47.5 (46.7 to 8.3) p=0.32 (across all groups) SF-12 Mental Composite (mean, 95% CI): G1: 44.2 (42.4 to 45.9) G2: 40.7 (41.9 to 45.5) G3: 42.5 (47.0 to 44.3) p=0.21 (across all groups) | Hospitalization at 1 year (mean, 95% CI)
G1: 0.2 (0.0 to 0.3) G2: 0.1 (0 to 0.3) G3: 0.2 (0 to 0.3) p=0.40 (across all groups) ED visits at 1 year (mean, 95% CI) G1: 0.3 (0.2 to 0.4) G2: 0.3 (0.2 to 0.4) G3: 0.3 (0.2 to 0.4) p=0.40 (across all groups) Ambulatory visits at 1 year (mean, 95% CI) G1: 5.4 (3.8 to 7.0) G2: 5.7 (4.1 to 7.3) G3: 5.9 (4.3 to 7.4) p=0.12 (across all groups) Hospitalization at 3 years (mean, 95% CI) G1: 0.2 (0.1 to 0.4) G2: 0.3 (0.1 to 0.4) G3: 0.2 (0.1 to 0.4) ED visits at 3 years (mean, 95% CI) G1: 0.6 (0.4 to 0.8) G2: 0.7 (0.5 to 0.9) G3: 0.6 (0.4 to 0.9) Ambulatory visits at 3 years (mean, 95% CI) G1: 12.7 (8.9 to 16.2) G2: 12.2 (8.4 to 16.1) G3: 11.6 (7.7 to 15.4) p=0.12 (across all groups) |
| Koziol-McLain et al, 201058
Fair | ED
G1: In-person screening followed by brief intervention, safety assessment, and information about referrals/resources (166) G2: Usual care (no formal IPV screening) (177) | IPV exposure at 3 months (30-item Composite Abuse Scale)
N positive (CAS ³7)/N analyzed G1: 20/167 G2: 24/177 Absolute risk difference (95% CI): −1.6 (−8.7 to 5.5) OR, (95% CI): 0.87 (0.46 to 1.64) | NR | NR |
| MacMillan et al, 200959
Fair | Mixed (primary care, OBGYN clinics and EDs)
G1: In-person screening prior to visit with notification of clinician (inclusion of positive screen in chart); provision of IPV resource list (347) G2: No screening before visit (IPV screening conducted after clinic visit); provision of IPV resource list (360) | Recurrence of IPV (30-item Composite Abuse Scale) among women disclosing past-year IPV at baseline, G1 vs. G2
OR, (95% CI)† 6 months: 0.93 (0.61 to 1.41) 12 months: 0.90 (0.50 to 1.63) 18 months: 0.88 (0.43 to 1.82) | WHOQOL-Bref, difference between groups in mean scores (95% CI),† G2 vs. G2
6 months: 1.32 (−0.99 to 3.63) 12 months: 1.86 (−1.39 to 5.12) 18 months: 2.29 (−1.71 to 6.28) SF-12 PCS, difference between groups in mean scores (95% CI),† G2 vs. G2 6 months: 0.91 (−0.34 to 2.15) 12 months: 1.28 (−0.48 to 3.04) 18 months: 1.57 (−0.59 to 3.73) SF-12 MCS, difference between groups in mean scores (95% CI),† G2 vs. G2 6 months: 0.60 (−0.98 to 2.19) 12 months: 0.85 (−1.39 to 3.09) 18 months: 1.05 (−1.70 to 3.79) | PTSD screen (SPAN)
OR, (95% CI)† 6 months: 0.77 (0.55 to 1.06) 12 months: 0.69 (0.43 to 1.08) 18 months: 0.63 (0.36 to 1.10) Depression (CES-D) difference in mean scores (95% CI)† 6 months: −1.14 (−2.50 to 0.22) 12 months: −1.61 (−3.53 to 0.32) 18 months: −1.97 (−4.33 to 0.39) |
- *
SF-12 scores adjusted for age, education, race/ethnicity, insurance status, and clustering by clinic) and baseline scores.
- †
All results shown are those adjusted for baseline differences and missing data using multiple imputation.
Abbreviations: CAS=Composite Abuse Scale; CES-D=Center for Epidemiologic Studies Depression; CI=confidence interval; ED=emergency department; G=group; IPV=intimate partner violence; KQ=key question; MCS=Mental Composite Score; N/n=sample size; NR=not reported; OBGYN=obstetrics and gynecology; OR=odds ratio; PCS=Physical Composite Score; PTSD=posttraumatic stress disorder; RCT=randomized, controlled trial; SF-12=Short Form Health Survey-12 Item; SPAN=Startle, Physiological Arousal, Anger, and Numbness instrument; WHOQOL-Bref=World Health Organization Quality of Life-Bref instrument; vs.=versus.
Appendix G Table 2Results of IPV KQ 2 studies reporting on accuracy of IPV screening instruments
| Author, Year Quality Rating | Timing of IPV Exposure | Screening Tools; Number of Items; Item Coverage Scores Used; Criteria for Positive Screen | Reference Standard(s) Number of Items, Item Coverage Criteria for Positive Score | Prevalence of IPV in Analyzed Population Based on Reference Standard | Total N Analyzed | Overall IPV Sensitivity, % (95% CI) | Overall IPV Specificity, % (95% CI) | Overall IPV Positive Likelihood Ratios, % (95% CI) | Overall IPV Negative Likelihood Ratios, % (95% CI) |
|---|---|---|---|---|---|---|---|---|---|
| Chen et al, 200566 | Current | HITS; 4 items; physical, psychological abuse
Scores: Overall abuse; positive screen: Score >10.5 | ISA-P; 11 items; dimensions: Only physical abuse included
Physical abuse cut score ≥10 | 5% | 113 | 86 (NR) | 99 (NR) | 91 | 0.1 |
| Dubowitz et al, 200767
Fair | Past year | PSQ; 3 items; physical, fear, considered court order
Scores: Any item; positive screen: # Endorsed ≥1 | CTS-2; 78 items; dimensions: Psychological aggression, physical assault, injury, sexual coercion
Cut score: Top 20% on psychological aggression; any past-year physical assault and injury | Psychological aggression: 76%a
Physical assault: 32% Injury: 9% Sexual coercion: 28% | 200 (n=185 for psychological aggression) | Physical assault: 19 (NR)
Injury: 29 (NR) Psychological aggression: 27 (NR) | Physical assault: 92 (NR)
Injury: 91 (NR) Psychological aggression: 92 (NR) | Physical assault: 2.5 (NR)
Injury: 3.3 (NR) Psychological aggression: 3.3 (NR) | Physical assault: 0.9 (NR)
Injury: 0.8 (NR) Psychological aggression: 0.8 (NR) |
| Ernst et al, 200463
Fair | Current | OVAT; 4 items; physical and nonphysical violence
Scores: Total abuse; positive screen: A “true” response to Q1, 2, or 4 and a ≥3 Q3 | ISA; 30 items; dimensions: Physical, emotional, and sexual abuse
