Women of childbearing age are most vulnerable to domestic abuse, experts say
A national task force recommends doctors ask those women about abuse
The group found insufficient evidence to recommend for or against child abuse intervention
At your next doctor’s appointment, amid questions about alcohol, smoking and medications, don’t be surprised if you’re asked, “How are things at home?”
Roughly one-third of women and one-quarter of men report experiencing some form of domestic violence, also referred to as inter-partner violence, during their lifetime.
While these statistics are alarming, the numbers are almost certainly worse, due to the systematic under-reporting of abuse.
But a panel of national experts has found there is a particular time-frame in a woman’s life when she is most vulnerable to abuse.
The U.S. Preventive Services Task Force previously found insufficient evidence to recommend for or against domestic violence screening by doctors.
But on Monday, the panel updated its guidance in the medical journal Annals of Internal Medicine, recommending that all women of childbearing age be screened for abuse, and women who screen positive should be provided or referred to intervention services.
The task force also issued a draft statement on primary care interventions to prevent child abuse.
First, some background
The task force, created in 1984, is comprised of experts in prevention and evidence-based medicine. It makes evidence-based recommendations about clinical preventive services, such as screenings, counseling services, or preventive medications.
The USPSTF is made up of 16 volunteer members who come from the fields of preventive medicine and primary care, including internal medicine, pediatrics, behavioral health, obstetrics/gynecology, and nursing. All members volunteer their time to serve on the USPSTF, and most are practicing clinicians.
By definition, domestic violence takes place in the home. For that reason, it’s sometimes referred to as spousal abuse or intimate partner violence, known as IPV. It not only encompasses physical aggression or assault, but sexual abuse, emotional abuse, intimidation, stalking – even economic deprivation.
“We have made significant progress in building the evidence base to effectively prevent violence against women,” said Dr. Virginia Moyer, chair of the USPSTF, in a written statement. “We now have the primary care methods and the means to help prevent violence against women in their reproductive years.”
While all women are at risk for abuse and should be screened, the task force also identified heightened risk factors, which include young age, substance abuse, marital difficulties, and economic hardships.
For its part, the Centers for Disease Control and Prevention has available its own comprehensive list of risk factors for IPV, which are organized into four categories: individual (e.g., low self-esteem), relationship (e.g., marital conflict and instability), community (e.g., poverty and associated factors), and societal (e.g., traditional gender roles). The CDC has resources available on its website for those needing them.
“Although abuse of men, abuse of middle-aged women and abuse and neglect of elderly and vulnerable (physically or mentally dysfunctional) adults can have equally devastating consequences as IPV among younger women, there is currently not enough evidence about how primary care clinicians can effectively screen and intervene,” the task force said Monday.
Principal problems, according to the task force, include the lack of standards as to how clinicians should question patients about abuse; varying definitions of abuse; lack of screening tools; unclear guidance on who to screen; and what to do if abuse is identified.
Furthermore, potential harms of preventive screening may in the end outweigh the benefits – shame, guilt, self-blame, fear of retaliation or abandonment by perpetrators, and the repercussions of false-positive results are all distinct possibilities, the task force said. More research is needed before the USPSTF can issue recommendations for or against preventive screenings under these circumstances.
Interventions to prevent child abuse
Nearly three-quarters of a million children fell victim to child abuse and neglect in 2011, the most recent year for which data was available, according to the Department of Health and Human Services. Besides death, there are innumerate possible short- and long-term physical and mental health repercussions.
The Administration for Children and Families defines child abuse and neglect as “any recent act or failure to act on the part of a parent or caregiver that results in death, serious physical or emotional harm, sexual abuse, exploitation, or an act or failure to act that presents an imminent risk for serious harm.”
Laws vary from state to state, but in all states, clinicians who suspect abuse or neglect are required by law to file a report with child welfare offices.
The USPSTF compiled a list of factors – in large part from CDC literature – associated with child maltreatment, including but not limited to:
– Young, single, or nonbiological parents
– Parental history of abuse or neglect in family of origin
– Family dysfunction or violence
– Substance abuse within the family
– Social isolation, poverty, or other socioeconomic disadvantages
– Parental stress and distress
However, “the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment,” the task force said Monday. The recommendation applies to children (aged newborn to 18 years) who do not have signs or symptoms of maltreatment.”
“The bottom line,” said task force member and pediatrician Dr. David Grossman, “is that more research is needed on how primary care clinicians can effectively screen and protect all populations, including older and vulnerable adults, middle-aged women, men, and children, from abuse and violence.”