Circumstances Preceding Homicide-Suicides Involving Child Victims: A Qualitative Analysis

Perpetrator characteristics and firearm use in pediatric homicides: Supplementary Homicide Reports - United States, 1976 to 2020

BACKGROUND

Describe trends in perpetrator characteristics and firearm use in pediatric homicides across the United States.

METHODS

Multiply-imputed data from the Federal Bureau of Investigation's 1976-2020 Supplementary Homicide Reports were used to estimate perpetrator characteristics (sex, age, and relationship to victim) and firearm use in pediatric homicides. Descriptive analyses were stratified by victim age group, sex, race, and five-year time periods.

RESULTS

Family members were the most common perpetrator of infant and toddler (ages 0-4) and child (ages 5-12) homicides, whereas acquaintances accounted for the majority of adolescent (ages 13-19) homicides. Perpetrator characteristics vary across victim sex and race, particularly among adolescents. Despite overall stability, there were changes in perpetrator characteristics from 1976 to 2020. There was a sustained increase in the proportion of homicides committed with a firearm. In 2016-2020, the proportion of firearm-involved homicides was an all-time high for infant and toddler (14.8%), child (53.1%), and adolescent victims (88.5%).

CONCLUSIONS

Policy interventions that improve family stability and well-being may be most effective at preventing infant, toddler, and child homicides, whereas programs that target peer and community relationships, as well as policies that focus on firearm access, may be more crucial for preventing adolescent homicides.

Intentional child and adolescent homicides in Milan (Italy): A 30-year interdisciplinary study

This study aims to discuss the forensic and criminological implications of child homicides in the territory of Milan, Italy. The authors present a retrospective study on all the cases of child and adolescent homicides, that were observed at the Institute of Legal Medicine of Milan (Italy) in the last 30 years (from January 1991 to December 2020). A total of 46 child homicides were collected, focusing on the sociological features, by highlighting peculiar cases, risk factors, potential changing social trends, and comparing our cases with the current literature. The analysis revealed a statistically significant relationship (p < 0.05) for male adolescents and indicated that adolescent homicides were more frequently perpetrated in extrafamilial contexts. In contrast, neonaticides and infanticides were mainly committed at home. Furthermore, the Fisher's Exact test revealed that child murders were mainly committed by immigrants in the Milan district after 2005 (p < 0.05). The two main causes of death were due to sharp and firearm injuries. While the relationship between homicide clusters and homicides committed by sharp objects was not significant, adolescent homicides were mainly committed using firearms (p < 0.05). The present study may help to identify risk factors for homicides against child and adolescent. Consequently, policies that identify, prevent, and minimize this extreme violence should be designed to interrupt the vicious circle of such dreadful murderous events. Child and adolescent homicides deserve additional focus and better education for healthcare professionals and further research should be carried out to develop therapeutic and caring strategies.

A Descriptive Study of the Characteristics of Homicide-Suicide in Forensic Autopsy Cases

Homicide followed by suicide (HS) is a tragic event with varied characteristics across countries and regions. Compared to Western countries, there are limited studies on HS in Asian countries. Therefore, this study aimed to clarify the characteristics of recent HS cases by examining forensic autopsy records from 2008 to 2020 collected from the Department of Legal Medicine, Chiba University, in Japan. A total of 77 HS cases were identified, involving 77 perpetrators (52 completed suicides, 25 attempted suicides), with 28 perpetrator and 89 victim autopsies. Our findings showed that older adults accounted for nearly half of the victims; victims were mostly females, whereas most perpetrators were male. The most common HS relationship was that between a parent and a child. Autopsy findings showed that the most common cause of death was strangulation, and illegal drugs were detected only in a few cases; however, psychotropic drugs were detected in child victims. No obvious evidence of past child physical abuse by caregivers was found. In contrast, intimate partner violence (IPV) was present, with a history of IPV found in half of HS cases involving adult intimate partner relationships. Notably, gender differences in age and relationship to the victim were identified. Likewise, some perpetrators may have expressed their plans and intentions for HS before the event, which may represent an important sign for HS prevention. However, to accurately reveal the course of HS, nationwide integrated statistics, forensic autopsies, including toxicological analyses of the deceased; and forensic psychiatric perspectives, including psychological autopsy, are required.