Overall IPV: Positive score on physical or nonphysical; physical abuse cut score ≥25; nonphysical abuse cut score ≥10 | Overall: 20%
Physical: 16% Nonphysical: 17% | 306 | 86 (75 to 93) | 83 (78 to 88) | 5.1 (3.8 to 6.8) | 0.2 (0.1 to 0.3) |
| Feldhaus et al, 199764
Fair | Past year | PVS; 3 items; physical violence and safety
Scores: Combined abuse positive screen: Yes to any question Positive screen partner physical violence: Yes Positive screen safety: Yes or unsure to either question | ISA; 30 items; dimensions: Physical, emotional, sexual abuse; physical and nonphysical scales
Combined abuse: Positive score on either physical or nonphysical: Physical abuse cut score >25; nonphysical abuse cut score >10 CTS (Form N); 19 items; dimensions: Verbal aggression, violence Combined abuse: Positive on either verbal or physical abuse; verbal abuse cut score >45.2; physical abuse cut score >7.4 | ISA combined abuse: 24%
CTS combined abuse: 27% | ISA: 255
CTS: 230 | ISA: 64 (51 to 76)
CTS: 71 (59 to 82) | ISA: 80 (74 to 86)
CTS: 84 (78 to 90) | ISA: 3.3 (2.3 to 4.6)
CTS: 4.6 (3.1 to 6.8) | ISA: 0.4 (0.3 to 0.6)
CTS: 0.3 (0.2 to 0.5) |
| Iverson et al, 201371
Fair | Past year | HITS; 4 items; physical, psychological abuse
Scores: Overall abuse; positive screen: Score ≥6 | CTS-2; 39 items; dimensions: Physical assault, sexual coercion, severe psychological aggression
Overall IPV cut score: ≥1 on physical, sexual or severe psychological aggression | Overall IPV in past year: 29% (N=46)
Physical IPV in past year: 14%d Sexual IPV in past year: 14%d Psychological IPV in past year: 18%d More than one type of IPV: 14%d | 160 | 78 (63 to 89) | 80 (71 to 87) | 3.9 (2.6 to 5.8) | 0.3 (0.2 to 0.5) |
| Iverson et al, 201572
Fair | Past year | HITS; 4 items; physical, psychological abuse
Overall IPV; positive screen: score ≥6 E-HITS; 5 items; 4 HITS items (physical, psychological abuse) and 1 sexual violence item Scores: Overall IPV; positive screen: Score ≥7 | CTS-2: 39 items: Physical assault, sexual coercion, severe psychological aggression
Overall IPV cutpoint ≥1 on physical, sexual, or severe psychological aggression CTS-2; 39 items; dimensions: Physical assault, sexual coercion, severe psychological aggression Overall IPV cut score: ≥1 on physical, sexual or severe psychological aggression | Overall IPV in past year: 25% More than one type of IPV: 45%
Overall IPV in past year: 25% More than one type of IPV: 45% | 80 | 75 (55 to 95)
75 (55 to 95) | 83 (73 to 92)
82 (72 to 90) | 2.3 (1.4 to 3.7)
2.1 (1.4 to 3.4) | 0.2 (0.1 to 0.4)
0.2 (0.1 to 0.4) |
| Koziol-McLain et al, 200173
Fair | Prediction of future (3–5 months) partner abuse | BRFSS-administered violence screen, 3 items
Scores: Physical violence, feeling unsafe, police called; positive screen: ≥1 yes | Combined CTS and CTS-2a; 22 items; dimensions: Verbal aggression, physical violence, severe physical violence Sexual coercion
Any partner abuse cut score: ≥13 or more verbally aggressive events or ≥1 physically violent, severe physically violent, or sexually coercive events | Any partner abuse: 24%
Verbal aggression: 19% Sexual coercion: 10% Physical violence: 4% Severe physical violence: 1% | 409 | 20 (13 to 30)b | 96 (93 to 98)b | 4.8 (2.4 to 9.3) | 0.8 (0.8 to 0.9) |
| MacMillan et al, 200675
Fair | Past year | PVS; 3 items; physical abuse, safety
Scores: Overall abuse; positive screen: Endorsing Q1 or 3 or not endorsing Q2 | CAS; 30 items; dimensions: Physical, sexual, emotional abuse
Overall abuse cut score: ≥7 | NRe | NRf | 49 (NR) | 94 (NR) | NR | NR |
| MacMillan et al, 200675
Fair | Past year | WAST; 8 items; physical, sexual, emotional abuse
Scores: Overall abuse; positive screen: Endorsing question “a lot of tension” or question “great difficulty” | CAS; 30 items; dimensions: Physical, sexual, emotional abuse
Positive IPV cut score: ≥7 | NRe | NRf | 47 (NR) | 96 (NR) | NR | NR |
| Mills et al, 200662
Fair | Past year | HITS; 4 items; physical, psychological abuse
Scores: Overall abuse; positive screen: Score >10 | CTS-2; 78 items (perpetrator and victim); psychological aggression, physical violence, negotiation, sexual coercion, injury
Psychological aggression cut score ≥21.7% Physical violence cut score ≥7.4% | Psychological aggression: 39%
Physical violence: 20% | 53 | Psychological aggression: 30 (13 to 54)
Physical violence: 46 (18 to 75) | Psychological aggression: 88 (71 to 96)
Physical violence: 88 (74 to 96) | Psychological aggression: 2.5 (0.8 to 7.7)
Physical violence: 3.8 (1.3 to 10.9) | NR |
| Mills et al, 200662
Fair | Past year | PVS; 3 items; physical violence and safety
Scores: Combined abuse; positive screen: Yes to any question | CTS-2; 78 items (perpetrator and victim);
Dimensions: Psychological aggression, physical violence, negotiation, sexual coercion and injury Psychological aggression score ≥21.7%; physical violence score ≥7.4% | Psychological aggression: 39%
Physical violence: 20% | 53 | Psychological aggression: 35 (16 to 59)
Physical violence: 46 (18 to 75) | Psychological aggression: 84 (67 to 94)
Physical violence: 83 (68 to 92)g | Psychological aggression: 2.3 (0.9 to 6.3)
Physical violence: 2.7 (1.1 to 7.0) | NR |
| Paranjape et al, 200365
Fair | Lifetime | STaT; 3 items; Physical violence
Scores: Any IPV; positive screen: ≥1 yes | Semistructured interview that followed a published interview guide to elicit a history of lifetime IPV
Classification of IPV based on specific acts | Overall lifetime IPV: 63% past 12 months: 15%
