The U.S. Preventive Services Task Force recently revised its recommendations on screening for domestic violence (DV). In a change from 2004, they now advocate that women of child-bearing age be screened for this problem, and referred to an appropriate agency if they screen positive.

While adding on yet another screening test is the last thing busy primary care clinicians want to hear about, there is some merit to finding ways to incorporate DV screening into our work flow. And keep in mind, the recommendation only applies to younger women.

A couple of facts about DV to consider:

• It is more prevalent than other common conditions we already screen for, such as breast  cancer. It is estimated that 31% of women will experience DV at some point in their lives, compared with 12.4% of women who will develop breast cancer.
• DV can be associated with very serious health problems, including depression, chronic pain, chronic GI disorders, chronic headaches, and other problems. DV is the leading cause of perinatal mortality in the U.S.

Screening does not need to be difficult or time-consuming. There are several, brief questionnaires which can be administered by your staff at intake or answered by the patient herself. One good example is the four-question HITS test (http://www.healthyplace.com/psychological-tests/domestic-violence-screening-test/), though there are others. If you do use a screening test, it is important that your patient not have her partner/spouse with her when answering the questions.

Every county in our network has domestic violence agencies to which you can refer your patients, if they screen positive. Patients can also be given the phone number for the National Domestic Violence Hotline (1-800-799-SAFE).

In 2004, the USPSTF did not recommend DV screening. The change in policy stems from interim research which shows both that screening tests can accurately identify those experiencing DV and that referrals of those screening positive can positively impact future health.

By screening for DV, you may reduce the risk that one of your patients will suffer from a lifetime of various medical problems, and you may even save her life.

Richard Fleming, MD

“Screening for Intimate Partner Violence,” Annals of Internal Medicine, January 22, 2013.