A systematic review of literature on homicide followed by suicide and mental state of perpetrators

BACKGROUND

Homicide followed by suicide is rare, devastating and perpetrated worldwide. It is commonly assumed that the perpetrator had a mental disorder, raising concomitant questions about prevention. Though events have been reported, there has been no previous systematic review of the mental health of perpetrators.

AIMS

Our aims were twofold. First, to identify whether there are recognisable subgroups of homicide-suicides in published literature and, secondly, to investigate the relationship between perpetrator mental state and aspects of the incident.

METHODS

We conducted a systematic review of published literature on studies of homicide followed within 24 h by suicide or serious suicide attempt that included measures of perpetrator mental state.

RESULTS

Sixty studies were identified, most from North America or Europe. Methodologically, studies were too heterogeneous for meta-analysis. They fell into three main groups: family, mass shooter, and terrorist with an additional small mixed group. There was evidence of mental illness in a minority of perpetrators; its absence in the remainder was only partially evidenced. There was no clear association between any specific mental illness and homicide-suicide type, although depression was most cited. Social role disjunction, motive, substance misuse and relevant risk or threat behaviours were themes identified across all groups. Pre-established ideology was relevant in the mass shooter and terrorism groups. Prior trauma history was notable in the terrorist group.

CONCLUSION

Research data were necessarily collected post-incident and in most cases without a standardised approach, so findings must be interpreted cautiously. Nevertheless, they suggest at least some preventive role for mental health professionals. Those presenting to services with depression, suicidal ideation, relationship difficulties and actual, or perceived, changes in social position or role would merit detailed, supportive assessment over time.

Intimate Partner Homicide: Comparison Between Homicide and Homicide-Suicide in Portugal

Intimate partner homicide (IPH) is a tragic event. Studies involving the comparison between IPH and intimate partner homicide-suicide (IPH-S) are scarce, with few studies in Portugal about this issue. The current study aims to compare IPH and IPH-S perpetrators, the victim-perpetrator relationships dynamics, and homicide circumstances. The data was collected through the analysis of 78 judicial processes of IPH that occurred in Portugal, between 2010 and 2015. Of the cases, 51 were IPH, 20 were IPH-S cases, and seven were attempted suicide cases, being perpetrated in 84.6% (n = 66) for male perpetrators. Suicide after intimate homicide were all committed by men. All judicial processes analyzed refer to heterosexual relationships. Bivariate and multivariate analyses were performed to compare the groups concerning perpetrator and victim sociodemographic characteristics, victim-perpetrator dyadic dynamics, and crime circumstances. The results show mostly common trends between the two groups with some differentiating factors when compared individually (e.g., perpetrator professional status, criminal records). Regression logistic analysis showed no differences between IPH and IPH-S.

Firearm Homicides of US Children Precipitated by Intimate Partner Violence: 2003-2020

OBJECTIVES

Examine characteristics associated with firearm homicides of children aged 0-17 years precipitated by intimate partner violence (IPV).

METHODS

Data were from the Center for Disease Control and Prevention's National Violent Death Reporting System (49 states, District of Columbia, Puerto Rico; 2003-2020). Logistic regression was used to examine associations between various characteristics and IPV among child firearm homicides.

RESULTS

From 2003-2020, a total of 11 594 child homicides were captured in the National Violent Death Reporting System, of which 49.3% (n = 5716) were firearm homicides; 12.0% (n = 686) of child firearm homicides were IPV-related. Among IPV-related child firearm homicides, 86.0% (n = 590) were child corollary victims (ie, children whose death was connected to IPV between others); 14.0% (n = 96) were teens killed by a current or former dating partner. Child firearm homicides had greater odds of involving IPV when precipitated by conflict, crises, and cooccurring with the perpetrator's suicide compared with those without these characteristics. Over half of IPV-related firearm homicides of child corollary victims included homicide of the adult intimate partner, of which 94.1% were the child victim's mother. Child firearm homicides perpetrated by mothers' male companions (adjusted odds ratio, 6.9; 95% confidence interval, 3.9-12.1) and children's fathers (adjusted odds ratio, 4.5; 95% confidence interval, 3.0-6.8) had greater odds of involving IPV compared with those perpetrated by mothers.

CONCLUSIONS

Multiple factors were associated with greater odds of child firearm homicides being IPV-related. Strategies promoting healthy intimate partner relationships starting at a young age; assessment of danger to children in IPV situations; strengthening economic supports for families; creating safe, stable, and nurturing relationships and environments for children; and addressing social and structural inequities are important for preventing firearm homicides of children, including those involving IPV.