IPV subtype: Physical abuse: 11% Physical and emotional abuse: 36% Physical, emotional, and sexual abuse: 38% | 75 | STaT score:
≥1: 96 (90 to 100) ≥2: 89 (80 to 98) ≥3: 64 (50 to 78) | STaT score:
≥1: 75 (59 to 91) ≥2: 100 (NA) ≥3: 100 (NA) | StaT score:
≥1: 3.8 (2.0 to 7.3) ≥2: Infinity (NA) =3: Infinity (NA) | STaT score:
≥1: 0.1 (0.05 to 0.2) ≥2: 0.1 (0.05 to 0.2) =3: 0.4 (0.2 to 0.5) |
| Paranjape et al, 200670
Fair | Current or most recent relationship | STaT; 3 items; physical violence
Scores: Any IPV; positive screen: ≥1 yes response | ISA; 30 items; dimensions: Physical, nonphysical (emotional and sexual abuse)
Positive IPV: Positive ISA-Physical (ISA-P) or ISA Nonphysical (ISA-NP); Positive ISA-P ≥10 Positive ISA-NP ≥25 | IPV during most recent relationship: 33%
Current IPV: 15% | 240 | STaT Score:
≥1: 95 (90 to 100) ≥2: 85 (77 to 93) =3: 62 (51 to 73) | STaT score:
≥1: 37 (29 to 44) ≥2: 54 (46 to 62) =3: 66 (58 to 73) | StaT score:
≥ 1: 1.5 (1.3 to 1.7) ≥ 2: 1.8 (1.5 to 2.2) =3: 1.8 (1.4 to 2.4) | StaT score:
≥1: 0.1 (0.05 to 0.4) ≥2: 0.3 (0.2 to 0.5) =3: 0.6 (0.4 to 0.8) |
| Sohal et al, 200768
Fair | Past year | HARK; 4 items; psychological, physical, sexual abuse
Scores: Overall abuse; positive screen: Score ≥1 | CAS; 30 items; dimensions: Physical abuse, emotional abuse, severe combined abuse, harassment
Overall abuse cut score: ≥3 | 23% | 232 | 81 (69 to 90) | 95 (91 to 98) | Multilevel LR 16 (8 to 31)c | NR |
| Wathen et al, 200876
Fair | Past year | WAST; 8 items; physical, sexual, and emotional abuse
Scores: Overall abuse; positive screen: Score ≥4 | CAS; 30 items; dimensions: Physical abuse, emotional abuse, severe combined abuse, harassment
Positive IPV cut score: ≥7 | 14% | 5,604 | Overall: 88 (85 to 90)
Screen group: 87 (83 to 90) No-screen group: 88 (85 to 91) | Overall: 89 (88 to 90)
Screen group: 89 (88 to 90) No-screen group: 89 (87 to 90) | Overall: 7.8 (7.2 to 8.5)
Screen group: 8 (7 to 9) No-screen group: 7.7 (6.9 to 8.7) | Overall: 0.1 (0.1 to 0.2)
Screen group: 0.2 (0.1 to 0.2) No-screen group: 0.1 (0.1 to 0.2) |
| Weiss et al, 200374
Fair | Current | AAS; 5 items; physical violence, emotional abuse safety, sexual assault
Scores: Overall abuse; positive screen: ≥1 yes response | ISA; 30 items; dimensions: Physical abuse, nonphysical abuse (emotional and sexual abuse)
Positive IPV cut score: NR | 19% | 856 | 92 (87 to 96) | 55 (52 to 59) | 2.1 (1.9 to 2.3) | 0.1 (0.1 to 0.2) |
| Weiss et al, 200374
Fair | Current | OAS; 5 items; physical violence, emotional abuse safety, sexual assault
Scores: Overall abuse; positive screen: ≥1 yes | ISA; 30 items; dimensions: Physical abuse, nonphysical abuse (emotional and sexual abuse)
Positive IPV cut score: NR | 19% | 856 | 60 (52 to 67) | 90 (87 to 92) | 5.8 (4.5 to 7.5) | 0.4 (0.4 to 0.5) |
| Zink et al, 200769
Fair | Current | Unnamed screener;h 5 items using nongraphic language; relationship quality, safety
Scores: Overall IPV; positive screen: A response >1 on at least one of the questions | CTS-2; 39 items; Dimensions: Verbal aggression, physical violence, injury, and sexual coercion
Positive verbal aggression, physical violence, injury, and sexual coercion ≥95th percentile on subscale; Positive IPV: A positive score on ≥1 subscale | 11% | 393 | DV combinations in which at least one of the questions had a response >1:
Q1 and 3: 39 (NR) Q1, 3, and 4: 46 (NR) Q1–5: 40 (NR) | DV combinations in which at least one of the questions had a response >1:
Q1 and 3: 95 (NR) Q1, 3, and 4: 95 (NR) Q1–5: 91 (NR) | DV combinations in which at least one of the questions had a response >1:
Q1 and 3: 7 (4 to 12) Q1, 3, and 4: 7.7 (4.5 to 13) Q1–5: 4.4 (2.7 to 7.3) | DV combinations in which at least one of the questions had a response >1:
Q1 and 3: 0.7 (0.51 to 0.82) Q1, 3, and 4: 0.6 (0.4 to 0.8) Q1–5: 0.7 (0.5 to 0.8) |
- a
Percentages refer to the number of respondents who endorsed that a partner had done any of the items on the subscales to them at least once in the past year.
- b
Sensitivity and specificity refer to prediction of abuse or nonabuse in the months immediately following the screen.
- c
Of individual HARK scores: 3 or 4: Undefined; 2: 15 (4 to 49); 1: 9 (4 to 22); 0: 0.2 (0.1 to 0.4).
- d
The numbers refer to overall sample with specific types of IPV (and not percentage of the positive IPV sample).
- e
12-month prevalence of IPV ranged from 4 to 18% across settings measured by the PVS and WAST, the two reference measures used.
- f
2,339 completed the gold standard CAS. Authors report numbers of participants who completed each screening tool and gold standard, but not the sample analyzed for each comparison.
- g
Document reported 2.4 as upper limit, but it appears to be 92.
- h
General Domestic Violence Screening Questions scored on a 3-point (Q1–Q2) or 5-point Likert scale (Q3–Q5) beginning at 0.
Abbreviations: AAS=Abuse Assessment Screen; BRFSS=Behavioral Risk Factor Surveillance System; CAS=Composite Abuse Scale; CI=confidence interval; CTS=Conflict Tactics Scale; CTS-2 Conflict Tactics Scale-2; E-HITS=Electronic HITS; HARK=Humiliation, Afraid, Rape, Kick; HITS=Hurt/Insult/Threaten/Scream Tool; n=sample size; IPV=intimate partner violence; ISA=Index of Spouse Abuse; ISA-P=Index of Spouse Abuse-Physical; KQ=key question; N=sample size; NA=not available; NR=not reported; OAS=Ongoing Abuse Screen; OVAT=Ongoing Violence Assessment Tool; PVS=Partner Violence Screen; STaT=Slapped, Things, Threaten; WAST=Woman Abuse Screening Tool.
