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Validation of screening tool for intimate partner violence

November 29, 2018


Dr. Katherine Iverson led research showing the value of a specialized brief questionnaire to identify intimate partner violence in women Veterans. (Photo by Mackenzie Adams)

Intimate partner violence (IPV), often called domestic violence, occurs when a current or former intimate partner, such as a boyfriend, girlfriend or spouse, harms, threatens to harm, or stalks his or her partner. VA has documented that women Veterans are at higher risk for IPV compared with women who have not served in the military, and that some of the forms of violence they experience are quite severe.

Women who have been through IPV may experience short-term health effects such as physical injuries, or long-term health effects such as obesity; problems with their heart, stomach, or digestive systems; chronic pain; sexual health problems; and other stress-related difficulties, such as headaches. They may also experience mental health issues like depression, substance abuse, posttraumatic stress disorder, and thoughts of hurting themselves.

To detect IPV within the previous year among female Veterans, VA uses a four-item screening tool called HITS (hurt, insult, threaten, scream). The tool asks questions that elicits information about how often a woman’s partner physically hurts, insults, threatens harms, and screams at her. It takes just minutes to administer.

HITS was tested in 2013 by a team led by researchers from the Women’s Health Sciences Division of VA’s National Center for PTSD. The team found the tool was both sensitive and specific in identifying IPV in women Veterans. In 2013, the team published a study of the tool, which documented that approximately 37 percent of 160 Veterans involved in the study had experienced violence with an intimate partner within the past year, and that there is a strong association between IPV and mental health issues, and with alcohol abuse.

VA now uses the tool in its national Social Work, Women’s Health Services, and Women’s Mental Health Services programs, and many VA employees have been trained in its use. The tool can be used in primary care, during mental health assessments, or during emergency department visits. Because women do not tend to spontaneously disclose IPV but are often willing to talk about it when asked, the HITS tool gives women an opportunity to disclose what may be happening to them and sends the message that it is important to discuss the subject and that someone at VA is available to talk to about it.

The VA New England Healthcare System is now testing an electronic version (E-HITS) of the tool, linked to VA’s Electronic Health Record system.

Principal investigator: Dr. Katherine Iverson, Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System

Selected publications and additional information:

Iverson KM, King MW, Resick PA, Gerber MR, Kimerling R, Vogt D. Clinical utility of an intimate partner violence screening tool for female VHA patients. J Gen Intern Med, 2013 Oct;28(10):1288-93.

A chat with our experts: How intimate partner violence affects women Veterans, VA Research Quarterly Update, Winter 2018


VA researchers tested and validated a screening tool, or brief questionnaire, to elicit reports of intimate partner violence experienced by women Veterans. VA now uses the tool nationwide.

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Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.