Intimate Partner Violence, Child Custody, and Financial Issues Among Female Suicide Decedents With Known Intimate Partner Problems: National Violent Death Reporting System, 2018

BACKGROUND

Hardships such as custody issues and financial stress may increase suicide risk for individuals experiencing intimate partner problems, particularly intimate partner violence (IPV). The objective of this study was to examine associations among custody issues, financial strain, and IPV among female suicide decedents with known intimate partner problems using data from the National Violent Death Reporting System (NVDRS).

METHODS

NVDRS data from 2018, which comes from 41 U.S. states, was used to examine the nature and frequency of custody and financial strain and IPV among a sample of 1,567 female suicide decedents with known intimate partner problems (e.g., divorce, breakup, argument). Case narratives were used to extract detailed information about these situations.

RESULTS

IPV was documented in 22.14% of cases. Compared with those without documented IPV, cases with documented IPV were more likely to include custody issues (3.44% vs. 6.34%). Controlling for demographic characteristics and mental health, documented child custody issues were associated with greater odds of IPV (odds ratio = 1.80; 95% confidence interval = 1.03-3.16). Financial strain was not statistically significantly associated with child custody issues or IPV among this sample.

CONCLUSIONS

Child custody issues can contribute to suicide among women with known intimate partner problems and are positively associated with IPV. Suicide prevention and intervention efforts should recognize child custody issues as a risk factor, particularly when coupled with IPV. There is also a need to promote policies and services that improve the financial and civil legal circumstances of IPV survivors.

Precipitating Circumstances Associated With Intimate Partner Problem-Related Suicides

INTRODUCTION

In 2020, suicide was the 12th leading cause of death among adults in the U.S. Previous research has shown that one common precipitating circumstance among adult suicide decedents is experiencing intimate partner problems (IPPs), such as divorce, separation, romantic break-ups, arguments, conflicts, and intimate partner violence. This study examines how precipitating factors differ between IPP- and non-IPP-related suicides.

METHODS

In 2022, this study analyzed National Violent Death Reporting System data from adult suicide decedents in 48 states and 2 territories between 2003 and 2020. Multivariable logistic regression models were used to compare precipitating circumstances between IPP- and non-IPP-related suicides, controlling for sociodemographic characteristics.

RESULTS

Of the 402,391 suicides, 20% (n=80,717) were known to be IPP-related. Circumstances that significantly increased the odds of IPP-related suicides included a history of suicidal thoughts and attempts and mental health problems (depressed mood, alcohol problem, mental health diagnosis), life stressors (interpersonal violence perpetration and victimization, arguments, financial problems, job problems, family problems), and recent legal problems. Non-IPP-related suicides were more likely to occur among older individuals and to be precipitated by a physical health problem or crime.

CONCLUSIONS

The findings can inform prevention strategies that build resiliency and problem-solving skills, strengthen economic support, and identify and assist people at risk for IPP-related suicides. The Centers for Disease Control and Prevention's Suicide Resource for Action and Intimate Partner Violence Prevention resource packages highlight the best available evidence for policies, programs, and practices related to preventing suicides and IPP.

Research utility and limitations of textual data in the National Violent Death Reporting System: a scoping review and recommendations

BACKGROUND

Many studies of injury deaths rely on mortality data that contain limited contextual information about decedents. The National Violent Death Reporting System (NVDRS) is unique among such data systems in that each observation includes both quantitative variables and qualitative texts (called "narratives") abstracted from original source documents. These narratives provide rich data regarding salient circumstances that can be used to inform prevention efforts. This review provides a comprehensive summary of peer-reviewed research using NVDRS narratives over the past 20 years, including the limitations of these texts and provides recommendations on utilizing and improving narrative quality for researchers and practitioners.

