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Trend in mortality from violent deaths: suicide and homicide, United States, 1960-1991.

Death rates from suicide and homicide have been rising since 1960 even as rates from all causes have decreased. Between 1960 and 1991, mortality from all causes among men aged 15 and over decreased from 885.1 per 100,000 population to 645.9. The suicide rates, however, increased from 16.6 to 18.7 per 100,000 and homicide mortality rates more than doubled, rising from 7.7 to 16.6 per 100,000. All three mortality rates were lower among women than among men. Deaths from all causes among women aged 15 and over dropped from 542.3 to 368.2 per 100,000; suicide rates decreased slightly from 5.0 to 4.3 while homicide rates among women rose from 2.4 in 1960 to 4.0 in 1991. Suicide rates remained the highest among men over age 75 and among women aged 45 to 54. Homicide rates were the highest among men aged 25 to 34 until 1988. In 1989 homicide rates among men aged 15 to 24 surpassed these and continue to rise at a rapid pace. Homicides among women were the highest among the age group 25 to 34. The second highest rates occurred at ages 35 to 44 through 1975 and at ages 15 to 24, thereafter.

Adolescent↗

Homicides of persons aged < or = 18 years--Fulton County, Georgia, 1988-1992.

Homicide is a major cause of death among persons aged < or = 18 years in the United States; among black males aged 15-24 years, homicide is the leading cause of death. Most efforts to characterize homicide among persons aged < or = 18 years have used databases at the national level rather than at the state or local level or have been restricted in scope to specific types of homicides (e.g., gang-related homicide. This report summarizes an epidemiologic study of homicides that occurred among persons aged < or = 18 years in Fulton County (Atlanta), Georgia (1990 population: 648,951), from 1988 through 1992.

Adolescent↗

Gang-related homicides in Los Angeles County.

The incidence of gang homicides in Los Angeles County has increased faster than that of non-gang homicides in the past decade. This study compares characteristics of gang homicide victims with those of non-gang homicide victims for the year 1987. In 1186 cases, gang members were more likely to be young Black men who died of gunshot wounds. Gang homicide victims were more likely to die of firearm injuries in the early evening, and were more likely to die in a relatively small area of Los Angeles County. Drive-by shooting was highly associated with gang homicide.

Adolescent↗

The epidemiology of homicide in Chicago.

Public health agencies across the country are beginning to view violence as a problem that demands a public health response. However, before such a response can be mounted effectively, there must be a sound data-based understanding of this epidemic. With this in mind, the Chicago Department of Public Health implemented an epidemiological analysis of homicide in the city. Using vital records, police data, and census data, we found that the city's homicide rate in 1993 was 31 per 100,000 population. This rate placed Chicago 14th among other large cities in the United States and 4th out of the eight cities with a population > 1 million. The homicide rate in the city has been increasing over the past 30 years, but not steadily. For some intervals, the homicide rate has remained almost constant. African Americans, Hispanics, the young, and males are overrepresented in the epidemic. While guns accounted for almost 75% of all homicides in Chicago in 1993, gangs accounted for only 15%. Homicide cannot be viewed in isolation from the context of society. The literature suggests that poverty and racism are important risk factors for this epidemic. Although we cannot wait until these risk factors are remedied to develop violence prevention interventions, we also cannot proceed effectively without understanding this context.

Black or African American↗

Homicide followed by suicide: Paris and its suburbs, 1991-1996.

