intimate partner femicide: the 12 city femicide study with femicide- suicide jacquelyn campbell phd...
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Intimate Partner Femicide: The 12 City Femicide Study With Femicide-
Suicide
Jacquelyn Campbell PhD RN FAANAnna D. Wolf Endowed Chair & Professor
Johns Hopkins University School of Nursing Multi City Intimate Partner Femicide Study
Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156
HOMICIDE IN BATTERING RELATIONSHIPSHOMICIDE IN BATTERING RELATIONSHIPS40 - 50% 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 15-34 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)
40 - 50% 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 15-34 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)
INTIMATE PARTNER FEMICIDE BY PERPETRATOR IN TEN CITIES (N= 311)
(same sex intimate femicides – Glass et al., 2004)
INTIMATE PARTNER FEMICIDE BY PERPETRATOR IN TEN CITIES (N= 311)
(same sex intimate femicides – Glass et al., 2004)
40.5%29.6%
8.0%
19.3%
2.6%
SPOUSEBOYFRIEND
EX-SPOUSE
EX-BF
OTHER
U.S. INTIMATE PARTNER HOMICIDE RATE U.S. INTIMATE PARTNER HOMICIDE RATE DECLINE 1976-06 DECLINE 1976-06 FBI (SHR, 1976-02; BJS ’05, ‘07)FBI (SHR, 1976-02; BJS ’05, ‘07)
U.S. INTIMATE PARTNER HOMICIDE RATE U.S. INTIMATE PARTNER HOMICIDE RATE DECLINE 1976-06 DECLINE 1976-06 FBI (SHR, 1976-02; BJS ’05, ‘07)FBI (SHR, 1976-02; BJS ’05, ‘07)
0
200
400
600
800
1000
1200
1400
1600
1800
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
2000
2002
2004
FEMALE
MALE
2004, 05 - no ex’s
Decline in Intimate Partner Homicide and FemicideDecline 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
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
Decrease by Race - Intimate Homicide Rate By Race Age 20-44 FBI, (SHR), 1976-96
Decrease by Race - Intimate Homicide Rate By Race Age 20-44 FBI, (SHR), 1976-96
0
5
10
15
20
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Anglo Male
Anglo FemaleA.A. Male
A.A. Female
U.S. INTIMATE PARTNER HOMICIDE RATES U.S. INTIMATE PARTNER HOMICIDE RATES & DOMESTIC VIOLENCE SERVICES 1976-9 & DOMESTIC VIOLENCE SERVICES 1976-9 (Resources per 50 million - Dugan, Nagin & Rosenfeld ‘03)(Resources per 50 million - Dugan, Nagin & Rosenfeld ‘03)
U.S. INTIMATE PARTNER HOMICIDE RATES U.S. INTIMATE PARTNER HOMICIDE RATES & DOMESTIC VIOLENCE SERVICES 1976-9 & DOMESTIC VIOLENCE SERVICES 1976-9 (Resources per 50 million - Dugan, Nagin & Rosenfeld ‘03)(Resources per 50 million - Dugan, Nagin & Rosenfeld ‘03)
0
500
1000
1500
2000
2500
3000
3500
4000
19
76
19
77
19
78
19
79
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
98
20
00
IP Homicides
Hotlines
Legal Advocacy
INTIMATE PARTNER HOMICIDE: KILLED BY GUNS US ‘76-’02 (SHR) (>2/3 of intimates)
INTIMATE PARTNER HOMICIDE: KILLED BY GUNS US ‘76-’02 (SHR) (>2/3 of intimates)
0
500
1000
1500
2000
2500
0
500
1000
1500
2000
2500
With Guns
Without Guns
Early 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 reports
Further work developing and refining and testing Danger Assessment (Campbell ‘86; ’89; ‘92 - & ‘08)
Femicide Risk Study(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)(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
RISK FACTORS FOR INTIMATE PARTNER RISK FACTORS FOR INTIMATE PARTNER FEMICIDE: RESEARCH TEAMFEMICIDE: RESEARCH TEAM(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)
RISK FACTORS FOR INTIMATE PARTNER RISK FACTORS FOR INTIMATE PARTNER FEMICIDE: RESEARCH TEAMFEMICIDE: RESEARCH TEAM(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)
R. Block, PhD (ICJA)D. Campbell, PhD, RN (FSU)J. McFarlane, DrPH, RN (TWU)C. Sachs MD, MPH (UCLA)P. Sharps, PhD, RN (GWU)Y. Ulrich, PhD, RN (UW)S. Wilt, PhD (NYC DOH)F. Gary, PhD, RN (UFl)
R. Block, PhD (ICJA)D. Campbell, PhD, RN (FSU)J. McFarlane, DrPH, RN (TWU)C. Sachs MD, MPH (UCLA)P. Sharps, PhD, RN (GWU)Y. Ulrich, PhD, RN (UW)S. Wilt, PhD (NYC DOH)F. Gary, PhD, RN (UFl)
