Homicide-suicide and the role of mental disorder: A national consecutive case series

PURPOSE:

There is a lack of robust empirical research examining mental disorder and homicide-suicide. Primary care medical records are seldom used in homicide-suicide research. The aims of this study were to describe the characteristics of offenders and victims; determine the prevalence of mental disorder and contact with mental health services and examine adverse events prior to the offence.

METHODS:

This was a mixed-methods study based on a consecutive case series of offences in England and Wales occurring between 2006 and 2008. 60 homicide-suicides were recorded. Data sources included coroner's records, police files, General Practice (GP) and specialist mental health records, and newspaper articles.

RESULTS:

The results show that most victims were spouse/partners and/or children. Most perpetrators were male (88 %) and most victims were female (77 %). The incidents were commonly preceded by relationship breakdown and separation. 62 % had mental health problems. A quarter visited a GP for emotional distress within a month of the incident. Few had been in recent contact with mental health services before the incident (12 %). Self-harm (26 %) and domestic violence (39 %) were common.

CONCLUSION:

In conclusion, GPs cannot be expected to prevent homicide-suicide directly, but they can reduce risk generally, via the treatment of depression and recognising the risks associated with domestic violence.

Full article at:   http://goo.gl/DwrChG

By:   Flynn S1, Gask L2, Appleby L3, Shaw J3.

• 1The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. sandra.m.flynn@manchester.ac.uk.
• 2Institute of Population Health, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
• 3The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. 
• Soc Psychiatry Psychiatr Epidemiol. 2016 Apr 16.

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A Longitudinal Study of Mental Health Symptoms in Young Prisoners: Exploring the Influence Of Personal Factors & the Correctional Climate

BACKGROUND:

Despite the high prevalence rate of mental health problems among young prisoners, little is known about the longitudinal course and covariates of their mental health symptoms during incarceration, especially the influence of the correctional climate. The current study aimed: (1) to examine changes in young prisoners' mental health symptoms during incarceration, (2) to identify personal factors associated with their mental health symptoms and perceptions of the correctional climate, and (3) to test the incremental effect of perceptions of the correctional climate on mental health symptoms.

METHODS:

Data were obtained from a sample of 75 youths (aged 17 to 22 years) detained in a Portuguese young offender prison. Data were gathered 1, 3, and 6 months after their admission in this facility. Socio-demographic, clinical and criminological variables were collected. Mental health symptoms and perceptions of the correctional climate were assessed through self-report assessment tools. Linear and logistic (multi-level) regressions and tests for differences between means were performed to analyze the data.

RESULTS:

Overall, mental health symptoms marginally declined by the sixth month in prison. Prisoners with a history of mental health treatment were more likely to have increased symptoms. Higher levels of mental health symptoms were associated with a history of mental health treatment, remand status, and a lower educational level. Better perceptions of the correctional climate were associated with Black race and participation in prison activities. A negative perception of the correctional climate was the strongest covariate of young prisoners' mental health symptoms and had incremental validity over that of personal variables.

CONCLUSIONS:

The results highlight that both characteristics of the prisoners and of the prison environment influence young prisoners' mental health. Prison management can try to reduce young prisoners' mental health problems by developing scientific procedures for their mental health assessment and creating a more beneficial correctional climate.

Level and Changes in Mental Health Symptoms over Time in Prison

	Month 1 (n = 70)	Month 3 (n = 58)	Month 6 (n = 49)
BSI Subscale	Mean (SD)	Mean (SD)	Mean (SD)	Mean difference/Contrast
Somatizationa	0.76 (0.82)	0.75 (0.74)	0.62 (0.70)	χ 2 = 6.70*
				M6 vs. M3*
Obsessive-compulsive	1.21 (0.70)	1.26 (0.81)	1.06 (0.78)	χ 2 = 6.97*
				M6 vs. M3*
Interpersonal sensitivitya	1.04 (0.83)	1.09 (0.77)	0.97 (0.86)	ns
Depression	1.28 (0.78)	1.26 (0.86)	1.12 (0.83)	ns
Anxietya	0.93 (0.79)	0.86 (0.72)	0.77 (0.71)	ns
Hostilitya	0.96 (0.69)	0.99 (0.89)	0.93 (0.74)	ns
Phobic anxietya	0.68 (0.67)	0.63 (0.67)	0.52 (0.65)	χ 2 = 5.88†
				M6 vs. M1†
Paranoid ideationa	1.25 (0.69)	1.34 (0.88)	1.31 (0.85)	ns
Psychoticisma	1.09 (0.78)	1.10 (0.77)	1.07 (0.89)	ns
GSIa	1.04 (0.63)	1.03 (0.65)	0.93 (0.65)	χ 2 = 5.87†
				M6 vs. M3†