MAIN BODY

Studies that used narratives to examine deaths related to suicide, homicide, undetermined intent, accidental firearm, or legal intervention were identified by a title/abstract screening, followed by a full-text review. The search was conducted on English-language, peer-reviewed literature and government reports published from 2002 to 2022 in PubMed, PsycInfo, Scopus, and Google Scholar. Abstracted elements focused on the methodologies used to analyze the narratives, including approaches to explore potential biases in these texts. Articles were abstracted independently by two reviewers, with disagreements resolved through consensus discussion. During the 20-year period, 111 articles used narratives. Two-thirds studied suicide (n = 48, 43%) and homicides (n = 25, 23%). Most studies analyzed the narratives using manual review (n = 81, 73%) and keyword searches (n = 9, 8%), with only 6 (5%) using machine learning tools. Narratives were mainly used for case finding (n = 49, 44%) and characterization of circumstances around deaths (n = 38, 34%). Common challenges included variability in the narratives and lack of relevant circumstantial details for case characterization.

CONCLUSION

Although the use of narratives has increased over time, these efforts would be enhanced by detailed abstraction of circumstances with greater salience to injury research and prevention. Moreover, researchers and practitioners would benefit from guidance on integrating narratives with quantitative variables and standardized approaches to address variability in the completeness and length of narratives. Such efforts will increase the reliability of findings and set the stage for more widespread applications of data science methods to these texts.

A Randomized Control Trial to Test Dissemination of an Online Suicide Prevention Training For Intimate Partner Violence Hotline Workers

Purpose

Suicide risk is higher among violence-involved individuals. Intimate Partner Violence hotline workers are a critical source of support and can potentially be suicide prevention champions. Our primary goal was to examine the effectiveness of disseminating a free, online IPV-Suicide Prevention curriculum, via a randomized control trial, to hotline workers in ten states with the highest suicide and IPV homicide rates.

Method

We divided the country into five regions and, based on criterion, chose two states in each region to randomize into the two arms of the study. We examined training participation and engagement between the two approaches: (1) 'dissemination as usual' (control) using a National Domestic Violence Hotline email and a postcard to state/county IPV directors, versus (2) 'enhanced dissemination' (intervention) using a four-point touch method (postcard, phone call, email, and letter) to 'drive' participation.

Results

Participation increased in the intervention arm as approaches became more personal (i.e., email and phone calls vs. letters). Results indicate that traditional dissemination strategies such as email announcements and invitations are not as effective as varied and multiple touchpoints for IPV hotline staff.

Conclusion

Successful dissemination strategies to promote digital training should consider the value added by personalized connection. Future research is needed to understand how to offer effective and efficient web-based training to those providing IPV and child abuse services.

Post-separation abuse: A literature review connecting tactics to harm

Post-separation abuse is a pervasive societal and public health problem. This literature review aims to critically synthesize the evidence on tactics and consequences of post-separation abuse. We examined 48 published articles in the US and Canada from 2011 through May 2022. Post-separation abuse encompasses a broad range of tactics perpetrated by a former intimate partner including patterns of psychological, legal, economic, and mesosystem abuse as well as weaponizing children. Functional consequences include risk of lethality and deprivation of fundamental human needs. Connecting tactics of post-separation abuse to harms experienced by survivors and their children is crucial for future research, policy, and intervention work to promote long-term safety, health, and well-being of children and adult survivors.

Intimate Partner Violence and Children: Essentials for the Pediatric Nurse Practitioner

Intimate partner violence (IPV) is a public health problem of epidemic proportions. IPV often starts early in adolescence and continues throughout an individual's lifespan. IPV is defined as abuse or aggression occurring in the context of a romantic relationship that is perpetrated by a current or former partner. IPV victims often experience severe psychological trauma, physical injury, and even death. The direct recipient of the violence is often not the only individual impacted. Children are often peripheral victims of IPV. It is vital that pediatric health care providers, including pediatric nurse practitioners, recognize that IPV is indeed a pediatric health care crisis requiring strategies for both identification and intervention. This continuing education article will discuss IPV and its impact on children from conception to adolescence while exploring implications for practice.

Factors contributing to filicide-suicide: Differences between male and female perpetrators

BACKGROUND

One-quarter of homicide-suicide deaths in the U.S. are children. Filicide-suicide, a subset of homicide-suicide involving parent or caregiver perpetrators, is the most common form of homicide-suicide involving children. While these incidents have significant impacts, relatively few studies examine modifiable factors that contribute to these incidents.

OBJECTIVES

The purpose of this study was to identify patterns of circumstances and contributing factors for filicide-suicide deaths, focusing on the individual and interpersonal differences between male and female perpetrators.