M.A. Curry PhD, RN (OHSU)N. Glass, PhD, RN (OHSU)J. Koziol-McLain, PhD, RN (JHU)J.Schollenberger MPH (JHU)A. Kellerman, MD, MPH (Emory)X. Xu, MSN (JHU)Kathryn Chouaf, MSN (JHU)
M.A. Curry PhD, RN (OHSU)N. Glass, PhD, RN (OHSU)J. Koziol-McLain, PhD, RN (JHU)J.Schollenberger MPH (JHU)A. Kellerman, MD, MPH (Emory)X. Xu, MSN (JHU)Kathryn Chouaf, MSN (JHU)
RISK FACTORS FOR INTIMATE PARTNER FEMICIDE: RISK FACTORS FOR INTIMATE PARTNER FEMICIDE:
CITIES AND CO-INVESTIGATORSCITIES AND CO-INVESTIGATORS (Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)
RISK FACTORS FOR INTIMATE PARTNER FEMICIDE: RISK FACTORS FOR INTIMATE PARTNER FEMICIDE:
CITIES AND CO-INVESTIGATORSCITIES AND CO-INVESTIGATORS (Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)
BaltimoreChicagoHoustonKansas City, KA&MOLos AngelosNew YorkPortland, ORSeattle, WA Tampa/St. PeteWichita, KA
BaltimoreChicagoHoustonKansas City, KA&MOLos AngelosNew YorkPortland, ORSeattle, WA Tampa/St. PeteWichita, KA
P. Sharps (GWU)B. Block (ICJA)J. McFarlane (TWU)Y. Ulrich (UW)C. Sachs (UCLA)S. Wilt (NYDOH)M. A. Curry (OHSU)Y. Ulrich (UW)D. Campbell (FSU)Y. Ulrich (UW)
P. Sharps (GWU)B. Block (ICJA)J. McFarlane (TWU)Y. Ulrich (UW)C. Sachs (UCLA)S. Wilt (NYDOH)M. A. Curry (OHSU)Y. Ulrich (UW)D. Campbell (FSU)Y. Ulrich (UW)
Case Control DesignData Source
CASES - women who are killed by their intimate partners
Police Homicide FilesProxy informants
CONTROLS - women who are physically abused by their intimate partners
(second set of nonabused controls – for later analysis)
Women themselves
Addition of Attempted Femicides
Data Source
CASES - women who are killed by their intimate partners
Police Homicide filesProxy informants
CONTROLS - women who are physically abused by their intimate partners
Women themselves
CASES - women who are ALMOST killed by their intimate partners
Women themselves – to address issue of validity of proxy information
Definition: Attempted FemicideGSW 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.
PRIOR PHYSICAL ABUSE & STALKING EXPERIENCED ONR YEAR PRIOR TO FEMICIDE (N=311) & ATTEMPTED FEMICIDE (N=182)
PRIOR PHYSICAL ABUSE & STALKING EXPERIENCED ONR YEAR PRIOR TO FEMICIDE (N=311) & ATTEMPTED FEMICIDE (N=182)
Prior physical abuseIncreased in frequencyIncreased in severityStalked
No prior physical abuse Stalked
Prior physical abuseIncreased in frequencyIncreased in severityStalked
No prior physical abuse Stalked
Femicide Femicide
70%70%
66%66%
62%62%
87%87%
30% 30%
58%58%
Femicide Femicide
70%70%
66%66%
62%62%
87%87%
30% 30%
58%58%
AttemptedAttempted
72%72%
54%54%
60%60%
95%95%
28%28%
72%72%
AttemptedAttempted
72%72%
54%54%
60%60%
95%95%
28%28%
72%72%
INTIMATE PARTNER ABUSED CONTROLS (N = 356)
Random sample selected from same cities as femicide and attempted femicide cases Telephone survey conducted 11/98 - 9/99 using random digit dialingWomen in household 18-50 years old & most recently celebrated a birthday Women abused (including sexual assault & threats) by an intimate partner w/in 2 years prior – modified CTSSafety protocols followed
Sample – (only those cases with prior physical abuse or threats)
Number FEMICIDE CASES 220
ATTEMPTED FEMICIDE CASES 143
ABUSED CONTROLS 356
Sociodemographic comparisons
0
10
20
30
40
50
60
70
80
90
Af/Am Anglo Hispanic <HS Ed Job
Fem/Att. Perp
Abuse Perp
Fem/Att. Victim
Abuse Victim
Mean AgeFem/Att Perp = 36Abuse Perp = 31Fem/Att Victim = 34Abuse Victim = 29
DANGER ASSESSMENT ITEMS COMPARING ACTUAL & ATTEMPTED FEMICIDE SURVIVORS (N=493) & ABUSED (WITHIN PAST 24 MONTHS) CONTROLS (N=427) (*p < .05)
DANGER ASSESSMENT ITEMS COMPARING ACTUAL & ATTEMPTED FEMICIDE SURVIVORS (N=493) & ABUSED (WITHIN PAST 24 MONTHS) CONTROLS (N=427) (*p < .05)
