i have advocated for routine screening women for intimate partner violence (IPV) as part of the social history of patients. there is another (a third study) published in the Lancet which found lack of utility (see Lancet 2013 doi:10.1016/S0140-6736(13)60052-5). in brief:
–australian study with postal screening of 20K women for “fear of a partner” in the past 12 months, with 52 different MDs. 5742 women responded. 731 positive screen. 386 enrolled
–intervention: usual care vs training MDs, alerting MDs that person screened positive for IPV, inviting women to 1 to 6 sessions of counseling for relationship and emotional issues.
–primary outcome of quality of live, safety planning and behavior, mental health at 12 months — no difference between groups. the only secondary outcome with benefit from intervention was depressive symptoms
but … IPV clearly affects health and should be asked if it could be part of woman’s presenting medical problem (eg, mental health issues of depression, anxiety, and some targeted medical probs such as abd or pelvic pain. also for women being treated for HIV or STIs. for antenatal services (where IPV is even more prevalent), there are some data that interventions may reduce IPV recurrences and improve maternal and infant outcomes (see also the editorial in the Lancet 2013, doi:10.1016/S0140-6736(13)60584-X).
this study is still pretty counterintuitive to me. i understand that interventions are not so successful over the years, both for men and women. but there must be some less measurable outcomes, such as improved provider-patient relationship, improved provider-patient communication, improved provider empathy and understanding — and that these should translate into some benefit (eg the therapeutic efficacy of the doctor-patient relationship).
geoff