Note. SD Standard deviation, M1 Month 1, M3 Month 3, M6 Month 6, ns not significant, BSI Brief Symptom Inventory, GSI Global Severity Index

a Distribution normalized through square root transformation. Descriptive statistics are based on the original data. Mean differences analyses are based on the transformed variables

† p < .10, * p < .05, two-tailed

Full article at:   http://goo.gl/FbBGHB

By:  Gonçalves LC1, Endrass J2,3, Rossegger A1,4, Dirkzwager AJ5.

• 1Department of Mental Health Services, Office of Corrections, Canton of Zurich, Hohlstrasse 552, P.O. Box 8090, Zurich, Switzerland.
• 2Department of Mental Health Services, Office of Corrections, Canton of Zurich, Hohlstrasse 552, P.O. Box 8090, Zurich, Switzerland. Jerome.Endrass@uni-konstanz.de.
• 3Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464, Konstanz, Germany. Jerome.Endrass@uni-konstanz.de.
• 4Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464, Konstanz, Germany.
• 5Netherlands Institute for the Study of Crime and Law Enforcement, 71304, 1008 BH, Amsterdam, Netherlands. 
• BMC Psychiatry. 2016 Apr 6;16(1):91. doi: 10.1186/s12888-016-0803-z.

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The Use of a Brief Mental Health Screener to Enhance the Ability of Police Officers to Identify Persons with Serious Mental Disorders

Police agencies in Canada and elsewhere have received much criticism over how they respond to persons with serious mental disorders. The adequacy of training provided to police officers on mental health issues and in particular on recognizing indicators of serious mental disorders has been a major concern. 

This paper describes the process that led to the development of a new brief mental health screener (interRAI Brief Mental Health Screener, BMHS) designed to assist police officers to better identify persons with serious mental disorders. The interRAI BMHS was developed in collaboration with interRAI, an international, not-for-profit consortium of researchers. The government of Ontario had previously partnered with interRAI to develop and implement the Resident Assessment Instrument for Mental Health (RAI-MH), the assessment system mandated for use on all persons admitted into inpatient psychiatric care in the province. Core items on the interRAI BMHS were obtained through analysis (N=41,019) of RAI-MH data together with input from representatives from health care, police services, and patient groups. 

Two police services in southwestern Ontario completed forms (N=235) on persons thought to have a mental disorder. Patient records were later accessed to determine patient disposition. The use of summary and inferential statistics revealed that the variables significantly associated with being taken to hospital by police included performing a self-injurious act in the past 30days, and others being concerned over the person's risk for self-injury. Variables significantly associated with being admitted included abnormal thought process, delusions, and hallucinations. 

The results of the study indicate that the 14-variable algorithm used to construct the interRAI BMHS is a good predictor of who was most likely to be taken to hospital by police officers and who was most likely to be admitted. The instrument is an effective means of capturing and standardizing police officer observations enabling them to provide more and better quality information to emergency department (ED) staff. 

Teaching police officers to use the form constitutes enhanced training on major indicators of serious mental disorders. Further, given that items on the interRAI BMHS are written in the language of the health system, language acts as common currency between police officers and ED staff laying the foundation for a more collaborative approach between the systems.

Full article at:   http://goo.gl/4FA5EB

By:  Hoffman R1, Hirdes J2, Brown GP3, Dubin JA4, Barbaree H5.

• 1Ministry of Community Safety and Correctional Services, Ontario Police College, 10716 Hacienda Road, Aylmer, Ontario N5H 2T2, Canada; Faculty of Applied and Professional Studies, School of Criminology and Criminal Justice, Nipissing University, 100 College Drive, Box 5002, North Bay, Ontario P1B 8L, Canada. Electronic address: Ron.Hoffman@sympatico.ca.
• 2School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada.
• 3Faculty of Applied and Professional Studies, School of Criminology and Criminal Justice, Nipissing University, 100 College Drive, Box 5002, North Bay, Ontario P1B 8L7, Canada.
• 4Department of Statistics and Actuarial Science, School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada.
• 5Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R, Canada; Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, Ontario L9M 1G3, Canada. 
• Int J Law Psychiatry. 2016 Apr 1. pii: S0160-2527(16)30044-9. doi: 10.1016/j.ijlp.2016.02.031.