Physical 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*
Physical 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*
Att/Actual
56%
62%
50%
64%
39%
55%
57%
54%
16%
4.6
Att/Actual
56%
62%
50%
64%
39%
55%
57%
54%
16%
4.6
Control
24%
18%
10%
16%
12%
23%
14%
24%
22%
2.4
Control
24%
18%
10%
16%
12%
23%
14%
24%
22%
2.4
VICTIM & PERPETRATOR OWNERSHIP OF WEAPON IN VICTIM & PERPETRATOR OWNERSHIP OF WEAPON IN FEMICIDE (N = 311), ATTEMPTED FEMICIDE (N = 182), FEMICIDE (N = 311), ATTEMPTED FEMICIDE (N = 182), ABUSED CONTROL (N=427) & NON-ABUSED CONTROL ABUSED CONTROL (N=427) & NON-ABUSED CONTROL (N=418) CASES(N=418) CASES
VICTIM & PERPETRATOR OWNERSHIP OF WEAPON IN VICTIM & PERPETRATOR OWNERSHIP OF WEAPON IN FEMICIDE (N = 311), ATTEMPTED FEMICIDE (N = 182), FEMICIDE (N = 311), ATTEMPTED FEMICIDE (N = 182), ABUSED CONTROL (N=427) & NON-ABUSED CONTROL ABUSED CONTROL (N=427) & NON-ABUSED CONTROL (N=418) CASES(N=418) CASES
15.7 14.6 16.915.6
74.1
52.9
26.8
12.7
0
10
20
30
40
50
60
70
80
Victim Perpetrator
FemicideAttemptedAbused controlNonabused control
2=125.6, P< .0001
DANGER ASSESSMENT ITEMS COMPARING ACTUAL & ATTEMPTED FEMICIDE SURVIVORS (N=493) & ABUSED (WITHIN PAST 24 MONTHS) CONTROLS (N=427) (*p < .05)
DANGER ASSESSMENT ITEMS COMPARING ACTUAL & ATTEMPTED FEMICIDE SURVIVORS (N=493) & ABUSED (WITHIN PAST 24 MONTHS) CONTROLS (N=427) (*p < .05)
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 suicide Partner 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
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 suicide Partner 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
Att/Actual
42%
60%
36%
79%
7%
39%
9%
49%
27%
10.1%
Att/Actual
42%
60%
36%
79%
7%
39%
9%
49%
27%
10.1%
Control
12%
32%
7.7%
32%
9%
19%
3%
38%
15%
8.5%
Control
12%
32%
7.7%
32%
9%
19%
3%
38%
15%
8.5%
Nonsignificant Variables of noteHurting a pet on purpose -10% of attempteds/actual victims vs. 8.5% of controls
BUT – 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 investigation
Perpetrator military history – 16% actual/attempteds vs. 22% of controls
Risk ModelsFemicides with abuse history only (violence & threats) compared to abused controls (*N=181 femicides; 319 abused controls – total = 500 (18-50 yo only) Missing variables
variables had to be excluded from femicide model due to missing responses – if don’t know – no – therefore underestimate risk
Logistic Regression Plan – comparing cases & controlsModel variable in blocks – background characteristics – individual & couple, general violence related variables, violent relationship characteristics – then incident level Interaction terms entered – theoretically derived
Significant (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
Femicide – 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 homeEstrangement
Unique 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 multivariate
Multicity 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 = 2.48 Results specific to pregnancy published: (McFarlane, Campbell et. al. ’02 OB/GYN, 100: 27-36; also Campbell, Webster et. al. AJPH ’03)
From 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 – 12/04 1237 documented DV maternal mortalities since ’90 - 88 per yr (vs. 1200+ DV femicides overall – 7%)
Maternal Mortality WorldwideHomicide 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 – 4-5.5 per 1000 live births (WHO) but % related to IP homicide not documented400 villages Maharastra State (Pune, Aurangabad & Ahmednagar districts) India – hand review of records
16% of all deaths during pregnancy due to IPV; 70% of maternal deaths in region unrecorded & 41% of recorded deaths misclassified (Ganatra et. al. ’98)
Lessons 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
Never forget who it’s for -
“please don’t let her death be for nothing – please get her story told”
(one of the Moms)