More evidence is needed for the impact of screening for intimate partner violence on healthcare cost, utilization & value, as well as on health and social outcomes.
This assessment was made possible through support from Elevance Health. HealthBegins retains full editorial independence, and the content herein reflects its sole views and conclusions.
The findings below synthesize the results of the studies on intimate partner violence screening across three domains of measurement:
Intimate partner violence (IPV) represents a significant public health crisis in the United States (U.S.), affecting millions of individuals annually[1]. Approximately 41% of women and 26% of men have experienced sexual violence, physical violence, or stalking by an intimate partner during their lifetime[2], with an estimated 6.5 million women experiencing IPV in a single year[3]. Over 61 million women and 53 million men have experienced psychological aggression by an intimate partner in their lifetime[4]. During pregnancy, approximately 30% of women experience emotional abuse, 15% physical abuse, and 8% sexual abuse[5]. The health consequences of IPV are extensive and long-lasting, including increased risk of mental health conditions such as depression, post-traumatic stress disorder (PTSD), anxiety disorders, substance use, and suicidal behavior, as well as sexually transmitted infections, unintended pregnancy, and chronic pain[6].
The economic burden of intimate partner violence affects individuals, families, and society as a whole. The lifetime economic cost of IPV is estimated at $103,767 per female victim and $23,414 per male victim, with a total population economic burden of nearly $3.6 trillion over victims' lifetimes, based on 43 million U.S. adults with a history of IPV[7]. This includes $2.1 trillion in medical costs, $1.3 trillion in lost productivity, $73 billion in criminal justice activities, and $62 billion in other costs, with government sources paying an estimated $1.3 trillion of the lifetime economic burden[8]. An estimated 15.5 million children are exposed to at least one episode of IPV annually, with lifetime costs estimated at over $50,000 per child due to increased healthcare costs, crime costs, and productivity losses[9]. At the workplace level, victims lost almost eight million days of paid work, equivalent to more than 32,000 full-time jobs, with 64% of victims reporting that their ability to work was affected by the violence[10].
Universal screening for IPV in healthcare settings aims to identify individuals who are experiencing abuse, and provide them with tailored support, resources and care. The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen for IPV in women of reproductive age and provide or refer women who screen positive to ongoing support services[11].
Progress has been made in advancing IPV screening through supportive policies and reimbursement for services. The Affordable Care Act (ACA) requires all private plans and Medicaid programs that expanded under the ACA to reimburse providers for IPV screening and brief intervention services without cost-sharing for patients, making IPV screening covered under most private health plans and Medicaid expansion groups[12].
However, there are still opportunities to improve delivery of universal IPV screening. Primary care clinicians report that changes to how IPV screening services are reimbursed, better resources to help patients who screen positive, and additional training may increase service delivery[13].
All women receiving care at participating primary care clinics three months before and nine months after the start of implementation facilitation.
An intervention by the Veterans Health Administration to integrate intimate partner screening programs into primary care. Implementation facilitation included an operations-funded external facilitator working for six months with a facility-funded internal facilitator from participating clinics. The pre-implementation facilitation period comprised implementation as usual in the Veterans Health Administration.
Randomized controlled trial. N=2,272 three months before implementation and N=5,149 nine months after.
Healthcare Cost, Utilization & Value: Women screened during implementation facilitation were more likely to use post-screening psychosocial services than those screened during pre-implementation facilitation (odds ratio OR=1.29, 95% CI 1.06, 1.57).
English-speaking female patients aged 18 to 64 who presented to 11 emergency departments, 12 family practices, or three obstetrics/gynecology clinics in Ontario, Canada, between July 2005 and December 2006, who could be seen individually and were well enough to participate.
Screening women for IPV.
Randomized controlled trial. N=6,743.
Social: At 18 months (n=411), observed recurrence of IPV among screened vs non-screened women was 46% vs 53% (modeled OR=0.82; 95% CI 0.32-2.12). Screened vs. non-screened women exhibited about a 0.2 standard deviation (SD) greater improvement in quality of life scores (modeled score difference at 18 months, 3.74; 95% CI 0.47-7.00). When multiple imputation was used to account for sample loss, differences between groups were reduced and quality of life differences were no longer significant. The results of this trial do not provide sufficient evidence to support IPV screening in healthcare settings.
Women (including pregnant and postpartum women), older adults, and adults with impaired functioning due to physical or mental disabilities.
Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults.
Evidence report and systematic review. Data sources included MEDLINE, Cochrane Library, EMBASE, and trial registries through October 4, 2017; references; experts; literature surveillance through August 1, 2018. 30 studies were included (N= 14,959). Three randomized clinical trials (RCTs) (N=3,759) compared IPV screening with no screening. 11 RCTs (N= 6,740) evaluated interventions for women with screen-detected IPV.
