Mandatory Reporting of Intimate Partner Violence: A Mixed Methods Systematic Review

Abstract

As one of the efforts to prevent intimate partner violence (IPV) and intimate partner homicide, countries have adopted legislation requiring professionals to report cases of IPV, or suspected IPV injuries, to the police or the criminal justice system. The term for this is mandatory reporting. In spite of its good intention, mandatory reporting of IPV is a controversial issue. The objective of this review was to systematically search for, appraise the quality of, and synthetize the evidence from quantitative and qualitative studies on mandatory reporting of IPV. A systematic review of the scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A comprehensive search was conducted through Ovid MEDLINE, PsycINFO, Scopus, Criminal Justice Abstracts, and SveMed+. Articles were included if they (a) were peer-reviewed empirical studies rather than theories or discussions, (b) described mandatory reporting of IPV, and (c) were written in English or Scandinavian languages. No time limit was applied. Twenty-five research studies met the criteria for review. Victims were generally supportive of a law requiring professionals to report IPV, although subsamples’ attitudes opposing mandatory reporting were presented as main findings in a substantial number of studies. Group differences between abused or nonabused women and knowledge about mandatory reporting of IPV among professionals was mixed and inconclusive. Few professionals had actually reported IPV under mandatory reporting. Empirical research appears to be scarce, with moderate to high degree of bias and with only limited recent development.

Keywords

mandatory reporting domestic violence professionals IPV victims intimate partner violence systematic review

As one of the efforts to protect individuals perceived to be at risk of harm, countries in different parts of the world have adopted legislation requiring professionals to report cases of IPV, or suspected IPV injuries, to the police or the criminal justice system. The most commonly used term for this is mandatory reporting (Jordan & Pritchard, 2018; A. Smith, 2000; World Health Organization [WHO], 2013). The purpose of mandatory reporting is to protect IPV victims from risk of harm, to relieve victims of having to report abusive partners themselves, and to improve the involvement of law enforcement and criminal justice response (Jordan & Pritchard, 2018; Rodriguez, Sheldon, & Rao, 2002). Furthermore, mandatory reporting sends a signal to abusive partners that IPV is a serious crime (A. Smith, 2000; WHO, 2013), and it establishes third-party documentation that may be critical to a criminal or civil legal action (Antle, Barbee, Yankeelov, & Bledsoe, 2010). Despite the legislation’s intention to protect, mandatory reporting of intimate partner violence (IPV) is a controversial issue. Supporters of the laws argue that mandatory reporting may increase victims’ safety by requiring professionals to report potential threats and thereby reduce the danger to victims (e.g., Antle et al., 2010). Critics argue that reporting requirements undermine victims’ autonomy and decision-making and may decrease willingness to disclose abuse and seek treatment for IPV injuries (e.g., Rodriguez et al., 2002). The authors conducted a review of the literature regarding this controversial issue to scrutinize the empirical evidence on mandatory reporting of IPV in the research literature.

Rationale

IPV comprises physical and sexual violence, stalking, and psychological aggression (including coercive tactics) by a current of former intimate partner (Breiding, Basile, Smith, Black, & Mahendra, 2015). An intimate partner is a person with whom one has a close personal relationship characterized by emotional connectedness, regular contact, ongoing physical and/or sexual contact, identity as a couple, and familiarity with each other’s lives (Breiding et al., 2015). The Centers for Disease Control and Prevention (2018) stresses that IPV is a “serious, preventable public health problem that affects millions of Americans.” Worldwide, almost one third of women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner (WHO, 2013). A systematic review of the global prevalence of intimate partner homicide, which obtained data from 169 countries, found that 13.5% of all homicides were committed by an intimate partner, and this proportion was 6 times higher for female homicides than for male homicides (Stöckl et al., 2013). Interpretations of these findings conclude that at least one in the seven homicides globally and more than a third of female homicides are perpetrated by an intimate partner. In addition, such violence commonly represents the culmination of a long history of IPV (Stöckl et al., 2013). Strategies to reduce intimate partner homicide risk include increased IPV prevention, structured professional risk assessments, awareness, and support for victims and perpetrators of IPV (Stöckl et al., 2013; Vatnar, Friestad, & Bjørkly, 2017).

Mandatory Reporting of IPV Controversy

The WHO (2013) concluded that mandatory reporting of IPV by health-care providers is not recommended. WHO maintains that the practice is not supported by evidence and claims that mandatory reporting would “impinge on women’s autonomy and decision-making” as it, particularly, “does not appear to be the preference for abused women.” Additional arguments opposing the laws include concerns that mandatory reporting may undermine the doctor–patient relationship and lead to retaliation by the abuser (Antle et al., 2010). Despite their recommendation against mandatory reporting of IPV by health-care providers, WHO characterizes the quality of evidence concerning this practice as very poor, thus indicating a need for further research.

Despite the claimed importance of mandatory reporting, on the one hand, and the controversies surrounding the practice, on the other, there are, to our knowledge, currently no systematic reviews of IPV victims’ and perpetrators’ attitudes toward mandatory reporting nor on medical personnel’s attitudes, knowledge, and compliance with the reporting requirements. As far as we know, the evidence for supporting or opposing mandatory reporting of IPV is mixed and inconclusive.

Objectives

The objective of this review was to systematically search for, appraise the quality of, and synthetize the evidence for empirical studies on mandatory reporting of IPV. The research questions were the following:

What is the extent of research on mandatory reporting of IPV?

What has existing research found concerning mandatory reporting of IPV? We investigated this question from the perspectives of both (a) IPV victims and (b) professionals.

What has existing research found concerning specific factors that support or oppose mandatory reporting of IPV?

Method

Protocol

A systematic review of the scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA) (Moher, Liberati, Tetzlaff, & Altman, 2009). The review protocol consists of background information, review questions, inclusion and exclusion criteria, electronic search strategy, identification of research evidence, study selection, data extraction, quality assessment, data synthesis, and dissemination. The procedure is described below. A more detailed description of the protocol can be obtained from the first author.

Eligibility Criteria

Inclusion criteria for study type

Articles were included if they (a) were peer-reviewed empirical studies (quantitative and qualitative) rather than theories or discussions, (b) described mandatory reporting of IPV, and (c) were written in English or Scandinavian languages. No time limit was applied. Studies were excluded if they described mandatory reporting of child abuse, elder abuse, other misdeeds, or reported IPV that is regulated by organizational rules or routines and not by state or national law enforcement.

Inclusion criteria for mandatory reporting

Studies were included if they presented separate analyses of mandatory reporting of IPV and were either (1) systematic reviews of empirical studies on this specific topic or (2) papers reporting individual studies that met the inclusion criteria.

Search

A comprehensive search was conducted through multiple databases including Ovid MEDLINE, PsycINFO, Scopus, Criminal Justice Abstracts, and SveMed+. Full electronic search strategy used for the database Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R) 1946 to Present. (1) Intimate Partner Violence/ or Domestic Violence/ or Spouse Abuse/ or Elder Abuse/ or Battered Women/ (2) ((partner* or domestic or spous* or woman or women or elder* or husband* or wife or wives or (significant and other*) or dating or relationship*) and (violen* or abus* or batter* or victim* or assault*)).ti. (3) (domestic violence or domestic abuse or spouse abuse or partner abuse or partner violence).ab. (4) (ipv or ipsa).ti, ab. (5) 1 or 2 or 3 or 4. (6) Mandatory Reporting/ (7) (reporting or reporter*).ti. (8) ((report or reports or reported or warn* or notif*) and (mandat* or duty or duties or designat* or oblig* or requir* or compulsory)).ti. (9) (mandat* and interven*).ti. (10) (mandatory report* or mandated report* or mandatory interven* or mandated interven*).ab. (11) (“duty to report” or “duties to report” or “duty to warn” or “duties to warn”).ab. (12) 6 or 7 or 8 or 9 or 10 or 11. (13) 5 and 12 (14) remove duplicates from 13. (15) limit 14 to (danish or english or norwegian or swedish). The full electronic search strategy used for the other databases can be obtained by request to the first author.

Information Sources

We conducted a systematic computer search on May 9, 2018, and an identical update search on January 11, 2019. The databases and resulting number of publications were as follows: Ovid MEDLINE, 647 publications; PsycINFO, 283; Scopus, 74; Criminal Justice Abstracts, 16; and SveMed+, 5. The total was 1,025 publications. After removal of duplicates, 860 original publications remained. After the study selection process, we conducted a hand search through the reference lists of the eligible articles for additional relevant articles.

