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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Modifiable Neighborhood Features Associated with Adolescent Homicide

IMPORTANCE:

Homicide is a leading cause of adolescent mortality. To our knowledge, relatively little has been studied in terms of the association between environmental neighborhood features, such as streets, buildings, and natural surroundings, and severe violent injury among youth.

OBJECTIVE:

To assess associations between environmental neighborhood features and adolescent homicide in order to identify targets for future place-based interventions.

DESIGN, SETTING, AND PARTICIPANTS:

Population-based case-control study conducted in Philadelphia, Pennsylvania, from April 15, 2008, to March 31, 2014. We identified adolescents who died by homicide at 13 to 20 years of age from 2010 to 2012 while residing in Philadelphia. We used incidence-density sampling and random-digit dialing to recruit control participants ages 13 to 20 years matched on sex and indoor-outdoor location at the time of each index case participant's homicide.

EXPOSURES:

To obtain environmental data about modifiable features that were present in the immediate surroundings of our case and control participants, blinded field researchers used standardized techniques to photograph case and control participant outdoor locations. Photographic data were stitched together to create 360° panoramic images that were coded for 60 elements of the visible environment.

MAIN OUTCOME AND MEASURE:

Adolescent homicide.

RESULTS:

We enrolled 143 homicide case participants (mean [SD] age, 18.4 [1.5] years) and 155 matched control participants (mean [SD] age, 17.2 [2.1] years) who were both outdoors at the time of the homicide. In adjusted analyses, multiple features of Philadelphia streets, buildings, and natural surroundings were associated with adolescent homicide. The presence of street lighting, illuminated walk/don't walk signs, painted marked crosswalks, public transportation, parks, and maintained vacant lots were significantly associated with decreased odds of homicide. The odds of homicide were significantly higher in locations with stop signs, security bars/gratings on houses, and private bushes/plantings.

CONCLUSIONS AND RELEVANCE:

Using a population-based case-control design, we identified multiple modifiable environmental features that might be targeted in future randomized intervention trials designed to reduce youth violence by improving neighborhood context.

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

By:  Culyba AJ1, Jacoby SF2, Richmond TS3, Fein JA4, Hohl BC5, Branas CC2.

• 1The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
• 2Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
• 3Biobehavioral and Health Systems Department, School of Nursing, University of Pennsylvania, Philadelphia.
• 4The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
• 5Department of Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, Piscataway. 
• JAMA Pediatr. 2016 Mar 7. doi: 10.1001/jamapediatrics.2015.4697. 

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Is Violence, in Part, a Lithium Deficiency State?

Violence, particularly firearm violence, leading to suicide and homicide is a significant problem worldwide. A majority of suicidal and homicidal violence involves males; homicidal violence is prevalent among young men and suicide is the leading cause of violence worldwide. 

Lithium, in pharmacological doses, has been used successfully for decades in treating bipolar disorders, and has been shown to decrease violent crime in this situation. Interestingly, lithium, in trace amounts, as occurs in some drinking water, has been inversely related to aggression, and suicidal and homicidal violence. Lithium is naturally found in vegetables, grains and drinking water, and dietary intake varies from nearly zero to 3mg daily. Elemental lithium, in trace doses, has been shown to improve mood in weeks. Moreover, lithium, in trace amounts, has no toxicity. 

In order to ensure adequate dietary intakes of elemental lithium daily for the purpose of decreasing aggression and violence, we propose considering the fortification of cereal grain products with lithium and also the addition of lithium to vitamin preparations for adults. Importantly, randomized trials in various populations are needed to test this hypothesis.

Purchase full article at:  http://goo.gl/fh8n24

By:  Goldstein MR¹, Mascitelli L².

¹NCH Physician Group, 1845 Veterans Park Drive, Suite 110, Naples, FL 34109, USA. Electronic address: markrgoldstein@comcast.net.

²Comando Brigata Alpina "Julia"/Multinational Land Force, Medical Service, 8 Via S. Agostino, Udine 33100, Italy. Electronic address: lumasci@libero.it.

Med Hypotheses. 2016 Apr;89:40-2. doi: 10.1016/j.mehy.2016.02.002. Epub 2016 Feb 10.

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Genetic Background of Extreme Violent Behavior

In developed countries, the majority of all violent crime is committed by a small group of antisocial recidivistic offenders, but no genes have been shown to contribute to recidivistic violent offending or severe violent behavior, such as homicide. 

Our results, from two independent cohorts of Finnish prisoners, revealed that a monoamine oxidase A (MAOA) low-activity genotype (contributing to low dopamine turnover rate) as well as the CDH13 gene (coding for neuronal membrane adhesion protein) are associated with extremely violent behavior (at least 10 committed homicides, attempted homicides or batteries). No substantial signal was observed for either MAOA or CDH13 among non-violent offenders, indicating that findings were specific for violent offending, and not largely attributable to substance abuse or antisocial personality disorder. 

