Domestic violence screening and intervention programmes for adults with dental or facial injury

 

Abstract

Background

Domestic violence exists in all communities across the world. Healthcare services have a pivotal role in the identification, assessment and response to domestic violence. As the face is a common target in assault, dentists and oral and maxillofacial surgeons are in a unique position to screen for domestic violence in the context of presentation of dental and facial injury. Owing to lack of training, dentists and oral and maxillofacial surgeons may not be the best persons to give advice to someone experiencing domestic violence. Improper advice such as encouragement to leave an abusive relationship may escalate the frequency of violence. It may be more appropriate to refer to specialist agencies for intervention and support. It would, therefore be useful to know whether screening and intervention programmes are effective.

Objectives

(1) To assess the benefits and harms of intervention programmes employed to reduce and or prevent domestic violence in adults with dental and/or facial injuries.
(2) To assess the benefits and harms of screening and the use of different screening tools in the detection of the proportion of adult victims of domestic violence who present with dental and/or facial injury.

Search strategy

We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO and LILACS databases. No language restrictions were applied. Personal contacts were used and international domestic violence organisations were contacted to identify any unpublished trials. Last search was done February 2004.

Selection criteria

Randomised controlled trials involving adults aged 16 years and over presenting with dental and/or facial injury relating to domestic violence in any healthcare setting.

Data collection and analysis

Screening of eligible studies was conducted in duplicate and independently by two reviewers. Results were to be expressed as random effects models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval. Heterogeneity was to be investigated including both clinical and methodological factors.

Main results

No eligible randomised controlled trials (RCTs) were identified.

Authors' conclusions

There is no evidence to support or refute that screening for domestic violence in adults with dental or facial injury is beneficial nor that it causes harm. Screening tools to detect domestic violence exist but no RCTs have specifically evaluated their effectiveness for patients presenting with facial and or dental injuries. There is also lack of evidence that intervention programmes are effective at reducing frequency of physical assaults and at reducing the severity of facial injuries.

 

Plain language summary

Domestic violence screening and intervention programmes for adults with dental or facial injury

There is no evidence to support or refute the effectiveness of screening and intervention programmes detecting and supporting victims of domestic violence with dental or facial injuries
Many studies highlighted difficulty in measuring domestic violence because of underreporting. Screening may be helpful to identify victims of domestic violence. Screening tools exist but no studies have evaluated their effectiveness. Dentist and oral and maxillofacial surgeons are not generally trained to intervene in situations involving domestic violence. Referral to specialist agencies for intervention maybe a better option. Many intervention programmes exist either to support, reduce and/or prevent domestic violence. However, the effectiveness or harms of these intervention programmes at reducing violence have not been properly investigated in healthcare settings.