Study Selection

References were recorded and managed in EndNote Version 8 (software). All studies were screened by title and abstract and key words (by the first author). If this step did not provide clear information that answered the eligibility questions, the full text was obtained. Both first and second author assessed full-text independent coding according to the following items: authors, year published, description of empirical study, discussion of mandatory reporting of IPV, inclusion of separate analyses for mandatory reporting of IPV, and whether it was a review study. Articles that were considered by consensus to meet the criteria were included in the review study.

Data Collection Process and Data Items

Each study was registered chronologically by a systematic assessment of the following items: authors, year, aim of the study, sample, methods, statistical analyses, and results. All results pertaining to mandatory reporting of IPV were registered. Based on a preliminary review, the categories used for registration were (1) female patients’ perspectives, (1a) IPV abused versus nonabused, (1b) supporting versus opposing mandatory reporting, (2) professionals’ perspectives (e.g., health-care providers, law enforcement providers, emergency departments, dental professionals, physicians, paramedics, clinicians), (2a) awareness, (2b) attitudes, (2c) and behavior.

Risk of Bias in Individual Studies

Each study was evaluated regarding design, strength of statistical analyses, degree distinctness of definitions, validity and reliability of measurements, number of participants, and sample characteristics. Bias and study limitations for quantitative studies were assessed at the outcome level by Hoy et al. (2012) Online Appendix 1: Risk of Bias Tool. Bias and Study Limitations for Qualitative Studies were monitored at the outcome level by using Tong, Sainsbury, and Craig (2007), Online Appendix 2: Consolidated Criteria for Reporting Qualitative (COREQ) studies.

Summary Measures

The quantitative studies were investigated, by two independent raters, for information on prevalence and for results from bivariate and multivariate variance analyses for group differences and associations between variables (linear and logistic regression). All findings with p ≤ .05 were registered as significant. The qualitative papers were examined by two independent raters for information about the analytical strategies, derivation of main themes, and the conclusions (Tong, Sainsbury, & Craig, 2007).

Synthesis of Results

All findings pertaining to mandatory reporting of IPV were classified as significant or insignificant associations. The results were separated in the discussion according to study type: studies of victims’ or patients’ attitudes to mandatory reporting of IPV and studies of professionals’ awareness, attitudes, and behaviors concerning mandatory reporting.

Risk of Bias Across Studies

We considered publication bias and whether some countries were disproportionately represented. We also looked for cultural context and location bias across the studies. Choice of study type, measurement, level of analyses, population, economic compensation, and group sizes were other possible risks of bias across studies. In small samples, the risk of statistical Type II errors increases. In such cases, we explored whether this risk was addressed and integrated into the interpretations and presentations of the actual findings.

Study Selection

The process of the selection of studies is presented in flow diagram (Figure 1). Among the 860 articles retrieved by the search, 15 were digitally listed with the term review in the title or key words. We excluded all 15 of these articles, either because they were not systematic reviews or did not meet other inclusion criteria. As there were no eligible systematic reviews, we proceeded to Step 2, original studies. Following the first author’s initial screening, 44 full-text articles were assessed by the first and second author independently. Of these 44 studies, 40 reported findings from original studies, and 4 were discussions of issues and cases with no empirical measurements provided. These were excluded. Among the remaining 40 papers, there were 37 that focused on mandatory reporting of domestic violence. Only 25 of these 37 included analyses that distinguished mandatory reporting for IPV, and these 25 were included in the present study (Table 1). The reference lists of the 25 articles were hand searched for additional relevant articles. None of the 11 full-text publications found by hand searches met the inclusion criteria.

Figure 1.

Flow diagram.

Table 1.

Summary of Reviewed Studies.