Homicide-suicides (HS) are relatively infrequent events. Yet, they are of great concern because they often result in the death of family members, young children, and cause additional morbidity, family disruption and childhood psychological trauma. The aims of our study were (a) to examine the sociodemographic, clinical, and autopsy characteristics of HS in Paris and its suburbs from 1991 through 1996, and (b) to analyze the psychodynamic determinants leading up to the onset of HS. Our findings are compared with those obtained in other international studies. For the purpose of the present study. HS was defined as a violent event in which an individual committed homicide and subsequently committed suicide within a few hours. The main results are as follows. During the six-year study period, 56 HS involving 133 victims were investigated at the Institute of Forensic Medicine of Paris. Seventeen events occurred in Paris and 39 in its suburbs. Paris has a population of approximately 2,200,000 while its suburbs are home to another 8,5000,000. Of the 56 offenders, 48 (85%) were males. The mean age of offenders was 51 years in males (range, 24 to 83) and 40.5 years in females (range, 33 to 56). In 45 events (80%), the offenders used a gun for both the homicide and suicide. A knife was used in only 4 murders, strangulation in 4 other cases, with poisoning, arson, or beating occurring in one case each. In 9 cases, the offender used a different weapon for homicide and suicide. Among firearms, handguns were more likely to be used (26 cases) than shotguns (6 cases) or rifles (13 cases). In 40 cases the offender killed one victim, in 11 cases 2 victims, and in 5 cases 3 victims. The homicide victims consisted of 34 children (21 boys), mean age 8 years (range, 1 to 16), 29 spouses (26 females), 2 girlfriends, 10 strangers, and 2 relatives. Five pets were killed. HS were most likely to be committed in the home. A suicide note was found near the victims in 29 cases (50% of events). In 42 cases the offender was found to be severely depressed. Familial HS were the most frequent events followed by suicidal pacts. When male sexual proprietariness and amorous jealousy were involved, the HS perpetrators acted often impulsively in carrying out the HS. There had been a chronically chaotic relationship and frequent physical violence and verbal threats. The triggering event was often the female withdrawal or estrangement. Only in a few cases, other motivations such as occupational or money problems were involved. Chronic alcoholism was found in 16 cases. In conclusion, the offender was more likely to be a male, severely depressed, violent and jealous who killed his spouse, and often his children, with impulsiveness, but after numerous threats. Our findings suggest that HS differ from both homicide and suicide and thus occupy a distinct epidemiological domain requiring specific prevention programs.

Adolescent↗

Homicide and schizophrenia: maybe treatment does have a preventive effect.

BACKGROUND: Persons with schizophrenia have been found to be at increased risk for homicide as compared with the general population. The increased risk may be associated with the implementation of the policy of deinstitutionalization. METHOD: Persons with schizophrenia who had committed or attempted homicide in the German state of Hessen from 1992 to 1996 and in the Federal Republic of Germany from 1955 to 1964 were compared. RESULTS: Schizophrenia increased the risk of homicide 16.6 times (95% CI 11.2-24.5) in the recent cohort and 12.7 times (95% CI 11.2-14.3) in the older cohort. These odds ratios are not statistically different. The lack of appropriate services for chronic high-risk patients and the non-use of mental health services by first episode, acutely psychotic patients were associated with homicide. CONCLUSION: There has been no increase in the risk of homicide among persons with schizophrenia since the implementation of the policy of deinstitutionalization. The examination of the recent period suggests that the provision of specialized long-term care to persons with schizophrenia who are at high risk for violent behaviour and the use of mental health services by acutely psychotic persons may reduce the risk of homicide.

Journal Article↗

The pattern of homicidal slash/chop injuries: a 10 year retrospective study in University Hospital Kuala Lumpur.

Homicides as a result of slash/chop injuries are not commonly reported in forensic literature. A 10 year retrospective study from 1987 to 1996 was performed on the pattern of homicidal slash/chop injuries in University Hospital, Kuala Lumpur. A total of 37 cases were analysed. The ages ranged from 17 to 85 years. The victims consisted of Indonesian (37.8%), Chinese (27.0%), Indian (24.3%) and Malay (8.1%) ethnic groups; 2.7% of the cases were not identified. Most of the cases were due to intentional violence (n = 27), while the rest consisted of domestic violence (n = 2), robbery (n = 2), psychiatric homicide (n = 1), accident (n = 2) and unclassified (n = 3). In the intentional violence group, the majority of the victims (n = 16) had more than five wounds. In contrast, the victims in other categories had less than five wounds each, with the exception of a single case in the psychiatric-homicide group. In homicide victims with a single wound, the most common site of injury was the neck. In those with multiple wounds, the common sites were the head and neck. Sixteen cases showed defence injuries, all of them belonging to the intentional-violence group. The reasons for the high incidence of homicidal slash/chop wounds are discussed, as well as the difficulties associated with interpretation of such wounds.

Journal Article↗

The epidemiology of adolescent homicide in North Carolina from 1990 to 1995.

