Routine, Single-Item Screening to Identify Abusive Relationships in Women

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Original Research

Routine, Single-Item Screening to Identify Abusive Relationships in Women

J Fam Pract. 2000 November;49(11):1017-1022

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This particular measure for an abusive relationship has face and criterion validity and reasonable reliability. It seems acceptable for use in practice, since 96% of the women who completed a health survey also completed this item. However, it is intentionally not as specific as direct questions about physical abuse such as: “Has your husband, boyfriend, partner/lover hit, kicked, threatened, or otherwise frightened you?”²² The clinicians and women who assisted in the design of the Relationships Chart felt that a screening question would appear less intimidating if it were less specific and did not require a yes or no response. We previously received the same advice from adolescents for inquiring about antisocial behavior and drug abuse.³⁴ The pictures add to the appeal of the Dartmouth COOP Charts but do not seem to influence responses.³⁷

The validation study (comparing response categories to another instrument) and the results illustrated in the Table (comparing functional and symptomatic impacts by response categories) indicate that a woman who says that she has experienced an abusive relationship at least some of the time in the past 4 weeks probably is experiencing abuse. For those women who screen positive, more direct inquiry is indicated about the nature of the abuse.

If clinicians do not actively screen but choose to wait for a woman in an abusive relationship to declare herself, the data suggest that she may enter a labyrinth of nonspecific complaints and increased utilization of services. If clinicians actively inquire about abuse, short-term demands for accurate documentation and effective referral will have to be met,^20-22 and the longer-term benefit to the patient and clinician may be considerable.

Conclusions

Domestic abuse is a prevalent and important problem for women, and simple measures can detect domestic abuse in community practice. It is necessary to think of abuse when some functional and symptomatic issues are present, but that alone is not sufficient. Direct inquiry will be more effective. The symptoms and functional problems of these women may be erroneously evaluated unless the domestic abuse is detected.

Acknowledgments

We thank and acknowledge the physician practice sites that participated in our project: Baylor College of Medicine, Houston, Tex; Berlin Health System, Green Bay, Wis; Beth Israel Deaconess Medical Center, Boston, Mass; Cambridge Health Alliance, Cambridge, Mass; Dana Farber Cancer Institute, Boston, Mass; Federation of Swedish County Councils/Sweden Anderstop Health Center, Greater Lawrence Family Health Center, Lawrence, Mass; Harvard University Health Services, Cambridge, Mass; Independent Health: Buffalo Medical Group, Tonawanda Medical Associates, Buffalo, NY; Joslin Diabetes Center, Boston, Mass; Lathem Medical Group, Lathem, NY; Magic Valley Health Center, Twin Falls, Idaho; Mayo Health System: Luther Midelfort, Eau Clair, Wis, and Mayo Clinic Scottsdale, Ariz; Medical University of South Carolina, Charleston, SC; MeritCare, Fargo, ND; PeaceHealth, Eugene, Ore; PennState Geisinger Health System, Pa; Scripps Clinic, La Jolla, Calif; SSM Health System, St. Louis, Ohio; Dean Health System, Madison, Wis; St. Mary’s Health System, Jefferson City, Mo; Strong Health, University of Rochester, Rochester NY; and ThedaCare, Appleton, Wis.