Authors	Purpose	Nature of Sample	Method	Statistical Analyses^a	Results^a
Allert, Chalkley, Whitney, and Librett (1997)	To improve the identification, treatment, and referral of domestic violence victims by prehospital care providers and emergency department (ED) personnel.	N = 213 ED staff, prehospital care providers	Evaluation of trainee program and guidelines. Pre- and posttest, and follow-up postsurvey (3 months later) to determine knowledge, attitudes, and procedure used to identify and treat domestic abuse victims.	Descriptive prevalence, %, t test to compare pre- and posttest	Regarding pretest: 27% not aware of the law (mandatory reporting). Posttest: 85% able to correctly identify injuries that should be reported under the law (t = 4.22; p = 1.9868, two-tailed; x = .05) In the pretest, 40% knew where to send a report; posttest 71% had learned that the injuries were reportable to law enforcement (t = 9.76; p = 1.968; two-tailed; x = .05) Of the 30% who posttest gave care to a patient injured from domestic violence, only 23% had reported the crime (posttest vs. follow-up, t = 2.08; p = 1.971; two-tailed; x = .05).
Antle, Barbee, Yankeelov, and Bledsoe (2010)	To evaluate the mandatory reporting law for domestic violence victims in the state of Kentucky.	N = 24 Female victims of domestic violence	Qualitative interview, phone. Structured interview guide developed for the study.	Descriptive and interpretive	Victims generally supported the law and professionals’ being required to report domestic abuse; did not feel a report put them at higher risk of revictimization or losing their children to child protective services. Those with children indicated reporting helped their children experience a safer home situation. Criticism of the process included the “secrecy” of contact, a simplistic conceptualization of family violence, and failure by police to act on the report.
Aved, Meyers, and Burma (2007)	Challenging dentistry to recognize and respond to family violence.	N = 1,213 Dental professionals	Evaluation of the Dental Professionals Against Violence Course, survey/posttests taken at the end of the training session.	Descriptive prevalence %, mean, and SD	The training generated a systematic change in how dental professionals viewed their role and responsibility relative to violence and neglect in their patients. Participants agreed that being a mandated reporter was an appropriate intervention for the dental profession. On a 4-point scale (4 = strongly agree), the mean response was 3.01 (SD = 1.15). No significant differences between dentist and other allied professionals. Most participants made no referrals for suspected domestic violence (97.4%) the previous 6 months. Re suspected domestic partner violence, nearly 99% did not file reports on these patients, and <1% indicated they filed one report.
Cho, Cha, and Yoo (2015)	To identify degree of awareness and legal knowledge about overall abuse and violence and investigate attitudes toward domestic violence in emergency nurses.	N = 131 Nurses in emergency units	Survey, questionnaire developed for the study (seven questions regarding mandatory reporting).	Descriptive prevalence %	70.2% knew they must report the discovery of abuse or violent incidents, but 45% did not know that having a duty to report meant being legally responsible. Of suspected abuse and violence cases not reported, 57.3% were for domestic violence. The most cited reasons for not reporting were “it was not severe and did not have sufficient evidence.” Nurses reported not knowing “where or how to report” or said because “of heavy workload, there is no time to report,” or because “it was considered a personal or family matter.” Only 7.6% had reported domestic violence. 35.1% not actual.
Coulter and Chez (1997)	To investigate abused women’s attitudes to laws that require a nurse or doctor to report mistreatment of women.	N = 45 Abused women	Self-administered questionnaire developed for the study, 5 items.	Descriptive prevalence %, Yates corrected analysis	80% stated that health professionals (HPs) should have to report cases of spouse or partner abuse or violence, 5% said they should not, and 17% didn’t know/did not answer. Medical doctors were seen as the ones who should report. About half would have gone to a doctor or health-care worker had they known they had to report, 9% wouldn’t have, and 40% didn’t know/weren’t sure. There was a significant correlation between positive attitudes to mandatory reporting and willingness to see doctor if mandatory reporting (51% of sample, Yates corrected analysis, p < .01). Over 50% felt a mandatory reporting law would have helped them in the past, 13% felt it would not, and 33% were not sure/did not know. 6% who felt that mandatory reporting would not have helped them changed their minds when given a list of possibilities. The most frequent response (53%) was: The reporting would teach my partner how serious abuse is. When asked how mandatory reporting could hurt them, 49% said it could make their partner angrier. Respondents were clearer about reporting helping others than they were about it helping themselves: 73% yes, 4% no, and 13% not sure. 76% would like a mandatory reporting law.^a
Feddock, Pursley, O’Brien, Griffith, and Wilson (2009)	To understand the attitudes of women clinic patients in Kentucky regarding mandatory reporting of IPV and how these attitudes may differ by abuser status.	N = 238 Women; 29% reported history of IPV	Anonymous 30-item questionnaire developed for the study, 1 item concerning mandatory reporting.	Descriptive prevalence %, logistic regression. No results reported by logistic regression	Of abused women, 48.5% supported mandatory reporting compared to 61.2% of women without abuse history (p = .05). 1.5% of abused women, indicated that doctors should never report versus 1.8% of nonabused women. 26.5% of abused women responded “unsure” versus 13.5% of nonabused women (p = .02). No demographic status was associated with opinion on mandatory reporting.^a
Gielen et al. (2000)	To describe women’s opinions and policy preferences concerning domestic violence screening and mandatory reporting.	N = 442 n = 202 abused women, n = 240 randomly selected control group, no history of abuse	Telephone interview, developed for the study, 5 items concerning mandatory reporting of IPV.	Logistic regression, multivariate	48% preferred it be the woman’s decision to report abuse to police; 73% thought it would be easier for abused women to get help with mandatory reporting, but 52% raised concerns re increases of risk. Two thirds thought women would be less likely to tell their health-care providers about abuse with mandatory reporting. In this table, re consequences of mandatory reporting, >70% of both abused and nonabused women would find it easier to get help and >80% would like someone else being responsible for calling the police. Table 3 (logistic regression) shows no significant group differences between abused versus nonabused concerning mandatory reporting. However, nonsignificant differences are reported as group differences in the results paragraph.^a
Glass, Dearwater, and Campbell (2001)	To provide clinical practice and recommendations for screening interventions for IPV in EDs settings.	N = 3,455 Women who came to the ED during 309 selected shifts	Anonymous survey, (18 items), including attitudes to mandatory reporting of IPV. Abstracted medical records.	Descriptive prevalence %	The majority (76–90%) agreed with the idea of health-care providers reporting IPV to the police. Women physically or sexually abused in the past year were less likely to support the practice (76% versus 90%, p < .01). Police were notified in 61% of cases involving acutely abused patients (n = 36).^a
Hayden, Barton, and Hayden (1997)	To survey women presenting to the ED and learn from them how best to identify and discuss issues of domestic violence	N = 243 n = 21 currently being abused, n = 109 were past victims	Anonymous 10-question survey, including attitudes to mandatory reporting of IPV.	Descriptive prevalence %	35% of respondents agreed or strongly agreed that they would not disclose IPV if they knew it had to be reported. Of past or current victims, 39% would not disclose IPV if they knew that ED personnel were required to report. 7% of victims agreed or strongly agreed that they would not disclose IPV even if asked whether they knew it had to be reported.
Houry, Feldhaus, Thorson, and Abbott (1999)	To investigate whether law of mandatory reporting deters IPV victims from seeking medical care.	N = 577 Ambulatory and ED patients (men and women)	Questionnaire given in three stages: (1) convenience time blocks at two ED and primary clinics, (2) prospective randomized blocks at inner-city ED, and (3) targeted group of women at risk of IPV. Focus interviews.	Descriptive prevalence %, group differences χ² test	55% were aware of the mandatory IPV reporting law, 43% were not, and 1% were unsure. There were no group differences re awareness. Re the law, 62% stated that it would not make a difference in their health-care–seeking behavior, 27% would be more likely to seek medical care, and 12% stated that they would be less likely to seek medical care for an IPV-related injury (15% men vs. 9% women, p = .001). There were no group differences in how a law of mandatory reporting of IPV would affect their decision to seek medical care for IPV-related injuries.
Lund (1999)	To learn whether law enforcement agencies in California have standard policies and procedures in place for responding to reports of IPV injuries from health practitioners and to describe the variation in policies and procedures across agencies.	N = 39 Police/sheriff departments	Survey, structured interview tool, and closed- and open-ended questions, 3 items.	Quantification/descriptive	Except two (who had never received this kind of report), all agencies reported having standard procedures for responding to HPs’ reports made by telephone. Written reports are handled differently. HP reports are a small portion of their overall IPV caseloads. EDs were the source of nearly all HP reports. No agency had procedures for counting or tracking this kind of report. Although the law requires both an immediate telephone report and a written report, less than one fourth of sampled agencies always receive both types. 79% stated that telephoned IPV reports could be an important component in their responses to domestic violence. Written HP reports do not fit into the usual response protocol for IPV situations. Because their protocols are best suited to situations requiring prompt dispatch of an investigation officer, only reports made by telephone can promote effective law enforcement.
Malecha et al. (2000)	To ascertain abused women’s perspectives on mandatory reporting of IPV.	N = 161 Abused women accessing the criminal justice system	Interview, six questions covering mandatory reporting of IPV.	Descriptive prevalence %	81% thought there should be a law making a nurse or doctor report abuse. 18% thought reporting should be the woman’s choice. 92% thought it would have been easier to get help with a mandatory report law. 78% would have liked someone else to call the police for her. 65% would be less likely to tell a nurse or doctor about an IPV. Less than half (45%) reported they would have been at greater risk of abuse following a mandatory report.^a
McDowell, Kassebaum, and Fryer (1994)	To evaluate dental practitioners’ recognition and reporting of child, elder, and spouse abuse.	N = 407 Dental practitioners	Survey developed for this study, sent to 1,000 Colorado dentists, 5 items covering mandatory reporting of physical IPV.	Descriptive prevalence %, group differences χ² test	3% have ever reported an IPV case to the police. 30% had considered that one of their patients might have been a spouse abuse victim. 76% did not know how to report a case of suspected spouse abuse. All except one of the dentists who reported at least one case were general dentists. Most were private practitioners from a metropolitan area.