BACKGROUND: Rates of homicides by adolescents under age 18 years tripled from 1984 to 1994. Most studies report data on urban adolescents and young adults as a single age group (age 15-24 years), but homicide characteristics among adolescents, especially those younger than 15 years, may differ from those of young adults. OBJECTIVE: To describe the homicide characteristics among adolescents age 11 to 18 years in North Carolina from 1990 to 1995. METHODS: A retrospective, descriptive analysis of adolescent homicides using the medical examiner database. Police interviews provided additional information for cases from 1993 to 1995. RESULTS: There were 419 victims from 1990 to 1995 (average annual rate: 9.7 per 100000 adolescents; 9.9 in urban counties, 7.1 in rural). Victims were mostly ages 15 to 18 years (85%), male (79%), and black (76%); 48% lagged behind in school, and, by police report, 40% had a criminal record. Only 23% of the identified perpetrators were strangers. Firearms (59% were handguns) were used in 83% of homicides. Proportionally more younger adolescents (age 11-14 years) were killed by means other than firearms than 15- to 18-year-olds (chi2 = 24.2, P = .007). Drug-related motives (23%) were most common, followed by non-drug-related altercations (20%) and retaliations (17%). CONCLUSIONS: Proportionally more North Carolina adolescents than urban young adults (ages 15-24 years) were killed by firearms (83% vs. 75%). Proportionally fewer adolescents were killed by police, strangers, or intimate partners. Interventions should include reducing access to firearms and drugs, and helping adolescents develop nonviolent strategies to resolve disputes. Efforts should be focused on adolescents who lag behind in school and have criminal records.

Adolescent↗

The relationship between lead exposure and homicide.

CONTEXT: Previous studies have suggested that excessive lead exposure is related to aggressive and violent behavior. OBJECTIVE: To evaluate the association between estimated air lead concentrations and homicide rates. DESIGN: Cross-sectional ecological study. SETTING: All counties in the contiguous 48 states of the United States. EXPOSURE MEASURE: Estimated air lead concentrations and blood lead levels. MAIN OUTCOME MEASURE: The homicide rate in each county. RESULTS: Negative binomial regression was used to examine the relationship between air lead concentrations and the incidence of homicide across counties in the United States (N = 3111). After adjusting for sociologic confounding factors and 9 measures of air pollution, the only indictor of air pollution found to be associated with homicide rates was air lead concentration. Across all counties, estimated air lead concentrations ranged from 0 to 0.17 microg/m(3). The adjusted results suggest that the difference between the highest and lowest level of estimated air lead is associated with a homicide incidence rate ratio of 4.12 (95% confidence interval, 1.02-16.61). CONCLUSION: The results of this study support recent findings that there is an association between lead exposure and violent behavior.

Air Pollutants↗

Homicide and suicide rates associated with implementation of the Brady Handgun Violence Prevention Act.

CONTEXT: In February 1994, the Brady Handgun Violence Prevention Act established a nationwide requirement that licensed firearms dealers observe a waiting period and initiate a background check for handgun sales. The effects of this act have not been analyzed. OBJECTIVE: To determine whether implementation of the Brady Act was associated with reductions in homicide and suicide rates. DESIGN AND SETTING: Analysis of vital statistics data in the United States for 1985 through 1997 from the National Center for Health Statistics. MAIN OUTCOME MEASURES: Total and firearm homicide and suicide rates per 100,000 adults (>/=21 years and >/=55 years) and proportion of homicides and suicides resulting from firearms were calculated by state and year. Controlling for population age, race, poverty and income levels, urban residence, and alcohol consumption, the 32 "treatment" states directly affected by the Brady Act requirements were compared with the 18 "control" states and the District of Columbia, which had equivalent legislation already in place. RESULTS: Changes in rates of homicide and suicide for treatment and control states were not significantly different, except for firearm suicides among persons aged 55 years or older (-0.92 per 100,000; 95% confidence interval [CI], -1.43 to -0.42). This reduction in suicides for persons aged 55 years or older was much stronger in states that had instituted both waiting periods and background checks (-1.03 per 100,000; 95% CI, -1.58 to -0.47) than in states that only changed background check requirements (-0.17 per 100,000; 95% CI, -1.09 to 0.75). CONCLUSIONS: Based on the assumption that the greatest reductions in fatal violence would be within states that were required to institute waiting periods and background checks, implementation of the Brady Act appears to have been associated with reductions in the firearm suicide rate for persons aged 55 years or older but not with reductions in homicide rates or overall suicide rates. However, the pattern of implementation of the Brady Act does not permit a reliable analysis of a potential effect of reductions in the flow of guns from treatment-state gun dealers into secondary markets. JAMA. 2000;284:585-591

Adult↗

Criminal records of homicide offenders.