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Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: A retrospective, descriptive study

Objectives

To identify patterns in euthanasia requests and practices relating to psychiatric patients; to generate recommendations for future research.

Design

Retrospective analysis of data obtained through medical file review.

Setting

Outpatient psychiatric clinical setting in the Dutch-speaking region of Belgium, between October 2007 and December 2011; follow-up at the end of December 2012.

Participants

100 consecutive psychiatric patients requesting euthanasia based on psychological suffering associated with psychiatric disorders (77 women, 23 men; mean age 47 years; age range 21–80 years).

Main outcome measures

Patient sociodemographic characteristics; diagnoses; decisions on euthanasia requests; circumstances of euthanasia procedures; patient outcomes at follow-up.

Results

Most patients had been referred for psychiatric counselling by their physician (n=55) or by LEIF (Life End Information Forum) (n=36). 90 patients had >1 disorder; the most frequent diagnoses were depression (n=58) and personality disorder (n=50). 38 patients required further testing and/or treatment, including 13 specifically tested for autism spectrum disorder (ASD); 12 received an ASD diagnosis (all Asperger syndrome). In total, 48 of the euthanasia requests were accepted and 35 were carried out. Of the 13 remaining patients whose requests were accepted, 8 postponed or cancelled the procedure, because simply having this option gave them enough peace of mind to continue living. In December 2012, 43 patients had died, including 35 by euthanasia; others died by suicide (6), palliative sedation (1) and anorexia nervosa (1).

Conclusions

Depression and personality disorders are the most common diagnoses in psychiatric patients requesting euthanasia, with Asperger syndrome representing a neglected disease burden. Further research is needed, especially prospective quantitative and qualitative studies, to obtain a better understanding of patients with psychiatric disorders who request euthanasia due to unbearable psychological suffering.

Below:  Frequency of age in 100 psychiatric patients who requested euthanasia, by gender

Full article at:   http://goo.gl/6fSQex

By:  Lieve Thienpont,1 Monica Verhofstadt,2 Tony Van Loon,3 Wim Distelmans,3 Kurt Audenaert,4 and Peter P De Deyn5,6,7

¹University Hospital Brussels, Brussels, Belgium

2MSc student at the Open University of the Netherlands, Heerlen, The Netherlands

3Free University of Brussels, Brussels, Belgium

4Department of Psychiatry, Ghent University Hospital, Ghent, Belgium

5University of Antwerp, Institute Born-Bunge, Wilrijk, Belgium

6University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

7

²MSc student at the Open University of the Netherlands, Heerlen, The Netherlands

³Free University of Brussels, Brussels, Belgium

⁴Department of Psychiatry, Ghent University Hospital, Ghent, Belgium

⁵University of Antwerp, Institute Born-Bunge, Wilrijk, Belgium

⁶University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

⁷Middelheim General Hospital, ZNA, Antwerp, Belgium

1University Hospital Brussels, Brussels, Belgium

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Sexual Orientation & Symptoms of Common Mental Disorder or Low Wellbeing: Combined Meta-Analysis of 12 UK Population Health Surveys

BACKGROUND:

Previous studies have indicated increased risk of mental disorder symptoms, suicide and substance misuse in lesbian, gay and bisexual (LGB) adults, compared to heterosexual adults. Our aims were to determine an estimate of the association between sexual orientation identity and poor mental health and wellbeing among adults from 12 population surveys in the UK, and to consider whether effects differed for specific subgroups of the population.

METHODS:

Individual data were pooled from the British Cohort Study 2012, Health Survey for England 2011, 2012 and 2013, Scottish Health Survey 2008 to 2013, Longitudinal Study of Young People in England 2009/10 and Understanding Society 2011/12. Individual participant meta-analysis was used to pool estimates from each study, allowing for between-study variation.

RESULTS:

Of 94,818 participants, 1.1 % identified as lesbian/gay, 0.9 % as bisexual, 0.8 % as 'other' and 97.2 % as heterosexual. Adjusting for a range of covariates, adults who identified as lesbian/gay had higher prevalence of common mental disorder when compared to heterosexuals, but the association was different in different age groups: apparent for those under 35 (OR = 1.78, 95 % CI 1.40, 2.26), weaker at age 35-54.9 (OR = 1.42, 95 % CI 1.10, 1.84), but strongest at age 55+ (OR = 2.06, 95 % CI 1.29, 3.31). These effects were stronger for bisexual adults, similar for those identifying as 'other', and similar for 'low wellbeing'.