PARTICIPANTS

This study utilized data from the National Violent Deaths Reporting System (NVDRS), which included 76 filicide-suicide incidents reported to NVDRS in 32 U.S. states between 2013 and 2015.

METHODS

We conducted a qualitative content analysis, which was grounded in the Marzuk, Tardiff, and Hirsch (1992) framework. We reviewed the filicide-suicide narratives and engaged in conversations about codes or themes that emerged for the filicide-suicide narratives. Additional codes were added as needed, and narratives were retroactively coded to ensure codes were consistently applied.

RESULTS

Relationship conflict and mental health issues were common among male and female perpetrators, but the manifestation of these factors differed greatly. For female perpetrators, relationship conflict, mental health issues, and children's chronic health issues commonly co-occurred. In contrast, relationship conflict, history of violence, and consequences of violence (e.g., legal issues, job problems) more commonly co-occurred among male perpetrators.

CONCLUSION

Filicide-suicides are preventable acts of violence with numerous contributing factors. Our findings highlight the need for prevention efforts to recognize interpersonal experiences, particularly differences between male and female perpetrators.

Is Homicide Followed by Suicide a Phenomenon in Itself? A Comparison of Homicide and Homicide-Suicide in Spain

The phenomenon of homicide followed by suicide (HS) has a low prevalence worldwide, although the literature has identified that these cases represent a significant percentage in homicide subtypes such as intimate partner homicide or filicide. In the present study, HS (n = 41) and homicides in which the perpetrator did not commit suicide after the event (n = 556) are compared. The information was extracted from police reports of homicides committed in Spain between 2010 and 2012 and belonging to the jurisdictions of the National Police and Civil Guard. The results showed that out of the total number of homicides analyzed, HS accounted for 4.9%, which implies a rate of 0.05 per 100,000 inhabitants. The findings of the study show that the profile of a HS victim of a 52-year-old Spanish woman. The perpetrator is of Spanish origin, 50 years old, unemployed, or retired, with a mental disorder, and with substance use being uncommon at the time of the event. HS events take place at the perpetrator's home, are related to interpersonal conflicts, involve a single perpetrator, several victims, and are mainly committed with a firearm. The findings are mostly consistent with previous studies and the prevalence of HS in the couple setting is highlighted (56.5%). However, the importance of studying cases outside of this setting is emphasized since it has been found that 30.5% of cases involve other family relationships and 13% occurred outside the domestic sphere.

Filicide as a cultural practice in Ghana: The qualitative understanding of a family tragedy and its implications for child protection practice

BACKGROUND

Contrary to evidence from the Western literature, cases of filicide in Ghana are mostly unreported because they are rooted in cultural practices and hidden from the general public.

OBJECTIVE

The purpose of this study was to explore the cultural context of filicide in a rural community. Particularly, to provide an understanding of the spirit child (SC) phenomenon, how the killing of a SC is performed and to provide a general understanding of filicide within a particular context.

PARTICIPANTS AND SETTING

Four relatives of a family that engaged in a filicide incident took part in the study. The interviews were conducted in a rural community in Ghana where the incident occurred.

METHODS

Short written narratives were used to explore the experiences and perceptions of relatives whose family engaged in filicide.

RESULTS

Children with severe deformities are likely to be associated with matters of divinity which gives way for the conceptualization of the SC and its attendant filicide. The findings highlight the critical role of traditional healers in rural communities and the consequences of strong community beliefs and expectations that influence parents to commit filicide.

CONCLUSION

The study provides directions for child protection workers to address the stigma parents face for having children with severe deformities and to provide education on child welfare legislation.

Intimate Partner Violence-Related Fatalities Among U.S. Youth Aged 0-24 Years, 2014-2018

INTRODUCTION

Little is known about intimate partner violence-related fatalities among young people. This study comprehensively identifies and describes intimate partner violence-related homicides, homicide-suicides, legal intervention deaths, and suicides among young people.

METHODS

Data from the 2014-2018 National Violent Death Reporting System were analyzed for all decedents aged 0-24 years in 38 states, the District of Columbia, and Puerto Rico with known circumstances of death (n=29,702). Intimate partner violence-related deaths were identified using National Violent Death Reporting System variables across all manners of death and supplementary narrative review for suicides. This article reports the proportion of intimate partner violence versus non-intimate partner violence-related deaths by manner of death, descriptive statistics, and rate of intimate partner violence-related death per 100,000 person years. To examine disparities in intimate partner violence-related deaths, generalized estimating equations were used with robust standard errors to account for clustering of deaths within states and fixed effects for years. Statistical analyses were conducted May and August 2021.

