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. 2004 Jun;58(6):523–527. doi: 10.1136/jech.2003.011742

Comparison between the abuse assessment screen and the revised conflict tactics scales for measuring physical violence during pregnancy

M Reichenheim 1, C Moraes 1
PMCID: PMC1732799  PMID: 15143123

Abstract

Study objective: Because of the promise of its ability to quickly identify cases of violence against women during pregnancy, the abuse assessment screen (AAS) should be the focus of numerous psychometric evaluations. This paper assesses its measurement accuracy compared with the revised conflict tactics scales (CTS2) used as standard.

Design: Cross sectional study. Besides several ancillary questions, the AAS consists of three anchor questions about violence against pregnant women. These are inclusive, respectively covering lifetime, preceding 12 months, and pregnancy periods. These questions are the main focus of this article. The CTS2 physical aggression scale consists of 12 items divided into minor and severe subscales. A positive event is defined as having at least one positive item in the respective subscale. The 12 item score is also used.

Setting and participants: The instruments were applied to 748 women, 24 to 72 hours after delivery in three major public sector maternity wards of Rio de Janeiro from March to September 2000.

Main results: According to the CTS2, prevalences of minor and severe physical violence perpetrated against a pregnant woman are 18.4% (95% CI 15.7 to 21.4) and 7.6% (95% CI 5.8 to 9.8), respectively. Taking these subscales as standards, sensitivities are 31.9% (95% CI 24.9 to 40.3) and 61.4% (95% CI 47.6 to 74.0), respectively. Specificities are above 97%.

Conclusion: These findings are somewhat worrying because the number of victims who are not identified and offered assistance is considerable. On a practical note, it would be sensible not to use the AAS as a stand alone screening tool until more evidence is gathered.

