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James E. Bailey, MD, MPH; Arthur L. Kellermann, MD, MPH; Grant W. Somes, PhD; Joyce G. Banton, MS; Frederick P. Rivara, MD, MPH; Norman P. Rushforth, PhD

Arch Intern Med. 1997;157(7):777-782.

Abstract
Objectives
To determine risk factors for violent death of women in the 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 population-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, Washington; and Cuyahoga County, Ohio. Randomly selected control subjects were 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. These answers were compared with those obtained from controls using matched-pairs methods.

Results
All cases (n=266) were identified in the 3-county area, including 143 homicides and 123 suicides, during a 5-year period. Matching controls (n=266) were also identified. Firearms were involved in 46% of the homicides and 42% of the suicides. Independent risk factors for suicide in the home included a history of mental illness (odds ratio [OR], 258.8; 95% confidence interval [CI], 18.2-3679.8), living alone (OR, 13.4; 95% CI, 2.0-87.8), and having 1 or more guns in the home (OR, 4.6; 95% CI, 1.2-17.5). Independent risk factors for homicide included living alone (OR, 5.1; 95% CI, 2.0-13.2), illicit drug use by any member of the household (OR, 4.9; 95% CI, 1.3-15.9), prior domestic violence (OR, 4.0; 95% CI, 1.5-10.5), 1 or more guns in the home (OR, 3.4; 95% CI, 1.6- 7.1), and previous arrest of any member 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 illness and living alone increase the risk of suicide in the home, and household use of illicit drugs and prior domestic violence increase the risk of homicide. Instead of conferring protection, keeping a gun in the home is associated with increased risk of both suicide and homicide of women. Household use of illicit drugs, domestic violence, and readily available firearms place women at particularly high risk of homicide at the hands of a spouse, an intimate acquaintance, or a close relative. Many factors place women at increased risk of violent death in the home. Community- and clinic-based interventions should target those with identifiable risk factors.

Arch Intern Med. 1997;157:777-782

Author Affiliations
From the Departments of Preventive Medicine (Drs Bailey and Somes and Ms Banton) and Medicine (Dr Bailey), Division of General Internal Medicine, University of Tennessee, Memphis; Center for Injury Control, Rollins School of Public Health, Emory University, Atlanta, Ga (Dr Kellermann); Harborview Injury Prevention and Research Center, University of Washington, Seattle (Dr Rivara); and Department of Biology, Case Western Reserve University, Cleveland, Ohio (Dr Rushforth).

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