These results indicate both low monoamine metabolism and neuronal membrane dysfunction as plausible factors in the etiology of extreme criminal violent behavior, and imply that at least about 5–10% of all severe violent crime in Finland is attributable to the aforementioned MAOA and CDH13 genotypes.

Below:  Age- and gender-adjusted odds ratios for low-activity MAOA genotype and CDH13 (rs11649622) as a function of the number of committed violent crimes. The number of individuals, allele frequencies and odds ratios are shown below. The number of control subjects was 1946 for MAOA and 1877 for CDH13 analysis.

Below:  Manhattan plot of extremely violent offenders GWAS. The highest cluster is seen in locus 16q23.3

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

By:  J Tiihonen,^1,2,3,19 M-R Rautiainen,^3,19 HM Ollila,^3,4 E Repo-Tiihonen,² M Virkkunen,^5,6 A Palotie,^7,8,9,10,11 O Pietiläinen,³ K Kristiansson,³ M Joukamaa,¹² H Lauerma,^3,13,14 J Saarela,¹⁵ S Tyni,¹⁶ H Vartiainen,¹⁶ J Paananen,¹⁷D Goldman,¹⁸ and T Paunio^3,5,6

¹Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

²Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland

³National Institute for Health and Welfare, Helsinki, Finland

⁴Stanford University Center for Sleep Sciences, Palo Alto, CA, USA

⁵Department of Psychiatry, University of Helsinki, Institute of Clinical Medicine, Helsinki, Finland

⁶Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland

⁷Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, England

⁸Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

⁹Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA

¹⁰Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland

¹¹Psychiatric & Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

¹²Social Psychiatry Unit, School of Health Sciences, University of Tampere, Finland

¹³Psychiatric Hospital for Prisoners, Turku, Finland

¹⁴University of Turku, Turku, Finland

¹⁵Finnish Genome Center, Helsinki, Finland

¹⁶The Criminal Sanctions Agency, Helsinki, Finland

¹⁷University of Eastern Finland, Bioinformatics Center, Kuopio, Finland

¹⁸Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, USA

Correspondence: Professor J Tiihonen, Karolinska Institutet, Department of Clinical Neuroscience, Byggnad R5, Stockholm, S-171 76, Sweden or Professor T Paunio, National Institute for Health and Welfare, PO Box 30, FI-00271, Finland. Email: es.ik@nenohiit.iraj or ; Email:if.lht@oinuap.aniit

¹⁹These authors contributed equaliy to this work.

Mol Psychiatry. Author manuscript; available in PMC 2016 Mar 3. Mol Psychiatry. 2015 Jun; 20(6): 786–792.

  

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Intimate Partner Homicide and Corollary Victims in 16 States: National Violent Death Reporting System, 2003–2009

Objectives. 

We estimated the frequency and examined the characteristics of intimate partner homicide and related deaths in 16 US states participating in the National Violent Death Reporting System (NVDRS), a state-based surveillance system.

Methods. 

We used a combination of quantitative and qualitative methods to analyze NVDRS data from 2003 to 2009. We selected deaths linked to intimate partner violence for analysis.

Results. 

Our sample comprised 4470 persons who died in the course of 3350 intimate partner violence–related homicide incidents. Intimate partners and corollary victims represented 80% and 20% of homicide victims, respectively. Corollary homicide victims included family members, new intimate partners, friends, acquaintances, police officers, and strangers.

Conclusions. 

Our findings, from the first multiple-state study of intimate partner homicide and corollary homicides, demonstrate that the burden of intimate partner violence extends beyond the couple involved. Systems (e.g., criminal justice, medical care, and shelters) whose representatives routinely interact with victims of intimate partner violence can help assess the potential for lethal danger, which may prevent intimate partner and corollary victims from harm.

Below:  Age distribution of corollary homicide victims and intimate partner homicide victims

Below:  Characterization of homicide victims among (a) all homicide victims (n = 3619) by intimate partner and corollary victims and (b) corollary homicide victims by relationship: National Violent Death Reporting System, United States, 2003–2009.

Full article at:  http://goo.gl/O7EjqB

By:  Sharon G. Smith, PhD,* Katherine A. Fowler, PhD, and Phyllis H. Niolon, PhD

At the time of the study, the authors were with the Centers for Disease Control and Prevention, Atlanta, GA.

*Corresponding author.

