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BackgroundMass shootings account for a small fraction of annual worldwide murders, yet disproportionately affect society and influence policy. Evidence suggesting a link between mass shootings and severe mental illness (i.e. involving psychosis) is often misrepresented, generating stigma. Thus, the actual prevalence constitutes a key public health concern.MethodsWe examined global personal-cause mass murders from 1900 to 2019, amassed by review of 14 785 murders publicly described in English in print or online, and collected information regarding perpetrator, demographics, legal history, drug use and alcohol misuse, and history of symptoms of psychiatric or neurologic illness using standardized methods. We distinguished whether firearms were or were not used, and, if so, the type (non-automatic v. semi- or fully-automatic).ResultsWe identified 1315 mass murders, 65% of which involved firearms. Lifetime psychotic symptoms were noted among 11% of perpetrators, consistent with previous reports, including 18% of mass murderers who did not use firearms and 8% of those who did (χ2 = 28.0, p < 0.01). US-based mass shooters were more likely to have legal histories, use recreational drugs or misuse alcohol, or have histories of non-psychotic psychiatric or neurologic symptoms. US-based mass shooters with symptoms of any psychiatric or neurologic illness more frequently used semi-or fully-automatic firearms.ConclusionsThese results suggest that policies aimed at preventing mass shootings by focusing on serious mental illness, characterized by psychotic symptoms, may have limited impact. Policies such as those targeting firearm access, recreational drug use and alcohol misuse, legal history, and non-psychotic psychopathology might yield more substantial results.

BACKGROUND Suicide is a leading cause of death among adolescents and young adults (AYA). AYA living with perinatally acquired HIV infection (AYALPHIV) are at higher risk of attempted suicide when compared with AYA who were perinatally HIV-exposed but uninfected (AYAPHEU). To inform interventions, we identified risk and protective factors of attempted suicide among AYALPHIV and AYAPHEU. SETTING Data were obtained from a longitudinal New York City-based study of AYALPHIV and AYAPHEU (n = 339; enrollment age 9-16 years) interviewed approximately every 12-18 months. METHOD Our main outcome was suicide attempt at any follow-up. The DISC was used to assess psychiatric disorder diagnoses and attempted suicide and the Child Depression Inventory to assess depressive symptoms. Psychosocial and sociodemographic risk factors were also measured. Analyses used backward stepwise logistic regression modeling. RESULTS At enrollment, 51% was female individuals, 49% Black, 40% Latinx, and 11% both Black and Latinx. Attempted suicide prevalence was significantly higher among AYALPHIV compared with AYAPHEU (27% vs 16%, P = 0.019), with AYALPHIV having 2.21 times the odds of making an attempt [95% confidence interval: (1.18 to 4.12), P = 0.013]. Higher Child Depression Inventory scores were associated with an increased risk of attempted suicide in both groups and the total sample. The presence of DISC-defined behavior disorder increased the risk of attempted suicide in the total sample and the AYALPHIV subgroup. Religiosity was protective of attempted suicide in AYALPHIV. CONCLUSIONS AYALPHIV had increased suicide attempts compared with AYAPHEU. Religiosity was protective in AYALPHIV. Highlighting a need for prevention of early mental health challenges was associated with risk.

Background Major depressive disorder (MDD) is common among young adults with perinatally acquired HIV (YAPHIV), however it is often underdiagnosed and untreated. The PHQ-9 and PHQ-2 are widely used screening instruments for MDD. This study evaluates the accuracy of recommended PHQ-9 and PHQ-2 cut-scores of 10 and 3 for YAPHIV and YA who were perinatally HIV exposed but uninfected (YAPHEU). Methods The PHQ-9 was administered to participants (n = 203) in a longitudinal cohort study using the DISC-IV as the gold standard for diagnosing depression. PHQ-9 and PHQ-2 sensitivity and specificity were calculated. ROC curves were constructed for the overall sample and YAPHIV and YAPHEU subsamples. Results Almost all participants were Black and Latinx, ages 18–29. Overall, the recommended PHQ-9 cut-score of ≥10 yielded a sensitivity of 0.47 (95%CI [0.23,0.72]) and specificity of 0.86 (95%CI [0.80, 0.91]). Results indicate that PHQ-9 cut-scores of 7 and PHQ-2 cut-scores of 2 increased sensitivity to 0.76 (95%CI [0.50, 0.93]) and 0.71(95%CI [0.44,0.90]), and decreased specificity to 0.72 (95%CI [0.65, 0.79]) and 0.73 (95%CI [0.66, 0.79]) respectively. Among subsamples, existing PHQ-9 cut-scores were more accurate for MDD diagnoses in YAPHEU (N = 11) than YAPHIV(N = 6). No race/ethnicity or age differences were found. Limitations Participants were recruited from clinics in NYC and may not reflect all YAPHIV and YAPHEU. Without a white HIV comparison group, no conclusions could be made on the impact of race/ethnicity on optimized PHQ-9 cut-scores. Conclusions Using tailored cut scores for HIV-affected populations may increase identification of those experiencing or at risk for MDD. Given the need for increased depression screening in HIV care, use of optimized cut-scores could benefit at-risk populations in the US and globally.

