How far does screening women for domestic (partner) - NIHR Health ...

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Review Question I
problems in social functioning, the relationship
between witnessing partner violence and the social
functioning of these children remains unclear, with
the majority of recent studies finding no significant
relationship. Eight studies assessed cognitive
functioning; three of these had been conducted
since the previous review. Except for the findings
of Christopoulos and colleagues, 74 the recently
conducted studies all found that children who
witness abuse are at risk for problems in cognitive
functioning. However, the limited number of recent
studies makes it difficult to draw firm conclusions
of a cause–effect relationship, and no mention is
made of the quality of these studies.
Ten of the studies examined physical health.
One of the only two studies using standardised
measures suggested a causal relationship after
finding clinical levels of somatic complaints among
witnesses of abuse. The second study did not find
any neurological deficit among such children,
and evidence of a causal link between exposure to
violence and health problems remains equivocal.
The reviewers concluded that although there is
still some uncertainty about the magnitude and
consistency of detrimental effects on children’s
social, cognitive and physical development, the
evidence for effects on children’s emotional and
behavioural development is far less equivocal.
Strengths and limitations
The strengths of this review of prevalence and
health impact studies include the independent
quality appraisal of primary studies by two
reviewers (using the STROBE quality appraisal tool
for prevalence studies and the CASP systematic
review tool for health impact reviews) and the
sensitivity analysis based on study quality. These
reviews fulfil the QUORUM and most of the
MOOSE reporting criteria lines (see Appendix
11.1 for MOOSE criteria and Appendix 11.2 for
a flowchart of this review). Limitations of this
review include the small number (six) of databases
searched for studies, and the exclusion of reviews
of health impact conducted prior to 1990 and
prevalence studies conducted prior to 1995.
Limitations of the primary prevalence studies
include investigators’ modification of instruments
to measure partner violence without reporting
how, or if, the adapted version of the instrument
was validated. Comparisons between the studies
were problematic because of different definitions
of partner violence, different questions to establish
the presence of partner violence and different
questionnaire administration methods. Limitations
of the reviews of health impact studies include a
lack of detailed reporting of search strategies, no
quality appraisal of primary studies and no pooling
of data. A major limitation in the field of domestic
violence research is the absence of systematic
reviews of physical consequences synthesising
primary studies.
Discussion
The reviews provide strong evidence that partner
violence can have a substantial detrimental effect
on mental health. Evidence for the impact on
pregnancy is more equivocal, but it is likely that
low birthweight is a consequence of abuse during
pregnancy. Recent studies on the impact on
children show a greater prevalence of behavioural
and mental health problems among children who
witness partner violence, as well as diminished
educational attainment. When the betterquality
systematic reviews are considered, the
findings on mental health, pregnancy and child
health consequences are similar to the overall
findings, although comparison between reviews
is problematic because they report different
outcomes.
Synthesis of prevalence
and health impact studies
Differences in definition, methodology, sampling
and assessment make it difficult to estimate
precisely the prevalence of partner violence in
the UK. Nonetheless, the studies reported here
delineate the lower boundaries of partner violence
prevalence, although possibly not the upper limit
as under-reporting is likely. It is unarguable that
partner violence against women is a common
problem. To fulfil the NSC screening criterion for
an important health problem, it also has to have a
substantial impact on health. The reviews of health
impact that we have considered, notwithstanding
heterogeneity of morbidity estimates associated
with partner violence, demonstrate that partner
violence significantly increases the risk of mental
illness and substance abuse and is likely to increase
the risk of pregnancy complications.
We have not systematically reviewed individual
studies of other health problems associated with
partner violence, but they probably support the
conclusion that partner violence has a substantial
and persistent detrimental effect on the health of
women. The most consistent and largest physical
health difference between abused and non-abused