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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

10.3 Intimate partner violence

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

Abused women use healthcare services more than non-abused women. They also identify healthcare providers as the professionals they would most trust with disclosure of abuse.52 Consider asking all pregnant adult and adolescent women about partner violence during antenatal care.1 There is insufficient evidence for screening the general population;53 however, there should be a low threshold for asking about abuse, particularly when the GP suspects underlying psychosocial problems.1 Training GPs to identify violence has resulted in increased identification and referral to services.54 Inviting women who are fearful of a partner to attend counselling by trained GPs has resulted in increased safety discussions with women and less depressive symptoms.55 There is some evidence for the effectiveness of interventions in clinical practice to reduce partner violence.56

Table 10.3.1. Intimate partner violence: Identifying risk
Who is at risk?What should be done?How often?
Average risk
Adult population aged ≥18 years, where no risk factors for intimate partner violence are identified53 Be alert to possible partner violence, but do not routinely screen (II, B) Opportunistically
Adolescents aged 12–18 years, particularly with57:
  • family history of violence
  • comorbid mental health conditions
  • pregnancy
Consider use of HE2ADS3 assessment tool (refer to Chapter 3. Preventive activities in children and young people; III, B)57 At every encounter
Increased risk1, 52, 53
  • Pregnant women
  • People who were abused or witnessed intimate partner violence as a child
  • People with psychiatric disorders, especially substance misuse
  • Unemployed people
  • People suffering poverty
Screen all pregnant women

Maintain a high level of clinical awareness of those at high risk of intimate partner violence and consider intimate partner violence when a person presents with suggestive symptoms such as symptoms of mental ill health, chronic unexplained physical symptoms, and unexplained injuries (II, B)
Opportunistically
10.3.2. Tests to detect intimate partner violence
TestTechnique
Ask about partner violence Victimised women stress the importance of a trusting doctor–patient relationship, confidentiality, and respectful and non-judgemental attitudes to achieving disclosure, as well as acceptance of non-disclosure 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 >2 years of age 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 action52

The World Health Organization (WHO) guidelines recommend that GPs should ask women who are ‘symptomatic’ (eg show symptoms of mental ill health, chronic unexplained physical symptoms, unexplained injuries, frequent attendance) about partner violence

Questions and statements to make if you suspect domestic violence:1
  • Has your partner ever physically threatened or hurt you?
  • Is there a lot of tension in your relationship? How do you resolve arguments?
  • Sometimes partners react strongly in arguments and use physical force. Is this happening to you?
  • Are you afraid of your partner?
  • Violence is very common in the home. I ask a lot of my patients about abuse because nobody should have to live in fear of their partners
WHO, World Health Organization

These recommendations might apply to people in same-sex relationships and male victims, but there has been insufficient research in these areas.

References

  1. The Royal Australian College of General Practitioners. Abuse and violence: Working with our patients in general practice. East Melbourne, Vic: RACGP, 2014.
  2. World Health Organization. Responding to intimate partner violence and sexual violence against women. WHO clinical and policy guidelines. Geneva: WHO, 2013.
  3. O’Doherty LJ, Taft A, Hegarty K, Ramsay J, Davidson LL, Feder G. Screening women for intimate partner violence in healthcare settings: Abridged Cochrane systematic review and meta-analysis. BMJ 2014;348:g2913.
  4. Feder G, Davies RA, Baird K, et al. Identification and referral to improve safety (IRIS) of women experiencing domestic violence with primary care training and support programme: A cluster randomised controlled trial. Lancet 2011;378(9805):1788–95.
  5. Hegarty K, O’Doherty L, Taft A, et al. Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): A cluster randomised controlled trial. Lancet 2013;382(9888):249–58.
  6. Bair-Merritt MH, Lewis-O’Connor A, Goel S, et al. Primary care-based interventions for intimate partner violence: A systematic review. Am J Prev Med 2014;46(2):188–94.
  7. Sanci L, Chondros P, Sawyer S, et al. Responding to young people’s health risks in primary care: A cluster randomised trial of training clinicians in screening and motivational interviewing. PLOS ONE 2015;10(9):e0137581.
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