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PubMed2004

Comorbid personality disorders and substance use disorders of mentally ill homicide offenders: a structured clinical study on dual and triple diagnoses.

Comorbid substance use disorders (SUDs) increase the risk of homicide by persons with major mental disorders (MMDs). However, there are no published data from clinical interviews or lifetime objective documents on the prevalence of lifetime personality disorder (PD) or SUD among a comprehensive sample of mentally ill homicide offenders. Therefore, a nationally representative sample of men with MMD (n = 90) who had committed or attempted homicide was assessed using the research version of the Structured Clinical Interview for DSM-IV Axis I and Axis II Disorders. Lifetime documents, records, and questionnaires from persons who knew the subjects since childhood were used. Seventy-eight percent of the mentally ill homicide offenders were diagnosed with schizophrenia, 17 percent with schizoaffective disorder, and 5 percent with other psychosis. A lifetime SUD was detected in 74 percent and alcohol use disorder in 72 percent. PD accounted for 51 percent, in 47 percent as antisocial personality disorder (APD). All subjects diagnosed with PD had SUD. Only 25 percent of the subjects had neither SUD nor PD. Among persons with dual diagnoses (MMD and SUD), about two-thirds had PD or APD. These results indicated that there were two-thirds major diagnostic categories of psychotic homicide offenders: about one-half had triple diagnosis (APD + SUD + MMD), one-quarter had "pure" dual diagnosis (SUD + MMD), and one-quarter had "pure" MMD. The fourth possible category, "APD + MMD but no SUD," was not found. The prevention of severe violence by persons with MMD necessitates effective treatments for those with dual diagnosis who also have a history of APD.

Adult↗
PubMed1996

Schizophrenia and homicidal behavior.

It is generally thought that schizophrenia does not predispose subjects to homicidal behavior. However, many previous studies have suffered from notable methodological weaknesses. In particular, obtaining comprehensive study groups of violent offenders has been difficult. Finnish police have been able to solve about 97 percent of homicides during the last few decades. Because most homicide offenders are subjected to intensive forensic psychiatric examination, we were able to obtain data for 93 homicide offenders with schizophrenia among 1,423 arrested during a 12-year period. Calculations of the odds ratios revealed that the risk of committing a homicide was about 10 times greater for schizophrenia patients of both genders than it was for the general population. Schizophrenia without alcoholism increased the odds ratio more than 7 times; schizophrenia with coexisting alcoholism more than 17 times males.

Adolescent↗
PubMed1999

Homicides in two Scandinavian capitals.

In this study we investigated homicides in the two Scandinavian capitals, Copenhagen, Denmark and Oslo, Norway, for the 10-year period from 1985 to 1994. The total number of homicides was 431; 63.8% occurred in Copenhagen and 36.2% in Oslo. The average homicide rate was 1.6/100,000 in Copenhagen and 1.8/100,000 in Oslo. Blunt force, sharp force, and strangulation were the most common methods. Firearms were also used but did not account for >20% in either of the two cities. This is probably due to strict gun laws in both countries. There was no clear difference between the homicide victim populations in the two cities with regard to age, gender, or social and marital status. The proportion of alcoholics and unemployed persons was much higher than in the background population and to a similar extent in both cities, indicating that the homicide victim populations differ from the background populations. The perpetrator knew the victim in the majority of the cases. The most frequent motives or circumstances in both cities were fights, family rows, financial controversies, or jealousy.

Adolescent↗
PubMed2000

Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children.

Defendants accused of inflicting fatal abdominal injuries to children occasionally raise the defense that the injuries were caused by cardiopulmonary resuscitation (CPR). The purpose of this study is to answer the question: Does closed chest CPR result in fatal blunt abdominal injuries that can be mistaken for homicidal assault? To that end, a retrospective study was conducted of all homicidal blunt abdominal injuries in children 10 years and younger from the Dade, Broward, and Palm Beach Medical Examiner's Offices from 1981 through 1997. These were compared to cases of children who died of natural causes during the same time period in Broward County who had CPR (control group 1) and to children who died of nonvehicular accidental blunt abdominal trauma (control group 2). Children with life-threatening head injuries were excluded. Medical examiner records, autopsy reports, documenting photographs, and clinical records were reviewed. The data analyzed included subject demographics, whether CPR was performed and by whom, and autopsy findings. Thirty-three child homicides with fatal abdominal injuries were reviewed. Twenty-four (73%) of the homicides received CPR. There was no difference in the nature and severity of injuries between the 24 children who received CPR and the 9 who did not. Three hundred and twenty-four cases of pediatric natural deaths were reviewed, all of which had CPR. No traumatic abdominal injuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal trauma related to CPR. No cases of nonvehicular accidental blunt abdominal trauma were identified during the 17-year period, although there were nonvehicular accidental fatalities due to extraabdominal injuries. The likelihood of CPR-related primary abdominal trauma in child homicides is very low.