CONCLUSIONS:

In the UK, LGB adults have higher prevalence of poor mental health and low wellbeing when compared to heterosexuals, particularly younger and older LGB adults. Sexual orientation identity should be measured routinely in all health studies and in administrative data in the UK in order to influence national and local policy development and service delivery. These results reiterate the need for local government, NHS providers and public health policy makers to consider how to address inequalities in mental health among these minority groups.

• Adults identifying as lesbian, gay, bisexual or ‘other’ are at increased risk of poor mental health and low wellbeing compared to those identifying as heterosexual.
• The association varies across the life course, with the lowest relative risks seen in midlife and the highest among older adults
• Our study used cross-sectional data suitable for estimating prevalence, but future studies should consider longitudinal patterns (such as onset and persistence of new mental health problems) and clarify mechanisms

Full article at:  http://goo.gl/c6MrVB

By:  Semlyen J1, King M2, Varney J3, Hagger-Johnson G4.

• 1Department of Psychology, London Metropolitan University, London, UK.
• 2Division of Psychiatry, UCL, London, UK.
• 3Public Health England, London, UK.
• 4Administrative Data Research Centre for England (ADRC-E), Farr Institute, UCL, London, NW1 2DA, UK. G.Hagger-Johnson@ucl.ac.uk.
• BMC Psychiatry. 2016 Mar 24;16(1):67. doi: 10.1186/s12888-016-0767-z. 

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Association of Lifetime Mental Disorders and Subsequent Alcohol and Illicit Drug Use: Results From the National Comorbidity Survey-Adolescent Supplement

OBJECTIVE:

To estimate the association of prior lifetime mental disorders with transitions across stages of substance use in a cross-sectional, nationally representative sample of US adolescents.

METHOD:

The sample includes 10,123 adolescents aged 13 to 18 years who participated in the National Comorbidity Survey-Adolescent Supplement (NCS-A), and who were directly interviewed with the Composite International Diagnostic Interview (CIDI) Version 3.0 that generates criteria for DSM-IV disorders.

RESULTS:

Adolescents with prior lifetime mental disorders had high rates of both alcohol (10.3%) and illicit drug (14.9%) abuse, with or without dependence. Alcohol and drug abuse were highest among adolescents with prior anxiety disorders (17.3% and 20%, respectively) and behavior disorders (15.6% and 24%, respectively). Any prior disorder significantly increased the risk of transition from nonuse to first use, and from use to problematic use of either alcohol or illicit drugs. Multivariate models attenuated the magnitude of the risk of transition associated with each disorder, although prior weekly smoking and illicit drug use demonstrated significant risks of transitions across the 3 stages of alcohol or drug use, as did behavior disorders.

CONCLUSION:

The findings provide the first evidence from a nationally representative sample that prior mental disorders represent risk factors for the transition from nonuse to use, and the progression to drug- and alcohol-related problems. Treatment of primary mental disorders is likely to be an important target for the prevention of secondary substance use disorders in youth.

Purchase full article at:   http://goo.gl/vK1AQ9

By:  Conway KP1, Swendsen J2, Husky MM3, He JP4, Merikangas KR5.

• 1Division of Epidemiology, Services and Prevention Research at the National Institute on Drug Abuse (NIDA), Rockville, MD.
• 2École Pratique des Hautes Études (EPHE), Paris, the National Center for Scientific Research (CNRS), Paris, and University of Bordeaux, France.
• 3University of Paris Descartes, Paris.
• 4Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health (NIMH), Bethesda, MD.
• 5Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health (NIMH), Bethesda, MD. Electronic address: merikank@mail.nih.gov. 
• J Am Acad Child Adolesc Psychiatry. 2016 Apr;55(4):280-8. doi: 10.1016/j.jaac.2016.01.006. Epub 2016 Feb 2.

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Mental Disorder Prevalence & Associated Risk Factors in Three Prisons of Spain

AIMS:

To determine the lifetime and monthly prevalence of people with mental disorders and its association with sociodemographic factors andcriminal risk in three Spanish prisons (Ocaña, Madrid I, II and VI).

METHOD:

Cross-sectional epidemiological study of a sample of 184 inmates. Socio-demographic and criminal data were collected by an ad hoc interview. Mental disorders were assessed with the clinical version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Axis I Disorders (SCID-I).