CONTEXT: Homicide prevention strategies can be either targeted toward high-risk groups or addressed to the population at large. One high-risk group of particular interest is adults with a criminal record. But the prevalence of a criminal record among homicide offenders has not been reliably quantified, nor has the prevalence of criminal record in the general population. OBJECTIVE: To determine what portion of the homicide problem would be addressed by interventions linked to arrest or conviction. DESIGN, SETTING, AND PARTICIPANTS: A case-control analysis was performed using a comprehensive data set of all arrests and felony convictions in Illinois for 1990-2001. Cases were defined as Illinois residents aged 18 to 64 years who were arrested for homicide in 2001. Controls were all other Illinois residents aged 18 to 64 years in 2001. Illinois criminal and juvenile record information for cases and controls was compiled for 1990-2000. Five definitions of previous record were considered (arrest, arrest for a violent crime, 5 or more arrests with at least 1 for a violent crime, felony conviction, and violent-felony conviction), each measured for 1990-2000 and for 1996-2000. MAIN OUTCOME MEASURE: The population-attributable risk: the portion of homicide offenses that would be eliminated by a hypothetical intervention that reduced the offending risk of individuals with a record to the offending risk of those who lack a record. RESULTS: For 1990-2000, 42.6% of 884 cases had at least 1 felony conviction compared with 3.9% of nearly 7.9 million controls, for a population-attributable risk of 40.3% (95% CI, 37.0%-43.8%); among cases, 71.6% had experienced any arrest from 1990-2000 compared with 18.2% of controls, for a population-attributable risk of 65.3% (95% CI, 61.6%-68.8%). For 1996-2000, the population-attributable risk among individuals with a felony conviction or any arrest was 31.0% (95% CI, 27.9%-34.2%) and 58.5% (95% CI, 54.9%-62.1%), respectively. CONCLUSIONS: Interventions after arrest or conviction, such as supervised release, imprisonment, correctional programs, or bans on firearm possession, are targeted toward a group that has relatively high incidence of lethal violence, but they leave a large portion of the problem untouched.

Adult↗

Suicides, homicides, and accidental death: a comparative risk assessment of police officers and municipal workers.

Inherent dangers in police work, such as the possibility of homicide victimization or accidents, often overshadow the psychological consequences of this occupation. The present study employed data from a Buffalo, NY retrospective mortality municipal worker cohort to evaluate the risk of suicide, homicide, and accidents among police officers, and compared that risk to other municipal workers. Within the police occupation, officers had an 8.23-fold risk of suicide over homicide and a 3.1-fold risk of suicide over accidents. Compared to municipal workers, police officers had an RR = 1.53 (95% CI = 0.633-3.72) for suicide over homicide, a significant RR = 3.1 (95% CI = 1.94-4.97) for suicide over accidents, and a significant RR = 2.65 (95% CI = 1.76-4.00) for suicide over homicide and accidents combined. Possible reasons for suicide among police officers are discussed.

Accidents, Occupational↗

Excessive violence and psychotic symptomatology among homicide offenders with schizophrenia.

BACKGROUND: It is not currently known how psychotic symptoms are associated with the nature of violence among homicide offenders with schizophrenia, or, more specifically, whether different psychotic symptoms are differentially linked with excessive violence. AIM: To identify factors associated with the use of excessive violence among homicide offenders with schizophrenia. METHODS: Forensic psychiatric examination statements and Criminal Index File data of 125 consecutive Finnish homicide offenders with a diagnosis of schizophrenia were analysed. RESULTS: Nearly one-third of the cases in this sample involved extreme violence, including features such as sadism, mutilation, sexual components or multiple stabbings. Excessive violence was a feature of acts when the offender was not the sole perpetrator or when there was a previous homicidal history. Positive psychotic symptoms, including delusions, were not associated with the use of excessive violence. CONCLUSIONS: These results highlight the importance of variables other than clinical state when examining qualitative aspects of homicidal acts, such as the degree and nature of violence, by offenders with schizophrenia. Further study is needed with a more specific focus on the qualities of the violence among different subgroups of offenders, but inclusive of those with psychosis.