Social: None of the RCTs comparing IPV screening with no screening found significant improvements in outcomes (e.g., IPV or quality of life) over three to 18 months.
Two RCTs enrolling pregnant women (N = 575) found significantly less IPV among women in the intervention group: One home visiting intervention (standardized mean difference [SMD], −0.34 [95% CI −0.59 to −0.08]) and one behavioral counseling intervention for multiple risks (IPV, smoking, depression, tobacco exposure) (SMD, −0.40 [95% CI −0.68 to −0.12]).
Women who experience IPV.
IPV screening programs for women delivered by frontline healthcare staff.
Systematic review. 59 studies were included.
Healthcare Cost, Utilization & Value: Among women screening positive, a median of 32% received a referral to follow-up services. Among those referred to such services, a median of 54% of women attended or received those services (based on N = 9 studies, 15%).
Adolescents and adults who are pregnant or postpartum, and women of reproductive age, as well as older adults and people with a physical or mental disability.
Screening for IPV, abuse of older adults, and abuse of vulnerable adults.
Systematic review.
Social: The USPSTF concluded that screening for IPV in women of reproductive age, including those who are pregnant and postpartum, and providing or referring those who screen positive to multicomponent interventions has a moderate net benefit.
The USPSTF also concluded that the benefits and harms of screening for caregiver abuse and neglect in older or vulnerable adults are uncertain and that the balance of benefits and harms cannot be determined.
[1] CDC. (2024, May 16). About Intimate Partner Violence. Intimate Partner Violence Prevention. https://www.cdc.gov/intimate-partner-violence/about/index.html
[2] CDC. (2024, May 16). About Intimate Partner Violence. Intimate Partner Violence Prevention. https://www.cdc.gov/intimate-partner-violence/about/index.html
[3] Ramaswamy, A., Ranji, U. & Salganicoff, A. (2019, December 2). Intimate Partner Violence (IPV) Screening and Counseling Services in Clinical Settings. KFF. https://www.kff.org/womens-health-policy/issue-brief/intimate-partner-violence-ipv-screening-and-counseling-services-in-clinical-settings/
[4] CDC. (2024, May 16). About Intimate Partner Violence. Intimate Partner Violence Prevention. https://www.cdc.gov/intimate-partner-violence/about/index.html
[5] Huecker, M. R., King, K. C., & Jordan, G. A. (2022). Domestic Violence. [Updated 2023 Apr 9]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499891/
[6] US Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Jr, Grossman, D. C., Kemper, A. R., Kubik, M., Kurth, A., Landefeld, C. S., Mangione, C. M., Silverstein, M., Simon, M. A., Tseng, C. W., & Wong, J. B. (2018). Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement. JAMA, 320(16), 1678–1687. https://doi.org/10.1001/jama.2018.14741
[7] Peterson, C., Kearns, M. C., McIntosh, W. L., Estefan, L. F., Nicolaidis, C., McCollister, K. E., Gordon, A., & Florence, C. (2018). Lifetime Economic Burden of Intimate Partner Violence Among U.S. Adults. American journal of preventive medicine, 55(4), 433–444. https://doi.org/10.1016/j.amepre.2018.04.049
[8] US Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Jr, Grossman, D. C., Kemper, A. R., Kubik, M., Kurth, A., Landefeld, C. S., Mangione, C. M., Silverstein, M., Simon, M. A., Tseng, C. W., & Wong, J. B. (2018). Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement. JAMA, 320(16), 1678–1687. https://doi.org/10.1001/jama.2018.14741
[9] Exposure to domestic violence costs U.S. government $55 billion each year. (2018, May 3). Science Daily. https://www.sciencedaily.com/releases/2018/04/180425093846.htm
[10] DomesticShelters.org. (2015). Economic Impact of Domestic Violence. DomesticShelters.org. https://www.domesticshelters.org/resources/statistics/economic-impact-of-domestic-violence
[11] U.S. Preventive Services Task Force. (2025, October 23). Final Recommendation Statement: Intimate ,Partner Violence and Caregiver Abuse of Older or Vulnerable Adults: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/intimate-partner-violence-and-abuse-of-elderly-and-vulnerable-adults-screening
[12] Ramaswamy, A., Ranji, U. & Salganicoff, A. (2019, December 2). Intimate Partner Violence (IPV) Screening and Counseling Services in Clinical Settings. KFF. https://www.kff.org/womens-health-policy/issue-brief/intimate-partner-violence-ipv-screening-and-counseling-services-in-clinical-settings/
[13] Medicaid Enrollees May Not Be Screened for Intimate Partner Violence Because of Challenges Reported by Primary Care Clinicians. (2024, May 2). Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services. hthatttps://oig.hhs.gov/reports/all/2024/medicaid-enrollees-may-not-be-screened-for-intimate-partner-violence-because-of-challenges-reported-by-primary-care-clinicians/
