Final Research Plan
Intimate Partner Violence and Caregiver Abuse of Older or Vulnerable Adults: Screening
April 20, 2023
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Intimate Partner Violence
*Includes reduction in the frequency or severity of IPV.
†Includes acute and chronic morbidity from physical abuse (e.g., fractures, dislocations, or brain injury), sexual abuse (e.g., unwanted pregnancy or sexually transmitted infections), psychological abuse (e.g., depression, anxiety, or posttraumatic stress disorder), and financial abuse (e.g., limiting access to money or other resources); healthcare utilization attributed to any form of abuse/neglect and associated physical and mental morbidity (e.g., rates of emergency department visits); adverse perinatal outcomes (e.g., miscarriage or low birth weight); social isolation; and quality of life.
Abbreviation: IPV=intimate partner violence.
Caregiver Abuse of Older and Vulnerable Adults
*Includes reduction in the level of violence or abuse or leaving an unsafe situation.
†Includes acute and chronic morbidity from physical abuse (e.g., fractures, dislocations, or brain injury), sexual abuse (e.g., unwanted pregnancy or sexually transmitted infections), psychological abuse (e.g., depression, anxiety, or posttraumatic stress disorder), and financial abuse (e.g., misuse of assets by a caregiver); healthcare utilization attributed to any form of abuse/neglect and associated physical and mental morbidity (e.g., rates of emergency department visits); adverse perinatal outcomes (e.g., miscarriage or low birth weight); social isolation; and quality of life.
Intimate Partner Violence
- Does screening for current or past intimate partner violence (IPV) in adolescents and adults reduce exposure to IPV, physical or mental morbidity, or mortality?
- What is the accuracy of screening questionnaires or tools for identifying adolescents and adults with current or past IPV?
- What are the harms of screening for IPV in adolescents and adults?
- How well do interventions reduce exposure to IPV, physical or mental morbidity, or mortality among screen-detected adolescents and adults with current or past IPV?
- What are the harms of interventions for IPV in adolescents and adults?
Caregiver Abuse of Older and Vulnerable Adults
- Does screening in healthcare settings for current or past caregiver abuse and neglect in older and vulnerable adults reduce exposure to abuse and neglect, physical or mental morbidity, or mortality?
- How effective are screening questionnaires or tools in identifying older and vulnerable adults with current or past caregiver abuse and neglect?
- What are the harms of screening for caregiver abuse and neglect in older and vulnerable adults?
- How well do interventions reduce exposure to caregiver abuse and neglect, physical or mental morbidity, or mortality among screen-detected older and vulnerable adults with current or past caregiver abuse and neglect?
- What are the harms of interventions for caregiver abuse and neglect in older and vulnerable adults?
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- Are there risk prediction tools that can help identify older and vulnerable adults who are at increased risk of caregiver abuse and neglect? If so, how well do they perform in distinguishing between those who are at high vs. low risk of abuse and neglect?
The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the evidence review. Criteria are overarching as well as specific to each of the key questions.
Intimate Partner Violence
| Include | Exclude | |
|---|---|---|
| Populations | Studies enrolling adolescents* and adults (age 18 years or older) presenting for primary care services without recognized signs or symptoms of IPV or abuse†
Specific populations of interest include those defined by age, sex, race or ethnicity, pregnancy status, sexual orientation, gender identity, type of abuse (e.g., physical abuse or sexual abuse), history of IPV, or presence of comorbid conditions |
Studies restricted to populations seeking care for IPV or for obvious signs or symptoms of abuse |
| Screening | KQs 1–3: Screening questionnaires designed to detect current or past IPV victimization, including self-administered, computer-enabled, or patient self-report instruments, as well as clinician-administered screening methods; instruments must be feasible for use in screening in U.S. primary care settings (i.e., brief, easy to interpret, and acceptable to patients and clinicians) | KQs 1–3: Screening tests designed to identify perpetrators of IPV |
| Interventions | KQs 4, 5: Services that could be offered in primary care settings or referred to by primary care services, including counseling, psychological interventions, case management, home visitation, mentor or peer support, safety planning, and referral to community services | KQs 4, 5: Public awareness campaigns without specific interventions linked to screening; studies of other interventions that do not include a health service component (e.g., effectiveness of women's shelters, unless referred by a clinician) |
| Comparisons | KQs 1, 3: Screened vs. nonscreened groups
KQ 2: Eligible instruments must be compared with an acceptable reference standard (verified or self-reported abuse or validated screening instrument for abuse) KQs 4, 5: No treatment, usual care, attention control, or wait-list control |
KQs 4, 5: Head-to-head comparisons of two active interventions |