Appendix G Table 3RCTs Reporting on Harms of IPV Screening (KQ 3) or Interventions (KQ 5)
| Author, Year | Key Question | Intervention Control | N | Harms Outcomes |
|---|---|---|---|---|
| Koziol-McLain et al, 201058 | KQ 3 | Screening: In-person screening in a New Zealand ED followed by brief intervention, safety assessment, and information about referrals/resources
Control: Usual care (no formal IPV screening) | 344 | No adverse events were reported by participants, clinicians, or research staff; however, it is not clear whether adverse events were prespecified or how they were monitored. |
| MacMillan et al, 200959 | KQ 3 | Mixed (primary care, OBGYN clinics, and ED settings)
Screening: In-person screening in mixed health care settings (primary care, OBGYN clinics, and EDs) prior to visit; clinicians notified of positive results by including copy of positive screening questionnaire in the chart; provision of IPV resource list Control: No screening before visit (IPV screening conducted after clinic visit); provision of IPV resource list | 591* | Effects on Quality of Life subscale of COST instrument administered to screened women regardless of abuse status. Mean score of 3.52 (SD 3.24) indicated that being asked IPV screening questions was not harmful to women immediately after screening; scores were similar across abuse categories. |
| Hegarty et al, 201386 | KQ 5 | IPV intervention: Physician training to respond to women and deliver a brief IPV counseling intervention in primary care settings (137)
Control: Usual care (135) | 272 | At 6 months, no women in the intervention group agreed strongly (on a 5-point scale) that they felt judged negatively by practice staff for being a participant or responded “worse” to the item “As a result of participating in this trial, I see the quality of my own life as….” No adverse events were reported and the authors detected no evidence of a difference in harm or abuse between groups. |
| Sharps et al, 201681 | KQ 5 | IPV intervention: Domestic Violence Enhanced Home Visitation Program (DOVE), structured brochure-based IPV intervention added to standard home visitation for screen-detected pregnant women
Control: Standard home-visiting protocol (4–6 prenatal visits, 6–12 postnatal visits over 2 years) | 239 | No adverse events, such as IPV-related deaths, were reported in either group. |
| Tiwari et al, 200583 | KQ 5 | IPV intervention: In-person counseling focused on empowerment and safety advice during routine prenatal care (51)
Control: Usual care for abused women (wallet-sized card with information on community resources) (55) | 106 | In phone interviews at 6 weeks postpartum, women were asked if they had experienced increased frequency of IPV and, if so, whether they attributed the increase to study participation. No adverse events of participation were reported by women in the intervention group or by controls. |
| Tiwari et al, 201090 | KQ 5 | IPV intervention: Advocacy Intervention, in-person interview, empowerment pamphlet to support the information provided, scheduled weekly telephone calls, 24-hour access to a hotline for additional support (100)
Control: Usual care (100) | 200 | No adverse events resulting from women’s participation in the study were reported. No details on how harms were measured and assessed were provided. |
| Rhodes et al, 201587 | KQ 5 | IPV intervention: Brief motivational intervention during ED visit (239)
Assessed control (232) No contact control (121) | 592 | No harms related to the intervention were identified. |
- *
This number differs from the sample size for benefit outcomes; the COST questionnaire was administered to a subset of 591 women out of 3271 screened (227 women who screened positive for abuse, 206 with mixed screen results, and 158 who screened negative).
Abbreviations: COST=Consequences of Screening Tool; DOVE=Domestic Violence Enhanced Home Visitation; ED=emergency department; KQ=key question; IPV=intimate partner violence; OBGYN obstetrics and gynecology; RCT randomized, controlled trial; SD=standard deviation.
Appendix G Table 4IPV KQ 4: Detailed Characteristics of Interventions for Included Randomized, Controlled Trials
| Author, Year Quality Sample Size | Population Recruitment Setting | Source Population | Category | Intervention Description | Additional (Non-IPV) Intervention Components | Delivery Provider | Delivery Site | Number of Sessions Length of Session(s) | Frequency Intervention Duration* |
|---|---|---|---|---|---|---|---|---|---|
| Pregnant/Postpartum | |||||||||
| Bair-Merrit et al, 201080
Fair N=643 | Pregnant/postpartum
Hawaiian hospitals, U.S. | Mothers ≥18 who gave birth between 1994-1995 on Oahu to children rated high risk for child maltreatment | HV | Family-based HV intervention aimed at preventing child abuse/neglect; provided direct services related to parenting, problem-solving skills, emotional support; linked families to community services (i.e., IPV shelters/advocacy groups, mental health treatment) | Multiple (e.g., education on child development, role-modeling positive parenting, offering emotional support) | Parapro-fessionals who completed a 5-week training (0.5 day devoted to IPV) | Home | 13.6† in year 1 (mean); number of sessions focused on IPV NR
Length NR | Weekly to biweekly to monthly to quarterly as family achieved goals
3 years |
| El-Mohandes et al, 200882
Kiely et al, 201085 El-Mohandes et al, 201192 Fair N=913 | Pregnant/postpartum
6 prenatal care sites in the District of Columbia, U.S. | African American women ≥18 yrs, ≤28 weeks’ gestation and reporting any of 4 risk factors; subgroup experiencing IPV screened positive for any IPV in year prior to pregnancy | C(IPV+dep+smoking) | Individual in-person CBT aimed at reducing behavioral risks (depression, IPV, smoking, and tobacco exposure); sessions targeted toward specific risks reported by women at that session; IPV components emphasized safety behaviors | Receipt of behavioral counseling for other risks (depression, smoking, tobacco exposure) in intervention group but not control group | Master’s-level trained social workers or psychologists | Prenatal care sites | Prenatal: 3.9 (mean), range 4-8
36±15 min. Postpartum: 0.8 (mean), range 0-2 38±13 min. | NR (frequency determined by mothers’ attendence at routinely scheduled perinatal care visits)
31 weeks (mean 19.3 weeks gestation to mean 10.3 weeks postpartum) |
| Sharps et al, 201681
Fair N=239 | Pregnant/postpartum
