MacMillan Harriet L, Wathen C Nadine, Jamieson Ellen, Boyle Michael H, Shannon Harry S, Ford-Gilboe Marilyn, Worster Andrew, Lent Barbara, Coben Jeffrey H, Campbell Jacquelyn C, McNutt Louise-Anne
Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Patterson Bldg, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada.
JAMA. 2009 Aug 5;302(5):493-501. doi: 10.1001/jama.2009.1089.
Whether intimate partner violence (IPV) screening reduces violence or improves health outcomes for women is unknown.
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.
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.
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.
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.
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.
clinicaltrials.gov Identifier: NCT00182468.
亲密伴侣暴力（IPV）筛查是否能减少暴力行为或改善女性的健康状况尚不清楚。
确定IPV筛查以及向临床医生传达阳性结果的有效性。
设计、地点和参与者：在加拿大安大略省的11个急诊科、12个家庭诊所和3个妇产科诊所进行的随机对照试验，研究对象为2005年7月至2006年12月期间前来就诊、年龄在18至64岁之间、能单独就诊且身体状况足以参与研究的6743名讲英语的女性患者。
筛查组（n = 3271）的女性自行完成妇女受虐筛查工具（WAST）；如果女性筛查呈阳性，此信息会在就诊前提供给她的临床医生。后续的讨论和/或转诊由主治医生自行决定。未筛查组（n = 3472）的女性在就诊后自行完成WAST和其他测量。
在基线时以及之后每6个月直至18个月，对披露过去一年遭受IPV的女性进行访谈，询问IPV再次暴露情况和生活质量（主要结局），以及一些健康结局和筛查的潜在危害。
随访中的参与者流失率很高：筛查组43%（148/347）的女性和未筛查组41%（148/360）的女性。在18个月时（n = 411），筛查组与未筛查组女性中观察到的IPV复发率分别为46%和53%（模型优势比为0.82；95%置信区间为0.32 - 2.12）。筛查组与未筛查组女性在生活质量评分上的改善约高0.2标准差（18个月时的模型评分差异为3.74；95%置信区间为0.47 - 7.00）。当使用多重填补法来处理样本流失时，组间差异减小，生活质量差异不再显著。筛查组女性报告筛查无危害。
尽管样本损耗促使谨慎解读，但该试验结果并未提供足够证据支持在医疗保健环境中进行IPV筛查。识别IPV后对女性服务的评估仍然是一个优先事项。
clinicaltrials.gov标识符：NCT00182468。