Background Prescription drug (PD) misuse, particularly opioid misuse, is a major US public health concern. While transgender and gender nonbinary (TGNB) individuals experience numerous health disparities, including substance use disparities, little research has focused on PD misuse in this population. Methods Data for this secondary analysis come from the US Transgender Survey (N = 26,689). First, we examined bivariate differences in past 12-month PD misuse among binary transgender women, binary transgender men, nonbinary individuals assigned-female-at-birth (AFAB), and nonbinary individuals assigned-male-at-birth (AMAB). We then used multivariable logistic regression (separately based on sex-assigned-at-birth) to examine the relationship between gender-identity related discrimination and PD misuse. Results PD misuse was significantly more common among binary transgender men (17.3 %), nonbinary AFAB individuals (18.7 %), and nonbinary AMAB individuals (18.0 %); compared to binary transgender women (13.5 %). In multivariable analyses, nonbinary identity was associated with higher odds of PD misuse among TGNB AFAB individuals (OR = 1.121; 95 %CI 1.021−1.232) and AMAB individuals (OR = 1.315; 95 % CI 1.133−1.527). Controlling for overall health status and psychological distress, public accommodations discrimination was associated with PD misuse among TGNB AMAB individuals (OR = 1.578, 95 %CI 1.354−1.839). Among both groups, healthcare discrimination was associated with PD misuse (AFAB OR = 1.388, 95 %CI 1.255−1.534; AMAB OR = 1.227, 95 %CI 1.073−1.404). Conclusion In this national sample of TGNB individuals, nonbinary individuals were at greater risk for PD misuse than binary individuals, possibly due to less societal affirmation. Similar to other TGNB health disparities, discrimination based on gender identity/expression was associated with PD misuse. This highlights the importance of interventions to reduce discrimination against TGNB individuals.

Almost no research has examined factors that contribute to mortality risk among sexual minority women (SMW). This study capitalizes on a 21-year community-based longitudinal study of SMW to examine the association between sexual identity disclosure and mortality risk. Forty-nine SMW who were recruited in 2000–01 or 2010–12 (6.3% of the sample), were confirmed dead by 2019. The mean age at death was 56.5 years. We used Cox proportional hazard models to show that SMW who had disclosed their sexual identity to 100% of their immediate family members had a 70% reduction in the risk of mortality compared to SMW who disclosed to less than 33% of their immediate family, after adjusting for several sociodemographic and health variables. Our results suggest that facilitating acceptance of SMW and their ability to disclose their identity may be an important way to improve health and life expectancy among SMW.

The need for data and information that can be used to enhance community resilience to coastal inundation and erosion has been highlighted by the devastating impacts of recent events such as Hurricane Katrina and the 2004 Indian Ocean tsunami. The physical systems causing coastal inundation and erosion are governed by a complex combination of oceanic, atmospheric, and terrestrial processes interacting across a broad range of temporal and spatial scales. Depending on time and place the expression of these processes may variously take the form of episodic storm-induced surge or wave overtopping and undercutting, chronic flooding and erosion associated with long-term relative sea level rise, or catastrophic inundation attributable to tsunami. Differences related to geographic setting, such as sea ice in Alaska or coral reefs in Hawai'i and the Pacific Islands, enhance this phenomenological variability. Anticipating the expression of these phenomena is also complicated by observed and projected changes in climate. Combined with these physical systems are social systems made up of diverse cultural, economic, and environmental conditions. Like the physical systems, the social systems are changing, largely because of increases in population and infrastructure along coastlines. These diverse conditions and systems reveal wide-ranging needs for the content, format, and timing of data and information to support decision-making. In addition, other considerations complicate these requirements for data and information: (1) the decentralized acquisition of information from a variety of platforms (e.g., tide gauges, wave buoys, satellites, radars); (2) data and models of varying complexity and spatial and temporal application; and (3) gaps and overlaps in agency, institutional, and organizational activity and authority. This systemic complexity presents a challenge to scientists, planners, managers, and others working to increase community resilience in the face of the risks associated with inundation and erosion. This paper describes a conceptual framework for an integrating architecture that would support program planning and product development toward hazard resilient communities. Central to this framework is a comprehensive, horizontally and vertically integrated view of the physical and social systems that shape the risks associated with coastal inundation and erosion, and the kinds of information needed to manage those risks. Equally important, the framework addresses the necessary connections among systems and scales. This integrated approach also emphasizes the needs of planners, managers, and decision-makers in a changing physical and social environment, as well as the necessity of an iterative, nested, collaborative, and participatory process.