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Scientific Review

C. Nadine Wathen, MA; Harriet L. MacMillan, MD, MSc

JAMA. 2003;289:589-600.

Context  Intimate partner violence is prevalent and is associated with significant impairment, yet it remains unclear which interventions, if any, reduce rates of abuse and reabuse.

Objective  To systematically review, from the perspective of primary health care, the available evidence on interventions aimed at preventing abuse or reabuse of women.

Data Sources  MEDLINE, PsycINFO, CINAHL, HealthStar, and Sociological Abstracts were searched from the database start dates to March 2001 using database-specific key words such as domestic violence, spouse abuse, partner abuse, shelters, and battered women. References of key articles were hand searched. The search was updated in December 2002.

Study Selection  Both authors reviewed all titles and abstracts using established inclusion/exclusion criteria. Twenty-two articles met the inclusion criteria for critical appraisal.

Data Extraction  Following the evidence-based methods of the Canadian Task Force on Preventive Health Care, both authors independently reviewed the 22 included studies using an established hierarchy of study designs and criteria for rating internal validity. Quality ratings of individual studies—good, fair, or poor—were determined based on a set of operational parameters specific to each design category developed with the US Preventive Services Task Force.

Data Synthesis  Screening instruments exist that can identify women who are experiencing intimate partner violence. No study has examined, in a comparative design, the effectiveness of screening when the end point is improved outcomes for women (as opposed to identification of abuse). No high-quality evidence exists to evaluate the effectiveness of shelter stays to reduce violence. Among women who have spent at least 1 night in a shelter, there is fair evidence that those who received a specific program of advocacy and counseling services reported a decreased rate of reabuse and an improved quality of life. The benefits of several other intervention strategies in treating both women and men are unclear, primarily because of a lack of suitably designed research measuring appropriate outcomes. In most cases, the potential harms of interventions are not assessed within the studies reviewed.

Conclusions  Much has been learned in recent years about the epidemiology of violence against women, yet information about evidence-based approaches in the primary care setting for preventing intimate partner violence is seriously lacking. The evaluation of interventions to improve the health and well-being of abused women remains a key research priority.

Author Affiliations: The Canadian Task Force on Preventive Health Care and Faculty of Information and Media Studies, The University of Western Ontario, London, Ontario (Ms Wathen); and McMaster University, Canadian Centre for Studies of Children at Risk, Chedoke Site, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario (Dr MacMillan).

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