The study, published in the July 2003 issue of the American Journal of Public Health, finds that a combination of factors, rather than a single factor, increases the likelihood that a woman will be murdered by her partner.
Researchers identified and interviewed family members and acquaintances of 220 intimate partner femicide victims in 11 U.S. cities, along with 343 women who reported physical abuse during the past two years. The relatives and acquaintances were people knowledgeable about the murder victims' relationships with the partner. The interviews used an instrument created by Campbell called the Danger Assessment and included questions about the victim and the perpetrator, characteristics of the relationship, and details about the abuse, including the type, frequency and severity of violence.
Results of the study show that the abuser's lack of a job is the strongest social risk factor, increasing the risk of femicide fourfold. The abuser's access to a firearm increased the risk to more than five times, and threats to kill her and threats with a weapon also were strongly associated with homicide after taking the other factors into account.
The most common relationship factors that independently increased risk included a home with a stepchild of the abuser, an abuser's highly controlling behavior, and separation. The combination of controlling behavior and separation made femicide five times more likely.
"Such information can be useful in preventing these killings," says Campbell, principal investigator of the study. "In the United States, women are killed by intimate partners more often than by any other type of perpetrator, with the majority of these murders involving prior physical abuse. Determining key risk factors, over and above a history of domestic violence, that contribute to the abuse that escalates to murder will help us identify and intervene with battered women who are most at risk."
According to Campbell, results of the study suggest that steps such as increasing shelter services for battered women, increasing employment opportunities, and restricting abusers' access to guns can potentially reduce rates of femicide. She says health care professionals also play a critical role in identifying women at high risk.
When treating women who have been abused, Campbell recommends that health care professionals ask questions such as: Is your partner unemployed? Is he very controlling of your behavior all the time? Has he threatened you before? Is there a stepchild in the home? Is there a gun in the home? "These are all relatively simple questions that can help assess the level of risk," she says. "In cases of extreme danger, such as a situation where the abuser is highly controlling and the woman is preparing to leave him, it is important for practitioners to warn the woman not to confront the partner with her decision and to alert her of the risk of homicide and the need for shelter."
The study was supported by funding from the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the National Institute of Mental Health, the National Institutes on Aging, the Centers for Disease Control and Prevention, and the National Institute of Justice. Other authors include Daniel Webster, Sc.D., M.P.H., Phyllis Sharps, Ph.D., R.N., Janet Schollenberger, M.H.S., Jennifer Manganello, Ph.D., M.P.H., and Kathryn Laughon, M.P.H., from Johns Hopkins University, as well as Jane Koziol-McLain, Ph.D., R.N., Carolyn Block, Ph.D., Doris Campbell, Ph.D., R.N., Mary Ann Curry, Ph.D., R.N., Faye Gary, Ph.D., R.N., Nancy Glass, Ph.D., M.P.H., R.N., Judith McFarlane, Ph.D., R.N., Carolyn Sachs, M.D., M.P.H., Yvonne Ulrich, Ph.D., R.N., Susan A. Wilt, Dr.P.H., Xiao Xu, Ph.D., R.N., and Victoria Frye, M.P.H.
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