Abdominal Injuries↗
PubMed2005

Pregnancy-associated death: a qualitative systematic review of homicide and suicide.

A systematic review of the literature on maternal homicide and suicide was performed to understand the causes of pregnancy-associated death. Forty-four studies examined homicide and/or suicide and pregnancy-associated death (defined as the death of a woman, from any cause, while she is pregnant or within 1 year of termination of pregnancy) (1). Of these studies, 747 homicides and 349 suicides were identified. All studies were included except duplicate datasets, case reports of less than 3 events, suicide attempts, unpublished manuscripts, review articles, or non-English studies. Homicide is a leading cause of pregnancy-associated death and suicide is also an important cause of death among pregnant and recently pregnant women. Healthcare providers should understand that homicide is a leading cause of pregnancy-associated death, most commonly as a result of partner violence. Therefore, screening for both partner violence and suicidal ideation are essential components of comprehensive medical care for women during and after pregnancy.

Adult↗
PubMed2006

A time-series analysis of the impact of heavy drinking on homicide and suicide mortality in Russia, 1956-2002.

AIM: Assess the impact of heavy drinking on homicide and suicide mortality in Russia between 1956 and 2002. MEASURES AND DESIGN: Alcohol-related mortality was used as a proxy for heavy drinking. We used autoregressive integrated moving average techniques to model total and sex-specific alcohol-homicide and alcohol-suicide relationships at the population level. FINDINGS: We found a positive and significant contemporaneous association between alcohol and homicide and between alcohol and suicide. We found no evidence of lagged relationships. These results held for overall and sex-specific associations. CONCLUSION: Our results lend convergent validity to the alcohol-suicide link in Russia found by Nemtsov and to the alcohol-homicide associations found in cross-sectional analyses of Russia. Levels of alcohol consumption, homicide and suicide in Russia are among the highest in the world, and the mounting evidence of the damaging effects of consumption on the social fabric of the country reveals the need for intervention at multiple levels.

Alcohol Drinking↗
PubMed1986

Relation between suicide and homicide in Portugal from 1970 to 1982.

To evaluate to what extent a suicide can be considered a hetero-aggression converted into self-aggression, this study analyses whether the increase in suicides corresponds to a decrease in homicides and vice-versa. Rates of suicide and homicide from 1970 to 1982 have been analysed in Portugal, Azores and Maderia, and the district and city of Lisbon; age and sex groups have also been compared. There is no inverse variation between suicides and homicides either globally or for males or females. There is also a difference in age distribution for suicides and homicides - suicides being mainly over 50 years, homicides mainly under. This suggests that it is not very plausible that self- and hetero-aggressive behaviours alternate in the same individual, although it is possible that, with increasing age, he may move from hetero- or potential hetero-aggression to self-aggression.

Age Factors↗
PubMed1987

The practice of forensic psychiatry in cases of homicide in Copenhagen, 1959 to 1983.

During the years 1959 to 1983 a doubling in the rate of homicide took place in Copenhagen. This increase was exclusively due to an increasing number of male offenders. By comparing with another Danish material, the frequency of female homicide as well as that of homicide combined with suicide was found practically unchanged since 1946, indicating that both of these kinds of homicides seem to have a background different from those of other offences of fatal violence. During the years 1959 to 1983, the criteria of selection of the defendants for a psychiatric examination for the court were fairly consistent. Examinations were performed in practically all cases, where a charge of murder raised by the police was followed by a legal trial for homicide. Less and less of the defendants, however, were hospitalized for the examination, while more were examined in The Clinic of Forensic Psychiatry in Copenhagen.

Denmark↗
PubMed1988

Increasing rates of homicide in Copenhagen from 1959 to 1983.

The increase in homicide in Copenhagen during the years from 1959 to 1983 was investigated in a material of 251 defendants of homicide examined by a psychiatrist. During the period the change in the pattern of female homicide was only slight. The rise in the consumption of alcohol and drugs in the general population was found related to the increase in the rate of homicide committed by male - mostly alcoholic - substance abusers. Further was noticed an increase in homicide involving victims outside the family of the defendant. This trend was most prominent among the youngest of the defendants. The results are commented by referring to recent changes in interpersonal relations and to the conditions for socialization of the rising generation of today.