Multiple urban and rural perinatal HV agencies, U.S. | Women ≥14 yrs, ≤32 weeks’ gestation, low income (i.e., Medicaid eligible) enrolled in a perinatal HV program who screened positive for current IPV | HV | Brochure-based IPV empowerment intervention embedded into a perinatal HV program; tailored to a woman’s expressed needs and level of danger; delivered during routine HVs | Women in both groups received 4-6 HVs prenatally and 6-12 postnatally up to 2 yrs postpartum providing routine perinatal support | Community health workers, nurses; unlicensed & licensed personnel | Home | 6 HVs focused on IPV (3 during pregnancy, 3 postpartum)
15-25 min. | NR
1-2 years postpartum |
| Tiwari et al, 200583
Fair N=110 | Pregnant/postpartum
1 public antenatal clinic, Hong Kong | Women ≥18 yrs, <30 weeks’ gestation who screened positive for abuse by a partner during their first antenatal appointment | C(IPV) | In-person counseling focused on empowerment to enhance independence (advice in areas of safety, choice making, and problem solving), followed by brochure reinforcing information. Content modified to be culturally relevant. | NA | Senior research assistant (described as a midwife with a master’s degree in counseling) | Antenatal clinic | 1
30 min. | Once
(NA) |
| Zlotnick et al, 201184
Fair N=54 | Pregnant/postpartum
3 primary care and OBGYN clinics in Rhode Island, U.S. | Women 18-40 yrs. who screened positive for past-year IPV | C(IPV) | Individual in-person counseling (based on interpersonal psychotherapy) emphasizing social support, improving interpersonal relationships, and improving social support networks; sessions also included education on IPV and advice on making a safety plan | Sessions also addressed emotional risks (signs/symptoms of PPD, PTSD, and substance abuse), role transitions into motherhood and self-care | Unclear; delivery personnel trained by first author (PhD-level psychologist) | Primary care and OBGYN clinics | 5 (4 during pregnancy, 1 postpartum); mean 3
60 min. | Pregnant: Weekly
Postpartum: ≤2 weeks post-delivery 14 weeks (mean) |
| Nonpregnant | |||||||||
| Hegarty et al, 201386
Fair N=272 (52 physicians) | Nonpregnant
Multiple family practice clinics in Victoria, Australia | Women 16-50 who screened positive for fear of their partner in the past 12 months‡ | C(IPV) | Physician training to respond to women who screen positive for IPV and deliver a brief in-person IPV counseling intervention to screen positive women | NA | Family practice physicians | Family practice clinic | 1 (median), range 1-6
30 min. | Intermittent (per authors, frequency and number of visits depended on patient need)
NR (varied per authors) |
| Miller et al, 201189
Fair N=904 | Nonpregnant
4 family planning clinics in Northern California, U.S. | Women 16-29 who agreed to a followup interview | C(IPV) | Provider training to deliver in-person enhanced IPV screening, education, and counseling for IPV/reproductive coercion and response to IPV exposure; all women received brief education and inquiry, those who disclosed IPV receivied more resources/counseling | NA | Trained paraprofes-sional reproductive health specialists | Family planning clinics | 1
<1 min to “longer” for those who disclosed IPV/sexual coercion | Once (no followup described for those who disclosed abuse)
NA |
| Miller et al, 201688
Fair N=3,540 | Nonpregnant
25 family planning clinics (17 clinicians) in Western PA, U.S. | Women 16-29 who agreed to a followup interview | C(IPV) | Clinician and staff training to deliver in-person universal screening/education, and counseling (emphasizing harm reduction strategies) for IPV/reproductive coercion; additional support, including referrals to victims’ services, provided to those who screened positive | NA | Medical assistants, health educators, or clinicians | Family planning clinic | 1
<1 min, plus “additional time” for those who disclosed IPV/sexual coercion | Once (no followup described for those who disclosed abuse)
NA |
| Rhodes et al, 201587
Fair N=592 | Nonpregnant
2 affiliated urban academic EDs in Philadelphia, PA, U.S. | Women 18-64 who screened positive for IPV and heavy drinking | C(IPV) | Brief in-person motivational intervention, manual-guided; focused on identifying reasons for change and personal goals | Intervention encouraged participants to identify any linkages between drinking and IPV | Master‘s-level therapists | ED | 2 (1 in-person session followed by telephone call from same therapist)
20-30 min. (in-person session, telphone call NR) | One telephone call 10 days after initial visit |
| Saftlas et al, 201491
Fair N=204 | Nonpregnant
2 family planning clinics in rural Iowa, U.S. | Women ≥18 who screened positive for current partner IPV | C(IPV) | In-person motivational interviewing focused on individual goal setting to improve health and increase safety | NA | Trained field coordinators | Family planning clinic | 4 (1 baseline face-to-face session followed by 3 telephone calls)
Baseline: 60 min. (in person) Followup: 10-15 min. (telephone) | Baseline, 1 month, 2 months, and 4 months
4 months |
| Tiwari et al, 201294
Tiwari et al, 201090 Good N=200 | Nonpregnant
1 community outpatient center, Hong Kong | Women ≥18 yrs who screened positive for IPV | C(IPV) | Advocacy intervention comprising in-person empowerment (e.g., individual safety plan), informal counseling, telephone support, and linkage to community resources; women received a pamplet reinforcing intervention content | NA | Trained research assistants (registered social workers) | Community health center | 13 (1 in-person, 12 telephone)
Baseline: 30 min. in-person Followup: 15-20 min. telephone 24-hour access to hotline for additional support | Weekly (88% completion)
12 weeks |
- *
Refers to the duration of the active intervention and not the timing of outcome assessment.
- †
Over the course of the intervention, 13.6 weekly visits occurred in year 1 (on average), tapering to 25 percent participation by year 3.
- ‡
Eligible physicians (for training) included those who worked ≥3 sessions per week, used electronic records, and ≥70% of their patients spoke English. Patients of eligible providers were mailed a survey regarding participant and screening for fear of partner.
Abbreviations: C=counseling; CBT=cognitive behavioral therapy; ED=emergency department; HV=home visits; IPV=intimate partner violence; N=number; NA=not applicable; NR=not reported; OBGYN=obstetrician/gynecologist; PPD= postpartum depression; PTSD=post-traumatic stress disorder.
Appendix G Table 5Results of KQ 4 Studies Reporting on IPV Exposure
| Author, Year Study Design Study Name Quality | Population Group (N) | Overall (Any) IPV Exposure Measure Results | Physical Abuse Exposure Measure Results | Psych. Abuse Exposure Measure Results | Sexual/Other Abuse Exposure Measure Results |