RESULTS

A total of 1,927 intimate partner violence-related deaths were identified, which represents 6.5% of violent deaths with known circumstances, at a rate of 0.35 per 100,000 person years. Supplementary narrative review identified 44.7% of all intimate partner violence-related deaths. There were significant differences by race/ethnicity and whether a firearm inflicted the fatal injury for male and female decedents by manner of death.

CONCLUSIONS

If the National Violent Death Reporting System does not assess whether intimate partner violence was a precipitating factor across all death manners, the true magnitude of intimate partner violence's contribution to violent death will be underestimated. Future research that identifies factors associated with all manners of intimate partner violence-related deaths among young people will help inform intervention and prevention strategies to save young lives.

Neuropathological Changes in the Brains of Suicide Killers

BACKGROUND

Homicide combined with subsequent suicide of the perpetrator is a particular form of interpersonal violence and, at the same time, a manifestation of extreme aggression directed against oneself. Despite the relatively well-described individual acts of homicide and suicide, both in terms of psychopathology and law, acts of homicide and subsequent suicide committed by the same person are not well-studied phenomena. The importance of emotional factors, including the influence of mental state deviations (psychopathology), on this phenomenon, is discussed in the literature, but still there is relatively little data with which to attempt neuropathological assessments of the brains of suicide killers. This paper is dedicated to the issue based on the neuropathological studies performed.

METHODS

We analyzed a group of murder-suicides using histochemical and immunohistochemical methods.

RESULTS

The results of our research indicate the presence of neurodegenerative changes including multiple deposits of ß-amyloid in the form of senile/amyloid plaques and perivascular diffuse plaques.

CONCLUSIONS

Neurodegenerative changes found in the analyzed brains of suicide killers may provide an interesting starting point for a number of analyses. The presence of neurodegenerative changes at such a young age in some murderers may suggest preclinical lesions that affect cognitive functions and are associated with depressed moods.

An Epidemiologic Examination of Perpetrators of Fatal Child Maltreatment Using the National Violent Death Reporting System (NVDRS)

Fatal child maltreatment in the United States increased 12.9% from 2013 to 2016. Parents are the predominant perpetrators, underscoring the need to examine risk factors associated with this class of offenders. This study examined the relationship between three primary forms of fatal child maltreatment (neonaticide, infanticide, and filicide) and perpetrator characteristics. Using the National Violent Death Reporting System, we employed a retrospective observational study to examine fatal child maltreatment in decedents aged 10 years and below from 2011 to 2015. Multinomial logistic regression of 1,023 maltreatment-related deaths was used to evaluate perpetrator characteristics. Perpetrators were most often male (58%) and the parent of the child victim (53%). Intimate partners represented 22% of perpetrators. The odds of fatal maltreatment were modified by perpetrator age, sex, and relationship to the victim. Results underscore a need for male-focused interventions and research examining the etiology of violence against children perpetrated by the intimate partner of a parent.

A Comparison of Intimate Partner Homicide With Intimate Partner Homicide-Suicide: Evidence From a Norwegian National 22-Year Cohort

Homicide-suicide incidents make up a relatively small proportion of homicides overall, but occur more frequently in certain subtypes of homicide, such as men who kill their female partners. This study investigates aspects of intimate partner homicide-suicide (IPHS) by comparing it with intimate partner homicide (IPH). All IPHs in Norway from 1990 to 2012 (N = 177) were included. Quantitative data were extracted from court documents. Qualitative data were collected by interviews with bereaved. Multivariate logistic regression analyses and systematic text condensation were conducted. Nearly one fourth of IPHs were identified as IPHS. Perpetrators of IPHS were less likely to have a previous criminal record, even having a history of disregard and violations of the law. Perpetrators of IPHS were mainly native-born citizens and were more educated than IPH perpetrators. The motive of IPHS was more often jealousy than a dispute, but the motive was most often recorded as "other" or "unknown." IPHS was perceived as intentional, and the bereaved did not unambiguously support the interpretation that the IPHS had been triggered by stressful situations. The bereaved pointed to the loss of hope or loss of a future combined with an inability to cope with severe disappointments as an important risk factor. Within the framework of an interactional perspective, our findings indicate that IPHS shares more characteristics with IPH than it does with other categories of homicide and other violent deaths in general.