Adolescent↗
PubMed2004

Neighbourhoods and homicide mortality: an analysis of race/ethnic differences.

OBJECTIVE: To examine whether measures of neighbourhood economic deprivation, social disorganisation, and acculturation explain homicide mortality differentials between Mexican Americans, non-Hispanic black Americans, and non-Hispanic white Americans, net of individual factors. DESIGN: Prospective study, National Health Interview Survey (1986-1994) linked to subsequent mortality in the National Death Index (1986-1997). SETTING: United States of America. PARTICIPANTS: A nationally representative sample of non-institutionalised Mexican Americans, non-Hispanic black Americans, and non-Hispanic white Americans, aged 18-50 at the point of interview. ANALYSIS: Cox proportional hazard models estimate the risk of death associated with various neighbourhood and individual factors. MAIN RESULTS: Both individual and neighbourhood risk factors partially account for race/ethnic disparities in homicide. Homicide mortality risks are between 20% and 50% higher for residents of areas that have economic inequality of 0.50 or greater based on the coefficient of variation, or where 4% or more of the residents are Mexican American, 10% or more of the residents are non-Hispanic black, or 20% or more of the households are headed by single parents (p< or = 0.05). But residents of areas where 10% or more of their neighbours are foreign born have 35% lower mortality risks than people living in areas with fewer foreign born people (p< or =0.05). These differences persist even after controlling for individual level risk factors. CONCLUSIONS: The findings support economic deprivation, social disorganisation, and acculturation theories, and suggest that both neighbourhood and individual risk factors affect race/ethnic differences in homicide mortality. Public health policies must focus on both individual and neighbourhood factors to reduce homicide risks in vulnerable populations.

Adolescent↗
PubMed2000

The rise and decline of homicide--and why.

A dramatic rise in homicide in the latter half of the 1980s peaked during the 1990s and then declined at an equally dramatic rate. Such trends in homicide rates can be understood only by examining rates in specific age, sex, and racial groups. The increase primarily involved young males, especially black males, occurred first in the big cities, and was related to the sudden appearance of crack cocaine in the drug markets of the big cities around 1985. This development led to an increased need for and use of guns and was accompanied by a general diffusion of guns into the larger community. The decline in homicide since the early 1990s has been caused by changes in the drug markets, police response to gun carrying by young males, especially those under 18 years old, the economic expansion, and efforts to decrease general access to guns, as well as an increase in the prison population and a continued decline in homicide among those over age 24. The lessons learned from the recent homicide trends and the factors associated with them have important implications for public health and the criminal justice system.

Adolescent↗
PubMed1984

Bereavement after homicide: a descriptive study.

The act of homicide specifically influences the clinical presentation of subsequent bereavement. Retrospective reports of 15 individuals who lost a relative through homicide revealed cognitive, behavioral, and affective reactions associated with the homicide. Several of these reactions match those described in the DSM-III diagnosis of posttraumatic stress disorder, chronic or delayed type. The identification of bereaved individuals with the homicide and the therapeutic implications of bereavement after homicide are discussed.

Adult↗
PubMed1990

Homicide patterns in the West Midlands.

In order to determine the incidence of various types of homicide, a retrospective review of 140 homicide post-mortems was carried out. Four major causes of death--stabbing, asphyxia, blunt head injury and shooting--accounted, alone or in combination, for 89% of the deaths. Within each of these major groups an analysis was carried out of the pattern of injuries sustained by homicide victims. In particular the changes seen at post-mortem in the cases of asphyxial death were analysed. Ligature strangulation was twice as common as manual, and fracture of the bones of the neck occurred in 50% of the cases of ligature strangulations compared to 33% of manual strangulations. Petechial haemorrhages were found with equal frequency in the facial skin and eyes above the level of neck constriction and in the thoracic organs below the level of constriction. Of the victims, 54% were male and 46% were female, whereas 90% of the assailants were male and 8% were female. A 'close' family relationship existed between the victim and the assailant in 43% of cases and in only 4% of the cases was there a proven sexual motive for the homicide. In 4% of the cases natural pre-existing disease in the victim contributed to the death by homicide.

Adolescent↗
PubMed1996

A survey of male homicide cases resident in an English special hospital.

