Preventive activities in general practice 7th edition | Identification of intimate partner violence

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Screening tests of unproven benefit

Appendices

Disclaimer

Identification of intimate partner violence

Identification of intimate partner violence age range table

Age

0 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 79

>80

There is currently a lack of evidence for the effectiveness of interventions in clinical practice to reduce intimate partner violence. Consensus guidelines⁴⁴⁸ recommend that clinicians ask all pregnant adult and adolescent women about intimate partner violence, but that a case finding approach be taken in situations where patients have symptoms of intimate partner violence or abusive behaviour.

Identification of intimate partner violence: Risk
Who is at higher risk of intimate partner violence?	What should be done?	How often?	Level of evidence and references
Increased risk Pregnant adult and adolescent women Women with: symptoms of mental ill health chronic unexplained physical symptoms unexplained injuries frequent attendance	Ask about partner violence	Opportunistically	Consensus 448
Men who: ask for help with anger issues have marital problems are ‘wife mandated’ to change their behaviour have alcohol or other substance abuse problems were abused or witnessed intimate partner violence as a child	Ask about relationship and any abusive or controlling behaviours

Identification of intimate partner violence: Risk

Who is at higher risk of intimate partner violence?

What should be done?

How often?

Level of evidence and references

Increased risk

Pregnant adult and adolescent women
Women with:
- symptoms of mental ill health
- chronic unexplained physical symptoms
- unexplained injuries
- frequent attendance

Ask about partner violence

Opportunistically

Consensus 448

Men who:
- ask for help with anger issues
- have marital problems
- are ‘wife mandated’ to change their behaviour
- have alcohol or other substance abuse problems
- were abused or witnessed intimate partner violence as a child

Ask about relationship and any abusive or controlling behaviours

Identification of intimate partner violence: Test
Intervention	Technique	References
Ask about intimate partner violence	Victimised women stress the importance of a trusting doctor-patient relationship, confidentiality, respectful and nonjudgmental attitudes to achieving disclosure as well as acceptance of nondisclosure and a supportive response. It is crucial for safety reasons that any questions are asked privately, when the patient is alone, not when another family member, adult or child over the age of 2 years is present. It is a clinician’s responsibility to ask and support women regardless of their response. Asking about abuse may ‘plant a seed’ for later action. The collaborative group believe that GPs should ask women who are ‘symptomatic’ (eg. symptoms of mental ill health, chronic unexplained physical symptoms, unexplained injuries, frequent attendance) Possible questions to ask if you suspect intimate partner violence	448
‘Sometimes partners use physical force. Is this happening to you?’ ‘Have you felt humiliated or emotionally abused by your partner (ex-partner)?’ ‘Are you now or have you been afraid of your partner (ex-partner)?’ ‘Has your partner ever physically threatened or hurt you? Or have you been kicked, hit, slapped or otherwise physically hurt by your partner (ex-partner)?’ ‘In the past year have you been forced to engage in any sexual activity by your partner (ex-partner)?’	449

Identification of intimate partner violence: Test

Intervention

Technique

References

Ask about intimate partner violence

Victimised women stress the importance of a trusting doctor-patient relationship, confidentiality, respectful and nonjudgmental attitudes to achieving disclosure as well as acceptance of nondisclosure and a supportive response. It is crucial for safety reasons that any questions are asked privately, when the patient is alone, not when another family member, adult or child over the age of 2 years is present. It is a clinician’s responsibility to ask and support women regardless of their response. Asking about abuse may ‘plant a seed’ for later action. The collaborative group believe that GPs should ask women who are ‘symptomatic’ (eg. symptoms of mental ill health, chronic unexplained physical symptoms, unexplained injuries, frequent attendance)

Possible questions to ask if you suspect intimate partner violence

448

‘Sometimes partners use physical force. Is this happening to you?’
‘Have you felt humiliated or emotionally abused by your partner (ex-partner)?’
‘Are you now or have you been afraid of your partner (ex-partner)?’
‘Has your partner ever physically threatened or hurt you? Or have you been kicked, hit, slapped or otherwise physically hurt by your partner (ex-partner)?’
‘In the past year have you been forced to engage in any sexual activity by your partner (ex-partner)?’

449

Guidelines for preventive activities in general practice 7th edition

Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

Identification of intimate partner violence