Jordan and Pritchard (2018)	To query women about their own experiences with mandatory reporting laws, the factors that influenced women’s views were explored.	N = 388 Women who had sought services from domestic violence shelters (DVS)	Survey administered to 388 women who had sought services from one of Kentucky’s 15 regional DVS.	Descriptive prevalence %, mean, SD, logistic regression, and multivariate	Almost two in the five women would have been less likely to contact a DVS had they known in advance that a mandatory report would be made. 36.2% thought domestic violence should only be reported with consent of the victim; 35.7% were supportive of mandatory reporting in all cases. Only 7.1% opposed mandatory reporting outright; 12.3% responded “don’t know.” The only significant factor predicting supporting or opposing mandatory reporting was personal opinion about whether or not to talk to certain services about their abuse if mandatory reporting. Women supporting mandatory reporting were odds ratio (OR) = 4.332, confidence interval (CI) [1.472, 12.749], more likely to discuss DV with shelters if mandatory reporting, and OR = 8.201, CI [2.890, 23.273], more likely to discuss with therapist if mandatory reporting.
Rodriguez, Craig, Mooney, and Bauer (1998)	To explore abused women’s experiences with and perspectives on medical care.	N = 51 Abused women	Focus groups (eight groups).	Descriptive and interpretive	Regarding physician reporting Domestic Violence (DV) to police, five themes were identified: fear of retaliation by the abuser, fear of family separation, mistrust of the legal system, desire for police protection, and preference for confidentiality and autonomy in the patient–HP relationship.
Rodriguez, McLoughlin, Bauer, Paredes, and Grumback (1999)	To examine physicians’ perspectives on mandatory reporting of IPV to police.	N = 508 Stratified random sample of California physicians practicing emergency, family, and internal medicine and obstetrics/gynecology	Survey, questions covering mandatory reporting of IPV. Two scenarios used to assess tendency to comply with mandatory reporting law.	Descriptive prevalence %, analysis of variance, Pearson, logistic regression	Most physicians were aware of mandatory reporting legislation (61–86%) and had identified a patient experiencing IPV (74–99%). Emergency physicians showed greater awareness and experience than those in other specialties (p < .05 pairwise comparison with each of the other three specialties for each category). 59% (CI [55, 63]) said they might not comply with the reporting law if a patient objected. Primary care physicians reported lower compliance (p < .001 pairwise comparison with each of the other three specialties for each category). Primary care providers were OR = 2.4–3.8 times less likely than emergency physicians to comply when patients objected. Most agreed the legislation has potential risks may escalate violence or abuse (53–82%), violates confidentiality (59–85%), raises ethical concerns, and may provide benefits, prosecution of perpetrators (72–87%), and physicians’ responsiveness (53–73%). More than 90% agreed the following circumstances require reporting to police regardless of the law: children or guns in the home, pregnancy, obvious injuries or repeated complaints of partner abuse, or immediate threats to a patient’s safety.
Rodriguez, McLoughlin, Nah, and Campbell (2001)	To examine attitudes of female ED patients toward mandatory reporting of IPV injuries to police and how these attitudes may differ by abuse status.	N = 1,218 Women patients in 12 ED in California (a state with mandatory reporting law) and Pennsylvania (no such law)	Cross-sectional survey, 20 items	Descriptive prevalence %, χ² test logistic regression	Of abused women, 55.7% supported mandatory reporting and 44.3% opposed it (7.9% preferred physicians never report abuse to police and 36.4% physicians report only with patients’ consent). Among nonabused women, 70.7% supported mandatory reporting and 29.3% opposed. Patients currently seeing/living with partners (OR = 1.5, CI [1.1, 2.0]), non-English speakers (OR = 2.1, CI [1.4, 3.0]), and those who had experienced physical or sexual IPV in the last year (OR = 2.2, CI [1.6, 2.9]) had higher odds of opposing mandatory reporting of IPV injuries. There were no differences between California and Pennsylvania.^a
Rodriguez, Sheldon, and Rao (2002)	To examine abused women’s preferences regarding medical clinician reporting of IPV to police and the influence of specific demographic factors on abused women’s reporting preferences.	N = 734 Random sample of women patients attending from one of the three public primary care clinics, San Francisco Community Health Network	Telephone interview, questions designed for the current study, 5 items covering mandatory reporting of IPV.	Descriptive prevalence %, Pearson, χ² test, Fisher exact test, logistic regression	68% of the abused women did not prefer a mandatory domestic violence injury reporting system. But almost all (92%) favored some form of police reporting by medical clinicians. 32% favored mandatory reporting regardless of a patient’s wishes; 20% favored reporting every time, except when a patient objects; 40% favored reporting only in cases of life-threatening injuries. 3% said doctors should never report IPV to police. Women who had been abused in the past year, younger women, and English-speaking women were more likely to oppose mandatory reporting. On the basis of logistic regression, only current abuse predicted decreased likelihood to select mandatory reporting in all situations (OR = 0.341, CI [0.14, 0.83]). There were no differences by ethnicity, marital status, education, employment, or the presence of children at home.
Sachs, Koziol-McLain, Glass, Webster, and Campbell (2002)	To measure support for mandatory reporting of IPV among women.	N = 845 Women in 11 cities (427 abused and 418 nonabused)	Telephone survey, questions designed for the current study, 7 items covering mandatory reporting of IPV.	Descriptive prevalence %, χ² test, logistic regression (multivariate)	Abused women were less likely than nonabused women to support mandatory reporting (59% vs. 73%, p < .001). Support for mandatory reporting did not vary by age, employment, education, or whether there were children in the home. The six variables associated with mandatory reporting positions among abused women were, for Predictors of nonsupport, (1) Women’s resentment of loss of autonomy in notifying police (OR = 6.0, CI [3.7, 9.7]), (2) Partner is employed (OR = 2.1, CI [1.2, 3.8]), (3) Latina (OR = 2.0, CI [1.1, 3.5]), and (4) Would increase risk (OR = 1.8, CI [1.1, 3.0]); and, for Predictors of support, (1) Easier to get help (OR = 3.3, CI [1.9, 5.7]) and would like someone else to call (OR = 2.2, CI [1.4, 3.7]).^a
Sawyer, Parekh, Williams, and Williams (2014)	To evaluate the level of basic knowledge as well as self-reported preparedness and frequency of encountering IPV.	N = 50 Australian paramedics	Cross-sectional descriptive design, paper-based questionnaire, 1 item covering mandatory reporting of IPV.	Descriptive prevalence %	66% were unaware there is no mandatory reporting of IPV in their region. Only 44% correctly identified that there is no mandatory reporting of IPV in the region. 60% reported their last IPV case to police, 12% to hospital staff, and 10% to supervisor.
A. Smith (2000)	To report the views of battered women on mandatory arrest laws, no-drop policies, and mandatory medical reporting for doctors and nurses.	N = 241 Battered women who resided in battered women’s shelters	Survey, instrument.	Descriptive prevalence %	74% supported mandatory medical reporting requirements, 11% did not support the adoption of such requirements, 11% were unsure, 4% had no opinion, and 58% saw benefits for themselves and 65%, for others. Reported as group differences without any statistical testing. 52.5% thought mandatory reporting for medical personal would make it more likely to report future violence, 20% less likely, 16% no difference, and 11% not sure. Several group differences reported with no statistical tests.^a
A. Smith (2001)	To report battered women’s views re mandatory arrest, mandatory reporting by doctors and nurses, no-drop policies, confidentiality and privilege laws, court-victim advocate programs, and specialized domestic violence courts.	N = 93 Victims of IPV located in battered women shelters in a Midwestern state	Survey, 4 items covering mandatory reporting of IPV.	Descriptive prevalence %	72% supported the adoption of laws requiring doctors and nurses to inform police about suspected IPV injuries. 44% believed that mandatory reporting laws would increase the likelihood that women would seek medical treatment for domestic violence injuries. 22% believed it would decrease the chance of women seeking medical treatment in the future. 64.5% believed the laws would benefit others; 55%, themselves. Several group differences reported with no statistical tests.^a
A. Smith and Parsons Winokur (2004)	To explore battered women’s views re mandatory medical reporting laws controlling for and examining a variety of situational, demographic, and legal factors.	N = 316 Victims of domestic violence who resided in battered women shelters	Survey, paper, mailed for distribution in 45 states.	Logistic regression (multivariate)	The odds of supporting the law increased by a factor of 3.310 times if a battered woman had called police during her most recent victimization. Women from multiple abusive relationships were more likely to perceive the law as beneficial. Non-White, not single women were more likely to seek treatment in a community with mandatory reporting laws (OR = 2.4). Having a child also increased the OR that a battered woman would be willing to seek medical care in a jurisdiction with mandatory reporting laws (OR = 2.7). Having a prior history of abuse decreased the OR of seeking care (OR = 0.3). Women with extensive histories of physical IPV had increased likelihood of help seeking if mandatory reporting compared to women with fewer incidents of abuse. If a woman had called police during her most recent victimization: (OR = 2.2) Nagelkerke R ² = .277. Being abused by multiple partners increased the likelihood in one model, not including legal factors (OR = 2.0) Nagelkerke R ² = .231.
J. S. Smith, Rainey, Smith, Alamres, and Grogg (2008)	To discover barriers nurses faced in relation to mandatory reporting of domestic violence.	N = 184 Survey was sent to randomly chosen 1,000 nurses	Survey, quantitative, paper, 16 items covering mandatory reporting of domestic violence, including open-end questions.	Descriptive prevalence %, χ²	73 nurses (39.7%) had reported abuse; 108 had never. 49 nurses (27%) had suspected but had not reported domestic violence, citing “not enough evidence” as the most frequent reason (32.1%), with patient did not want episode recorded (16.5%), and nurse/patient confidentiality (9.2%) as the second and third most frequent reasons. Of the 73 respondents who reported abuse, 30 had personal experience with domestic violence and 37 had not (χ² = 13.54, p < .001).
Tilden et al. (1994)	To describe which factors influence clinicians’ decision-making about identifying abuse and intervening with victims.	N = 1,521 Random sample of practicing clinicians in six disciplines	Survey, mailed questionnaire, and designed for the current study.	Descriptive prevalence %, χ², logistic regression (multivariate)	Most clinicians agreed that they had to deal with domestic violence. Significant numbers of subjects did not see themselves as responsible for dealing with problems of family violence (dental hygienists, 45.9%; dentists, 47.3%; nurses, 13.3%; physicians, 15.4%; psychologists, 1.5%; and social workers, 2.6%), with a wide distribution among the professional disciplines. Subjects indicated low confidence in and low competence with mandatory reporting laws. Reporting was never the most common intervention for clinicians in any discipline when IPV. Attitudes toward mandatory reporting laws for spouse abuse found that 66% of dental hygienists, 55% dentists, 76% nurses, 56% physicians, 48% psychologists, and 68% social workers supported having a law. More women than men held this opinion (69% vs. 53%, p < .001). Logistic regression for the effect of educational level on attitudes re mandatory reporting showed that in the multivariate models, there was no significant effect of this variable.

