Presentation on theme: "Jacquelyn Campbell PhD RN FAAN Anna D. Wolf Endowed Chair & Professor"— Presentation transcript:
1Intimate Partner Femicide: The 12 City Femicide Study With Femicide-Suicide Jacquelyn Campbell PhD RN FAANAnna D. Wolf Endowed Chair & ProfessorJohns Hopkins University School of NursingMulti City Intimate Partner Femicide Study Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156
2HOMICIDE IN BATTERING RELATIONSHIPS % OF US WOMEN KILLED BY HUSBAND, BF OR EX (vs. 5-8% of men) (9 times rate killed by a stranger)7th leading cause of premature death for US women; #2 cause of death-African & Native American women yoImmigrant women at increased risk in NYC (Wilt ’04)US – At least 2/3 of women killed – battered prior – if male killed – prior wife abuse in 75% of cases (Campbell, ‘92; Morocco et al, ‘98)More at risk when leaving or left (Wilson & Daly, ‘93; Campbell et. al. ’01; Websdale ‘99) – 1st 3 mos & 1st year - but eventually more safeWomen far more likely victims of homicide-suicide (29% vs.1% male-US–29.3 vs. 2.3%-Canada) 40% - Ontario (DVDRC ‘06)44-47% of women killed seen in health care system before killed (Sharps, Campbell ’02; Wadman & Muelleman ‘99)
3INTIMATE PARTNER FEMICIDE BY PERPETRATOR IN TEN CITIES (N= 311) (same sex intimate femicides – Glass et al., 2004)EX-BFOTHEREX-SPOUSEBOYFRIENDSPOUSE
5Decline in Intimate Partner Homicide and Femicide Decline in male victimization in states where improved DV laws and services - resource availability (Browne & Williams ’89; ’98, Dugan, Nagin, & Rosenfeld ‘99)Exposure reduction - increased female earnings, lower marriage rate, higher divorce rate (Dugan, Nagin & Rosenfeld ’99; Smith & Brewer ’90)Gun availability decline (Wilt ‘97; Block ‘95; Kellerman ‘93, ‘97- gun increases risk X3) – special issue of Evaluation Review ’06 – Sorenson, Special Editor
6Decrease by Race - Intimate Homicide Rate By Race Age 20-44 FBI, (SHR), 1976-96 A.A. FemaleA.A. MaleAnglo FemaleAnglo Male
7U.S. INTIMATE PARTNER HOMICIDE RATES & DOMESTIC VIOLENCE SERVICES (Resources per 50 million - Dugan, Nagin & Rosenfeld ‘03)
8INTIMATE PARTNER HOMICIDE: KILLED BY GUNS US ‘76-’02 (SHR) (>2/3 of intimates) With GunsWithout Guns
9Early work on FemicideDayton, OH study on IP homicide – 28 women & 26 men killed by intimate partners – prior DV in 66% of female cases; 75% of male (Campbell ‘81 & ’92)Several women seen in local ED’s before killedOthers – police called but nothing donePower and control issues clear in reportsFurther work developing and refining and testing Danger Assessment (Campbell ‘86; ’89; ‘92 - & ‘08)
10Femicide Risk Study (Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156) Purpose: Identify and establish risk factors for IP femicide – (over and above domestic violence)Significance: Determine strategies to prevent IP femicide – especially amongst battered women – Approximately half of victims (54% of actual femicides; 45% of attempteds) did not accurately perceive their risk – that perpetrator was capable of killing her &/or would kill her
13Case Control Design Data Source CASES - women who are killed by their intimate partnersPolice Homicide FilesProxy informantsCONTROLS - women who are physically abused by their intimate partners(second set of nonabused controls – for later analysis)Women themselves
14Addition of Attempted Femicides Data SourceCASES - women who are killed by their intimate partnersPolice Homicide filesProxy informantsCONTROLS - women who are physically abused by their intimate partnersWomen themselvesCASES - women who are ALMOST killed by their intimate partnersWomen themselves – to address issue of validity of proxy informationTherefore, our funding source advised that we include women who were ALMOST killed. This created a situation where we now had 2 groups of cases – femicides and attempted femicides.