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Selected References

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  1. Brenner H. Correcting for exposure misclassification using an alloyed gold standard. Epidemiology. 1996 Jul;7(4):406–410. doi: 10.1097/00001648-199607000-00011. [DOI] [PubMed] [Google Scholar]
  2. Campbell J., Torres S., Ryan J., King C., Campbell D. W., Stallings R. Y., Fuchs S. C. Physical and nonphysical partner abuse and other risk factors for low birth weight among full term and preterm babies: a multiethnic case-control study. Am J Epidemiol. 1999 Oct 1;150(7):714–726. doi: 10.1093/oxfordjournals.aje.a010074. [DOI] [PubMed] [Google Scholar]
  3. Curry M. A., Perrin N., Wall E. Effects of abuse on maternal complications and birth weight in adult and adolescent women. Obstet Gynecol. 1998 Oct;92(4 Pt 1):530–534. doi: 10.1016/s0029-7844(98)00258-0. [DOI] [PubMed] [Google Scholar]
  4. Djeddah C., Facchin P., Ranzato C., Romer C. Child abuse: current problems and key public health challenges. Soc Sci Med. 2000 Sep;51(6):905–915. doi: 10.1016/s0277-9536(00)00070-8. [DOI] [PubMed] [Google Scholar]
  5. Díaz-Olavarrieta C., Campbell J., García de la Cadena C., Paz F., Villa A. R. Domestic violence against patients with chronic neurologic disorders. Arch Neurol. 1999 Jun;56(6):681–685. doi: 10.1001/archneur.56.6.681. [DOI] [PubMed] [Google Scholar]
  6. Foy R., Nelson F., Penney G., McIlwaine G. Antenatal detection of domestic violence. Lancet. 2000 May 27;355(9218):1915–1915. doi: 10.1016/s0140-6736(05)73366-3. [DOI] [PubMed] [Google Scholar]
  7. Gazmararian J. A., Lazorick S., Spitz A. M., Ballard T. J., Saltzman L. E., Marks J. S. Prevalence of violence against pregnant women. JAMA. 1996 Jun 26;275(24):1915–1920. [PubMed] [Google Scholar]
  8. Gazmararian J. A., Petersen R., Spitz A. M., Goodwin M. M., Saltzman L. E., Marks J. S. Violence and reproductive health: current knowledge and future research directions. Matern Child Health J. 2000 Jun;4(2):79–84. doi: 10.1023/a:1009514119423. [DOI] [PubMed] [Google Scholar]
  9. Gielen A. C., O'Campo P. J., Faden R. R., Kass N. E., Xue X. Interpersonal conflict and physical violence during the childbearing year. Soc Sci Med. 1994 Sep;39(6):781–787. doi: 10.1016/0277-9536(94)90039-6. [DOI] [PubMed] [Google Scholar]
  10. Hasselmann Maria Helena, Reichenheim Michael E. Adaptaço transcultural da versão em português da Conflict Tactics Scales Form R (CTS-1), usada para aferir violência no casal: equivalências semântica e de mensuraço. Cad Saude Publica. 2003 Sep 8;19(4):1083–1093. doi: 10.1590/s0102-311x2003000400030. [DOI] [PubMed] [Google Scholar]
  11. Herdman M., Fox-Rushby J., Badia X. A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach. Qual Life Res. 1998 May;7(4):323–335. doi: 10.1023/a:1024985930536. [DOI] [PubMed] [Google Scholar]
  12. Hillard P. J. Physical abuse in pregnancy. Obstet Gynecol. 1985 Aug;66(2):185–190. [PubMed] [Google Scholar]
  13. Janssen Patricia A., Holt Victoria L., Sugg Nancy K., Emanuel Irvin, Critchlow Cathy M., Henderson Angela D. Intimate partner violence and adverse pregnancy outcomes: a population-based study. Am J Obstet Gynecol. 2003 May;188(5):1341–1347. doi: 10.1067/mob.2003.274. [DOI] [PubMed] [Google Scholar]
  14. Leung W. C., Leung T. W., Lam Y. Y., Ho P. C. The prevalence of domestic violence against pregnant women in a Chinese community. Int J Gynaecol Obstet. 1999 Jul;66(1):23–30. doi: 10.1016/s0020-7292(99)00053-3. [DOI] [PubMed] [Google Scholar]
  15. Martin S. L., Mackie L., Kupper L. L., Buescher P. A., Moracco K. E. Physical abuse of women before, during, and after pregnancy. JAMA. 2001 Mar 28;285(12):1581–1584. doi: 10.1001/jama.285.12.1581. [DOI] [PubMed] [Google Scholar]
  16. McFarlane J., Hughes R. B., Nosek M. A., Groff J. Y., Swedlend N., Dolan Mullen P. Abuse assessment screen-disability (AAS-D): measuring frequency, type, and perpetrator of abuse toward women with physical disabilities. J Womens Health Gend Based Med. 2001 Nov;10(9):861–866. doi: 10.1089/152460901753285750. [DOI] [PubMed] [Google Scholar]