Note. IPV = intimate partner violence. ED = emergency department.

^a We found errors in the calculation and/or reporting of the numerator and/or denominator in the original studies (Hoy et al., 2012).

In summary, Step 1 yielded no systematic reviews. Step 2 yielded 25 original empirical studies. A hand search resulted in 0 additional original studies. A total of 25 publications were thus included in the present study.

Results

Study Characteristics

The 25 studies were published between 1994 and 2018 (see Table 1). A majority of them (n = 23) used quantitative analyses or quantifications. Two studies used qualitative analyses. A total of 35 analysis units (range = 1–3 units of analysis per study) were found. One study used qualitative analysis of single-person interviews (Antle et al., 2010) and the other one focus group interviews (Rodriguez, Craig, Mooney, & Bauer, 1998). All except two studies, which came from Korea (Cho, Cha, & Yoo, 2015) and Australia (Sawyer, Parekh, Williams, & Williams, 2014), were conducted in the United States. Nine studies (36%) claimed they had conducted multivariate analyses (logistic regression analyses; Table 1). Still, only seven studies reported results from logistic regression analyses (Gielen et al., 2000; Jordan & Pritchard, 2018; Rodriguez, McLoughlin, Bauer, Paredes, & Grumback, 1999; Rodriguez, McLoughlin, Nah, & Campbell, 2001; Rodriguez et al., 2002; Sachs, Koziol-McLain, Glass, Webster, & Campbell, 2002; A. Smith & Parsons Winokur, 2004; Table 2). Twenty-three studies had a cross-sectional design, whereas two had a pre- and posttest evaluation of education programs (Allert, Chalkley, Whitney, & Librett, 1997; Aved, Meyers, & Burma, 2007). All eligible articles were published in English.

Table 2.

Attitudes, Awareness, Behavior, and Group Differences Regarding Mandatory Reporting of IPV.

