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

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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.