Barriers to screening for domestic violence

J Gen Intern Med. 2002 Feb;17(2):112-6. doi: 10.1046/j.1525-1497.2002.10233.x.


Context: Domestic violence has an estimated 30% lifetime prevalence among women, yet physicians detect as few as 1 in 20 victims of abuse.

Objective: To identify factors associated with physicians' low screening rates for domestic violence and perceived barriers to screening.

Design: Cross-sectional postal survey.

Participants: A national systematic sample of 2,400 physicians in 4 specialties likely to initially encounter abused women. The overall response rate was 53%.

Main outcome measure: Self-reported percentage of female patients screened for domestic violence; logistic models identified factors associated with screening less than 10%.

Results: Respondent physicians screened a median of only 10% (interquartile range, 2 to 25) of female patients. Ten percent reported they never screen for domestic violence; only 6% screen all their patients. Higher screening rates were associated with obstetrics-gynecology specialty (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.31 to 0.78), female gender (OR, 0.51; CI, 0.35 to 0.73), estimated prevalence of domestic violence in the physician's practice (per 10%, OR, 0.72; CI, 0.65 to 0.80), domestic violence training in the last 12 months (OR, 0.46; CI, 0.29 to 0.74) or previously (OR, 0.54; CI, 0.34 to 0.85), and confidence in one's ability to recognize victims (per Likert-scale point, OR, 0.71; CI, 0.58 to 0.87). Lower screening rates were associated with emergency medicine specialty (OR, 1.72; CI, 1.13 to 2.63), agreement that patients would volunteer a history of abuse (per Likert-scale point, OR, 1.60; CI, 1.25 to 2.05), and forgetting to ask about domestic violence (OR, 1.69; CI, 1.42 to 2.02).

Conclusions: Physicians screen few female patients for domestic violence. Further study should address whether domestic violence training can correct misperceptions and improve physician self-confidence in caring for victims and whether the use of specific intervention strategies can enhance screening rates.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Clinical Competence
  • Cross-Sectional Studies
  • Data Collection
  • Domestic Violence / prevention & control*
  • Domestic Violence / statistics & numerical data*
  • Female
  • Humans
  • Logistic Models
  • Mandatory Reporting*
  • Mass Screening / standards
  • Mass Screening / trends*
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prevalence
  • United States / epidemiology