Correspondence should be sent to Sharon G. Smith, PhD, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS F-64, Atlanta, GA 30341 (e-mail: vog.cdc@4htimss). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Contributors

S. G. Smith conceptualized the study, conducted analyses, and led the writing. K. A. Fowler and P. H. Niolon assisted with analyses, contributed to the writing and editing of article drafts, and approved the final version.

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Domestic Homicide: Neuropsychological Profiles of Murderers Who Kill Family Members and Intimate Partners

Domestic homicide is the most extreme form of domestic violence and one of the most common types of homicide. 

The objective was to examine differences between spontaneous domestic homicide and nondomestic homicide offenders regarding demographics, psychiatric history, crime characteristics, and neuropsychological status, utilizing neuropsychological test data from forensic examinations of 153 murderers. 

Using standard crime classification criteria, 33% committed spontaneous domestic homicides (SDH) and 61% committed nondomestic homicides (NDH). SDH offenders were more likely to manifest psychotic disorders, but less likely to be diagnosed with antisocial personality disorder or to have prior felony convictions. SDH offenders manifested significantly worse neuropsychological impairments than NDH offenders. The mean number of victims was lower for the SDH than the NDH group and only 14% of SDH offenders used a firearm, whereas 59% of NDH offenders used a firearm. 

These findings corroborate the notion that spontaneous domestic homicide may represent a discernible criminological phenotype.

Purchase full article at:   http://goo.gl/zc4NH2

By:  Hanlon RE1,2, Brook M1, Demery JA3,4, Cunningham MD5.

• 1Feinberg School of Medicine, Northwestern University, Department of Psychiatry and Behavioral Sciences, 446 E. Ontario, Chicago, IL.
• 2Neuropsychological Associates of Chicago, 645 N. Michigan Ave., Ste. 803, Chicago, IL.
• 3Gainesville V.A. Medical Center, 1601 SW Archer Rd, Gainesville, FL.
• 4Neuropsychological Sciences, 10247 SW 98th Terrace, Gainesville, FL.
• 5Private Practice, 610 Brazos St., Ste. 680, Austin, TX.
• J Forensic Sci. 2015 Aug 21. doi: 10.1111/1556-4029.12908. 

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Murder & Psychosis: Neuropsychological Profiles of Homicide Offenders with Schizophrenia

BACKGROUND:

Neurocognitive dysfunction, a core feature of schizophrenia, is thought to contribute to the impulsive violent aggression manifested by some individuals with schizophrenia, but not enough is known about how homicidal individuals with schizophrenia perform on neuropsychological measures.

AIMS:

The primary aim of our study was to describe the neuropsychological profiles of homicide offenders with schizophrenia. Supplementary analyses compared the criminal, psychiatric and neuropsychological features of schizophrenic homicide offenders with and without God/Satan/demon-themed psychotic symptoms.

METHODS:

Twenty-five men and women diagnosed with schizophrenia who had killed another person - 21 convicted of first-degree murder and 4 found not guilty by reason of insanity - completed neuropsychological testing during forensic evaluations.

RESULTS:

The sample was characterised by extensive neurocognitive impairments, involving executive dysfunction (60%), memory dysfunction (68%) and attentional dysfunction (50%), although those with God/Satan/demon-themed psychotic symptoms performed better than those with nonreligious psychotic content.

CONCLUSIONS:

Our findings indicate that impaired cognition may play an important role in the commission of homicide by individuals with schizophrenia. A subgroup with God/Satan/demon delusions seem sufficiently less impaired that they might be able to engage in metacognitive treatment approaches, aimed at changing their relationship to their psychotic symptoms, thus reducing the perception of power and omnipotence of hallucinated voices and increasing their safety

Purchase full article at:   http://goo.gl/lat1a1

By:  Stratton J1, Brook M1, Hanlon RE1,2.

• 1Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
• 2Neuropsychological Associates of Chicago, Chicago, IL, USA. 
• Crim Behav Ment Health. 2016 Feb 10. doi: 10.1002/cbm.1990.

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Associations with Violent and Homicidal Behaviour among Men with Schizophrenia

Objective 

We aimed to assess the risk factors associated with homicidal behaviour in male patients diagnosed with schizophrenia. 

Methods 

In a period of 1 year, male schizophrenia cases between 18-65 years of age (n = 210) were included. The clinical evaluation included the Positive and Negative Syndrome Scale (PANSS) and Overt Aggression Scale (OAS). The patients were divided into three groups in terms of violent behaviour history: (1) homicide group (n = 30), (2) a violent act resulting in serious injury (n = 71), (3) control group (patients without a history of a violent act) (n = 109). 

