To the Editor: In their randomized controlled trial, Dr MacMillan and colleagues1 concluded that there was not sufficient evidence to support intimate partner violence (IPV) screening in health care settings. Their results suggested that IPV screening did not significantly improve the quality of life and depression scores among women who experienced IPV in Canada or significantly reduce IPV recurrence. However, the results of this study should be interpreted with caution for 2 reasons.
First, the authors used 2 groups of women, a screened group (n = 3271) and a nonscreened group (n = 3472), to assess the effectiveness of IPV screening. The screened group completed the Woman Abuse Screening Tool (WAST) before seeing the clinician, and the nonscreened group completed it after seeing the clinician. In the screened group, the information was given to the clinician when a woman screened positive on WAST. Because the study gave clinicians standardized training in responding to IPV, clinicians were expected to discuss IPV with the WAST-positive women.
However, in the screened group, only 44% of the 347 women who were positive on WAST reported that they had a discussion about violence with their clinicians. Discussion between clinicians and women on their experience of IPV is known to provide an opportunity to support such women.2 - 3 Although the outcome of the participants who discussed violence with physicians might therefore be different from the outcome of other participants who did not discuss it, the authors did not provide an analysis stratified on this difference. The results of such an analysis with stratification might provide better conclusions on the outcome of IPV screening in health care settings.
Second, in this study the majority of the participants who experienced IPV (75% of the screened group and 71% of the nonscreened group) had used a violence-related service during 6 months preceding the study baseline. These participants might have already obtained the benefits expected from screening in a health care setting. If the authors had excluded women who had a history of using a violence-related service, their results might have been different.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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