Association of Health Conditions and Health Service Utilization With Intimate Partner Violence Identified via Routine Screening Among Middle-Aged and Older Women | Intimate Partner Violence | JAMA Network Open | JAMA Network
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    1 Comment for this article
    WPSI and Coverage for Routine Screening of IPV
    Sarah Son, MPH | American College of Obstetricians and Gynecologists
    On behalf of the Women’s Preventive Services Initiative (WPSI), we want to recognize the findings of the recent study published in JAMA Network Open, Association of Health Conditions and Health Service Utilization With Intimate Partner Violence Identified via Routine Screening Among Middle-Aged and Older Women, indicating high prevalence of intimate partner violence (IPV) among this age group and the importance of screening. WPSI recommends screening adolescents and women of all ages for interpersonal and domestic violence, at least annually, and, when needed, providing or referring for initial intervention services. All WPSI recommendations, including Screening for Interpersonal and Domestic Violence, are included among preventive services for women under provisions of the prevention service requirement of the Patient Protection and Affordable Health Care Act of 2010. These preventive service recommendations are similar to A-level and B-level recommendations from the U.S. Preventive Services Task Force (USPSTF) and must be covered without cost-sharing by all private health plans. The Screening for Interpersonal and Domestic Violence recommendation includes screening women beginning at age 13, and intervention services that include, but are not limited to, counseling, education, harm reduction strategies, and referral to appropriate supportive services.(1) WPSI defines interpersonal and domestic violence as physical violence, sexual violence, stalking and psychological aggression (including coercion), reproductive coercion, neglect, and the threat of violence, abuse, or both.

    WPSI is a national coalition of 21 health professional organizations and patient representatives that develop, review, update, and disseminate evidence-based clinical recommendations for women’s preventive health care services in the United States. WPSI considers conditions that are unique, more common, or differ in women and focuses on gaps in current preventive services recommendations. It is supported by the U.S. Department of Health and Human Services and Health Resources and Service Administration (HRSA) and led by the American College of Obstetricians and Gynecologists. WPSI recommendations, once adopted by HRSA, are available without cost sharing, thus helping to ensure that women receive a comprehensive set of preventive services without having to pay a copayment, coinsurance, or deductible for most group and individual plans. WPSI summarized all currently covered preventive services recommendations for women from the WPSI, USPSTF, and Bright Futures in clinical summary tables for use in clinical practice.

    (1) Women’s Preventive Services Initiative: Accessed May 6, 2020 at:
    CONFLICT OF INTEREST: Program Director for the Women's Preventive Services Initiative, a federally funded cooperative agreement with HRSA. Employee of the American College of Obstetricians and Gynecologists
    Original Investigation
    April 21, 2020

    Association of Health Conditions and Health Service Utilization With Intimate Partner Violence Identified via Routine Screening Among Middle-Aged and Older Women

    Author Affiliations
    • 1VA Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
    • 2VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
    • 3Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
    • 4Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
    • 5Temple University School of Social Work, Philadelphia, Pennsylvania
    • 6VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
    JAMA Netw Open. 2020;3(4):e203138. doi:10.1001/jamanetworkopen.2020.3138
    Key Points español 中文 (chinese)

    Question  How often do middle-aged and older women have positive results when undergoing routine screening for intimate partner violence (IPV), and what health-related outcomes are associated with positive results in these age groups?

    Findings  In this cohort study of 4481 female veterans aged 45 years and older who were screened for past-year IPV, 8.7% of those aged 45 to 59 years and 5.1% of those aged 60 years and older screened positive. Having screened positive for IPV was associated with mental and physical health outcomes as well as increased health service utilization over the subsequent 20 months.

    Meaning  Performing routine screening for IPV among women in middle age and older may improve detection and service delivery in this underserved population.


    Importance  The US Preventive Services Task Force recently determined that there is insufficient evidence to recommend routine screening for intimate partner violence (IPV) in women who are middle-aged and older. Certain Veterans Health Administration (VHA) clinics have been routinely screening women of all ages for IPV since 2014.

    Objectives  To examine the proportion of women older than childbearing age (ie, ≥45 years) who have positive results when routinely screened for past-year IPV at VHA clinics and to evaluate the associations of a positive screening result with health conditions and health service utilization.

    Design, Setting, and Participants  This cohort study included 4481 women aged 45 years and older who were screened for past-year IPV in 13 VHA outpatient clinics in 11 states between April 2014 and April 2016. Data analysis was conducted from March 2019 to August 2019.

    Exposure  Positive screening result for past-year IPV.

    Main Outcomes and Measures  Mental and physical health conditions (identified using International Classification of Diseases, Ninth Edition [ICD-9] and ICD-10 codes from VHA medical record data) and VHA health services utilization (identified using inpatient and outpatient VHA encounter data) in the 20 months after screening.

    Results  In this study, 2937 of 4481 women (65.5%) were middle-aged (ie, aged 45 to 59 years), and 1544 (34.5%) were older (ie, aged ≥60 years), with 1955 (43.6%) black participants. A total of 255 middle-aged women (8.7%; mean [SD] age, 51 [4] years) and 79 older women (5.1%; mean [SD] age, 64 [5] years) screened positive for past-year IPV. In adjusted logistic regression models among middle-aged women, screening positive for IPV was associated with subsequent diagnoses of anxiety (adjusted odds ratio [aOR], 2.00; 95% CI, 1.50-2.70; P < .001), depression (aOR, 2.30; 95% CI, 1.80-3.00; P < .001), posttraumatic stress disorder (aOR, 2.30; 95% CI, 1.80-3.00; P < .001), suicidal ideation and/or behavior (aOR, 3.80; 95% CI, 2.10-6.90; P < .001), and substance use disorder (aOR, 2.50; 95% CI, 1.80-3.50; P < .001). Similar but attenuated associations were seen for older women (eg, substance use disorder: aOR, 2.20; 95% CI, 1.10-4.40; P = .04). In adjusted negative binomial regression models among middle-aged women, screening positive for IPV was associated with a higher rate of subsequent psychosocial (eg, mental health) visits (adjusted rate ratio [aRR], 2.40; 95% CI, 2.00-2.90; P < .001), primary care visits (aRR, 1.20; 95% CI, 1.10-1.30; P < .001), and emergency department visits (aRR, 1.50; 95% CI 1.20-1.80; P < .001). Older women screening positive for IPV had a higher rate of psychosocial visits (aRR, 1.90; 95% CI, 1.30-2.70; P < .001) but not of other visit types.

    Conclusions and Relevance  To our knowledge, this study was the largest to evaluate routine screening for IPV among women aged 45 years and older, and it found that IPV remained prevalent and was associated with morbidity for these women. Screening for IPV in women older than 44 years may improve detection and provision of evidence-based services to this growing population.