Association of Health Conditions and Health Service Utilization With Intimate Partner Violence Identified via Routine Screening Among Middle-Aged and Older Women
Authors: Lena K. Makaroun, Emily Brignone, Ann-Marie Rosland, Melissa E. Dichter
Journal: JAMA Network Open (2020)

<h3>Importance</h3> 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. <h3>Objectives</h3> 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. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposure</h3> Positive screening result for past-year IPV. <h3>Main Outcomes and Measures</h3> Mental and physical health conditions (identified using<i>International Classification of Diseases, Ninth Edition </i>[<i>ICD</i>-<i>9</i>] and<i>ICD</i>-<i>10</i>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. <h3>Results</h3> 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;<i>P</i> &lt; .001), depression (aOR, 2.30; 95% CI, 1.80-3.00;<i>P</i> &lt; .001), posttraumatic stress disorder (aOR, 2.30; 95% CI, 1.80-3.00;<i>P</i> &lt; .001), suicidal ideation and/or behavior (aOR, 3.80; 95% CI, 2.10-6.90;<i>P</i> &lt; .001), and substance use disorder (aOR, 2.50; 95% CI, 1.80-3.50;<i>P</i> &lt; .001). Similar but attenuated associations were seen for older women (eg, substance use disorder: aOR, 2.20; 95% CI, 1.10-4.40;<i>P</i> = .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;<i>P</i> &lt; .001), primary care visits (aRR, 1.20; 95% CI, 1.10-1.30;<i>P</i> &lt; .001), and emergency department visits (aRR, 1.50; 95% CI 1.20-1.80;<i>P</i> &lt; .001). Older women screening positive for IPV had a higher rate of psychosocial visits (aRR, 1.90; 95% CI, 1.30-2.70;<i>P</i> &lt; .001) but not of other visit types. <h3>Conclusions and Relevance</h3> 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.