The study examines a sample of 120 male special hospital patients whose index offence was one of homicide. Demographic, criminological and psychiatric details are described and the characteristics of those committing psychotic and non-psychotic homicides are compared. The results generally confirmed most of the findings reported in international studies of abnormal homicide. Compared with other studies on in-patient populations we found a greater than expected proportion of non-psychotic homicide offenders, the majority of whom had a clinical diagnosis of personality disorder. Key factors distinguishing psychotic from non-psychotic homicide included a pre-offence criminal history, the objective relationship between perpetrator and victim and the behaviour after the offence. Psychotic men were less likely to have a prior history of criminality and substance abuse than their non-psychotic pears but they were more likely to have had previous contact with the psychiatric services and to have known their victims. Compared with the non-psychotic group the majority of psychotic offenders remained at the crime scene or summoned help. A marked age differential between psychotic and nonpsychotic offenders was not apparent in this study.

Adult↗
PubMed2002

Homicide in the Canadian Prairies: elderly and nonelderly killings.

OBJECTIVE: To examine the psychosocial and clinical characteristics of male perpetrators of elderly and nonelderly homicides in the Canadian Prairies. METHOD: We examined data drawn from a study of 901 adult homicide offenders who were incarcerated or on parole between 1988 and 1992 in Alberta, Saskatchewan, and Manitoba. RESULTS: Of those studied, 67 men were convicted of homicide involving 79 elderly victims, and 671 were convicted of homicide involving 675 nonelderly victims. Most perpetrators were single and engaged in irregular patterns of employment at the time of their index offence. Fourteen (20.8%) offenders with elderly victims had a history of psychiatric treatment, compared with 98 (14.6%) offenders with nonelderly victims; however, this difference was not statistically significant. Approximately 30% of both groups were diagnosed with personality disorders. A comparison of the index- offence characteristics showed no significant differences between the 2 groups. CONCLUSION: Our findings suggest that elderly individuals are more likely to be killed in their own homes by strangers. Social isolation appears to be a significant risk factor in cases of elderly homicide.

Aged↗
PubMed1993

Homicide, schizophrenia and substance abuse or dependency.

Few studies have extensively studied the aggressive behaviours of mentally disordered offenders. This investigation compared 14 schizophrenics found not guilty of homicide by reason of insanity (NGRI) with 12 schizophrenics convicted of homicide. A comparison group of 15 homicide offenders with no major mental disorder was used. Drug and alcohol consumption, previous history of aggression against others as well as mental health were assessed using standardized, reliable, valid instruments. Significantly more of the inmates with no major mental disorder were diagnosed as having a history of drug or alcohol abuse or dependency (60%) than the NGRI schizophrenics (35.7%). In addition, both groups of convicted homicide offenders were more likely to have committed homicide under the influence of drugs or alcohol than the NGRI group. No significant difference distinguished the groups for the mean number of aggressive incidents. The subjects found NGRI assaulted more often during an acute phase of mental illness than the convicted schizophrenics. Although both groups appeared to have a similar number of hospitalizations, most of the hospitalizations of the convicted schizophrenics occurred after the crime.

Adolescent↗
PubMed2005

Examining anxiety as a predictor of homicidality: a pilot study.

Homicidality rates have been shown to be more prominent among persons diagnosed with mental disorders as compared to the general population. However, the role that anxiety plays in homicidal ideation and intent is poorly understood. This study investigated predictors of homicidal intent, thought, or plan in an adult population of psychiatric inpatients diagnosed with anxiety disorders. Results suggest that the factors most strongly associated with homicidality include male gender, substance abuse, mania, and current legal problems. Multiple regression analyses showed that only male gender predicted homicidality when other variables were taken into account.

Adult↗
PubMed1999

Violence, homicide and suicide: strong correlation and wide variation across districts.

BACKGROUND: The clinical assessment and management of the risk of violence and suicide by people with mental illness may have to focus on environmental as well as individual factors. AIMS: To investigate possible associations between violence, homicide and suicide rates, population density and indices of deprivation, with particular reference to inner-city boroughs. METHOD: Coroners' statistics in London for homicide and suicide were obtained, with police-reported homicide and violence rates as a validity check. Correlations were made between these data and population density, the Jarman under-privileged areas score, and the Mental Illness Needs Index for each of the 32 London boroughs. RESULTS: Homicide rates had a 14.3-fold range, suicide a 4.4-fold range and interpersonal violence a 6.6-fold range. The variables under study were strongly correlated with each other. Rates were highest in boroughs with high population density and deprivation scores. The associations persisted when covarying for deprivation, age structure or population density. CONCLUSIONS: Because violence, homicide and suicide are so closely correlated, they are likely to be valid indices of the differences between adjacent boroughs; this has implications for the delivery of preventive and mental health services and for clinical management of risk.

Adolescent↗