|---|---|---|---|---|---|
| Bair-Merritt et al, 201080
RCT Hawaiian HSP Fair | Pregnant/postpartum
G1: Home visits: Weekly home visits from paraprofessionals, linkage to services (373) G2: Usual care (270) | CTS-2, adj. IRR, of average IPV events per person-year*
3 years: 7.50 vs. 9.55 IRR: 0.86 (0.73 to 1.01) 7–9 years):† 3.35 vs. 4.01 IRR: 0.95 (0.77 to 1.17) CTS-2, N (%) with any IPV event at 1 year: G1: 143 (44) G2: 103 (55) | CTS-2 (physical assault), adj. IRR, of events per person-year
3 years: 5.23 vs. 6.68 IRR: 0.85 (0.71 to 1.00) 7–9 years:† 2.32 vs. 2.72 IRR: 0.87 (0.70 to 1.09) CTS-2 (injury), Adj. IRR, of events per person year 3 years: 1.18 vs.1.67 IRR: 0.86 (0.67 to 1.12) 7–9 years:† 0.55 vs. 0.88 IRR: 0.78 (0.56, 1.08) | CTS-2 (verbal abuse), adj. IRR, of events per person-year
3 years: 18.35 vs. 20.86 IRR: 0.97 (0.87 to 1.10) 7–9 years:† 15.77 vs. 15.40 IRR: 1.14 (0.97 to 1.34) | CTS-2 (sexual violence), adj. IRR, of average IPV events per person-year
3 years: 1.13 vs. 1.21 IRR: 1.02 (0.81 to 1.28) 7–9 years:† 0.12 vs. 0.22 IRR: 0.83 (0.56, 1.22) |
| El-Mohandes et al, 200882; Kiely et al, 201085; El-Mohandes et al, 201192
RCT Fair | Pregnant/postpartum
G1: Individual cognitive behavioral intervention delivered during prenatal care visits (specific to IPV and other risk factors) (452) G2: Usual care (461) | CTS-2, % experiencing IPV, overall sample
Baseline, N (%)ǂ G1: 169 (37.4) G2: 167 (36.2) Postpartum (recurrence since baseline), N (%) G1: 39 (8.6) G2: 52 (11.3) Change in % from baseline to postpartum (G1 vs. G2): −28.8 vs. −24.9; p=0.074 Subgroup of women experiencing IPV at baseline, % with recurrence (baseline to postpartum) Adj. ORs (95% CI)ǁ 0.48 (0.29 to 0.80) | CTS-2, physical IPV exposure during followup (G1 vs. G2)
Baseline to 22–26 weeks gestation: Adj. OR, (95% CI):§ 0.49 (0.27 to 0.91) Absolute RD: 0.054 22–26 weeks gestation to 34–38 weeks gestation: Adj. OR, (95% CI): 0.56 (0.27 to 1.17) Absolute RD: 0.054 34–38 weeks gestation to postpartum interview: Adj. OR, (95% CI): 0.47 (0.27 to 0.82) Absolute RD: 0.050 | NR | CTS-2, sexual IPV exposure (G1 vs. G2)
Baseline to 22–26 weeks gestation Adj. OR, (95% CI): 0.39 (0.15 to 1.03) Absolute RD: 0.031 22–26 weeks gestation to 34–38 weeks gestation: Adj. OR, (95% CI): 0.99 (0.46 to 2.16) Absolute RD: 0.018 34–38 weeks gestation to postpartum interview: Adj. OR, (95% CI): 0.99 (0.46 to 2.16) Absolute RD: 0.001 |
| Tiwari et al, 200583
RCT Fair | Pregnant/postpartum
G1: In-person counseling focused on empowerment and safety advice (51) G2: Usual care for abused women (wallet-sized card with information on community resources) (55) | NR | CTS-2, mean score (SD)
Minor physical violence Baseline: G1: 1.3 (3.0) G2: 0.7 (1.6) 6 weeks postpartum G1: 0.05 (0.4) G2: 0.51 (1.3) Mean difference (95% CI) −1.0 (−1.8 to 0.17); p=0.05 Severe physical violence Baseline G1: 0.82 (3.0) G2: 0.35 (1.2) 6 weeks postpartum G1: 0.25 (1.2) G2: 0.17 (0.54) Mean difference (95% CI) 0.08 (−0.26 to 0.42); p=NS | CTS-2, mean score (SD)
Psychological aggression Baseline: G1: 3.1 (2.8) G2: 2.8 (2.5) 6 weeks postpartum G1: 0.79 (1.0) G2: 1.6 (2.2) Mean difference (95% CI) −1.1 (−2.2 to −0.04); p=0.05 | CTS-2, mean score (SD)
Sexual abuse Baseline G1: 0.16 (0.63) G2: 0.18 (0.80) 6 weeks postpartum G1: 0.03 (0.11) G2: 0.12 (0.55) Mean difference (95% CI) −0.07 (−0.30 to 0.16); p=NS |
| Sharps et al, 201681
Cluster RCT by home visiting program DOVE Trial Fair | Pregnant/postpartum
G1: Domestic Violence Enhanced Home Visitation Program (DOVE), structured brochure-based IPV intervention added to standard home visitation (124) G2: Standard home-visiting protocol (4–6 prenatal visits, 6–12 postnatal visits over 2 years) (115) | CTS-2, adj. mean decrease in IPV scores from baseline to 24 months (SD):
G1: −40.82 (NR) G2: −35.87 (NR) Mean difference between groups in change from baseline score (G1 vs. G2): −4.95; p<0.01 | NR | NR | NR |
| Zlotnick et al, 201184
RCT Fair | Pregnant/postpartum
G1: Interpersonal psychotherapy based (25) G2: Control, educational material and a listing of resources for IPV (21) | CTS-2: frequency of IPV acts, mean (SD):
Baseline (past-year incidence): G1: 33.4 (28.4) G2: 38.7 (39.0) Frequency since last assessment (SD) 6 weeks (from baseline): G1: 7.8 (15.6) G2:12.7 (24.1) 2 weeks postpartum: G1: 7.3 (11.6) G2: 5.9 (9.0) 3 months postpartum: G1: 16.3 (28.6) G2: 12.7 (24.1) Overall interaction across all groups and time periods: p=0.44 | NR | NR | NR |
| Hegarty et al, 201386
Cluster RCT (by physician) Fair | Nonpregnant
G1: Physician training to respond to women and deliver a brief IPV counseling intervention (137) G2: Usual care (135) | CAS score ≥7
N positive/N analyzed (%) Baseline: G1: 101/135 (75) G2: 93/132 (71) 12 months: G1: 44/93 (47) G2: 40/96 (42) Change from baseline to 12 months in % with CAS score ≥7 (G1 vs. G2): −28 vs. −29 | NR | NR | NR |
| Miller et al, 201189
Cluster RCT by clinic Fair | Nonpregnant
G1: Clinician training to deliver enhanced IPV screening, education, and counseling for IPV and appropriate referrals (453; 96 IPV exposed) G2: Usual car (2 violence screening questions on intake form, usual clinic protocol for positive disclosures) (451; 60 IPV exposed) Co-intervention: Card listing local violence-related resources | Recent IPV (past 3-month physical or sexual violence)# Total sample
N positive (%) Baseline: G1: 96 (21.2) G2: 60 (13.5) 3–6 months: G1: 97 (22.1) G2: 70 (15.7) Difference between groups NS per authors; rates of IPV exposure in subgroup experiencing IPV at baseline NR | Pregnancy coercion (past 3-month, using investigator developed 4-item scale), total sample
N positive (%) Baseline: G1: 41 (9.3) G2: 35 (7.9) 3–6 months: G1: 31 (7.5) G2: 32 (7.6) Pregnancy coercion in subgroup of women with recent IPV exposure at baseline; N positive (%) Baseline G1: 22 (23.2) G2: 15 (25.4) 3–6 months: G1: 9 (10.5) G2:14 (23.7) AOR, (95% Ci) 0.29 (0.09 to 0.91) Birth control sabotage (past 3-month, 5-item investigator developed scale); Total sample N positive (%) Baseline G1: 47 (10.7) G2: 31 (7.0) 3–6 months: G1: 18 (4.4) G2: 20 (4.8) Birth control sabotage in subgroup of women with recent IPV exposure at baseline N positive (%) Baseline G1: 23 (24.2) G2: 10 (17.0) 3–6 months G1: 8 (9.3) G2: 5 (8.5) AOR, (95% CI) 0.71 (0.17 to 2.94) | ||
| Miller et al, 201688
Cluster RCT by clinic Fair | Nonpregnant