| Outcomes | KQs 1, 4: Reduced exposure to IPV as measured by a validated instrument (e.g., Conflict Tactics Scale) self-report frequency of abuse (e.g., number of physical assaults), or discontinuation of an unsafe relationship; physical morbidity caused by IPV, including acute physical trauma (e.g., fractures or dislocations), chronic medical conditions (e.g., chronic pain or brain injury), and sexual trauma; mental health morbidity caused by IPV, including acute mental morbidity (e.g., stress or nightmares) and chronic mental health conditions (e.g., posttraumatic stress disorder, anxiety, or depression); sexual trauma, unintended pregnancy, and sexually transmitted infections; adverse perinatal outcomes (e.g., preterm birth, low birth weight, or decreased mean gestational age); healthcare utilization attributed to physical or mental effects of IPV (e.g., rates of emergency department visits); quality of life and social isolation; and mortality
KQ 2: Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, diagnostic odds ratios, and relative risks for future abuse KQ 3: Psychosocial harms that result from screening, including labeling and stigma; false-positive and false-negative results; increased abuse or other forms of retaliation; and other reported harms of screening or identification KQ 5: Any harms that result from interventions, such as increased abuse or other forms of retaliation, and emotional distress |
All KQs: Screening or referral rates, attitudes about screening, plans or intentions related to screening, and other intermediate outcomes
KQ 2: Theory or survey development and validation without correlation to abuse outcomes or studies that focus only on particular risk factors or assessment of provider or participant attitudes toward the instrument |
| Study designs | All KQs: RCTs
KQ 2: Cross-sectional and cohort studies of diagnostic accuracy are also eligible KQs 3, 5: Cohort studies with a concurrent control group are also eligible |
All other study designs, including case series, case-control studies, and systematic reviews‡ |
| Quality | Studies rated good or fair quality | Studies rated poor quality |
| Settings | All KQs: Primary care clinics or other settings where primary care services are offered, such as student health centers; studies recruiting participants from emergency departments are also eligible§
KQs 4, 5: Settings referable from primary care are also eligible |
Nonclinical-based settings or nonapplicable settings (e.g., prisons) |
| Country | Research conducted in the United States or in populations similar to U.S. populations with services and interventions applicable to U.S. practice (i.e., countries categorized as “Very High” on the United Nations Human Development Index, as defined by the United Nations Development Programme |
Research not relevant to the United States (i.e., countries not categorized as “Very High” on the Human Development Index) |
| Language | Full text published in English | Languages other than English |
* Studies enrolling adolescents at any age will be included as long as the focus is on abuse from an intimate partner and not a parent or other caregiver.
† Adolescents and adults with problems directly related to abuse (e.g., physical injuries) will have evaluations outside the scope of screening.
‡ Relevant systematic reviews will be identified in database searches and used for handsearches to ensure the databases have captured all relevant studies.
§ Results will be stratified by study setting to assess whether results for IPV screening accuracy and intervention studies differ based on whether populations were enrolled from primary care or emergency department settings.
Abbreviations: IPV=intimate partner violence; KQ=key question; RCT=randomized, controlled trial.
Caregiver Abuse of Older and Vulnerable Adults
| Include | Exclude | |
|---|---|---|
| Populations | Studies enrolling older adult (age 60 years or older) and vulnerable* adult (age 18 years or older) populations presenting for primary care services without recognized signs or symptoms of abuse or neglect
Specific populations of interest include those defined by age, sex, race or ethnicity, pregnancy status, sexual orientation, gender identity, type of abuse (e.g., physical abuse or sexual abuse), history of abuse, or presence of comorbid conditions |
Studies restricted to populations seeking care for abuse or presenting with obvious signs or symptoms of abuse |
| Screening | KQs 1–3: Screening questionnaires designed to detect current or past abuse or neglect, including self-administered, computer-enabled, or patient self-report instruments, as well as clinician-administered screening methods; screening may involve input from caregivers and instruments must be feasible for use in U.S. primary care settings (i.e., brief, easy to interpret, and acceptable to patients and clinicians) | KQs 1–3: Screening to detect behavioral problems in elderly and vulnerable adults with specific conditions (e.g., dementia) |
| Interventions | KQs 4, 5: Services that could be offered in primary care settings or referred to by primary care services, including counseling, psychological interventions, case management, home visitation, and referral to community services (e.g., adult protective services) | KQs 4, 5: Public awareness campaigns without specific interventions linked to screening; studies of other interventions that do not include a health service component (e.g., effectiveness of nursing facility policies and procedures to reduce violence) |
