Sex differences in intimate partner violence lethality risk screening administration and outcomes

IMPORTANCE: Intimate partner violence (IPV) is a critical public health issue. Health care systems, including the Veterans Health Administration, routinely screen patients for IPV and conduct secondary screening for IPV-related lethality when IPV is detected. Despite studies investigating IPV screening and response in the health care system, there has been limited empirical work on the implementation of screening for IPV-related lethality, especially among men. 

OBJECTIVE: To examine sex differences in IPV-related lethality screening administration and clinical outcomes. 

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used electronic health record data from veterans screened for IPV at 135 Veterans Affairs medical centers between October 1, 2022, and September 30, 2023. 

EXPOSURE: Intimate partner violence screening. 

MAIN OUTCOMES AND MEASURES: The receipt of protocol-concordant IPV-related lethality screening was assessed and subsequent clinical outcomes examined. Mixed-effects logistic regression was used to evaluate associations between sex and outcome variables. RESULTS: Among the 67 379 patients with IPV-positive screens who should have received the secondary IPV-related lethality screening per protocol, 55 482 (82.3%; mean [SD] age, 52.3 [16.1] years; 77.0% men) were administered the secondary screen, with the error rate in screening administration higher among men than women (adjusted odds ratio, 1.42 [95% CI, 1.33-1.51]). Of patients screened, 16.9% reported past-year IPV-related lethality risk. Women were significantly more likely to be at risk of IPV-related lethality compared with men (adjusted odds ratio, 2.29 [95% CI, 2.16-2.41]), with 29.9% of women and 13.3% of men reporting lethality risk. 

CONCLUSIONS AND RELEVANCE: This cross-sectional study of sex differences in IPV-related lethality screening found sex-based differences in the administration and clinical outcomes of IPV-related lethality screening among patients screened for IPV during health care encounters. Nearly 1 in 5 men were misclassified as negative for IPV and, therefore, not administered the IPV-related lethality screen per protocol. Among patients who received the second screen, lethality risk was significantly higher for women across all screening items compared with men. Further research is needed to assess IPV experiences among men, including gaps in health care and opportunities to improve implementation of IPV screening and response for men, as well as to identify effective strategies for connecting all patients at risk of lethal IPV to lifesaving services.