G1: Clinicians and staff IPV education training (1/2 day), discussion of IPV encouraged for all encounters, guided by palm-sized brochure (1,429) G2: Usual care (standard IPV question on intake sheet; referral if IPV disclosed) (1,396) | Recent exposure to IPV (3 items, physical or sexual, measuring past 3 months IPV) baseline to 12 months, G1 vs. G2:
Overall sample Adj. RR** (95% CI) 1.07 (0.84 to 1.38) Subgroup reporting IPV at baseline Adj. RR** (95% CI) 1.16 (0.82 to 1.64 | NR | NR | Recent reproductive coercion (10 items measuring exposure over past 3 months) baseline to 12 months, G1 vs. G2:
Overall sample Adj. RR** (95% CI) 1.50 (0.95 to 2.35) Subgroup reporting recent IPV at baseline Adj. RR** (95% CI) 1.19 (0.63 to 2.22) |
| Rhodes et al, 201587
RCT Fair | Nonpregnant
G1: Brief motivational intervention during ED visit (239) G2: Assessed control (232) G3: No contact control (121) Co-intervention: All received usual care and a standard list of social service resources | Experienced any IPV in past week (CTS-2 score ³1)
Baseline G1: 4.5 (3.8 to 5.2) G2: 4.9 (4.0 to 5.7) G3: 5.9 (4.7 to 7.2) 3 months G1: 5.2 (3.5 to 5.2) G2: 4.7 (3.8 to 5.6) G3: 3.3 (2.3 to 4.3) 6 months G1: 3.0 (2.3 to 3.6) G2: 3.3 (2.6 to 4.1) 12 months G1: 3.1 (2.3 to 3.9) G2: 3.8 (2.8 to 4.8) OR, (G1 vs. G2) for experiencing IPV at 3 months: 1.02; 95% CI, 0.98 to 1.06; p=0.33 CTS-2 score, mean (95% CI) Baseline G1: 9.8 (8.6 to 11.0) G2: 10.3 (8.9 to 11.6) G3: 12.7 (01.5 to 14.9) 3 months G1: 10.3 (8.9 to 11.6) G2: 8.5 (7.0 to 10.0) G3: 7.4 (5.4 to 9.4) 6 months G1: 6.2 (5.1 to 7.3) G2: 6.1 (4.8 to 7.4) 12 months G1: 12.7 (10.5 to 14.9) G2: 6.8 (5.2 to 8.4) | NR | NR | NR |
| Tiwari et al, 201294
Tiwari et al, 201090 RCT Good | Nonpregnant
G1: Advocacy intervention, in-person interview, empowerment pamphlet to support the information provided, scheduled weekly telephone calls, 24-hour access to a hotline for additional support (100) G2: Control (100) | NR | CTS-2, mean score (SD)
Physical assault Baseline G1: 1.68 (4.21) G2: 1.55 (4.10) 3 months G1: 1.27 (3.22) G2: 3.21 (6.07) 9 months: G1: 0.23 (1.27) G2: 0.45 (1.74) Adj. difference (3–9 months)†† −0.35 (−0.80 to 0.10); p=.013 | CTS-2, mean score (SD)
Psych. aggression Baseline G1: 18.54 (10.20) G2: 18.95 (10.36) 3 months G1: 23.67 (15.89) G2: 20.84 (10.45) 9 months: G1: 10.07 (5.91) G2: 12.11 (8.57) Adj. differences (3 months to 9 months):†† −1.87 (−3.34 to −0.40); p=0.01 | CTS-2, mean score (SD)
Sexual coercion Baseline G1: 0.68 (3.32) G2: 0.14 (0.73) 3 months G1: 0.33 (1.29) G2: 1.11 (2.70) 9 months: G1: 0.03 (0.30) G2: 0.14 (0.75) Adj. difference (3 months to 9 months):†† −0.02 (−0.12 to 0.09); p=0.60 |
- *
Analyses adjusted for missing data; imputed data adjusted for child age, program site, maternal mental health comorbidity, problem alcohol use, and past-year employment with control group as referent. Overall IPV rates also adjusted for baseline IPV (continuous term).
- †
The values for the long-term followup reflect the time period when the child was approximately 7 to 9 years of age (4–6 years after the home-visiting intervention ended).
- ǂ
Baseline information obtained at approximately 13 weeks gestation; numbers refer to women in the overall study who reported any acts of IPV in the year before study entry
- §
Adjusted for depression and substance use.
- ǁ
Adjusted for depression and substance use. Authors also report outcomes at each specific time point during pregnancy and postpartum visit. Women in the intervention group were less likely to be victimized at all time points, but the difference between groups at the postpartum visit was not statistically significant (12.7% vs. 21.2%; p=0.063)
- ¶
Analyzes adjusted for missing data (multiple imputation), maternal age, maternal depression, and site (urban/rural).
- #
Per authors, recent (past 3-month) experiences of physical and sexual violence were assessed using items modified from the Conflict Tactics Scales and the Sexual Experiences Survey.
- **
Models adjusted for baseline values, survey time point, interaction between baseline and time point, and clustering; missing data accounted for using multiple imputation.
- ††
Between-group difference adjusted for baseline values.
Abbreviations: AOR=adjusted odds ratio; CAS=Composite Abuse Scale; CI=confidence interval; CTS-2=Conflict Tactics Scale-2; DOVE=Domestic Violence Enhanced Home Visitation Program; ED=emergency department; G=group; HSP=Health Start Program; IPV=intimate partner violence; IRR=incidence rate ratio; KQ=key question; N/n=sample size; NR=not reported; NS=not significant; RCT=randomized, controlled trial; RD=risk difference; RR=risk ratio; SD=standard deviation.
Appendix G Table 6Results of IPV KQ 4 Studies Reporting QOL, Mental Health and Pregnancy Outcomes
| Author, Year Study Design Quality | Population | G1 (N analyzed)
G2 (N analyzed) | Quality-of-Life Measure Results | Mental Health and Pregnancy Outcomes Results |
|---|---|---|---|---|
| El-Mohandes et al, 200882; Kiely et al, 201085; El-Mohandes et al, 201192
RCT Fair | Pregnant/postpartum | G1: Individual cognitive behavioral intervention delivered during prenatal care visits (IPV: 452, 169 experiencing IPV at baseline; pregnancy outcomes 403)
G2: Usual prenatal care (IPV: 461, 167 experiencing IPV at baseline; pregnancy outcomes 416) | NR | Pregnancy outcomes
Intervention vs. control N positive/N analyzed (%) for women experiencing IPV throughout pregnancy Low birth weight (<2,500 g) G1: 17/150 (12.8) G2: 24/156 (18.5) p=0.204 Very low birth weight (<1,500 g) G1: 1/150 (0.8) G2: 6/156 (4.6) p=0.052 Preterm birth (<37 weeks of gestation) G1: 18/150 (13.0) G2: 27/156 (19.7) p=0.135 Very preterm birth (<33 weeks of gestation) Intervention: 2/150 (1.5) Control: 9/156 (6.6) p=0.030 |
| Tiwari et al, 200583
RCT Fair | Pregnant/postpartum | G1: In-person session by midwife counselor focused on empowerment to enhance abused women’s independence and control (advice concerning safety, choice making, and problem solving), followed by brochure with reinforcing information (51)
G2: Usual care for abused women consisting of wallet-sized card with information on community resources (55) | SF-36, difference between groups in component scores at 6 weeks (G1–G2):
Physical functioning 10 (2.5 to 18); p≤0.05 Role-physical 19 (1.5 to 37); p≤0.05 Bodily pain −13 (−23 to −2.2); p≤0.05 General health −1.3 (−6.4 to 3.9); p=NS Vitality 0.45 (−5.4 to 6.3); p=NS Social functioning 3.1 (−4.3 to 11); p=NS Role-emotional 28 (9.0 to 47); p≤0.05 Mental health 0.28 (−4.4 to 5.0); p=NS | Postpartum depression
EPDS score ≥10 at 5 weeks N positive/N analyzed (%) G1: 9/51 (18%) G2: 25/55 (45%) RR, (95% CI) 0.36 (0.15 to 0.88) |
