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Introduction: Poverty is a consistent correlate of firearm-involved mortality, yet little work has considered the effects of social and economic policies on these deaths. This study examined associations of state elimination of the asset test and increases in the income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility with rates of firearm-involved suicide and homicide deaths in the United States., Methods: This ecological repeated cross-sectional study used 2015-2019 data from the SNAP Policy Database and death certificate data from the National Vital Statistics System. The exposures were (1) state elimination of the asset test for SNAP eligibility and (2) state elimination of the asset test and increases in the income limit for SNAP eligibility, compared with (3) state adoption of neither policy. The outcomes were firearm-involved suicide deaths and firearm-involved homicide deaths. The research team conducted mixed-effects regressions to estimate associations., Results: State elimination of the asset test for SNAP eligibility (incidence rate ratio (IRR), 0.67; 95% CI, 0.48 to 0.91) and state adoption of both eliminating the asset test and increasing the income limit for SNAP eligibility (IRR, 0.68; 95% CI, 0.49 to 0.92) were associated with decreased rates of firearm-involved suicide deaths compared with state adoption of neither policy. There were no associations with state firearm-involved homicide rates., Conclusions: SNAP is an important social safety net programme that addresses food insecurity, and the present results suggest it may also contribute to reducing firearm-involved suicide., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: our objective was to analyze the trends in the leading causes of death among the pediatric population aged 1-19 years in Mexico and the United States (US) from 2000 to 2022. Methods. Data for Mexico were sourced from the National Institute of Statistics and Geography (INEGI), while the US data were extracted from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC-WONDER) databases., Results: Homicide has been the leading cause of death since 2017 in Mexico and since 2019 in US youths aged 1-19. In Mexico, it reached 6.5 deaths per 100,000 people in 2022. Despite the overall pediatric mortality decline from 2000 to 2022 in both countries, the pediatric homicide rate has increased by 93.3 and 35.8% In Mexico and the US, respectively, and suicide by 86.6 and 36.9%. In both countries, death by firearm-related injuries had risen in a parallel sense. In the US, deaths by drug overdose and poisoning have increased by 314.8%., Conclusion: Despite advancements in infant healthcare over the past two decades in Mexico, there remains a significant gap in the provision of healthcare services to the adolescent population. Addressing issues related to violence, mental health, and substance abuse through targeted public policies is imperative for both Mexico and the US, especially given their shared border region., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Castilla-Peon, Rendón and Gonzalez-Garcia.)

Objective: Rates of death due to homicide, suicide and overdose during pregnancy and the first year postpartum have increased substantially in the USA in recent years. The aims of this study were to use 2018-2019 data on deaths identified for review by the North Carolina Maternal Mortality Review Committee (NC-MMRC), data from the North Carolina Violent Death Reporting System (NC-VDRS) and data from the Statewide Unintentional Drug Overdose Reporting System (NC-SUDORS) to examine homicide, suicide and unintentional opioid-involved overdose deaths during pregnancy and the first year postpartum., Methods: We linked data from the 2018-2019 NC-MMRC to suicide and homicide deaths among women ages 10-50 years from the 2018-2019 NC-VDRS and to unintentional opioid-involved overdose deaths among women ages 10-50 years from the 2018-2019 NC-SUDORS. We conducted descriptive analyses to examine the prevalence of demographic characteristics and the circumstances surrounding each cause of death., Results: From 2018 to 2019 in North Carolina, there were 23 homicides, nine suicides and 36 unintentional opioid-involved overdose deaths (9.7, 3.8 and 15.1 per 100 000 live births, respectively) during pregnancy and the first year postpartum. Most homicide deaths (87.0%) were by firearm, and more than half (52.5%) were related to intimate partner violence. More than two-thirds of women who died by suicide had a current mental health problem (77.8%). Less than one-fourth (22.2%) of those who died by unintentional opioid-involved overdose had a known history of substance use disorder treatment., Conclusion: Our approach to quantifying and describing these causes of pregnancy-associated death can serve as a framework for other states to inform data-driven prevention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: Domestic violence (DV; including intimate partner and family violence) is associated with heightened lethality risks, yet limited research has comprehensively assessed the connection between DV and fatal violence considering both homicides and suicides. Understanding the fatal consequences of DV can point to missed opportunities to support individuals and their families., Objective: To assess the proportion of violent deaths that were connected to