Screening for Intimate Partner Violence and for Caregiver Abuse of Older or Vulnerable Adults: An Evidence Report and Systematic Review for the US Preventive Services Task Force

Abstract

Importance: Intimate partner violence (IPV) and caregiver abuse of older or vulnerable adults are common and cause significant morbidity.

Objective: To review the evidence on screening and interventions for IPV and caregiver abuse among adults.

Data sources: PubMed, Cochrane Library, and EMBASE through December 14, 2023; ongoing literature surveillance through March 21, 2025.

Study selection: Screening test accuracy studies, randomized clinical trials (RCTs) of screening or interventions for abuse, cohort studies reporting harms.

Data extraction and synthesis: Dual review of abstracts, full-text articles, study quality, and data extraction; narrative synthesis of results.

Main outcomes and measures: Test accuracy; abuse exposure and associated morbidity, quality of life, and harms.

Results: Thirty-five studies were included (N = 18 358). Three RCTs (n = 3759) comparing IPV screening with no screening found no significant reduction in IPV or benefit for other outcomes over 3 to 18 months and 2 (n = 935) reported no harms of screening. Nine studies (n = 9800) assessed 9 tools to detect any type of past-year IPV exposure among women; sensitivity ranged from 26% to 87% and specificity ranged from 80% to 97%. Thirteen RCTs (n = 7425) evaluated heterogeneous interventions among women with screen-detected IPV. Of these, 1 RCT (n = 239) assessing the benefit of multiple perinatal home visits found a significant reduction in IPV (standardized mean difference, -0.34 [95% CI, -0.59 to -0.08]) and 1 RCT (n = 336) assessing behavioral counseling for multiple risks (IPV, smoking, depression, tobacco exposure) found significantly fewer recurrent episodes of IPV (standardized mean difference, -0.40 [95% CI, -0.68 to -0.12]). RCTs assessing brief counseling or advocacy interventions specific to IPV found no difference between groups in rates of overall IPV. Results for other outcomes were mixed. No studies evaluated screening or interventions for caregiver abuse among older or vulnerable adults. Two studies assessed the accuracy of different screening tools to detect caregiver abuse among older adults and found mixed results.

Conclusions and relevance: Although available screening tools may reasonably identify women with past-year IPV, RCTs of IPV screening did not show reduced IPV or improvement in other outcomes. Limited evidence suggested that home visiting and behavioral counseling interventions addressing multiple risk factors may lead to reduced IPV among pregnant or postpartum women. No studies assessed screening among vulnerable adults or treatment for caregiver abuse among older or vulnerable adults.