Do you feel safe in your home?

Intimate partner violence (IPV)—violence or aggression that occurs within the context of a close relationship—is estimated to affect 8.5 million women in the United States over the course of their lifetime.

According to the Centers for Disease Control, IPV can pose serious health risks to victims, including physical injuries (including death), an increased risk of substance use disorder and mental health problems such as depression and post-traumatic stress disorder.

Identifying those who are at risk of IPV and connecting them with support services can help. But this can be a challenge, as many IPV victims are reluctant to report abuse due to fear of the abuser, feelings of stigma or shame, or a lack of resources.

How Mammography Screenings Could Help

With millions of women presenting for mammography every year, could breast imaging centers help to identify women at risk for IPV and connect them with the support services they need?

That concept was recently tested by a Mass General research team led by Anand K. Narayan, MD, PhD, and Constance D. Lehman, MD, PhD. The team presented the results of their two-year IPV screening study in the Journal of the American College of Radiology last month.

The IPV screening, which occurred both at Massachusetts General Hospital and the hospital’s satellite breast imaging centers, consisted of a short question that was added to the patient intake questionnaire: “Do you feel safe in your home?”

Among 66,150 unique patients who presented for mammography during 2016 and 2017, 71 patients indicated that they did not feel safe at home.

Those patients were then referred to Mass General’s HAVEN program (Helping Abuse and Violence End Now) if they were at the hospital’s main campus, or provided with contact information for HAVEN if they were at a satellite location.

HAVEN provides free, confidential support for individuals affected by abusive relationships. They help clients plan for safety, find resources and connect with support groups.

Promising Results and Next Steps

While study team was not able to provide specific data on the patients who were referred to HAVEN due to confidentiality issues, feedback from HAVEN administrators indicates that 95% of those referred to the center took contact information and program materials with safety support resources.

Five percent of those referred became long-term HAVEN clients, visiting the program on a weekly basis for counseling, support and safety planning.

While the overall percentage of women identified as being at risk for IPV was low (less than 1% of the 68,150 women screened), the identification rates were consistent with other screening tools that have been tested in the health care setting, the researchers note.

The researchers note that the reliance of women to self-report (given the established pattern of underreporting) was a limitation on the study, as were a lack of ways to quantify if the intervention helped to reduce the risk the women’s likelihood of experiencing more severe IPV down the line.

There may be additional strategies that could be used to improve the screening process, such as developing prediction systems to proactively identify high-risk women before their mammography appointments. Future studies could also seek to measure subsequent incidents of physical, verbal and sexual assault, the team says.

It may also be helpful to try asking more detailed questions during the screening, such as: “Have you ever been in a relationship in which you were threatened, controlled, physically hurt or made to feel afraid?”

More Information and Resources

• Learn more about HAVEN
• Intimate Partner Violence Resources from the Centers for Disease Control
• Massachusetts Domestic Violence Help, Programs and Resources

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