NCHR Comment on USPSTF’s Draft Recommendation Statement Screening for Intimate Partner Violence and Elder Abuse

National Center for Health Research: May 21, 2018

National Center for Health Research’s Public Comments
on USPSTF’s Draft Recommendation Statement on Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening

Thank you for the opportunity to share our views regarding USPSTF’s draft recommendation regarding screening for intimate partner violence, elder abuse, and abuse of vulnerable adults. The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research, policies, and programs on a range of issues related to health and safety.

Intimate Partner Violence (IPV) is an important public health issue because it can lead to injury and death as well as mental health conditions such as depression; posttraumatic stress disorder (PTSD); anxiety disorders; substance misuse; and suicidal behavior.1 Because of the complexity and sensitivity of this issue, research may suggest changes regarding the benefit and risk profile for screening in treatment for IPV. Furthermore, due to these factors, it is important to continuously evaluate evidence. Data from the National Intimate Partner and Sexual Violence Survey (NISVS) show that 1 in 4 women have experienced IPV during their lifetime, and 52% of IPV victims reported symptoms of PTSD.2

Elder abuse is also a major public health concern. A nationwide study found that 9% experienced verbal mistreatment, 3.5% financial mistreatment, and 0.2% physical mistreatment by a family member.3 However, rates may be underestimated as differences in definition and data collection make it hard to measure elder abuse nationally and compare it between states or counties.4

Intimate Partner Violence

We support the efforts of the U.S. Preventive Services Task Force (USPSTF) to re-evaluate its recommendations for women of childbearing age and for older or vulnerable adults in light of new research and to attempt to extend recommendations to cover men and adolescents. We agree there is enough evidence to continue recommending screening for women of childbearing age with a grade of “B” and that there is insufficient data to recommend screening for abuse in older or vulnerable adults, thus maintaining a grade of “I”.  We agree that reviewers had insufficient data to provide recommendations for screening for men and adolescents.

Women of reproductive age are at the highest risk for IPV. The CDC reports that 36% of women experience IPV during their lifetime, and 21% experience severe IPV during their lifetime.5 As discussed in the recommendation and review, studies demonstrated that screening for intimate partner violence can identify women who are currently experiencing IPV or have experienced IPV in the last 12 months.

While brief interventions did not reduce IPV exposure or improve quality of life, interventions that included ongoing support services, such as providing behavioral and social services, provided more benefits. For example, one randomized controlled trial evaluated integrated behavioral counseling to usual care in women with one or more risk factors for very low birth weight or very preterm births.6 Women in the intervention group who experienced IPV at the start of the trial were significantly less likely to have a very preterm or very low birth weight baby.

Regarding harms, reviewers found no adverse effects of IPV screening and no significant harms related to IPV interventions. They concluded that the overall impact of the harms of screening or intervention for IPV could be no greater than small. Thus, as the benefits of screening outweigh the potential risks, we concur with the USPSTF draft recommendation for IPV screening in women of childbearing age.

Elder Abuse

We agree with the USPSTF that, currently, there is insufficient evidence to evaluate the accuracy of screening tools for elder abuse. No studies were conducted that assessed screening or randomized controlled trials on treatments for elder abuse or abuse of vulnerable adults, and only one study evaluated a screening tool for elder abuse, which had poor accuracy. USPSTF correctly concluded that more research needs to be conducted in this area, and we agree that there is not sufficient evidence to conclude that screening is effective for detecting and treating elder abuse.  

According to the CDC, 55.8% of men who experience sexual violence, physical violence, or stalking by an intimate partner did so before the age of 25.5 In the evidence review, 15 studies were identified evaluating screening for IPV. Of these studies, most enrolled women or a majority of women; only one study included just men. We support the USPSTF’s recognition of a need for data on screening and treatment for IPV in men and adolescents.

In conclusion, we agree with the USPSTF’s efforts to provide updated recommendations on screening of IPV and abuse based on quality, up-to-date studies. The benefits of screening for IPV for women outweigh the risks, and future studies should allow recommendations to be made for other populations. We agree with the USPSTF draft recommendation on IPV and elder abuse.

Thank you for the opportunity to share our views regarding USPSTF’s draft recommendation regarding screening for intimate partner violence, elder abuse, and abuse of vulnerable adults.

NCHR can be reached through Stephanie Fox-Rawlings at sfr@center4research.org.

 

References

  1. Draft Recommendation Statement: Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening. U.S. Preventive Services Task Force. April 2018. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/intimate-partner-violence-and-abuse-of-elderly-and-vulnerable-adults-screening1
  2. Centers for Disease Control and Prevention. Violence Prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/nisvs/infographic.html. Published April 28, 2017. Accessed May 21, 2018.
  3. Laumann EO, Leitsch SA, Waite LJ. Elder mistreatment in the United States: prevalence estimates from a nationally representative study. J Gerontol B Psychol Sci Soc Sci. 2008;63(4):S248-54.
  4. Hall, JE, Karch, DL, Crosby, AE. Elder Abuse Surveillance: Uniform Definitions and Recommended Core Data Elements For Use In Elder Abuse Surveillance, Version 1.0. Atlanta (GA): National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2016.
  5.  Smith SG, Chen J, Basile KC, et al. National Intimate Partner and Sexual Violence Survey: 2015 Data Brief. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2017.
  6. Kiely M, El-Mohandes AA, El-Khorazaty MN, Blake SM, Gantz MG. An integrated intervention to reduce intimate partner violence in pregnancy: a randomized controlled trial. Obstet Gynecol. 2010;115(2 Pt 1):273-83.