Child maltreatment fatalities among children and adolescents 5-17 years old

BACKGROUND

Child maltreatment-related fatalities occur among children of all ages. However, few published studies have examined child abuse and neglect deaths among older children and adolescents.

OBJECTIVE

To epidemiologically describe child maltreatment-related fatalities among children in the United States 5-17 years old.

PARTICIPANTS AND SETTING

Ten years of data from the United States National Violent Death Reporting System (2006-2015) were analyzed to examine child maltreatment deaths among children 5-17 years of age.

METHODS

Child fatalities attributed to homicide or undetermined causes were reviewed by the study team to identify deaths related to child abuse and/or neglect, injury mechanisms, relationships between perpetrators and victims, victim and perpetrator characteristics, and circumstances surrounding the deaths.

RESULTS

The study team identified 285 abuse- and/or neglect-related fatalities during the study period. The mean age of the victims was 9.2 years and 54.4 % of victims were male. Suspected perpetrators were most frequently mothers (28.1 %) and fathers (26.3 %). The most common injury mechanism was firearms (20.7 %). A significantly greater percentage of deaths among children 11-17 years were attributable to firearms (31.6 %), compared to deaths among children 5-10 years. Among younger children 5-10 years, blunt force trauma was the most frequent injury mechanism (22.6 %).

CONCLUSIONS

Older children and adolescents are frequently excluded from child maltreatment research. Although child maltreatment deaths are less common among older children compared to younger children, these fatalities have unique characteristics that should be considered when developing prevention strategies.

Familicide in Italy: An Exploratory Study of Cases Involving Male Perpetrators (1992-2015)

This article adds to the literature on familicide by providing specific insights from the Italian experience. It presents results of an exploratory investigation into male-perpetrated familicides in Italy between 1992 and 2015. Familicide is defined as the killing of the spouse or intimate partner, and at least one child, at the hand of the other spouse/partner. Incidents of familicide were collated from newspaper reports. We identified 90 cases, resulting in 207 deaths. On average, perpetrators were middle aged (M = 46.8; age ranging from 25 to 76), and most (n = 66; 73%) committed, or attempted to commit, suicide. While significant contributory roles were played by health problems and financial worries, the origin of the primary emotional upset for the killers tended to be interpersonal conflicts involving their partners. For those cases with available information (n = 56; 62%), six types of familicide were also identified on the basis of the murderer's homicidal motivations. Most frequent were three circumstances. Fifteen cases concerned the "doubly-protective familicide" (which corresponds to the "suicide-by-proxy"), characterized by the preservation of the family in the face of a presumed catastrophic event. Triggers included the killer's financial distress, health troubles, or anxiety associated with other personal problems. Thirteen cases referred to "doubly-punitive familicide," whose distinctive feature, in addition to punishing the partner because of her estrangement, her infidelity, or other disputes, is to directly involve the child(ren) in the punitive homicidal act. The children are viewed as contributory factors to the killer's stress, or are considered to be in league with the mother. Twelve cases exemplified "indirectly-punitive familicide" (also termed "murder-by-proxy"), in which the victimized child(ren) are killed as an extension of the partner. Overall, this typology provides a more nuanced conceptualization of familicide occurrences than those examined in previous research.

Intimate partner problems and suicide: are we missing the violence?

BACKGROUND

Suicide consistently ranks in the top ten causes of death nationally. The purpose of this study was to develop a novel coding scheme to determine what percentage of suicide cases from 2005-2015 in Kentucky involved violence when intimate partner problems were identified. Currently, researchers using the national dataset, containing these data, only have the option to identify intimate partner problems unless each case is reviewed individually.

METHODS

Data from the Kentucky Violent Death Reporting System from 2005-2015 were used to create a subset of cases where intimate partner problems were identified and qualitative and quantitative analysis of the death scene investigation incident narratives was conducted to identify cases where intimate partner violence also contributed to the suicide.

RESULTS

Intimate partner problems were identified in 1,327 (26%) of all suicide cases where circumstances were known and intimate partner violence in 575 (43%) cases identified as having intimate partner problems. There was an argument or fight in 30% of cases where intimate partner problems were identified and most were immediately followed by the suicide.