15Definition: Attempted Femicide GSW or SW to the head, neck or torso.Strangulation or near drowning with loss of consciousness.Severe injuries inflicted that easily could have led to death.GSW or SW to other body part with unambiguous intent to kill.If none of above, unambiguous intent to kill.
16Increased in frequency Increased in severity Stalked PRIOR PHYSICAL ABUSE & STALKING EXPERIENCED ONR YEAR PRIOR TO FEMICIDE (N=311) & ATTEMPTED FEMICIDE (N=182)Femicide70%66%62%87%30%58%Attempted72%54%60%95%28%Prior physical abuseIncreased in frequencyIncreased in severityStalkedNo prior physical abuse
17INTIMATE PARTNER ABUSED CONTROLS (N = 356) Random sample selected from same cities as femicide and attempted femicide casesTelephone survey conducted 11/98 - 9/99 using random digit dialingWomen in household years old & most recently celebrated a birthdayWomen abused (including sexual assault & threats) by an intimate partner w/in 2 years prior – modified CTSSafety protocols followed
18Sample – (only those cases with prior physical abuse or threats) NumberFEMICIDE CASES220ATTEMPTED FEMICIDE CASES143ABUSED CONTROLS356Therefore, our funding source advised that we include women who were ALMOST killed. This created a situation where we now had 2 groups of cases – femicides and attempted femicides.
19Sociodemographic comparisons The graph shows the demographic differences between the femicide/attempted femicide victims and perpetrators and the abused control groups.Mean AgeFem/Att Perp = 36Abuse Perp = 31Fem/Att Victim = 34Abuse Victim = 29
20DANGER ASSESSMENT ITEMS COMPARING ACTUAL & ATTEMPTED FEMICIDE SURVIVORS (N=493) & ABUSED (WITHIN PAST 24 MONTHS) CONTROLS (N=427) (*p < .05)Att/Actual56%62%50%64%39%55%57%54%16%4.6Control24%18%10%16%12%23%14%22%2.4Physical violence increased in frequency*Physical violence increased in severity *Partner tried to choke victim *A gun is present in the house *Partner forced victim to have sex *Partner used street drugs *Partner threatened to kill victim *Victim believes partner is capable of killing her *Perpetrator AD Military History (ns.)Stalking score*
21VICTIM & PERPETRATOR OWNERSHIP OF WEAPON IN FEMICIDE (N = 311), ATTEMPTED FEMICIDE (N = 182), ABUSED CONTROL (N=427) & NON-ABUSED CONTROL (N=418) CASES2=125.6, P< .0001
22DANGER ASSESSMENT ITEMS COMPARING ACTUAL & ATTEMPTED FEMICIDE SURVIVORS (N=493) & ABUSED (WITHIN PAST 24 MONTHS) CONTROLS (N=427) (*p < .05)Att/Actual42%60%36%79%7%39%9%49%27%10.1%Control12%32%7.7%9%19%3%38%15%8.5%Partner is drunk every day *Partner controls all victim’s activities *Partner beat victim while pregnant *Partner is violently jealous of victim (says things like “If I can’t have you,no one can”)*Victim threatened/tried to commit suicidePartner threatened/tried to commit suicide *Partner is violent toward victim’s children*Partner is violent outside house*Partner arrested for DV* (not criminality)Partner hurt a pet on purpose
23Nonsignificant Variables of note Hurting a pet on purpose -10% of attempteds/actual victims vs. 8.5% of controlsBUT – some clear cases of using cruelty to a pet as a threat to killWAS a risk for women to be abused (compared with nonabused controls) (AOR = 7.59 – Walton-Moss et al ’05)AND more (but still not sign.) risk in attempted femicide sample – perhaps proxies not as knowledgeable about pets – warrants further investigationPerpetrator military history – 16% actual/attempteds vs. 22% of controls
24Risk ModelsFemicides with abuse history only (violence & threats) compared to abused controls (*N=181 femicides; 319 abused controls – total = 500 (18-50 yo only)Missing variablesvariables had to be excluded from femicide model due to missing responses – if don’t know – no – therefore underestimate riskLogistic Regression Plan – comparing cases & controlsModel variable in blocks – background characteristics – individual & couple, general violence related variables, violent relationship characteristics – then incident levelInteraction terms entered – theoretically derived
