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US Preventive Services Task Force Recommendation Statement, Michael Silverstein, John B Wong, Esa M Davis, David Chelmow, Tumaini Rucker Coker, Alicia Fernandez, Ericka Gibson, Carlos Roberto Jaén, Marie Krousel-Wood, Sei Lee, Wanda K Nicholson, Goutham Rao, John M Ruiz, James Stevermer, Joel Tsevat, Sandra Millon Underwood, Sarah Wiehe
IMPORTANCE: Intimate partner violence (IPV) affects millions of US residents across the lifespan and is often unrecognized. Abuse of older or vulnerable adults by a caregiver or someone else they may trust is common and can result in significant injury, death, and long-term adverse health consequences.
OBJECTIVE: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for IPV, abuse of older adults, and abuse of vulnerable adults.
POPULATION: The recommendation on screening for IPV applies to adolescents and adults who are pregnant or postpartum, and women of reproductive age. The recommendation on screening in older and vulnerable adults applies to persons without recognized signs and symptoms of abuse or neglect.
EVIDENCE ASSESSMENT: The USPSTF concludes that screening for IPV in women of reproductive age, including those who are pregnant and postpartum, and providing or referring those who screen positive to multicomponent interventions has a moderate net benefit. The USPSTF concludes that the benefits and harms of screening for caregiver abuse and neglect in older or vulnerable adults are uncertain and that the balance of benefits and harms cannot be determined.
RECOMMENDATION: The USPSTF recommends that clinicians screen for IPV in women of reproductive age, including those who are pregnant and postpartum. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for caregiver abuse and neglect in older or vulnerable adults.
Intimate partner violence and abuse of older or vulnerable adults are common in the United States but often remain undetected. Although estimates vary, IPV (including sexual violence, physical violence, and stalking) is experienced by approximately 36% of US women and 33% of US men during their lifetime. Severe physical violence is experienced by 21% of US women and 15% of US men during their lifetime.1 Prevalence rates vary by age, race/ethnicity, and income. Estimates also vary for prevalence of elder abuse and abuse of vulnerable adults. A 2008 nationwide survey of US adults 60 years or older found that the prevalence of any abuse or neglect in the past year was 10%.2 A 2004 survey of Adult Protective Services (APS) agencies found 40,848 substantiated reports of vulnerable adult abuse (in those aged 18 to 59 years) in 19 states.3
In addition to the immediate effects of IPV, such as injury and death, there are other health consequences, many with long-term effects, including development of mental health conditions such as depression, posttraumatic stress disorder (PTSD), anxiety disorders, substance abuse, and suicidal behavior; sexually transmitted infections; unintended pregnancy; and chronic pain and other disabilities.4, 5 Violence during pregnancy is associated with preterm birth and low birth weight6 and adverse effects on maternal and infant health, including postpartum mental health problems7 and hospitalization during infancy.8
Long-term negative health effects from elder abuse include death,9 higher risk of nursing home placement10 among those referred to APS, and adverse psychological consequences (distress, anxiety, and depression).11
Nearly 1 in 6 pregnant women in the U.S. have been abused by a partner.
Women who experience intimate partner violence prior to and during pregnancy are at increased risk of low maternal weight gains, infections, high blood pressure and are more likely to deliver pre-term or low birth weight babies.
Women who received prenatal counseling for IPV had fewer recurrent episodes of IPV during and post pregnancy, as well as better birth outcomessuch as lower rates of preterm birth and low birth weight.
