RISK-FACTORS FOR VIOLENT DEATH OF WOMEN IN THE HOME

Objectives: To determine risk factors for violent death of women in th e home, and particularly, to assess the strength and direction of any association between domestic violence or keeping firearms and homicide or suicide in the home.Methods: Subgroup analysis of a large populati on-based case-control study database was performed, defining cases as all homicides and suicides occurring in the homes of female victims in 3 metropolitan counties: Shelby County, Tennessee, King County, Washi ngton; and Cuyahoga County, Ohio. Randomly selected control subjects w ere matched to the victims by neighborhood, sex, race, and age range. Exposures to potential risk factors were ascertained by interviewing a proxy for the victim 3 to 6 weeks after the violent death occurred. T hese answers were compared with those obtained from controls using mat ched-pairs methods. Results: All cases (n=266) were identified in the 3-county area, including 143 homicides and 123 suicides, during a 5-ye ar period. Matching controls (n=266) were also identified. Firearms we re involved in 46% of the homicides and 42% of the suicides. Independe nt risk factors for suicide in the home included a history of mental i llness (odds ratio [OR], 258.8; 95% confidence interval [CI], 18.2-367 9.8),Living alone (OR, 13.4; 95% CI, 2.0-87.8), and having 1 or more g uns in the home (OR, 4.6; 95% CI, l.2-17.5). Independent risk factors for homicide included living alone (OR, 5.1; 95% CI, 2.0-13.2), illici t drug use by any member of the household (OR, 4.9; 95% CI, 1.1-15.9), prior domestic violence (OR, 4.0; 95% CI, 1.5-10.5), 1 or more guns i n the home (OR, 3.4; 95% CI, 1.6-7.1), and previous arrest of any memb er of the household (OR, 3.0; 95% CI, 1.3-6.6). The increased risk of homicide associated with domestic violence, firearms, or illicit drugs was attributable to the homicides at the hands of a spouse, intimate acquaintance, or close relative. Conclusions: Among women, mental illn ess and living alone increase the risk of suicide in the home, and hou sehold use of illicit drugs and prior domestic violence increase the r isk of homicide. Instead of conferring protection, keeping a gun in th e home is associated with increased risk of both suicide and homicide of women. Household use of illicit drugs, domestic violence, and readi ly available firearms place women at particularly high risk of homicid e at the hands of a spouse, an intimate acquaintance, or a close relat ive. Many factors place women at increased risk of violent death in th e home. Community- and clinic-based interventions should target those with identifiable risk factors.