25Significant (p<.05) Variables (Entered into Blocks) before Incident (overall fit = 85% correct classification)Perpetrator unemployed OR = 4.4Perpetrator gun access OR = 5.4Perpetrator Stepchild OR = 2.4Couple Never Lived Together OR = .34Highly controlling perpetrator OR = 2.1Estranged X Low control (interaction) OR = 3.6Estranged X Control (interaction) OR = 5.5Threatened to kill her OR = 3.2Threatened w/weapon prior OR = 3.8Forced sex OR = 1.9Prior Arrest for DV OR = .34
26Femicide – Suicide Cases (32% of femicide cases in study – 29% US) Significant explanatory power for same femicide – suicide risk factors.Partner access to gunThreats with a weapon, chokingStep child in the homeEstrangementUnique to femicide – suicide:Partner suicide threats – history of poor mental healthMarriedSomewhat higher education levels (unemployment still a risk factor), more likely to be white, Hispanic or Asian (vs. African America) but not significant in multivariateIn this analysis significant explanatory power was achieved in identifying risk factors for femicide-suicide. General violence variables alone resulted in an r2 of Most notable among risk factors, based on magnitude of the odds ratio, werepartner access to a gun,threats with a weapon,and a stepchild in the household.Several risk factors emerged that were unique to femicide-suicides:Partner suicide threatsMarriedThe trigger of a new relationship.
27Multicity Femicide Study – Results related to pregnancy 25.8% of women killed reported abuse during pregnancy (vs. 8.4% of abused controls) – AOR = 3.813 women (4.2%) killed while pregnant – 11 of 13 abused in relationship before killedStepchild in home AOR = 2.48Results specific to pregnancy published: (McFarlane, Campbell et. al. ’02 OB/GYN, 100: 27-36; also Campbell, Webster et. al. AJPH ’03)
28From Public Health Perspective – Maternal Mortality Maternal mortality – Death from all causes during pregnancy & year after delivery or pregnancy terminationHomicide - leading cause of maternal mortality in US cities where measured (NYC, Chicago, DC) (Dannenberg, ’95; Krulewitch ‘01)Leading cause of maternal mortality in entire state of MD (Horon & Cheng, 2001) – 20% of deathsHas been neglected in maternal death reviews – (perpetrator data missing) & therefore programming in US but fatality reviews increasingSt. George – Washington Post – 12/ documented DV maternal mortalities since ’ per yr (vs DV femicides overall – 7%)
29Maternal Mortality Worldwide Homicide shown to be an important cause in other countries also – e.g. Mozambique, Bangaledesh (Fauveau & Koenig,’88)Maternal deaths in developing countries – ongoing and serious problem –e.g. in India – 13% of deaths of women – per 1000 live births (WHO) but % related to IP homicide not documented400 villages Maharastra State (Pune, Aurangabad & Ahmednagar districts) India – hand review of records16% of all deaths during pregnancy due to IPV; 70% of maternal deaths in region unrecorded & 41% of recorded deaths misclassified (Ganatra et. al. ’98)
30Lessons learnedImportance of proxy informants – otherwise NEVER get true incidence of prior DVImportance of hand search of police records – miss many cases otherwiseImportance of homicide-suicides – need for further studyImportance of maternal mortality – data base disconnectImportance of attempted femicides victims as sources of data
31Never forget who it’s for - “please don’t let her death be for nothing – please get her story told”(one of the Moms)