CONCLUSIONS

We did find supporting evidence of our hypothesis that there is a great deal of underlying and outright violence in intimate relationships, which is exacerbating the risk of suicide. This detailed coding schema guided abstractors to better identify intimate partner violence in suicides, which could be easily replicated.

The Role of Intimate Partner Violence in Homicides of Children Aged 2-14 Years

INTRODUCTION

Child victims physically harmed in intimate partner violence incidents are understudied. The U.S. National Violent Death Reporting System abstractors can identify intimate partner violence-related child homicides in part through descriptive narratives from coroner/medical examiner and law enforcement reports. This study characterizes these homicides and assesses how well the coded and narrative data within the National Violent Death Reporting System align in identifying intimate partner violence-related child homicides.

METHODS

This study examines homicides of children ages 2-14 years from 16 states for 2005-2014. An existing variable purportedly indicates intimate partner violence-related child homicides where the perpetrator also kills or attempts to kill the intimate partner (Type 1) or intimate partner conflict (e.g., divorce, separation, custody) precedes the homicide (Type 2). The authors read all narratives in 2018 to assess whether the death was intimate partner violence-related and compared this classification to that coded by the National Violent Death Reporting System abstractor.

RESULTS

Of 1,386 child homicide victims, 144 (10.4%) were coded in the National Violent Death Reporting System as intimate partner violence-related. However, from the narratives, an additional 138 were classified as intimate partner violence-related, identifying a total of 280 (20.2%) victims. Of the 280 victims, 54.3% were killed in Type 1 incidents. Compared with other perpetrators of child homicides, intimate partner violence-related perpetrators were more likely to be white, use a firearm, and die by suicide. Type 2 incidents were more likely than Type 1 to be homicide-suicides.

CONCLUSIONS

The National Violent Death Reporting System currently understates intimate partner violence-related child homicide cases. Many cases involve immediate intimate partner conflict, suggesting the need for services to help people cope before conflicts lead to deadly incidents. Primary prevention of intimate partner violence may have survival benefits for children.

An Examination of the Mental Health and Negative Life Events of Women Who Killed Their Children

Research on filicide, the killing of a child by a biological or a de facto parent or parents, has largely focused on mothers. However, little is known about how filicidal women compare to filicidal men or whether they differ from women who commit non-filicide murder. The study explores pre-incarceration negative life events and mental health histories of women incarcerated for filicide as compared to men incarcerated for the same offense and women who were incarcerated for non-filicide murder. Extensive gender differences in filicidal parents were found in terms of economic marginalization, physical and sexual abuse, mental health problems. Filicidal women had more mental health problems and lower monthly income than women incarcerated for non-filicide murder, but there were more similarities than differences detected between the two groups of female offenders. The paper concludes with policy recommendations.

Injury-Related Healthcare Use and Risk of Filicide Victimization: A Population-Based Case-Control Study

Research on child-related risk factors for filicide is scant. We investigated whether prior healthcare use for injury (including poisoning) influences filicide risk. Victims (0-14 years; n = 71) were identified in a national autopsy database for the years 1994-2012 and compared to matched, general population controls (n = 355). Healthcare use data were retrieved from a national patient registry. Risks were estimated using odds ratios (ORs) and 95% confidence intervals (CIs). For females, prior inpatient care for injury conferred a statistically significant sevenfold risk (OR = 6.67 [95% CI: 1.49-29.79]), and any prior injury-related healthcare use conferred a statistically significant fourfold risk (OR = 3.57 [95% CI: 1.13-11.25]), of filicide victimization. No statistically significant risks were found for males. Healthcare personnel should be aware that children treated for injuries, especially females, may be at an elevated risk of filicide victimization. Nevertheless, the filicide base rate remains low, and parents may be stigmatized by unfounded alerts; thus, prudent reflection should precede reports to the authorities.

Understanding Homicide-Suicide

Homicide-suicide is the phenomenon in which an individual kills 1 or more people and commits suicide. Research on homicide-suicide has been hampered by a lack of an accepted classification scheme and reliance on media reports. Mass murder-suicide is gaining increasing attention particularly in the United States. This article reviews the research and literature on homicide-suicide, proposing a standard classification scheme. Preventive methods are discussed and sociocultural factors explored. For a more accurate and complete understanding of homicide-suicide, it is argued that future research should use the full psychological autopsy approach, to include collateral interviews.