Nature of Sample	Statistical Analyses	Authors (Year)	Results	Significant Results	Bias Estimate^a
A. Female (patients)
Abused versus nonabused
Women medical clinic	Descriptive prevalence %	Feddock, Pursley, O’Brien, Griffith, and Wilson (2009)	Of abused women, 48.5% supported mandatory reporting compared to 61.2% of women without abuse history (p = .05). 26.5% of abused women responded “unsure” versus 13.5% of nonabused women (p = .02).	Yes Omitted statistical test	2.5
Women survey health maintenance organization	Logistic regression	Gielen et al. (2000)	48% preferred it to be the woman’s decision to report abuse to police. 73% thought it would be easier for abused women to get help with mandatory reporting, although concerns were raised re increases of risk (52%). Two thirds thought women would be less likely to tell their health-care providers about abuse under mandatory reporting policy. Consequences of mandatory reporting: >70% of both abused and nonabused women responded that women would find it easier to get help; >80% would like having someone else be responsible for calling police. Logistic regression analyses: no significant group differences between abused versus nonabused concerning mandatory reporting.	No Nonsignificant differences reported as group differences in the results section.	5.0
Women EDs	Descriptive prevalence %	Rodriguez, McLoughlin, Nah, and Campbell (2001)	Of abused women, 55.7% supported mandatory reporting, 44.3% opposed mandatory reporting (7.9% preferred physicians never report abuse to police and 36.4% physicians report only with patient’s consent). Among nonabused women, 70.7% supported mandatory reporting and 29.3% opposed it.	No	4.0
Women population survey	Descriptive prevalence %, χ² test	Sachs, Koziol-McLain, Glass, Webster, and Campbell (2002)	Abused women were less likely to support mandatory reporting compared to nonabused women (59% vs. 73%, p < .01).	Yes	5.0
Supporting versus opposing mandatory reporting
Female victims of domestic violence	Qualitative Descriptive and interpretive	Antle, Barbee, Yankeelov, and Bledsoe (2010)	Victims generally supported the law and professionals being required to report domestic abuse; did not feel a report put them at higher risk of revictimization or losing their children to child protective services. Those with children indicated reporting that it helped their children experience a safer home situation. Criticism of the process included the “secrecy” of contact, a simplistic conceptualization of family violence, and failure by police to act on the report.		12^b
Women medical clinic	Logistic regression.	Feddock et al. (2009)	No demographic status was associated with opinion on mandatory reporting.	NoNo results reported by logistic regression	2.5
Women survey health maintenance organization	Descriptive prevalence %	Gielen et al. (2000)	48% preferred it to be the woman’s decision to report abuse to police. 73% thought it would be easier for abused women to get help with mandatory reporting, although concerns were raised about increases of risk (52%). Two thirds thought women would be less likely to tell their health-care providers about abuse under mandatory reporting policy. Consequences of mandatory reporting: >70% of both abused and nonabused women respond that women would find it easier to get help; >80% would like having someone else being responsible for calling the police.	No	5.0
Women sought DVS	Logistic regression	Jordan and Pritchard (2018)	Almost 2 in the 5 said they would have been less likely to contact a DVS whether they knew a report must be made. 36.2% said DV should only be reported with consent of the victim; 35.7% supported mandatory reporting in all cases. Only 7.1% opposed mandatory reporting outright; 12.3% responded “don’t know.” The only significant and influential factor predicting support for the current mandatory reporting law was their personal opinion about whether or not to talk to certain service providers about their abuse experiences. Women supporting mandatory reporting were odds ratio (OR) = 4.332, confidence interval (CI) = [1.472, 12.749] more likely to discuss DV with shelters if mandatory reporting, and OR = 8.201, CI [2.890, 23.273] more likely to discuss with therapist if mandatory reporting.	Yes	3.0
Abused women	Focus groups (eight groups) descriptive and interpretive	Rodriguez, Craig, Mooney, and Bauer (1998)	Regarding physician reporting DV to police, five themes were identified: fear of retaliation by the abuser, fear of family separation, mistrust of the legal system, desire for police protection, and preference for confidentiality and autonomy in the patient–HP relationship.		11^b
Women patients EDs	Logistic regression	Rodriguez et al. (2001)	Patients currently seeing/living with partners (OR = 2.1, CI [1.1, 2.0]), non-English speakers (OR = 2.1, CI [1.4, 3.0]) and those who had experienced physical or sexual IPV in the last year (OR = 2.2, CI 1.6, 2.9]) had higher odds of opposing mandatory reporting of IPV injuries.	Yes	4.0
Women patients public primary care clinics	Logistic regression	Rodriguez, Sheldon, and Rao (2002)	On the basis of logistic regression, only current abuse predicted decreased likelihood to select mandatory reporting in all situations (OR = 0.341, CI [014, 0.83]). There were no differences by ethnicity, marital status, education, employment, or the presence of children at home.	YesNo	3.0
Battered women shelters	Logistic regression (multivariate)	Smith & Parsons Winokur. (2004)	Non-White women who were not single (OR = 0.3) were more likely to seek treatment in a community with mandatory reporting laws (OR = 2.4). Having a child increased the OR that a battered woman would seek medical care in such a jurisdiction (OR = 2.7). Having a prior history of abuse decreased the OR of seeking care (OR = 0.3). An extensive history of physical IPV increased likelihood of help seeking if mandatory reporting compared to women with fewer incidents of abuse (categorical). If a battered women had called the police during her most recent victimization (OR = 2.2) increased likelihood of help seeking if mandatory reporting Nagelkerke R ² = .277. Being abused by multiple partners increased the likelihood in one model, not including legal factors (OR = 2.0) Nagelkerke R ² = .231.	YesOmitted statistical data (CI)	4.0
Women population survey	Logistic regression (multivariate)	Sachs et al. (2002)	The six variables associated with mandatory reporting positions among abused women were for predictors of nonsupport: (1) resentment of the loss of autonomy in notifying police (OR = 6.0, CI [3.7, 9.7]), (2) partner is employed (OR = 2.1, CI [1.2, 3.8]), (3) Latina (OR = 2.0, CI [1.1, 3.5]), (4) would increase risk (OR = 1.8, CI [1.1, 3.0]), for Predictors of support, (1) easier to get help (OR = 3.3, CI [1.9, 5.7]), (2) would like someone else to call (OR = 2.2, CI [1.4, 3.7]).Support for mandatory reporting did not vary by age, employment, education, or whether there were children in the home.	YesOmitted tablesNo	5.0
Abused women	Yates corrected analysis	Coulter and Chez (1997)	There was a significant correlation between positive attitudes to mandatory reporting and willingness to see doctor if mandatory reporting (51% of sample, Yates corrected analysis, p < .01).	Yes	1.0
Women ED	Descriptive prevalence %	Glass, Dearwater, and Campbell (2001)	Women physically or sexually abused in the past year were less likely to support the practice (76% vs. 90%, p < .01).	YesUnknown statistical test	3.5
Women ED	Descriptive prevalence %	Hayden, Barton, and Hayden (1997)	35% agreed or strongly agreed they would not disclose IPV if it had to be reported. Of past or current victims, 39% would not disclose IPV if ED personnel were required to report it. 7% of victims agreed or strongly agreed they would not disclose IPV even if asked if they knew it had to be reported.	No	2.5
Men and women patients	Descriptive prevalence %, χ² test	Houry, Feldhaus, Thorson, and Abbott (1999)	55% were aware of the mandatory IPV reporting law, 43% were not, and 1% were unsure. There were no group differences concerning awareness. 62% said the law would not make a difference in their health care–seeking behavior; 27% would be more likely to seek medical care because of this law.More men stated they would be less likely to seek medical care for an IPV-related injury because of this law (15% men vs. 9% women, p = .001). There were no group differences in how they said a mandatory reporting law of IPV would affect their decision to seek medical care for IPV related injuries.	NoYesNo	3.5
Abused women criminal justice system	Descriptive prevalence %	Malecha et al. (2000)	81% thought there should be a law making a nurse or doctor report abuse. 92% thought it would have been easier to get help with a mandatory report law. 78% would have liked someone else to call the police for them. 65% would be less likely to tell a nurse or doctor about the IPV. Less than half (45%) reported they would have been at greater risk of abuse following a mandatory report.	No	1.5
Abused women	Descriptive and interpretive	Rodriguez, McLoughlin, Bauer, Paredes, and Grumback (1999)	Re physician reporting domestic violence to police, five themes were identified: fear of retaliation by the abuser, fear of family separation, mistrust of the legal system, desire for police protection, and preference for confidentiality and autonomy in the patient-HP relationship.	No	5.0
Battered women’s shelters	Descriptive prevalence %	A. Smith (2000)	74% supported mandatory reporting requirements, 11% did not support adopting mandatory medical reporting, 11% were unsure; 4% no opinion. 58% perceived benefit for themselves if mandatory reporting; 65%, for others. 52.5% thought mandatory reporting for medical personal would make reporting future violence more likely; 20% less likely; 16% no difference; and 11% not sure.	NoGroup differences reported with no statistical tests.	2.5
Battered women’s shelters	Descriptive prevalence %	A. Smith (2001)	72% support adopting laws requiring doctors and nurses to inform police about possible IPV injuries. 44% believe mandatory reporting laws will increase the likelihood women will seek medical treatment for domestic violence injuries, 22% that it will decrease the chance of their seeking medical treatment. 64.5% women believe the laws will benefit others; 55% themselves.	NoGroup differences reported with no statistical tests.	3.0
B. Professionals
Awareness
Prehospital care and ED	Descriptive prevalence %, t test	Allert, Chalkley, Whitney, and Librett (1997)	Pretest, 27% were not aware of the law (mandatory reporting). Posttest, 85% were able to correctly identify injuries that should be reported under the law (t = 4.22; p = 1.9868, two-tailed; X = .05). Pretest, 40% knew where to report; posttest 71% had learned that the injuries were reportable to law enforcement (t = 9.76; p = 1.968; two-tailed, X = .05).	YesMixing p values and statistical outcomes.	5.0
Nurses emergency units	Descriptive prevalence %	Cho, Cha, and Yoo (2015)	72% knew they must report the discovery of abuse or violent incidents; 45% did not know that if someone who had a duty to report did not, she or he had a legal responsibility.	No	3.5
Dentists	Descriptive prevalence %	McDowell, Kassebaum, and Fryer (1994)	76% indicated that they did not know how to report a case of suspected spouse abuse.	No	3.5
Physicians practicing emergency, family, and internal medicine and obstetrics/gynecology	Descriptive prevalence %, χ² test	Rodriguez et al. (1999)	Most physicians (61–86%) had prior knowledge of mandatory reporting legislation and had identified a patient experiencing IPV (74–99%). Emergency physicians showed greater awareness and experience than those in other specialties (p < .05, pairwise comparison with each of the other three specialties for each category).	Yes	5.0
Paramedics	Descriptive prevalence %	Sawyer, Parekh, Williams, and Williams (2014)	66% were unaware there is no mandatory reporting of IPV in their region. Only 44% correctly identified there is no mandatory reporting of IPV in the region.	No	7.0
Clinicians in six disciplines	Descriptive	Tilden et al. (1994)	Subjects indicated low confidence in and low competence with mandatory reporting laws.	No	6.0
Attitudes
Dental professionals	Descriptive prevalence, mean, SD	Aved, Meyers, and Burma (2007)	Participants agreed that being a mandated reporter was an appropriate intervention for the dental profession. On a 4-point scale, with 4 as strongly agree, the mea response was 3.01 (SD = 1.15). There were no significant differences between dentists and other allied professionals.	No	6.0
Physicians practicing emergency, family, and internal medicine and obstetrics/gynecology	Logistic regression	Rodriguez et al. (1999)	59% (CI [5, 63]) reported they might not comply with reporting law if a patient objected. Primary care physicians reported lower compliance (p < .001 pairwise comparison with each of the other three specialties for each category). Primary care providers were (OR) 2.4–3.8 times less likely than emergency physicians to comply when patients objected.	Yes	5.0
	Logistic regression	Rodriguez et al. (1999)	Most agreed the legislation has potential risks, may escalate violence or abuse (53–82%), violates confidentiality (59–85%), raises ethical concerns, and may provide benefits, prosecution of perpetrators (72–87%), and physicians’ responsiveness (53–73%). More than 90% in each category agreed the following require reporting to police regardless of the law: children or guns in home, pregnancy, obvious injuries or repeated complaints of partner abuse, or immediate threats to patient’s safety.	No	5.0
Clinicians in six disciplines	Descriptive prevalence %, χ², logistic regression (multivariate)	Tilden et al. (1994)	The majority agreed they had to deal with domestic violence. Significant numbers did not agree (dental hygienists, 45.9%; dentists, 47.3%; nurses, 13.3%; physicians, 15.4%; psychologists, 1.5%; and social workers, 2.6%), with a wide distribution among professional disciplines. Re attitudes toward mandatory reporting for spouse abuse: 66% dental hygienists, 55% dentists, 76% nurses, 56% physicians, 48% psychologists, and 68% social workers supported having a law.	No	6.0
			More women than men held this opinion as well (69% vs. 53%, p < .001).	Yes
			Conducting logistic regression for the effect of education level on attitudes to mandatory reporting showed that in the multivariate models, there was no significant effect of this variable.	No
Behavior
Prehospital care and ED	Descriptive prevalence %, t test to compare pre- and posttest	Allert et al. (1997)	Of the 30% who posttest indicated they had given care to a patient injured during domestic violence, only 23% had reported the crime to law enforcement (posttest vs. follow-up, t = 2.08, p = 1.971, two-tailed, X = .05).	YesMixing p values and statistical outcomes.	5.0
Dental professionals	Descriptive prevalence, mean, SD	Aved et al. (2007)	The majority made no referrals for suspected domestic violence (97.4%). Regarding suspected domestic partner violence, nearly 99% did not file reports and <1% indicated they filed one report.	No	6.0
Nurses emergency units	Descriptive prevalence %	Cho et al. (2015)	Of suspected abuse and violence cases not reported, 57.3% were for domestic violence. The most cited reasons for not reporting were it was not severe and did not have sufficient evidence. Nurses also cited not knowing where or how to report; workload too heavy, no time to report, or considered it a personal or family matter. Only 7.6% had reported domestic violence. 35.1% not actual.	No	3.5
Dentists	Descriptive prevalence %, χ² test	McDowell et al. (1994)	3% had ever reported an IPV case to the police. 30% had considered one of their patients a possible victim of spouse abuse. 76% indicated they did not know how to report a case of suspected spouse abuse. Of those who reported at least one case, all except one were general dentists. The majority were private practitioners from a metropolitan area.	No	3.5
Nurses	Descriptive prevalence %, χ²	J. S. Smith, Rainey, Smith, Alamres, and Grogg (2008)	73 nurses (39.7%) had reported abuse; 108 had never. 49 nurses (27%) said they had suspected but didn’t report it, citing “not enough evidence” as the most frequent reason (32.1%). Reasons #2 and #3 were patient did not want episode recorded (16.5%) and nurse/patient confidentiality (9.2%). Of the 73 respondents who did report abuse, 30 had had personal experience with domestic violence, and 37 had not (χ² = 13.54, p < .001).	No	3.5
Nurses	Yes	J. S. Smith, Rainey, Smith, Alamres, and Grogg (2008)		No	3.5
Clinicians in six disciplines	Descriptive prevalence %	Tilden et al. (1994)	Reporting was never the most common intervention for clinicians in any discipline when IPV.	No	6.0
Police/sheriff departments	Quantification/descriptive	Lund (1999)	Except for two agencies (which had never received this kind of report), all reported having standard procedures for responding to HPs’ reports when a report was made by telephone. Written reports are not handled differently. HP reports are a small portion of their overall IPV caseloads. EDs were the source of nearly all HP reports. No agency had procedures for counting or tracking this kind of report. Although the law requires both an immediate telephone report and a written report, less than one fourth of the agencies always receive both types. Written HP reports do not fit into their usual response protocols for IPV situations. Because protocols are best suited to situations requiring prompt dispatch of an officer, only telephoned reports promote effective law enforcement.	No	3.5

Note. IPV = intimate partner violence.