RESULTS:

Life prevalence of mental disorders was 90.2%. The most common mental disorders and substance abuse or dependence was 72.3%, followed by mood disorder (38.5%) and psychotic disorders (34.2%). Moreover, the prevalence of any mental disorder in the last month was 52.2%. The main psychotic disorder (20.7%) was followed by substance abuse or dependence (18.5%), and mood disorder state (13%). A socio-demographic profile as a risk for each disorder was found.

DISCUSSION:

The prevalence of people with mental disorders is very high in Spanish prisons, and is associated with a distinct demographic profile. It is essential to continue researching this reality, translating the results into therapeutic and preventive action adapted to the status of inmates to reduce social inequalities in this high priority public health situation.

Full article at:   http://goo.gl/SUykGQ

By:  M.C. Zabala-Baños¹, A. Segura¹, C. Maestre-Miquel¹, M. Martínez-Lorca², B. Rodríguez-Martín¹, D. Romero and M. Rodríguez¹

¹ Nursing, Physiotherapy and Occupational Therapy Department. Occupational Therapy, Logaoedics and Nursing School. University of Castilla la Mancha, Talavera de la Reina, Spain 
² Department of Psychology. Occupational Therapy, Logaoedics and Nursing School. University of Castilla la Mancha, Talavera de la Reina, Spain

Rev Esp Sanid Penit. 2016 Jun;18(1):13-23. doi: 10.4321/S1575-06202016000100003.

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Guns, Impulsive Angry Behavior & Mental Disorders: Results from the National Comorbidity Survey Replication (NCS-R)

Analyses from the National Comorbidity Study Replication provide the first nationally representative estimates of the co-occurrence of impulsive angry behavior and possessing or carrying a gun among adults with and without certain mental disorders and demographic characteristics. 

The study found that a large number of individuals in the United States self-report patterns of impulsive angry behavior and also possess firearms at home (8.9%) or carry guns outside the home (1.5%). These data document associations of numerous common mental disorders and combinations of angry behavior with gun access. Because only a small proportion of persons with this risky combination have ever been involuntarily hospitalized for a mental health problem, most will not be subject to existing mental health-related legal restrictions on firearms resulting from a history of involuntary commitment. Excluding a large proportion of the general population from gun possession is also not likely to be feasible. 

Behavioral risk-based approaches to firearms restriction, such as expanding the definition of gun-prohibited persons to include those with violent misdemeanor convictions and multiple DUI convictions, could be a more effective public health policy to prevent gun violence in the population.

Below: Estimated number per 100,000 population with gun violence risk indicator and percent ever hospitalized for a mental health problem

Full article at:   http://goo.gl/o1kv77

By:  Swanson JW1, Sampson NA2, Petukhova MV2, Zaslavsky AM2, Appelbaum PS3, Swartz MS1, Kessler RC2.

• 1Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.
• 2Department of Health Care Policy, Harvard Medical School, Boston, MA.
• 3Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY. 
• Behav Sci Law. 2015 Jun;33(2-3):199-212. doi: 10.1002/bsl.2172. Epub 2015 Apr 8.

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Psychological Functioning among Vertically Infected HIV-Positive Children & Their Primary Caregivers

The current study sought to explore the association between primary caregiver depressive symptoms and the psychological functioning in children vertically infected with human immunodeficiency virus (HIV) living in Eastern Cape, South Africa. 

A cross-sectional data were collected using the Beck Depression Inventory and Strength and Difficulties Questionnaire in a sample of 152 caregiver/child dyads. The results revealed that poorer psychological functioning in children was significantly associated with depressive symptoms in caregivers. This relationship existed whether or not the child was raised by a biological or non-biological caregiver as well as for both genders. Younger children's psychological functioning was more negatively influenced than that of older children raised by a caregiver with depressive symptoms. 

In the context of a large treatment gap for common mental disorders in South Africa, there is a need for interventions to address maternal mental health in families infected and affected by the HIV/AIDS pandemic as a mental health promotion strategy given that HIV-infected children are a particularly vulnerable population for poor mental and behavioural health outcomes.

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By:  Lentoor AG1, Oppong Asante K2, Govender K3, Petersen I2.

• 1 Department of Psychology , University of the Witwatersrand , Johannesburg , South Africa.
• 2 Discipline of Psychology, School of Applied Human Sciences , University of KwaZulu-Natal , Durban , South Africa.
• 3 Heath Economics and HIV/AIDS Research Division (HEARD) , University of KwaZulu-Natal , Durban , South Africa. 
• AIDS Care. 2016 Feb 1:1-7. 

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