This Article  • Full text  • PDF  • eAppendix  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Patient-Physician Relationship/ Care  • Patient-Physician Communication  • Psychosocial Issues  • Violence and Human Rights  • Violence and Human Rights, Other  • Women's Health  • Women's Health, Other  • Randomized Controlled Trial  • Diagnosis  • Alert me on articles by topic  Social Bookmarking   What's this?

A Randomized Trial

Harriet L. MacMillan, MD, MSc, FRCPC; C. Nadine Wathen, PhD; Ellen Jamieson, MEd; Michael H. Boyle, PhD; Harry S. Shannon, PhD; Marilyn Ford-Gilboe, RN, PhD; Andrew Worster, MD; Barbara Lent, MD; Jeffrey H. Coben, MD; Jacquelyn C. Campbell, PhD; Louise-Anne McNutt, PhD; for the McMaster Violence Against Women Research Group

JAMA. 2009;302(5):493-501.

Context  Whether intimate partner violence (IPV) screening reduces violence or improves health outcomes for women is unknown.

Objective  To determine the effectiveness of IPV screening and communication of positive results to clinicians.

Design, Setting, and Participants  Randomized controlled trial conducted in 11 emergency departments, 12 family practices, and 3 obstetrics/gynecology clinics in Ontario, Canada, among 6743 English-speaking female patients aged 18 to 64 years who presented between July 2005 and December 2006, could be seen individually, and were well enough to participate.

Intervention  Women in the screened group (n=3271) self-completed the Woman Abuse Screening Tool (WAST); if a woman screened positive, this information was given to her clinician before the health care visit. Subsequent discussions and/or referrals were at the discretion of the treating clinician. The nonscreened group (n=3472) self-completed the WAST and other measures after their visit.

Main Outcome Measures  Women disclosing past-year IPV were interviewed at baseline and every 6 months until 18 months regarding IPV reexposure and quality of life (primary outcomes), as well as several health outcomes and potential harms of screening.

Results  Participant loss to follow-up was high: 43% (148/347) of screened women and 41% (148/360) of nonscreened women. At 18 months (n = 411), observed recurrence of IPV among screened vs nonscreened women was 46% vs 53% (modeled odds ratio, 0.82; 95% confidence interval, 0.32-2.12). Screened vs nonscreened women exhibited about a 0.2-SD greater improvement in quality-of-life scores (modeled score difference at 18 months, 3.74; 95% confidence interval, 0.47-7.00). When multiple imputation was used to account for sample loss, differences between groups were reduced and quality-of-life differences were no longer significant. Screened women reported no harms of screening.

Conclusions  Although sample attrition urges cautious interpretation, the results of this trial do not provide sufficient evidence to support IPV screening in health care settings. Evaluation of services for women after identification of IPV remains a priority.

Trial Registration  clinicaltrials.gov Identifier: NCT00182468

Author Affiliations: Departments of Psychiatry and Behavioural Neurosciences (Drs MacMillan and Boyle and Ms Jamieson), Pediatrics (Dr MacMillan), Clinical Epidemiology and Biostatistics (Drs Boyle and Shannon), and Emergency Medicine (Dr Worster), McMaster University, Hamilton, Ontario, Canada; Faculty of Information and Media Studies (Dr Wathen), Arthur Labatt Family School of Nursing (Dr Ford-Gilboe), and Department of Family Medicine (Dr Lent), The University of Western Ontario, London, Canada; Department of Emergency Medicine and Community Medicine, West Virginia University School of Medicine, Morgantown (Dr Coben); School of Nursing, Johns Hopkins University, Baltimore, Maryland (Dr Campbell); and Department of Epidemiology, School of Public Health, University at Albany, State University of New York, Albany (Dr McNutt).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Preventing Intimate Partner Violence: Screening Is Not Enough
Kathryn E. Moracco and Thomas B. Cole
JAMA. 2009;302(5):568-570.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Is Screening for Intimate Partner Violence Helpful?
JWatch General 2009;2009:4-4.
FULL TEXT  

Does It Matter Whether We Ask About Intimate Partner Violence?
JWatch Women's Health 2009;2009:1-1.
FULL TEXT  

All you need to read in the other general journals
BMJ 2009;339:b3257-b3257.
FULL TEXT  

Preventing Intimate Partner Violence: Screening Is Not Enough
Moracco and Cole
JAMA 2009;302:568-570.
FULL TEXT