^aBias estimate range 0–10: 0–3 = high risk of bias; 4–6 = moderate risk of bias; 7–10 = low risk of bias (Hoy et al., 2012). ^bBias estimate range 0–32 (Tong et al., 2007).

Sample sizes ranged from 24, in a qualitative study (Antle et al., 2010), to 3,455 (Glass, Dearwater, & Campbell, 2001). The smallest sample size in a quantitative study was 39 (Lund, 1999). In 16 studies, the population was female victims of IPV, and, in 8 of these, victims of IPV were compared to other female patient groups or other control groups. In 8 studies, the population was professionals: emergency department personnel; dental professionals; family, internal medicine, and obstetrics/gynecology doctors; paramedics; nurses; psychologists; or social workers. In one study, the population was police or sheriff responding to reports of IPV injuries from health practitioners (Lund, 1999). Race was reported in 15 studies, ranging from 20% (Malecha et al., 2000) to 83% White (Jordan & Pritchard, 2018). One of these 15 studies consisted of professionals (Rodriguez et al., 1999). Age was reported in 15 studies. Mean age of the participants ranged from 28.1 years (Cho et al., 2015) to 49 years (Feddock, Pursley, O’Brien, Griffith, & Wilson, 2009). One of these 15 studies consisted of professionals (Rodriguez et al., 1999).

Risk of Bias Within Studies

Bias and study limitations for quantitative studies were assessed at the outcome level by Hoy et al. (2012) Online Appendix 1: Risk of Bias Tool and for Qualitative Studies by Tong et al. (2007) Online Appendix 2: COREQ studies (Table 2). The results showed that the average measure reliability of Intraclass correlation (ICC) for two raters assessing 23 research (quantitative) studies was very high (ICC = .918, 95% confidence interval [.807, .965]). The average bias was moderate (M = 3.783); 1 study (4.3%; Sawyer et al., 2014) had low bias, 14 studies (60.9%) had moderate bias, and 8 studies (34.8%) had high bias. Seven studies indicated errors in the calculation and/or reporting of the numerator and/or denominator (Hoy et al., 2012; Table 2). The two qualitative studies (Antle et al., 2010; Rodriguez et al., 1998) obtained a score of 12 and 11 of a maximum score of 32, respectively (Tong et al., 2007).

Regarding measures of attitudes toward mandatory reporting, none of the studies used specific instruments to identify attitudes. All studies used questionnaires developed specifically for that study. None of the studies reported interrater reliability for the questionnaire tools. Attitudes were measured by items like the following: What do you feel/think/believe, view yourself as? Would it be more/less likely? Your opinion about, when, if ever, doctors should report? Would it prevent you from telling if mandatory reporting? Do you agree or disagree? Which one do you think is better? Should you have the right to, or would you have prevented? and the presentation of cases. Measures of attitudes toward mandatory reporting of IPV ranged from 1 single item (Feddock et al., 2009; Rodriguez et al., 2001; Sawyer et al., 2014) to 16 items (A. Smith & Parsons Winokur, 2004). However, some studies reported the number of items; others, the number of variables. Finally, conflating two or more mandatory policies (reporting, screening, arrest, no drop) in a study might affect the results (Gielen et al., 2000; Glass et al., 2001; A. Smith, 2000, 2001).

Results of Individual Studies

For presentation of all outcomes, see Table 2.

Synthesis of Results

This systematic literature review about mandatory reporting of IPV indicated, first, that IPV victims were generally supportive of the law that professionals should be required to report IPV. However, subsamples’ attitudes opposing mandatory reporting were presented as main findings in a substantial number of studies. Second, group differences between abused and nonabused women were mixed. Some studies found significant group differences regarding attitudes to mandatory reporting and consequences in help-seeking if mandatory reporting (e.g., current abuse, ethnicity, language, age, marital status, employment status, having children, multiple abusive relations, called the police, severity and frequency of IPV); others did not. In addition, some of the studies reporting group differences conducted analyses that included dependent variables. Third, knowledge about mandatory reporting of IPV among professionals was mixed and inconclusive. There were indications of group differences among professional disciplines and gender regarding compliance with mandatory reporting of IPV. Fourth, very few professionals had actually reported IPV under mandatory reporting. Fifth, none of the included studies investigated perpetrators’ attitudes to mandatory reporting of IPV. Finally, empirical research appears to be scarce, with moderate to high degree of bias and with only limited recent development: Six studies within the last 10 years, 2008–2019.

Victims’ attitudes to mandatory reporting of IPV

Four studies did statistical testing of the attitudes of abused versus nonabused women toward mandatory reporting of IPV. Two found a significant association (Feddock et al., 2009; Sachs et al., 2002); two did not (Gielen et al., 2000; Rodriguez et al., 2001). However, none of the studies that found significant differences conducted analyses adjusting for other group differences. Gielen et al. (2000), who conducted logistic regression analyses, did not find significant group differences.

Of the 15 studies that compared samples either supporting or opposing mandatory reporting, 8 found significant differences. Five of the 15 studies conducted logistic regression (Jordan & Pritchard, 2018; Rodriguez et al., 2001, 2002; Sachs et al., 2002; A. Smith & Parsons Winokur, 2004). Predictors of support were (1) non-White, (2) nonsingle, (3) had called the police during most recent victimization, (4) had been in multiple abusive relationships, (5) had children, and (6) extensive history of physical IPV (several incidents). Predictors of nonsupport were (1) living with perpetrator, (2) non-English speaker, (3) partner was employed, (4) Latina, (5) current IPV/IPV within the last year, and (6) prior history of IPV. Seven of the 15 studies were limited to descriptive analyses and results such as prevalence measured by %.

Professionals’ awareness, behavior, and attitudes to mandatory reporting of IPV

Nine studies conducted statistical testing of professionals’ awareness, behaviors, and attitudes. Two of these were evaluations of trainee programs for emergency department staff, prehospital care providers, and dental professionals (Allert et al., 1997; Aved et al., 2007). These studies found a significant increase of awareness and changing attitudes regarding mandatory reporting of IPV. Six studies did statistical testing of knowledge/awareness of mandatory reporting. Two of the six studies found significant results. However, neither of these two studies had conducted multivariate analyses. Three studies did statistical testing regarding professionals’ attitudes to mandatory reporting. Two studies had conducted logistic regression (Rodriguez et al., 1999; Tilden et al., 1994). One study found that primary care physicians reported lower compliance than other specialties (Rodriguez et al., 1999). However, education was not found to make a difference (Tilden et al., 1994). Eight studies did statistical testing of mandatory reporting behavior. Two studies found significant differences. However, none of these studies had conducted multivariate analyses. Only one descriptive study investigated whether the police/sheriff had standard procedures in place for responding to reports of IPV from health practitioners (Lund, 1999).

Risk of Bias Across Studies

Use of standard case definitions, of supporting or opposing mandatory reporting of IPV and awareness of mandatory reporting laws, is a key factor needed to ensure that information is collected in a systematic fashion. There were no explicit, uniform operational definitions of support for or opposition to mandatory reporting, nor of awareness of mandatory reporting laws. The risk of bias increased when all measurement scales and interview guides on mandatory reporting had been developed by the authors and not adequately validated prior to the investigation (Fellmeth, Heffernan, Nurse, Habibula, & Sethi, 2013). In addition, some measurements implied authors were having predefined values/attitudes about mandatory reporting in studies of help seekers: When, if ever, should doctors report? Would it prevent you from telling if doctors have mandatory reporting? If you knew in advance that your case would be reported, would you be less likely? Should you have the right to? Would you have prevented? The majority of studies had an acceptable sample size for the conducted analyses (Table 1). Only 36% of the studies conducted multivariate statistical testing. With descriptive and bivariate testing, it is not known if the group differences are significant or remain significant when adjusted for other group differences. Language bias arises because studies with statistically significant results conducted in non-English-speaking countries may be more likely to be published in English-language journals than those with nonsignificant results. Thus, as this review only reported on studies in English, our analysis may be based on fewer data.

