4-7 RISK FACTORS FOR VIOLENT DEATH OF WOMEN IN THE HOME
Murders of women have focused national attention on domestic violence and have led some to promote gun ownership for self-protection.
This study assessed risk factors for violent death in the home, and the association between domestic violence (and keeping firearms) and homicide and suicide in the home.
Women are most likely to be killed by someone they know, usually a spouse or an intimate acquaintance. A firearm is often used.
Women have lower suicide rates than men, even though they make more suicide attempts, because they are less likely to choose a gun. This may be particularly true among women who live alone, since most firearms are owned by men.
Conclusion: Instead of conferring protection, keeping a gun in the home is associated with increased risk of both suicide and homicide in women.

STUDY

1. Large population-based case-control study defined all cases of homicide and suicide (n=266) occurring in the homes of female victims.
2. Matched to randomly selected control subjects.
3. Exposures to potential risk factors were ascertained by interviewing proxies of victims and controls.

RESULTS

1. Firearms were involved in 46% of homicides and 42% of suicides. (The single most common manner of violent death in the home.)
2. For suicide independent risk factors included: a history of mental illness or depression (Odds Ratio = 259); living alone (OR = 13); having a gun in the home (OR = 4.6).
3. For homicide, independent risk factors included: living alone (OR = 5); illicit drug use by any member of the household (OR = 5); prior domestic violence (OR = 4); gun in the home (OR = 3.4); previous arrest of any member of the household (OR = 3).
4. The increased risk of homicide associated with domestic violence, firearms, or illicit drug or alcohol abuse was attributable to the homicides at the hands of a spouse, intimate acquaintance, or close relative.
5. Suicides occurred almost exclusively in white women. Homicide victims were disproportionately African American.
6. Only 4 female victims who were killed in their own home were known to have been killed by strangers.

DISCUSSION

1. 1. Domestic violence is strongly associated with homicide in the home.
2. 2. The presence of a gun (primarily hand guns) is linked to increased risk of domestic homicide.
3. 3. One fourth of intimate offenders killed themselves after killing the victim. The great majority of murder-suicides involved amorous jealousy by a spouse or intimate acquaintance. A gun was most commonly used. Assaults with a gun are far more likely to end in death than assaults involving knives or other means.
4. 4. Keeping a gun in the home was also associated with risk of suicide.
5. 5. Both suicide and homicide in the home involve a confluence of multiple risk factors. Many of these are amenable to intervention.
6. 6. "Our finding support efforts to identify and intervene in cases of battering and other forms of physical and mental abuse."
7. 7. Practitioners should be alert for signs or symptoms of domestic violence in women suffering from depression.
8. 8. Family members should be encouraged to store fire arms securely or remove them from households that have problems with domestic violence, substance abuse, or depression.
9. 9. Physicians can play an important role in preventing violent deaths by recognizing and addressing

risk factors for suicide and homicide. With accurate information and the will to act, many of these needless deaths can be prevented.

CONCLUSION
Mental illness, living alone, household use of illicit drugs, and prior domestic violence increase risk of violent death among women.
Keeping a gun in the house increases risk.
Archives Int. Med. April 14, 1997; 777-82 Original investigation first author from Univ. Of Tennessee, Memphis

Comment:
I believe this is a valid concern for primary care. Would not screening for gun possession in a large subset of patients be as rewarding as some other screening purposes? RTJ

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