Results 

Lower level of education, rural residence, being unemployed and living alone were found to be significantly more common in patients who had committed a violent act compared to the schizophrenia patients in the control group. In order to explore the predictive value of several factors associated with violent behaviour, a logistic regression model was used, and variables (shorter duration of education, living alone, and lack of insight) significantly predicted the presence of violent behaviour (murder and/or injury) (χ²=31.78, df = 12, p = 0.001). 

Conclusions 

In order to be able to determine causality of homicidal acts in schizophrenia patients, our significant findings between homicidal violence, non-homicidal violence and the control group would merit further attention and exploration in further studies.

Purchase full article at:   http://goo.gl/81CrDF

By:  Karabekiroğlu A1, Pazvantoğlu O2, Karabekiroğlu K3, Böke Ö4, Korkmaz IZ5.

• 1 Department of Psychiatry , Training and Research Hospital , Samsun , Turkey ;
• 2 Sokrates Psychiatry and Psychotherapy Center , İzmir , Turkey ;
• 3 Department of Child and Adolescent Psychiatry , Ondokuz Mayis University Medical Faculty , Samsun , Turkey ;
• 4 Department of Psychiatry , Ondokuz Mayis University Medical Faculty , Samsun , Turkey ;
• 5 Department of Psychiatry , Dogubeyazit Hospital , Agri , Turkey.
• Nord J Psychiatry. 2015 Dec 4:1-6.  

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Emergency Department Visits Prior to Suicide and Homicide

BACKGROUND:

Emergency departments (EDs) serve a wide range of patients who present at risk of impending suicide and homicide.

AIMS:

Two statewide surveillance systems were probabilistically linked to understand who utilizes EDs and then dies violently within 6 weeks.

METHOD:

Each identified case was matched with four randomly selected controls on sex, race, date of birth, resident zip code, and date of ED visit vs. date of death. Matched-pair odds ratios were estimated by conditional logistic regression to assess differences between cases and controls on reported diagnoses and expected payment sources.

RESULTS:

Of 1,599 suicides and 569 homicides in the 3-year study period, 10.7% of decedents who died by suicide (x = 13.6 days) and 8.3% who died by homicide (x = 16.3 days) were seen in a state ED within 6 weeks prior to death. ED attendees who died by suicide were more likely to have a diagnosis of injury/ poisoning diagnosis or mental disorder and more likely to have Medicare. Those who died by homicide were more likely to have a diagnosis of injury/poisoning and less likely to have commercial insurance.

CONCLUSION:

It is essential for research to further explore risk factors for imminent suicide and homicide in ED patients who present for psychiatric conditions and general injuries.

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By:  Cerel J1, Singleton MD2, Brown MM3, Brown SV3, Bush HM4, Brancado CJ5.

• 1 University of Kentucky, College of Social Work (https://socialwork.uky.edu/), Lexington, KY, USA.
• 2 University of Kentucky, Department of Biostatistics and the Kentucky Injury Prevention and Research Center, Lexington, KY, USA.
• 3 University of Kentucky, Department of Epidemiology and Kentucky Injury Prevention and Research Center, College of Public Health, Lexington, KY, USA.
• 4 University of Kentucky, Department of Biostatistics, Lexington, KY, USA.
• 5 University of Kentucky , Department of Statistics/DATAQUeST, Lexington, KY, USA.
• Crisis. 2015 Dec 1:1-8. 

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Maternal Filicide among Women Admitted to Forensic Psychiatric Institutions in Malaysia: Case Series

OBJECTIVES:

To examine the characteristics of maternal filicide and describe the adverse life events experienced by women who have committed filicide and been hospitalised in forensic psychiatric institutions in Malaysia.

METHODS:

Registration records from 2000 through 2012 of female patients from 2 main forensic psychiatric institutions in Malaysia were reviewed. The medical records of patients who had committed maternal filicide were selected and descriptively evaluated.

RESULTS:

A total of 18 cases of maternal filicide were identified. Family dysfunction that presented with marital discord, domestic violence, or husband with substance abuse was the main stress experienced by the women. Three social circumstances, including an adolescent who became a victim of date rape; immigrants who experienced sexual abuse; and filicide-suicide precipitated by financial difficulties were highlighted.

CONCLUSION:

Women who committed filicide had experienced various difficulties in their life. The presence of such life events might alert mental health professionals to investigate the possibility of filicide among their patients.

Via:  http://goo.gl/KGbPY5 

Full PDF article at:  http://goo.gl/0L9nCc

  

By:  Razali S1, Salleh RM2, Yahya B3, Ahmad SH1.

• 1Psychological and Behavioural Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Malaysia.
• 2Forensic Psychiatry Unit, Hospital Bahagia Ulu Kinta, Perak, Malaysia.
• 3Forensic Psychiatry Unit, Hospital Permai, Tampoi, Johore, Malaysia.

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