DV and describe contacts with the legal system or social services prior to each DV-related fatality., Design, Setting, and Participants: This cross-sectional study used quantitative and qualitative data from the National Violent Death Reporting System (NVDRS) for all individuals who died by homicide or suicide in Washington from January 1, 2015, to December 31, 2020. Analyses were conducted from August 1, 2022, to September 30, 2023., Main Outcomes and Measures: A multipronged approach was used to assess DV history using existing NVDRS variables, leveraging data from prior review of NVDRS death narratives, applying a validated natural language processing tool, and linking related deaths. Domestic violence was recorded as yes or no, but the decedent's role in the abusive relationship (ie, experiencing or enacting DV) could not be differentiated. To describe system involvement prior to each death, keyword searching and hand review of NVDRS death narratives were used., Results: A total of 7352 intentional violent deaths (1192 homicides [16.2%]; 6160 suicides [83.8%]) with known circumstances were recorded in Washington during the study period. Of these, 948 deaths (12.9%) were connected to DV (624 [65.8%] among males; mean [SD] age at death, 45.3 [19.2] years), including 588 suicides (62.0%) and 360 homicides (38.0%). For 420 DV-related deaths (44.3%), there was evidence to suggest that the person who died or their intimate partner(s), family, or cohabitants had prior contacts with the legal system or social services. Specifically, 318 records (33.5%) mentioned prior contacts with law enforcement or the criminal legal system (eg, prior 9-1-1 calls, criminal convictions), and 225 (23.7%) described engagement with social services or the civil legal system (eg, civil protection order, divorce, or child custody problems)., Conclusions and Relevance: In this cross-sectional study, 12.9% of violent deaths in Washington were connected to DV. The findings suggest that more resources are needed to support law enforcement, court professionals, and social services specialists to proactively identify and refer families to wraparound supports before the situation can escalate to a fatality.

Background: Differences in social and environmental factors contribute to disparities in fatal injury rates. This study assessed the relationship between social vulnerability and homicide and suicide rates across United States counties., Methods: County-level age-adjusted homicide and suicide rates for 2016-2020 were linked with data from the Centers for Disease Control and Prevention's 2020 Social Vulnerability Index (SVI), a dataset identifying socially vulnerable communities. We conducted negative binomial regressions to examine the association between SVI and homicide and suicide rates, overall and by Census region/division. We mapped county-level data for SVI and homicide and suicide rates in bivariate choropleth maps., Results: Overall SVI was associated with homicide rates across U.S. counties. While no association was found for overall SVI and suicide rates, Socioeconomic Status and Racial & Ethnic Minority Status domains were associated. The geographic distribution of SVI and homicide and suicide rates varied spatially; notably, counties in the South had the greatest levels of social vulnerability and greatest homicide rates., Conclusions: Our findings demonstrate county-level social vulnerability is associated with homicide rates but may be more nuanced for suicide rates. A modified SVI for injury should include additional social and structural determinants and exclude variables not applicable to injuries., Practical Applications: This study combines the SVI with homicide and suicide data, enabling researchers to examine related social and environmental factors. Modifying the SVI to include relevant predictors could improve injury prevention strategies by prioritizing efforts in areas with high social vulnerability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Background: Annual global data on mental disorders prevalence and firearm death rates for 2000-2019, enables the U.S. to be compared with comparable counties for these metrics., Methods: The Institute for Health Metrics and Evaluation (IHME) Global Health Burden data were used to compare the prevalence of mental disorders with overall, homicide and suicide firearm death rates including homicides and suicides, in high sociodemographic (SDI) countries., Results: Overall and in none of the nine major categories of mental disorders did the U.S. have a statistically-significant higher rate than any of 40 other high SDI countries during 2019, the last year of available data. During the same year, the U.S. had a statistically-significant higher rate of all deaths, homicides, and suicides by firearm (all p<<0.001) than all other 40 high SDI countries. Suicides accounted for most of the firearm death rate differences between the U.S. and other high SDI countries, and yet the prevalence of mental health disorders associated with suicide were not significantly difference between the U.S. and other high SDI countries., Conclusion: Mental disorder prevalence in the U.S. is similar in all major categories to its 40 comparable sociodemographic countries, including mental health disorders primarily associated with suicide. It cannot therefore explain the country's strikingly higher firearm death rate, including