| Zlotnick et al, 201184
RCT Fair | Pregnant/postpartum | G1: Interpersonal psychotherapy-based (25)
G2: Control, educational material and a listing of resources for IPV (21) Co-intervention: Usual medical care provided at the clinic | NR | Postnatal depression (EPDS scores), mean (SD)
Baseline: G1: 7.18 (4.36) G2: 8.77 (6.07) Postpartum (6 weeks from baseline) G1: 6.84 (4.10) G2: 9.84 (6.05) 2 weeks postpartum: G1: 6.68 (5.54) G2: 7.14 (5.18) 3 months postpartum: G1: 6.12 (5.86) G2: 8.00 (5.74) Overall interaction across all groups and time periods: p=0.20 LIFE* structured interview, cases of MDD diagnosed during study period, N cases/N analyzed (%): G1: 6/25 (24%) G2: 5/21 (24%) p=NS per authors PTSD (Davidson Trauma Scale), mean (SD) Baseline: G1: 9.96 (10.62) G2: 16.11 (23.49) Postpartum (6 weeks from baseline): G1: 5.58 (7.51) G2:12.08 (17.60) 2 weeks postpartum: G1: 6.04 (7.75) G2: 10.09 (16.09) 3 months postpartum: G1: 8.44 (13.98) G2: 9.19 (14.20) Overall interaction across all groups and time periods: p=0.24 LIFE* structured interview, cases of PTSD diagnosed during study period, N cases/N analyzed (%): G1: 1/25 (5%) G2: 0/21 (0%) p=NS per authors |
| Hegarty et al, 201386
Cluster RCT (by physician) Fair | Nonpregnant | G1: Physician training to respond to women and deliver a brief IPV counseling intervention (137)
G2: Usual care if presented with concerns (135) Co-intervention: All doctors received basic IPV education associated with CME credit. All women received a list of resources. | SF-12 mental health status, G1 vs. G2, adj.† mean difference (95% CI), p-value
6 months: 0.8 (−2.3 to 3.9); p=0.61 12 months: 2.4 (−1.0 to 5.7); p=0.17 WHOQOL-Bref. G1 vs. G2, adj. mean difference (95% CI); p-value Physical, 6 months 4.9 (1.1–8.6), p=0.01 Physical, 12 months 2.7 (−1.4–6.8), p=0.20 Psychological, 6 months 2.5 (−1.2–6.2), p=0.19 Psychological, 12 months 2.3 (−1.5–6.1), p=0.23 Social, 6 months 4.8 (−1.0–10.7), p=0.11 Social, 12 months 2.1 (−4.3–8.5), p=0.52 Environmental, 6 months 1.0 (−2.6–4.7), p=0.57 Environmental, 12 months 1.9 (−1.7–5.5), p=0.29 | HADS depression score ≥8
Adj. OR, (95% CI), p-value 6 months: 0.4 (0.1 to 1.0); p=0.05 12 months: 0.3 (0.1 to 0.7); p=0.005 HADS anxiety score ≥8 Adj. OR, (95% CI), p-value 6 months: 0.5 (0.2 to 1.3); p=0.14 12 months: 0.4 (0.2 to 1.2); p=0.11 |
| Miller et al, 201688
Cluster RCT by clinic Fair | Nonpregnant | G1: Clinicians and staff IPV education training (1/2 day), Discussion of IPV encouraged for all encounters, guided by palm-sized brochure (1,429)
G2: Usual care (standard IPV question on intake sheet; referral if IPV disclosed) (1,396) Co-intervention: Women’s health resource sheet | NR | Unintended past-year pregnancyǂ
N positive/N analyzed (%) G1: 50/1,429 (3.5) G2: 40/1,396 (2.9) Adj. RR§ (95% CI) 1.03 (0.80 to 1.94) Women with recent IPV/RC at baseline N positive/N analyzed (%) G1: 41/176 (23.2) G2: 32/162 (19.8) Adj. RR§ (95% CI) 1.15 (0.67 to 1.96) |
| Saftlas et al, 201491
RCT Fair | Nonpregnant | G1: Motivational interviewing conducted by field coordinator (98)
G2: In-person meeting with field coordinator or certified domestic abuse advocate who provided written information on community-based resources and referrals (106) | NR | Depression, Center for Epidemiologic Studies Short Depression Scale (10-items, score range 0–30)
Score, mean (SD) Baseline G1: 15.7 (6.4) G2: 14.3 (5.9) 6 months G1: 11.7 (5.5) G2: 11.8 (6.1) Difference between groups in mean change from baseline: −4.2 vs. −2.6; p=0.07 |
| Tiwari et al, 201294
Tiwari et al, 201090 RCT Good | Nonpregnant | G1: Advocacy intervention, in-person interview, empowerment pamphlet to support the information provided, scheduled weekly telephone calls, 24-hour access to a hotline for additional support (100)
G2: Usual care (100) | SF-12, Physical Composite Score, mean (SD)
G1: 43.28 (7.67) G2: 43.32 (7.59) 3 months G1: 42.37 (7.22) G2: 42.39 (7.37) 9 months: G1: 44.35 (7.64) G2: 43.55 (7.30) Adj. differences (3–9 months): 0.37 (−0.91 to 1.65); p=0.58 SF-12, Mental Health Composite Score, mean (SD) G1: 26.58 (7.64) G2: 25.44 (7.66) 3 months G1: 34.79 (8.87) G2: 34.39 (8.26) 9 months: G1: 38.26 (8.56) G2: 37.89 (8.08) Adj. differences (3–9 months): 0.80 (−1.16 to 2.77); p=0.42 | Depression
CBDI-II,ǁ mean score (SD) Baseline G1: 37.88 (14.90) G2: 39.33 (15.60) 3 months G1: 24.38 (14.45) G2: 39.33 (15.60) 9 months G1: 16.10 (10.69) G2: 18.25 (11.40) Adj. difference (95% CI) over 3–9 months: −2.66 (−5.06 to −0.26); p=0.03 |
- *
At 3 months postpartum, the longitudinal Interval Followup Examination (LIFE) structured interview was administered to assess for MDD and PTSD diagnoses.
- †
Adjusted for baseline measures and practice location in addition to missing data (using multiple imputation). For QOL between-group differences, “estimated effect size” refers to mean difference in scores.
- ǂ
Based on 7-item investigator developed tool.
- §
Adjusted for baseline value, time point, interaction term between baseline outcome value and time point, age, race, education, number of clinics in cluster and cluster rural/urban status, and accounting for clients within clinics within the cluster randomization.
- ǁ
Chinese version of the Beck Depression Inventory II; range of scores is from 0 to 36, higher scores indicate higher levels of depression.
- ¶
Between-group difference (intervention-control) adjusted for baseline values.
Abbreviations: CBDI-II=Chinese Beck Depression Inventory-II; EPDS=The Edinburgh Postnatal Depression Scale; G=group; HADS =Hospital Anxiety and Depression Scale; IPV=intimate partner violence; KQ=key question; LIFE=Longitudinal Interval Follow-up Examination; MDD=major depressive disorder; N/n=sample size; NR=not reported; NS=not sufficient; OR=odds ratio; RC=Reproductive Coercion; RCT=randomized, controlled trial; RR=relative risk; SD=standard deviation; SF-36=Short Form Health Survey-36 Item; WHOQOL-Bref=World Health Organization Quality of Life-Bref instrument.
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Appendix G Figure 1Benefit of IPV Interventions in Studies Enrolling Pregnant or Postpartum Women (Organized by Study)
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Appendix G Figure 2Benefit of IPV Interventions in Studies Enrolling Nonpregnant Women (Organized by Study)
- Additional Tables and Study Results - Screening for Intimate Partner Violence, E...Additional Tables and Study Results - Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: An Evidence Review for the U.S. Preventive Services Task Force
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