  17. McFarlane J., Parker B., Soeken K., Bullock L. Assessing for abuse during pregnancy. Severity and frequency of injuries and associated entry into prenatal care. JAMA. 1992 Jun 17;267(23):3176–3178. doi: 10.1001/jama.267.23.3176. [DOI] [PubMed] [Google Scholar]
  18. McFarlane J., Parker B., Soeken K., Silva C., Reed S. Severity of abuse before and during pregnancy for African American, Hispanic, and Anglo women. J Nurse Midwifery. 1999 Mar-Apr;44(2):139–144. doi: 10.1016/s0091-2182(99)00030-0. [DOI] [PubMed] [Google Scholar]
  19. McGrath M. E., Hogan J. W., Peipert J. F. A prevalence survey of abuse and screening for abuse in urgent care patients. Obstet Gynecol. 1998 Apr;91(4):511–514. doi: 10.1016/s0029-7844(98)00002-7. [DOI] [PubMed] [Google Scholar]
  20. Moraes C. L., Reichenheim M. E. Domestic violence during pregnancy in Rio de Janeiro, Brazil. Int J Gynaecol Obstet. 2002 Dec;79(3):269–277. doi: 10.1016/s0020-7292(02)00250-3. [DOI] [PubMed] [Google Scholar]
  21. Moraes Claudia Leite, Hasselmann Maria Helena, Reichenheim Michael E. Adaptaço transcultural para o português do instrumento "Revised Conflict Tactics Scales (CTS2)" utilizado para identificar violência entre casais. Cad Saude Publica. 2002 Jan-Feb;18(1):163–176. doi: 10.1590/s0102-311x2002000100017. [DOI] [PubMed] [Google Scholar]
  22. Moraes Claudia Leite, Reichenheim Michael E. Cross-cultural measurement equivalence of the Revised Conflict Tactics Scales (CTS2) Portuguese version used to identify violence within couples. Cad Saude Publica. 2002 May-Jun;18(3):783–796. [PubMed] [Google Scholar]
  23. Norton L. B., Peipert J. F., Zierler S., Lima B., Hume L. Battering in pregnancy: an assessment of two screening methods. Obstet Gynecol. 1995 Mar;85(3):321–325. doi: 10.1016/0029-7844(94)00429-H. [DOI] [PubMed] [Google Scholar]
  24. O'Campo P., Gielen A. C., Faden R. R., Xue X., Kass N., Wang M. C. Violence by male partners against women during the childbearing year: a contextual analysis. Am J Public Health. 1995 Aug;85(8 Pt 1):1092–1097. doi: 10.2105/ajph.85.8_pt_1.1092. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Parker B., McFarlane J. Identifying and helping battered pregnant women. MCN Am J Matern Child Nurs. 1991 May-Jun;16(3):161–164. doi: 10.1097/00005721-199105000-00013. [DOI] [PubMed] [Google Scholar]
  26. Parker B., McFarlane J., Soeken K. Abuse during pregnancy: effects on maternal complications and birth weight in adult and teenage women. Obstet Gynecol. 1994 Sep;84(3):323–328. [PubMed] [Google Scholar]
  27. Parker Barbara, Chouaf Kathryn. Intimate partner violence following pregnancy. Arch Pediatr Adolesc Med. 2002 Apr;156(4):313–314. doi: 10.1001/archpedi.156.4.313. [DOI] [PubMed] [Google Scholar]
  28. Purwar M. B., Jeyaseelan L., Varhadpande U., Motghare V., Pimplakute S. Survey of physical abuse during pregnancy GMCH, Nagpur, India. J Obstet Gynaecol Res. 1999 Jun;25(3):165–171. doi: 10.1111/j.1447-0756.1999.tb01142.x. [DOI] [PubMed] [Google Scholar]
  29. Reichenheim M. E., Moraes C. L., Hasselmann M. H. Equivalência semântica da versão em português do instrumento Abuse Assessment Screen para rastrear a violência contra a mulher grávida. Rev Saude Publica. 2000 Dec;34(6):610–616. doi: 10.1590/s0034-89102000000600008. [DOI] [PubMed] [Google Scholar]
  30. Stewart D. E., Cecutti A. Physical abuse in pregnancy. CMAJ. 1993 Nov 1;149(9):1257–1263. [PMC free article] [PubMed] [Google Scholar]
  31. Webster J. J., Palmer R. L. The childhood and family background of women with clinical eating disorders: a comparison with women with major depression and women without psychiatric disorder. Psychol Med. 2000 Jan;30(1):53–60. doi: 10.1017/s0033291799001440. [DOI] [PubMed] [Google Scholar]
  32. Webster J., Sweett S., Stolz T. A. Domestic violence in pregnancy. A prevalence study. Med J Aust. 1994 Oct 17;161(8):466–470. [PubMed] [Google Scholar]

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