suicide. Reducing firearm prevalence, which is correlated with the country's firearm death rate, is a logical solution that has been applied by other countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bleyer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Homicides using knives or other sharp objects are the most common type of homicide in Europe, and the second most common type of homicide worldwide. In contrast, suicides using sharp objects are rarer, constituting only a few per cent of all suicides in western countries. We investigated single stab injuries to the trunk in both homicides and suicides to assess differences in extent of injuries and in medical care, which could be of value for trauma management, public health and forensic assessment., Methods: We identified all cases in Sweden between 2010 and 2021 that died of a single stab to the trunk, in either a homicide (n = 94) or a suicide (n = 45), and that were the subject of a forensic autopsy. We obtained data on demographics, hospital care and injured structures. To assess the severity of injuries, we applied AIS (Abbreviated Injury Score) and NISS (New Injury Severity Score). The inter-rater reliability of NISS between two raters was evaluated with intra-class correlation (ICC), with 95 % confidence intervals (CI). The data was analysed using Fisher's exact test, Mann-Whitney U test and logistic regression models., Results: The inter-rater reliability between the two NISS raters showed an ICC of 0.87 (95 % CI 0.68-0.95). We observed a larger variation of injuries in suicides, with a higher proportion of both unsurvivable (NISS 75) and minor injuries (NISS ≤ 8) (66.7 % and 8.9 % respectively) compared to in homicides (46.8 % and 0 % respectively). We observed a larger proportion of injuries to the heart in suicides (68.9% vs. 46.8 %, p = 0.018). In homicides, injuries involving vessels (52.1% vs. 13.3 %, p < 0.001) and hospital care (56.4 % vs. 8.9 %, p < 0.001) were significantly more common compared to suicides., Discussion and Conclusion: Causation (self-inflicted or assaults) seems to be associated with characteristics of injury and the likelihood of receiving hospital care. These findings could potentially be valuable for trauma management and forensic assessment of manner of death, however, determining the mortality of the injuries would require a comparison group comprising injured survivors., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Ltd.)

Importance: Causal associations between household firearm ownership rates (HFRs) and firearm mortality rates are not well understood., Objective: To assess the population-level temporal sequencing of firearm death rates and HFRs., Design, Setting, and Participants: This cohort study used autoregressive cross-lagged models to analyze HFRs, firearm suicide rates, and firearm homicide rates in the US from 1990 to 2018. The suicide analyses included 16 demographic subgroups of adults, defined by study year, state, sex, race and ethnicity, marital status, and urbanicity. The homicide analyses consisted of adult subgroups living in urban or rural areas. Data analysis was conducted from March to December 2023., Exposures: Firearm mortality rates and HFRs., Main Outcomes and Measures: Firearm homicide and suicide rates with HFRs as the exposure, and HFR with mortality as the exposure., Results: A total of 10 416 observations of 16 demographic subgroups by state and 2-year periods were included in the suicide analyses, while 1302 observations from 2 demographic subgroups by state and 2-year period were included in the homicide analysis. At baseline, the mean (SD) rate per 100 000 population across strata was 7.46 (7.21) for firearm suicides and 3.32 (2.13) for firearm homicides. The mean (SD) baseline HFR was 36.9% (20.2%) for firearm suicides and 36.9% (14.8%) for firearm homicides. Higher HFR preceded increases in suicide rates: demographic strata with equal firearm suicide rates but which differ by 18.6 percentage points on HFR (1 SD) would be expected to have firearm suicide rates that diverged by 0.19 (95% CI, 0.15-0.23) deaths per 100 000 population per period. With these differences accumulated over 8 years, firearm suicide rates in subgroups with the highest decile HFR would be expected to have 1.93 (95% CI, 1.64-2.36) more suicides per 100 000 population than strata with lowest decile HFR, a difference of 25.7% of the overall firearm suicide rate in 2018 and 2019. Firearm suicide rates had a smaller magnitude of association with subsequent changes in HFR: strata with equal HFRs but which differ by 1 SD in firearm suicide rates had minimal subsequent change in HFRs (-0.02 [95% CI, -0.04 to 0.01] percentage points). A 1-SD difference in HFRs was associated with little difference in next-period overall firearm homicides rates (0.03 [95% CI, -0.02 to 0.08] per 100 000 population), but a 1-SD difference in homicide rates was associated with a decrease in HFR (-0.09 [95% CI, -0.16 to -0.04] percentage points)., Conclusions and Relevance: This cohort study found an association between high HFRs and subsequent increases in rates of firearm suicide. In contrast, higher firearm homicide rates preceded decreases in HFRs. By demonstrating the temporal sequencing of firearm ownership and mortality, this study may help to rule out some theories of why gun ownership and firearm mortality are associated at the population level.

