Three brief tools for identification of male intimate partner violence in the emergency department

Abstract

Study objectives: Intimate partner violence (IPV) is a significant health concern. National surveys and law enforcement statistics have shown that women and men are victims of IPV. Most of the survey tools used to identify IPV in the emergency department (ED) have been constructed for, and validated with, female victims. The objective of this study was to compare screening tools for identification of IPV in men with a population-based, validated standard. Methods: Data were collected prospectively in randomized 4-hour blocks over a 6-week period. Consecutive male ED patients were approached for eligibility and consent. Questions were asked in a randomized fashion. The standard for comparison was the Conflict Tactics Scale (CTS), previously validated in men, by using a 95% population norm cutoff for physical IPV (physIPV) and psychologic IPV (psyIPV). Three screening tools, previously validated in women, the Hurt, Insult, Threaten, and Scream (HITS) Brief Domestic Violence Screening Tool, Partner Violence Screen (PVS), and Index of Spousal Abuse (ISA), along with a new, previously unvalidated scale, the Charity Hospital Intimate Partner Abuse Scale (CHIPAS) were compared to the CTS using sensitivity, specificity, and Chronbach's α. Results: Seventy-one (53%) of the eligible men approached agreed to participate in the study. Using the CTS, 15.5% of men reported a history of physIPV (Chronbach's α 0.92) and 8.5% reported a history of psyIPV (Chronbach's α 0.79). Comparing the HITS with CTS physIPV showed a sensitivity of 63.6% and specificity of 95%; comparing HITS to CTS psyIPV showed a sensitivity of 66.7% and specificity of 91% (Chronbach's α 0.84). Comparing the PVS to CTS physIPV showed a sensitivity of 66.7% and specificity of 91%; comparing PVS to CTS psyIPV showed a sensitivity of 83.3% and specificity of 76.9%. Comparing the ISA to CTS physIPV showed a sensitivity of 81.8% and specificity of 93.3% (Chronbach's α 0.89); comparing ISA to CTS psyIPV showed a sensitivity of 81.8% and specificity of 93.3% (Chronbach's α 0.94). Comparing the CHIPAS to the CTS physIPV showed a sensitivity of 100% and specificity of 23.1% (Chronbach's α 0.8); comparing CTS to psyIPV showed a sensitivity of 91.2% and specificity of 71.4% (Chronbach's α 0.74). Conclusion: Survey tools validated for screening for IPV in women showed promise for use in men in the ED setting. Study objectives: Intimate partner violence (IPV) is a significant health concern. National surveys and law enforcement statistics have shown that women and men are victims of IPV. Most of the survey tools used to identify IPV in the emergency department (ED) have been constructed for, and validated with, female victims. The objective of this study was to compare screening tools for identification of IPV in men with a population-based, validated standard. Methods: Data were collected prospectively in randomized 4-hour blocks over a 6-week period. Consecutive male ED patients were approached for eligibility and consent. Questions were asked in a randomized fashion. The standard for comparison was the Conflict Tactics Scale (CTS), previously validated in men, by using a 95% population norm cutoff for physical IPV (physIPV) and psychologic IPV (psyIPV). Three screening tools, previously validated in women, the Hurt, Insult, Threaten, and Scream (HITS) Brief Domestic Violence Screening Tool, Partner Violence Screen (PVS), and Index of Spousal Abuse (ISA), along with a new, previously unvalidated scale, the Charity Hospital Intimate Partner Abuse Scale (CHIPAS) were compared to the CTS using sensitivity, specificity, and Chronbach's α. Results: Seventy-one (53%) of the eligible men approached agreed to participate in the study. Using the CTS, 15.5% of men reported a history of physIPV (Chronbach's α 0.92) and 8.5% reported a history of psyIPV (Chronbach's α 0.79). Comparing the HITS with CTS physIPV showed a sensitivity of 63.6% and specificity of 95%; comparing HITS to CTS psyIPV showed a sensitivity of 66.7% and specificity of 91% (Chronbach's α 0.84). Comparing the PVS to CTS physIPV showed a sensitivity of 66.7% and specificity of 91%; comparing PVS to CTS psyIPV showed a sensitivity of 83.3% and specificity of 76.9%. Comparing the ISA to CTS physIPV showed a sensitivity of 81.8% and specificity of 93.3% (Chronbach's α 0.89); comparing ISA to CTS psyIPV showed a sensitivity of 81.8% and specificity of 93.3% (Chronbach's α 0.94). Comparing the CHIPAS to the CTS physIPV showed a sensitivity of 100% and specificity of 23.1% (Chronbach's α 0.8); comparing CTS to psyIPV showed a sensitivity of 91.2% and specificity of 71.4% (Chronbach's α 0.74). Conclusion: Survey tools validated for screening for IPV in women showed promise for use in men in the ED setting.