Risk Factors and Psychometric Properties of Intimate Partner Homicide Lethality Risk Assessment Tools: A Systematic Review Restricted; Files Only

Abstract

Background: Intimate partner homicide (IPH) is the most severe outcome of intimate partner violence (IPV) and a major public health concern globally. According to the United Nations Office on Drugs and Crime (UNODC) and UN Women, approximately 83,000 women and girls were intentionally killed in 2024, with nearly 60% — an estimated 50,000 — perpetrated by an intimate partner or family member.  Despite the existence of lethality risk assessment tools, the psychometric evidence supporting their use remains limited, inconsistent, and rarely validated against homicide-specific outcomes. 

Methods: A systematic review of six databases — PubMed, Embase, PsycINFO, Web of Science, CINAHL, and Global Health — was conducted to identify studies evaluating IPH risk factors and lethality risk assessment tools. Two reviewers independently screened studies against pre-established inclusion and exclusion criteria. The review was conducted in accordance with PRISMA 2020 guidelines. 

Results: Twenty-five studies met inclusion criteria, spanning 14 countries. Prior IPV or domestic violence history (n=13 studies), separation or threatened separation (n=13), and firearm access (n=16) were the most consistently identified IPH perpetration risk factors. Behavioral indicators — including controlling behavior, jealousy, and suicidal threats — appeared more consistently than static demographic characteristics. Nine lethality tools were identified; the Danger Assessment (DA) and DA-R20 were most frequently referenced. Psychometric evidence was uneven, with few studies reporting sensitivity, specificity, or area under the curve (AUC) values, and predictive validity for homicide outcomes was rarely evaluated. 

Discussion: Most instruments have not been validated against IPH outcomes specifically, and behavioral risk factors such as coercive control and escalating threats are rarely fully operationalized in existing tools. Evidence was concentrated in high-income Western settings, leaving significant gaps for low- and middle-income countries. Prospective validation against lethal outcomes and culturally responsive tool development are needed to strengthen IPH lethality risk identification globally. 

Keywords: intimate partner homicide, lethality risk assessment, femicide, risk factors, psychometric properties, systematic review 

Table of Contents

Tables of Tables and Figure Acronym List

Chapter 1: Introduction Introduction and Rationale Problem statement Purpose statement Significance statement

Chapter 2: Comprehensive Review of the Literature

Chapter 3: Manuscript

Introduction

Methods

Research Design

Study selection and sample

Method of searching

Eligibility Criteria

Study Selection

Data Extraction

Quality Assessment

Ethical considerations

Results

Introduction

Research Question 1: Risk Factors for Intimate Partner Homicide

Socioeconomic Factors Criminal and Violence

History Behavioral and Mental Health Factors

Weapon Access

Substance use

Situational Stressors

Other Risk Factors

Research Questions 2 and 3: Lethality Risk Assessment Tools and Psychometric Properties

Danger Assessment (DA)

Danger Assessment: Immigrant version (DA-I)

Danger Assessment: Lethality Extension (DA-LE)

Danger Assessment – 5 Item (DA-5)

Danger Assessment: Revised 20-items Version (DA-R20)

Lethality Screen Lethality Assessment Protocol (LAP)

H-Scale

Targeted Intimate Partner Violence Danger Assessment (TIPVDA)

Limitations

Discussion

References

Chapter 4: Public Health Implications

References

Annex 1

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	IPV IPH
Committee Chair / Thesis Advisor	Dabney P. Evans, Emory University

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