چکیده (انگلیسی):

Background:Family physicians and other primary care practitioners are encouraged or expected to screen for an
expanding array of concerns and problems including intimate partner violence (IPV). While there is no debate
about the deleterious impact of violence and other adverse psychosocial exposures on health status, the key
question raised here is about the value of routine screening in primary care for such exposures.
Discussion:Several characteristics of IPV have led to consideration for routine IPV screening in primary care and
during other healthcare encounters (e.g., emergency room visits) including: its high prevalence, concern that it may
not be raised spontaneously if not prompted, and the burden of suffering associated with this exposure. Despite
these factors, there are now three randomized controlled trials showing that screening does not reduce IPV or
improve health outcomes. Yet, recommendations to routinely screen for IPV persist.
Similarly, adverse childhood experiences (ACEs) have several characteristics (e.g., high frequency, predictive power
of such experiences for subsequent health problems, and concerns that they might not be identified without
screening) suggesting they too should be considered for routine primary care screening. However, demonstration
of strong associations with health outcomes, and even causality, do not necessarily translate into the benefits of
routine screening for such experiences. To date, there have been no controlled trials examining the impact and
outcomes–either beneficial or harmful - of routine ACEs screening. Even so, there is an expansion of calls for
routine screening for ACEs.
Summary:While we must prioritize how best to support and intervene with patients who have experienced
IPV and other adverse psychosocial exposures, we should not be lulled into a false sense of security that our
routine use of “screeners” results in better health outcomes or less violence without evidence for such.
Decisions about implementation of routine screening for psychosocial concerns need similar rigorous debate
and scrutiny of empirical evidence as that recommendedfor proposed physical health screening (e.g., for
prostate and breast cancer).