Validated Questionnaires for IPV Screening in Adults
For screening intimate partner violence in adult women of reproductive age, use the HITS (Hurt, Insult, Threaten, Scream) questionnaire, which is a 4-item tool available in both English and Spanish that can be administered in 2 minutes in primary care settings. 1
Recommended Screening Tools
The USPSTF identifies six validated instruments with the highest sensitivity and specificity for detecting IPV 1:
Primary Recommendations:
- HITS (Hurt, Insult, Threaten, Scream): 4 questions, self- or clinician-administered, available in English and Spanish, specifically designed for primary care 1
- HARK (Humiliation, Afraid, Rape, Kick): 4-item self-administered instrument 1
- STaT (Slapped, Threatened, and Throw): 3-item self-report tool, validated in emergency department settings 1
Alternative Options:
- WAST (Woman Abuse Screen Tool): Validated with high sensitivity/specificity 1
- OAS/OVAT (Ongoing Abuse Screen/Ongoing Violence Assessment Tool): Specifically detects ongoing IPV with 86% sensitivity and 83% specificity 2
- Modified CTQ-SF (Childhood Trauma Questionnaire-Short Form): Validated screening option 1
Population-Specific Considerations
Women of Reproductive Age (14-46 years):
The USPSTF recommends screening this population with moderate certainty of net benefit, as effective interventions exist that reduce violence and physical/mental harms 1. All the above tools are validated for this group.
Elderly and Vulnerable Adults:
Critical caveat: The USPSTF found no valid, reliable screening tools to identify abuse in elderly or vulnerable adults in primary care settings 1. The evidence for benefits and harms of screening this population is insufficient to make a recommendation.
Men and Other Populations:
The evidence base is significantly lacking for screening men for IPV, despite CDC data showing 26% of men experience some form of IPV in their lifetime 1. No validated screening tools exist specifically for this population.
Practical Implementation
HITS is the optimal choice because it:
- Takes only 2 minutes to administer
- Works in busy primary care settings
- Available in multiple languages
- Can be self-administered or clinician-administered
- Has demonstrated high sensitivity and specificity 1
OVAT is preferred for emergency departments when detecting ongoing (current) IPV is the priority, with a 31% detection rate and 96% negative predictive value 2.
Important Caveats
- No gold standard exists: All screening instruments are validated against other validated instruments rather than objective outcomes 1
- Screening interval unknown: No evidence exists on optimal screening frequency 1
- Harms are minimal: Risk of harm from screening is no greater than small 1
- Screening alone is insufficient: Must be coupled with interventions including counseling, safety planning, and referrals to community services 1
The evidence strongly supports routine screening of women of reproductive age using brief, validated instruments, with HITS being the most practical choice for primary care settings.