Discussion

Summary of Evidence

Supporting versus opposing mandatory reporting

The most striking finding of this review is the scarcity of scientific research on mandatory reporting of IPV. The evidence on this issue is more limited than that on other efforts to prevent IPV. Even though WHO (2013) advised against mandatory reporting of IPV for clinicians and researchers, there has been limited scientific assessment of this practice to support this view. Although concerns are raised about mandatory reporting undermining victim autonomy (WHO, 2013) and reducing help-seeking, the included studies indicated victims generally were supportive of the law that professionals should be required to report IPV. Studies with results indicating abused women were less supportive of mandatory reporting were descriptive studies that did not adjust or control for other group differences between abused and nonabused women (Feddock et al., 2009; Sachs et al., 2002).

Awareness, attitudes, and behavior

The results of this review indicate that very few professionals or IPV victims have experiences with mandatory reporting of IPV, and several studies investigated awareness and attitudes toward it in populations that had no experience with it. Our results also indicate a moderate to high degree of bias within and across studies as well as limited recent research development on this topic. Above all, in several studies, we found indications of attitudes opposed to mandatory reporting among the researchers themselves: that is, systematic reporting of the statistical minorities who opposed mandatory reporting as being more significant than the statistical majorities who supported it, as well as interpreting the mandatory reporting laws as the major or only barrier to IPV help-seeking (Coulter & Chez, 1997; Jordan & Pritchard, 2018). Even analyses including dependent variables in the tested models were published as significant results (Jordan & Pritchard, 2018).

Women who supported mandatory reporting were more likely to discuss IPV with shelters or therapists whether there was mandatory reporting than women who were opposed to it. However, there were a few studies conducting multivariate analyses, controlling for group differences, that found significant contextual, sociodemographic, and IPV characteristics related to supporting versus opposing mandatory reporting of IPV (Rodriguez et al., 2001, 2002; Sachs et al., 2002; A. Smith & Parsons Winokur, 2004; Table 2). Some of these studies mixed dependent and independent variables in the models (Jordan & Pritchard, 2018; Sachs et al., 2002).

Pre- and posttests of professionals participating in courses indicated changes in awareness (Allert et al., 1997; Cho et al., 2015), but no changes in practicing mandatory reporting of IPV were measured. Similarly, studies of professionals asked about attitudes and awareness without including experiences with mandatory reporting (Allert et al., 1997; Aved et al., 2007; Cho et al., 2015; Rodriguez et al., 1999; Sawyer et al., 2014; Tilden et al., 1994). Some studies that included experiences with mandatory reporting of IPV indicated prevalence <10% (Aved et al., 2007; Cho et al., 2015; McDowell, Kassebaum, & Fryer, 1994). However, two studies found that 20–40% had reported abuse (Allert et al., 1997; J. S. Smith, Rainey, Smith, Alamres, & Grogg, 2008). The gap between attitudes and experiences might contribute to a vulnerable group not getting optimal and evidence-based treatment and risk assessment. Few studies measured professionals’ compliance with mandatory reporting laws (Rodriguez et al., 1999) or whether professionals regarded mandatory reporting as an appropriate intervention (Aved et al., 2007; Tilden et al., 1994). Moreover, the gap between victim support for mandatory reporting and limited professional experience or compliance with reporting might result in IPV victims not receiving the professional assistance they prefer.

Limitations

We may have missed studies of interest if they are not properly registered in the data bases by the search words we used. In addition, studies may have been overlooked if they have been published in less renowned journals, do not have the format of a scientific article, or are not published in the English or Scandinavian languages. The limited number of studies of mandatory reporting of IPV and the absence of the use of similar measurement tools in these investigations preclude making firm conclusions about patients’, abused women’s, women’s, or professionals’ attitudes, behaviors, or awareness of mandatory reporting of IPV. Furthermore, the suggested group differences and factors are far from establishing causal relationships. Finally, differences in the relevant legislation make comparisons across studies and countries difficult. The findings in this review offer no valid evidence for a major attitude, awareness, or behavior regarding mandatory reporting of IPV.

Most research still targets female victims, the main argument being that females suffer more severe consequences (Coker et al., 2002; Hines & Douglas, 2009) and seek help more frequently than male IPV victims. Only one study that included male patients was found (Houry, Feldhaus, Thorson, & Abbott, 1999), and no studies pertaining to perpetrators’ attitudes toward mandatory reporting of IPV were found in the search. There is no empirical evidence for generalizing to male victims or perpetrators of IPV from the current study.

Conclusions

Even though mandatory reporting of IPV was intended as a means of enhancing victims’ safety, preventing future violence, and improving the involvement of law enforcement and the criminal justice response, it has become a controversial issue. In this systematic literature review, we found 25 studies that investigated mandatory reporting of IPV. Our results indicated moderate to high degree of bias, and recent years have seen an increase neither in the number of research publications on mandatory reporting of IPV nor in the quality of empirical research. However, the WHO concluded that mandatory reporting of IPV by health-care providers is not recommended. The findings of our review did not provide empirical evidence supporting this advice. On the contrary, the results from the highest quality studies contradicted the WHO recommendation. If our findings are supported by further research, a vulnerable group might not achieve optimal and evidence-based treatment and risk assessment. Above all, we found some indications of attitudes opposing mandatory reporting among the researchers in several studies—that is, their systematically reporting findings of statistical minorities who opposed mandatory reporting as being more significant than those of statistical majorities who supported mandatory reporting of IPV, as well as mandatory reporting laws being the major or only barrier to IPV help-seeking. The gap between (1) strong attitudes, (2) limited awareness, and (3) scarce experience of mandatory reporting of IPV among professionals needs further investigation.

Summary of Critical Findings

Empirical research appears to be scarce with moderate to high degree of bias and few recent studies.

Victims were generally supportive of mandatory reporting laws. In spite of this, subsamples’ attitudes opposing mandatory reporting were presented as main findings in a substantial number of studies. Findings of group differences for attitudes between abused and nonabused women were inconclusive.

Knowledge about mandatory reporting of IPV among professionals was mixed and inconclusive. There were indications of group differences between professional disciplines and gender regarding compliance concerning mandatory reporting of IPV. Very few professionals had experiences with mandatory reporting of IPV.

None of the included studies investigated perpetrators’ attitudes to mandatory reporting of IPV.

Implications of Research, Practice, and Policy

Research

More empirical research is needed to ascertain whether mandatory reporting of IPV enhances victim safety and improves law enforcement.

Uniform operational definitions of supporting/opposing mandatory reporting and validated instruments are prerequisites for reliable and valid findings.

Practice

The gap between victim support of mandatory reporting and limited professional experience or compliance with reporting might result in IPV victims not receiving the professional assistance they prefer.

Policy

The findings in this review offer no valid evidence for the existence of a dominant attitude, awareness, or behavior regarding mandatory reporting of IPV.

Policy makers should put mandatory reporting on the educational agenda for the organizations that have professionals who are confronted with this challenge.

Supplemental Material

Supplemental Material, Appendix_2_Tong_2007 - Mandatory Reporting of Intimate Partner Violence: A Mixed Methods Systematic Review

Supplemental Material, Appendix_2_Tong_2007 for Mandatory Reporting of Intimate Partner Violence: A Mixed Methods Systematic Review by Solveig Karin Bø Vatnar, Kjartan Leer-Salvesen and Stål Bjørkly in Trauma, Violence, & Abuse

Supplemental Material

Supplemental Material, Hoy_et_al_2012_risk_of_bias_prevalence - Mandatory Reporting of Intimate Partner Violence: A Mixed Methods Systematic Review

Supplemental Material, Hoy_et_al_2012_risk_of_bias_prevalence for Mandatory Reporting of Intimate Partner Violence: A Mixed Methods Systematic Review by Solveig Karin Bø Vatnar, Kjartan Leer-Salvesen and Stål Bjørkly in Trauma, Violence, & Abuse

Footnotes

Acknowledgment

Acknowledgment is due to the skilled librarian of Oslo University Hospital, Norway, Marie Susannah Isachsen, for valuable help in the database search.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Solveig Karin Bø Vatnar

Supplemental Material

Supplemental material for this article is available online.

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