McLennan John D, MacMillan Harriet L
Departments of Pediatrics, Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Departments of Psychiatry & Behavioural Neurosciences, and of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
BMC Fam Pract. 2016 Aug 3;17:103. doi: 10.1186/s12875-016-0500-5.
Family physicians and other primary care practitioners are encouraged or expected to screen for an expanding array of concerns and problems including intimate partner violence (IPV). While there is no debate about the deleterious impact of violence and other adverse psychosocial exposures on health status, the key question raised here is about the value of routine screening in primary care for such exposures.
Several characteristics of IPV have led to consideration for routine IPV screening in primary care and during other healthcare encounters (e.g., emergency room visits) including: its high prevalence, concern that it may not be raised spontaneously if not prompted, and the burden of suffering associated with this exposure. Despite these factors, there are now three randomized controlled trials showing that screening does not reduce IPV or improve health outcomes. Yet, recommendations to routinely screen for IPV persist. Similarly, adverse childhood experiences (ACEs) have several characteristics (e.g., high frequency, predictive power of such experiences for subsequent health problems, and concerns that they might not be identified without screening) suggesting they too should be considered for routine primary care screening. However, demonstration of strong associations with health outcomes, and even causality, do not necessarily translate into the benefits of routine screening for such experiences. To date, there have been no controlled trials examining the impact and outcomes - either beneficial or harmful - of routine ACEs screening. Even so, there is an expansion of calls for routine screening for ACEs. While we must prioritize how best to support and intervene with patients who have experienced IPV and other adverse psychosocial exposures, we should not be lulled into a false sense of security that our routine use of "screeners" results in better health outcomes or less violence without evidence for such. Decisions about implementation of routine screening for psychosocial concerns need similar rigorous debate and scrutiny of empirical evidence as that recommended for proposed physical health screening (e.g., for prostate and breast cancer).
家庭医生和其他初级保健从业者被鼓励或期望对包括亲密伴侣暴力（IPV）在内的一系列日益增多的问题进行筛查。虽然暴力及其他不良社会心理因素对健康状况的有害影响并无争议，但这里提出的关键问题是，在初级保健中针对此类因素进行常规筛查是否有价值。
IPV的几个特点促使人们考虑在初级保健及其他医疗接触（如急诊室就诊）期间进行常规IPV筛查，这些特点包括：其高发性、担心若不提示可能不会被主动提及，以及与此类因素相关的痛苦负担。尽管有这些因素，但目前有三项随机对照试验表明，筛查并不能减少IPV或改善健康结局。然而，对IPV进行常规筛查的建议仍然存在。同样，童年不良经历（ACEs）也有几个特点（如高发生率、此类经历对后续健康问题的预测能力，以及担心若不筛查可能无法识别），这表明它们也应被考虑纳入初级保健常规筛查。然而，与健康结局的强关联甚至因果关系并不一定意味着对此类经历进行常规筛查会带来益处。迄今为止，尚无对照试验研究常规ACEs筛查的影响和结局（无论是有益还是有害）。即便如此，要求对ACEs进行常规筛查的呼声仍在增加。虽然我们必须优先考虑如何最好地支持经历过IPV和其他不良社会心理因素的患者并对其进行干预，但我们不应误以为常规使用“筛查工具”就能带来更好的健康结局或减少暴力，而目前并无此类证据。关于实施社会心理问题常规筛查的决策，需要像建议对提议的身体健康筛查（如前列腺癌和乳腺癌筛查）那样，进行类似严格的辩论并审视实证证据。
