Taft Angela, O'Doherty Lorna, Hegarty Kelsey, Ramsay Jean, Davidson Leslie, Feder Gene
Mother and Child Health Research, La Trobe University, Victoria, Australia.
Cochrane Database Syst Rev. 2013 Apr 30(4):CD007007. doi: 10.1002/14651858.CD007007.pub2.
Intimate partner violence (IPV) damages individuals, their children, communities, and the wider economic and social fabric of society. Some governments and professional organisations recommend screening all women for intimate partner violence rather than asking only women with symptoms (case-finding); however, what is the evidence that screening interventions will increase identification, and referral to support agencies, or improve women's subsequent wellbeing and not cause harm?
To assess the effectiveness of screening for intimate partner violence conducted within healthcare settings for identification, referral to support agencies and health outcomes for women.
We searched the following databases in July 2012: CENTRAL (2012, Issue 6), MEDLINE (1948 to September Week June Week 3 2012), EMBASE (1980 to Week 28 2012), MEDLINE In-Process (3 July 2012), DARE (2012, Issue 2), CINAHL (1937 to current), PsycINFO (1806 to June Week 4 2012), Sociological Abstracts (1952 to current) and ASSIA (1987 to October 2010). In addition we searched the following trials registers: metaRegister of Controlled Trials (mRCT) (to July 2012), and International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Australian New Zealand Clinical Trials Registry and the International Standard Randomised Controlled Trial Number Register to August 2010. We also searched the reference lists of articles and websites of relevant organisations.
Randomised or quasi-randomised trials assessing the effectiveness of IPV screening where healthcare professionals screened women face-to-face or were informed of results of screening questionnaires, compared with usual care ( which included screening for other purposes).
Two review authors independently assessed the risk of bias in the trials and undertook data extraction. For binary outcomes, we calculated a standardised estimation of the risk ratio (RR) and for continuous data, either a mean difference (MD) or standardised mean difference (SMD). All are presented with a 95% confidence interval (CI).
We included 11 trials that recruited 13,027 women overall. Six of 10 studies were assessed as being at high risk of bias.When data from six comparable studies were combined (n = 3564), screening increased identification of victims/survivors (RR 2.33; 95% CI 1.40 to 3.89), particularly in antenatal settings (RR 4.26; 95% CI 1.76 to 10.31).Only three studies measured referrals to support agencies (n = 1400). There is no evidence that screening increases such referrals, as although referral numbers increased in the screened group, actual numbers were very small and crossed the line of no effect (RR 2.67; 95% CI 0.99 to 7.20).Only two studies measured women's experience of violence after screening (one at three months, the other at six, 12 and 18 months after screening) and found no significant reduction of abuse.Only one study measured adverse effects and data from this study suggested that screening may not cause harm. This same study showed a trend towards mental health benefit, but the results did not reach statistical significance.There was insufficient evidence on which to judge whether screening increases take up of specialist services, and no studies included economic evaluation.
AUTHORS' CONCLUSIONS: Screening is likely to increase identification rates but rates of referral to support agencies are low and as yet we know little about the proportions of false measurement (negatives or positives). Screening does not appear to cause harm, but only one study examined this outcome. As there is an absence of evidence of long-term benefit for women, there is insufficient evidence to justify universal screening in healthcare settings. Studies comparing screening versus case finding (with or without advocacy or therapeutic interventions) for women's long-term wellbeing would better inform future policies in healthcare settings.
亲密伴侣暴力（IPV）会对个人、其子女、社区以及更广泛的社会经济结构造成损害。一些政府和专业组织建议对所有女性进行亲密伴侣暴力筛查，而不是仅询问有症状的女性（病例发现）；然而，有哪些证据表明筛查干预措施会增加识别率，并转介至支持机构，或者改善女性随后的健康状况且不会造成伤害呢？
评估在医疗机构中进行的亲密伴侣暴力筛查对于识别、转介至支持机构以及女性健康结局的有效性。
我们于2012年7月检索了以下数据库：Cochrane系统评价数据库（CENTRAL，2012年第6期）、医学索引数据库（MEDLINE，1948年至2012年9月第3周）、荷兰医学文摘数据库（EMBASE，1980年至2012年第28周）、MEDLINE在研数据库（2012年7月3日）、循证卫生保健数据库（DARE，2012年第2期）、护理学与健康领域数据库（CINAHL，1937年至今）、心理学文摘数据库（PsycINFO，1806年至2012年第4周）、社会学文摘数据库（1952年至今）以及澳大利亚社会科学索引数据库（ASSIA，1987年至2010年10月）。此外，我们还检索了以下试验注册库：对照试验元注册库（mRCT，截至2012年7月）、国际临床试验注册平台（ICTRP）、美国国立医学图书馆临床试验数据库（ClinicalTrials.gov）、澳大利亚和新西兰临床试验注册库以及国际标准随机对照试验编号注册库（截至2010年8月）。我们还检索了相关文章的参考文献列表以及相关组织的网站。
随机或半随机试验，评估亲密伴侣暴力筛查的有效性，其中医疗保健专业人员对女性进行面对面筛查或被告知筛查问卷的结果，并与常规护理（包括为其他目的进行的筛查）进行比较。
两位综述作者独立评估试验中的偏倚风险并进行数据提取。对于二分类结局，我们计算风险比（RR）的标准化估计值；对于连续性数据，计算均数差（MD）或标准化均数差（SMD）。所有结果均给出95%置信区间（CI）。
我们纳入了11项试验，共招募了13,027名女性。10项研究中有6项被评估为存在高偏倚风险。当合并6项可比研究的数据时（n = 3564），筛查提高了受害者/幸存者的识别率（RR 2.33；95% CI 1.40至3.89），尤其是在产前环境中（RR 4.26；95% CI 1.76至10.31）。仅有3项研究测量了转介至支持机构的情况（n = 1400）。没有证据表明筛查会增加此类转介，因为尽管筛查组的转介人数增加，但实际人数非常少且未超过无效应线（RR 2.67；95% CI 0.99至7.20）。仅有2项研究测量了女性在筛查后的暴力经历（一项在筛查后3个月，另一项在筛查后6个月、12个月和18个月），发现虐待情况没有显著减少。仅有1项研究测量了不良反应，该研究的数据表明筛查可能不会造成伤害。同一研究显示出心理健康受益的趋势，但结果未达到统计学显著性。关于筛查是否会增加专科服务的使用率，证据不足，且没有研究进行经济评估。
筛查可能会提高识别率，但转介至支持机构的比例较低，而且我们对错误测量（阴性或阳性）的比例了解甚少。筛查似乎不会造成伤害，但仅有1项研究考察了这一结局。由于缺乏对女性长期益处的证据，因此没有足够的证据证明在医疗机构中进行普遍筛查是合理的。比较筛查与病例发现（有或没有宣传或治疗干预）对女性长期健康状况影响的研究，将为未来医疗机构的政策提供更好的依据。
