(CNN) -- At your next doctor's appointment, amid questionsabout alcohol, smoking and medications, don't be surprised if you're asked, "Howare things at home?"
Roughly one-third of women andone-quarter of men report experiencing some form of domestic violence, alsoreferred to as inter-partner violence, during their lifetime.
While these statistics arealarming, the numbers are almost certainly worse, due to the systematicunder-reporting of abuse.
But a panel of national expertshas found there is a particular time-frame in a woman's life when she is mostvulnerable to abuse.
The U.S. Preventive Services TaskForce previously found insufficient evidence to recommend for or againstdomestic violence screening by doctors.
But on Monday, the panel updatedits guidance in the medical journal Annals of Internal Medicine,recommending that all women of childbearing age be screened for abuse, and womenwho screen positive should be provided or referred to intervention services.
The task force also issued adraft statement on primary care interventions to prevent child abuse.
The taskforce, created in 1984, is comprised of experts in prevention andevidence-based medicine. It makes evidence-based recommendations about clinicalpreventive services, such as screenings, counseling services, or preventivemedications.
The USPSTF is made up of 16volunteer members who come from the fields of preventive medicine and primarycare, including internal medicine, pediatrics, behavioral health,obstetrics/gynecology, and nursing. All members volunteer their time to serve onthe USPSTF, and most are practicing clinicians.
By definition, domestic violencetakes place in the home. For that reason, it's sometimes referred to as spousalabuse or intimate partner violence, known as IPV. It not only encompassesphysical aggression or assault, but sexual abuse, emotional abuse, intimidation,stalking -- even economic deprivation.
"We have made significantprogress in building the evidence base to effectively prevent violence againstwomen," said Dr. Virginia Moyer, chair of the USPSTF, in a written statement."We now have the primary care methods and the means to help prevent violenceagainst women in their reproductive years."
While all women are at risk forabuse and should be screened, the task force also identified heightened riskfactors, which include young age, substance abuse, marital difficulties, andeconomic hardships.
For its part, the Centers for Disease Control and Prevention has available itsown comprehensive list of risk factors for IPV, which are organized into fourcategories: individual (e.g., low self-esteem), relationship (e.g., maritalconflict and instability), community (e.g., poverty and associated factors), andsocietal (e.g., traditional gender roles). The CDC has resources available onits website for those needing them.
"Although abuse of men, abuse ofmiddle-aged women and abuse and neglect of elderly and vulnerable (physically ormentally dysfunctional) adults can have equally devastating consequences as IPVamong younger women, there is currently not enough evidence about how primarycare clinicians can effectively screen and intervene," the task force saidMonday.
Principal problems, according tothe task force, include the lack of standards as to how clinicians shouldquestion patients about abuse; varying definitions of abuse; lack of screeningtools; unclear guidance on who to screen; and what to do if abuse isidentified.
Furthermore, potential harms ofpreventive screening may in the end outweigh the benefits -- shame, guilt,self-blame, fear of retaliation or abandonment by perpetrators, and therepercussions of false-positive results are all distinct possibilities, the taskforce said. More research is needed before the USPSTF can issue recommendationsfor or against preventive screenings under these circumstances.
Interventions to preventchild abuse
Nearly three-quarters of amillion children fell victim to child abuse and neglect in 2011, the most recentyear for which data was available, according to the Department of Health and Human Services. Besides death, thereare innumerate possible short- and long-term physical and mental healthrepercussions.
The Administration for Children andFamiliesdefines child abuse and neglect as "any recent act or failure toact on the part of a parent or caregiver that results in death, serious physicalor emotional harm, sexual abuse, exploitation, or an act or failure to act thatpresents an imminent risk for serious harm."
Laws vary from state to state,but in all states, clinicians who suspect abuse or neglect are required by lawto file a report with child welfare offices.
The USPSTF compiled a list offactors -- in large part from CDC literature -- associated with childmaltreatment, including but not limited to:
-- Young, single, ornonbiological parents
-- Parental history of abuse orneglect in family of origin
-- Family dysfunction orviolence
-- Substance abuse within thefamily
-- Social isolation, poverty, orother socioeconomic disadvantages
-- Parental stress anddistress
However, "the current evidenceis insufficient to assess the balance of benefits and harms of primary careinterventions to prevent child maltreatment," the task force said Monday. Therecommendation applies to children (aged newborn to 18 years) who do not havesigns or symptoms of maltreatment."
"The bottom line," said taskforce member and pediatrician Dr. David Grossman, "is that more research isneeded on how primary care clinicians can effectively screen and protect allpopulations, including older and vulnerable adults, middle-aged women, men, andchildren, from abuse and violence."