New Tool Helps Doctors Screen Female Veterans for Domestic Violence

female army doctor

A new, modified screening tool can help doctors identify female veterans exposed to intimate partner violence, recent research from a group of U.S. institutions indicates.

Intimate partner violence or IPV (domestic violence) is known for its ability to substantially harm the mental health and well-being of affected men and women. In a study published in January 2015 in the Journal of Traumatic Stress, researchers from seven U.S. institutions assessed the accuracy and usefulness of a modified form of a screening tool—called Hurt/Insult/Threaten/Scream (HITS)—in helping doctors identify female veterans of military service who have been exposed to intimate partner violence. These researchers concluded that the modified screening tool, called E-HITS, is both accurate and useful when administered by a health professional.

Women, IPV and Mental Health

Intimate partner violence is an umbrella term that applies to any form of physical or non-physical violence that occurs in the context of the relationships between current or former spouses or romantic partners. This violence falls into five main categories: acts of physical assault, acts of sexual assault or misconduct, acts of mental/emotional duress or coercion, threats of sexual or physical violence and stalking. Depending on the data source, verifiable rates of IPV exposure among U.S. women range from roughly 22 percent to 31 percent over the course of a lifetime. For a number of reasons, women have a significantly higher rate of exposure to intimate partner violence than men. Men commit acts of IPV more often than women, although substantial numbers of women are IPV perpetrators.

The physical and sexual assaults associated with intimate partner violence are well-known for their potential to act as triggers for the onset of post-traumatic stress disorder (PTSD). The relative frequency of sexual assaults among women is largely responsible for women’s overall higher chances of developing this disorder. Other mental health issues often found in women exposed to IPV include substance use disorder (diagnosable substance abuse and/or substance addiction), depression-related illness and anxiety-related illness. Women with a childhood history of sexual or physical abuse have unusually elevated chances of experiencing serious mental health issues in the aftermath of intimate partner violence.

HITS Screening Tool

The Hurt/Insult/Threaten/Scream screening tool gets its name from the four questions it contains. These questions ask any given individual to describe how often a spouse or partner physically hurt him or her in the previous year, how often a spouse or partner used insults in the same timeframe, how often a spouse or partner made threats of physical violence in the previous year and how often a spouse or partner screamed or cursed at him or her in the same timeframe. Each of these questions is answered on a scale of one (never) to five (frequently). Any person with a total score of seven or higher (out of a possible 20) likely qualifies as a victim of intimate partner violence.

Accuracy of the Modified HITS Tool

The HITS screening tool does not contain questions that pertain to sexual forms of intimate partner violence. In the study published in the Journal of Traumatic Stress, researchers from institutions including the National Center for PTSD, the Boston University School of Medicine and Duke University Medical Center used information gathered from 80 women to assess the accuracy and real-world usefulness of the Extended HITS (E-HITS) screening tool, which adds a sexual violence-oriented question to the HITS tool. All of the women were veterans of military service receiving some form of medical care from the Veterans Health Administration; in addition, all of the women had an intimate partner in the year prior to the beginning of the study.

The researchers used a third screening tool, called the Revised Conflict Tactics Scales or CTS-2, to compare the results obtained from HITS testing to the results obtained from E-HITS testing. They concluded that the score required to merit a finding of intimate partner violence on the E-HITS screening is only slightly lower than the required score on the HITS screening. The researchers also concluded that both screening tools have the same basic accuracy rate for making an IPV finding and do a roughly equal job of successfully excluding people not affected by IPV.

Altogether, the study’s authors believe that use of the modified E-HITS screening tool adds a beneficial sexual violence-related component to the HITS screening tool while retaining accuracy and usefulness in real-world environments.

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