Adolescent↗

Drugs and homicide: a theory.

In this paper we report our experience with 24 cases in which there was a homicide or homicides committed in association with use of large amounts of psychoactive drugs. Many, if not most of these homicides, would not have occurred without drug effects, for frequently there was evidence of grossly illogical thinking in close temporal association with use of intoxicants and in many cases there was no previous history of violence, no evidence of premeditation, no plan to avoid arrest and little or no discernible motivation. Usually there were multiple losses or other severe stress in the lives of the persons committing the homicide in the months preceding the crime. The stress increase was accompanied by increased and extraordinary intake of psychoactive substances. We theorize that high doses of psychoactive drugs impaired severely the brain systems upon which the mental functions of reality testing and judgment depend. Drug induced impairment of reality testing and judgment is frequently uncritically equated with hallucinations, disorientation, changes in time perception or other drug induced mental phenomena. Impairment of reality testing and judgment are basic criteria for linking drug effects with the behavior of homicide in the cases reviewed.

Adult↗

Homicide in Alabama: an analysis of urban, suburban and rural murders in the Deep South.

Eleven hundred forty-four (1144) homicides occurring in Alabama, U.S.A. during a 2-year period are presented and analyzed according to the demographic parameters of the victims, location in urban, suburban, or rural community, type of homicide based on a medical examiner's classification, presence of drugs, weapon employed and other factors. Urban dwellers, Blacks and males are found to be at high risk. Alcohol is much more prevalent than other drugs in homicide victims. Although the handgun is the weapon most commonly used throughout the state, in the rural regions the longgun is used almost as often. The difficulty of making valid comparisons with other homicide studies is discussed and the establishment of a uniform classification of homicides urged.

Adolescent↗

Homicide survivors: research and practice implications.

Approximately 16.4 million people in the United States have been affected by homicide. Five million adults have experienced the murder of an immediate family member; 6.6 million people have experienced the murder of a relative other than a family member, and 4.8 million have experienced the murder of a close friend. These homicide survivors experience a variety of difficulties, some similar to post-traumatic stress disorder (PTSD). The large incidence of homicide in the U.S. warrants an examination of the research on the impact of a murder on a victim's friends and family and the implications for healthcare providers. Homicide survivors experience negative psychological and physical effects that often result in an increase in the usage of primary care services. Provider training should include protocols to screen for, discuss, and make referrals for the family and friends of homicide victims. This article recommends the development of a training program to equip providers with the tools to recognize and serve this growing population of patients.

Adult↗

Social trust, firearm prevalence, and homicide.

PURPOSE: Past research suggests that Americans arm themselves when they do not trust one another. We reexamine the relationship between social trust and firearm prevalence with improved data and methods. We also control for conditions, including area homicide rates, that other research showed to be related to both social trust and firearm prevalence. METHODS: We use structural equation models to assess reciprocal effects of social trust, firearm prevalence, and homicide rates for a nationally representative sample of counties and county clusters (n = 99). RESULTS: We found no direct relationship between social trust and firearm prevalence. Social trust is related to firearm prevalence indirectly through its influence on homicide rates. Areas with low levels of social trust have high homicide rates, which, in turn, increase firearm prevalence. CONCLUSIONS: Americans arm themselves in response to high levels of firearm violence. Because greater social trust is related to lower homicide rates, public health researchers should be concerned with the community conditions that promote social trust.

Adolescent↗

Triad-related homicides in Hong Kong.

This study provides an overview of the first systematic research on triad-related homicide in a Chinese society. In the 10-year period from 1989 to 1998, 11.9% of all homicides or a total of 95 triad-related homicides were extracted from the Hong Kong Homicide Monitoring Database. These events resulted in 124 victims (13.2 percent of all victims) and involved 526 known offenders. Triad homicides were classified into various types based on different combinations of circumstances, motivation, and outcomes including unintended outcomes.

Adult↗