| Comparisons | KQs 1, 3: Screened vs. nonscreened groups
KQ 2: Eligible instruments must be compared with an acceptable reference standard (verified or self-reported abuse or validated screening instrument for abuse) KQs 4, 5: No treatment, usual care, attention control, or wait-list control |
KQs 4, 5: Head-to-head comparisons of two active interventions |
| Outcomes | KQs 1, 4: Reduced exposure to caregiver abuse or neglect (e.g., reduced episodes of physical violence); physical morbidity associated with abuse or neglect, including physical trauma (e.g., fractures or dislocations) and chronic conditions (e.g., brain injury or physical disability); mental morbidity associated with abuse or neglect (e.g., anxiety or nightmares) and chronic mental health conditions (e.g., posttraumatic stress disorder, anxiety, or depression); sexual trauma, unintended pregnancy†, and sexually transmitted infections; adverse perinatal outcomes† (e.g., preterm birth, low birth weight, or decreased mean gestational age); healthcare utilization attributed to physical or mental effects of abuse (e.g., rates of emergency department visits); social isolation and quality of life; and mortality
KQ 2: Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, diagnostic odds ratios, and relative risks for future abuse KQ 3: Psychosocial harms that result from screening, including labeling and stigma; false-positive and false-negative results; increased abuse or other forms of retaliation; and other reported harms of screening or identification KQ 5: Any harms that result from interventions, such as increased abuse or emotional distress |
KQs 1, 4: Screening or referral rates, attitudes about screening, plans or intentions related to screening, and other intermediate outcomes
KQ 2: Theory or survey development and validation without correlation to abuse outcomes or studies that focus only on particular risk factors or assessment of provider or participant attitudes toward the instrument |
| Study designs | All KQs: RCTs
KQ 2: Cross-sectional and cohort studies of diagnostic accuracy are also eligible KQs 3, 5: Cohort studies with a concurrent control group are also eligible |
All other study designs, including case series, case-control studies, and systematic reviews‡ |
| Quality | Studies rated good or fair quality | Studies rated poor quality |
| Setting | Primary care clinics§ or other settings where primary care services are offered§; studies recruiting participants from emergency departments are also eligible¶ | Nonclinical-based or nonapplicable settings (e.g., prisons), populations or services/interventions not applicable to U.S. practice |
| Country | Research conducted in the United States or in populations similar to U.S. populations with services and interventions applicable to U.S. practice (i.e., countries categorized as “Very High” on the United Nations Human Development Index as defined by the United Nations Development Programme) | Research not relevant to the United States (i.e., countries not categorized as “Very High” on the Human Development Index) |
| Language | Full text published in English | Languages other than English |
*“Vulnerable adult” is a person age 18 years or older whose ability to provide their own care or protection is impaired.
†Outcomes that are specific to pregnancy apply to vulnerable adults who are pregnant or may become pregnant.
‡Relevant systematic reviews will be identified in database searches and used in handsearches to ensure the databases have captured all relevant studies.
§This includes community-dwelling, assisted living settings where primary care services are delivered and where patients or residents are able to live independently and receive care similar to a traditional primary care setting.
¶Results will be stratified by study setting to assess whether results for older or vulnerable adult abuse screening accuracy or intervention studies differ based on whether populations were enrolled from primary care or emergency department settings.
Abbreviations: KQ=key question; RCT=randomized, controlled trial.
The draft Research Plan was posted on the U.S. Preventive Services Task Force website for public comment from February 9, 2023, to March 8, 2023. Several comments were related to the difference in population eligibility criteria for the Analytic Frameworks for IPV and for older and vulnerable adults, specifically concerns that the frameworks separated populations by age rather than by type of abuse. For the IPV Analytic Framework, we clarified that there is no upper age limit for adults by adding “(age 18 years or older)” after “adults” in the IPV eligibility criteria. Additionally, for the older and vulnerable adults Analytic Framework, we added the term “caregiver” before “abuse” and “neglect,” when appropriate, to make clear that the focus is on screening for abuse or neglect perpetrated by a caregiver. Definitions of each type of abuse will be outlined in the evidence report. Other comments asked for definitions of “harms” of screening (KQ 3); a minor edit was made to the criteria specifying that the goal is to assess harms specific to screening. Examples of harms are already provided in the list of eligible outcomes for KQ 3, including labeling, stigma, and others. Lastly, we added “psychological interventions” to the list of eligible interventions for clarity; the previous list of examples included “counseling” but did not specifically mention psychological interventions.