Introduction: The objective of this study was to compare jealousy as a correlate of intimate partner homicide-suicide cases to homicide-only cases using data from the National Violent Death Reporting System (NVDRS), a state-based surveillance system maintained by the Centers for Disease Control and Prevention. Jealousy is categorized as jealous feelings or distress over a current or former intimate partner's relationship or suspected relationship with another person., Methods: NVDRS data from a 5-year period (2016-2020) was used to estimate frequencies and identify significant differences in jealousy and other sociodemographic, mental health, relationship, and incident-related correlates of intimate partner homicide-suicide compared to homicide-only cases. Cases were included if they involved an intimate partner single homicide or a single homicide followed by suicide., Results: The study sample included 5335 cases (intimate partner homicide-suicide n = 1402; homicide-only n = 3933). A significantly higher percentage of intimate partner homicide-suicide cases reported jealousy preceding the event (9%) compared to homicide-only cases (6%). Compared with homicide-only cases, homicide-suicide cases had 3.5 greater odds of recording jealousy as a precipitating event., Conclusion: Findings suggest that intimate partner homicide-suicide cases are distinct from homicide-only cases both in terms of individual- and incident-level and situational factors, including the presence of jealousy., (© 2024 American Association of Suicidology.)

Introduction: Alcohol use is involved in a large proportion of homicides and suicides each year in the U.S., but there is limited evidence on how policies targeting alcohol influence violence in the U.S., Context: Extant studies generally focus on individual policies in isolation of each other. This study examines the impacts of changes in states' alcohol policy restrictions on overall homicide and suicide rates and firearm-related homicide and suicide rates using a holistic measure of states' alcohol policy environments., Methods: Using a composite measure of state-level alcohol policies (Alcohol Policy Scale) and data from the National Vital Statistics System from 2002 to 2018, this study applied a Bayesian time series model to estimate the impacts of alcohol policy changes on overall and firearm-involved homicide and suicide rates. The analysis was performed in 2023 and 2024., Results: A 1 SD change in the Alcohol Policy Scale was associated with a 6% decline in homicide rates both overall (incident rate ratio=0.94; 95% credible interval = 0.89, 1.00) and for firearm homicides specifically (incident rate ratio=0.94, 95% CI=0.88, 1.01). There was no clear association of alcohol policy with suicides. The model predicts that a nationwide increase in alcohol restrictions equivalent to a shift from the 25 th to 75 th percentile of the scale's distribution would result in almost 1,200 fewer homicides annually., Conclusions: Increases in the restrictiveness of state-level alcohol policies are associated with reductions in homicides. More restrictive alcohol policy environments may offer an opportunity to reduce homicides., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Problem/condition: In 2021, approximately 75,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 48 states, the District of Columbia, and Puerto Rico in 2021. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. This report introduces additional incident and circumstance variables, which now include child victim-specific circumstance information. This report also incorporates new U.S. Census Bureau race and ethnicity categories, which now account for more than one race and Native Hawaiian or other Pacific Islander categories and include updated denominators to calculate rates for these populations., Period Covered: 2021., Description of System: NVDRS collects data regarding violent deaths from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2021. Data were collected from 48 states (all states with exception of Florida and Hawaii), the District of Columbia, and Puerto Rico. Forty-six states had statewide data, two additional states had data from counties representing a subset of their population (31 California counties, representing 64% of its population, and 13 Texas counties, representing 63% of its population), and the District of Columbia and Puerto Rico had jurisdiction-wide data. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident., Results: For 2021, NVDRS collected information on 68,866 fatal incidents involving 70,688 deaths that occurred in 48 states (46 states collecting statewide data, 31 California counties, and 13 Texas counties), and the District of Columbia. The deaths captured in NVDRS accounted for 86.5% of all homicides, legal intervention deaths, suicides, unintentional firearm injury deaths, and deaths of undetermined intent in the United States in 2021. In addition, information was collected for 816 fatal incidents involving 880 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 70,688 deaths, the majority (58.2%) were suicides, followed by homicides (31.5%), deaths of undetermined intent that might be due to violence (8.2%), legal intervention deaths (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm injury deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged ≥85 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) persons had the highest suicide rates among all racial and ethnic groups. Among both males and females, the most common method of injury for suicide was a firearm. Among all suicide victims, when circumstances were known (84.4%), suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black or African American (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 30-34 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When circumstances were known, the most frequent circumstances reported for legal intervention deaths were as follows: the victim used a weapon in the incident and the victim had a substance use problem (other than alcohol use). Other causes of death included unintentional firearm injury deaths and deaths of undetermined intent. Unintentional firearm injury deaths were most frequently experienced by males, non-Hispanic White (White) persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger. The rate of deaths of undetermined intent was highest among males, particularly among AI/AN and Black males, and among adults aged 30-54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances., Interpretation: This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2021. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black males. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary precipitating circumstances for multiple types of deaths examined., Public Health Action: Violence is preventable, and data can guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. NVDRS data can be used to enhance prevention efforts into actionable strategies. States or jurisdictions have used their Violent Death Reporting System (VDRS) data to guide suicide prevention efforts and highlight where additional focus is needed. For example, North Carolina VDRS program data have played a significant role in expanding activities related to firearm safety and injury prevention. The program served as a primary data source for partners, which led to the creation of the Office of Violence Prevention in the state, focusing on combatting firearm-related deaths. In Maine, the VDRS provided data on law enforcement officer suicides that were used to help support a bill mandating mental health resiliency and awareness training in the state's law enforcement training academy, along with plans for similar training addressing mental health, substance use, and alcohol problems among corrections officers. In addition, states and jurisdictions have also used their VDRS data to examine factors related to homicide in their state or jurisdiction. For example, Georgia VDRS collaborated with the City of Atlanta Mayor's Office of Violence Reduction to develop two public dashboards that not only offer comprehensive data on violent deaths but also present data on the geographic distribution of populations disproportionately affected by violence to help inform violence prevention interventions., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Introduction: Despite being relatively rare in our country, murder-suicide phenomena have garnered increasing media attention over the years. However, actual data on their prevalence and characteristics remain limited. This study aims to describe and characterize all murder/suicide events reported at the Institute of Forensic Medicine in the Province of Messina, with a particular focus on distinguishing between cases of filicide/suicide and dyadic deaths., Materials and Methods: A retrospective observational analysis of judicial cases from 2018 to 2023 was conducted. Injuries were primarily localized to the head, neck, and chest for women, and to the head for men. In the case of filicides, death occurred through an asphyxiation mechanism, followed by the mother's suicide by hanging or falling., Conclusion: Within the scope of the medical examiner's activities, it is clear that acquiring more information through a standardized technical investigation and adopting a uniform approach could enhance the quality of the forensic service provided daily. This improvement, which would be in the interest of institutions and civil society, could be achieved through the sharing of procedures at both national and international levels.

Importance: Despite high social and public health costs of firearm violence in the United States, the effects of many policies designed to reduce firearm mortality remain uncertain., Objective: To estimate the individual and joint effect sizes of state firearm policies on firearm-related mortality., Design, Setting, and Participants: In this comparative effectiveness study, bayesian methods were used to model panel data of annual, state-level mortality rates (1979-2019) for all US firearm decedents, with analyses conducted in October 2023., Exposures: Six classes of firearms policies: background checks, minimum age, waiting periods, child access, concealed carry, and stand-your-ground laws., Main Outcome and Measures: Primary outcomes (total firearm deaths, firearm homicide deaths, and firearm suicide deaths) were assessed using the National Vital Statistics System. Bayesian estimation was used to estimate the partial association of changes in firearms policies with subsequent changes in firearm mortality., Results: The estimated effect sizes of individual policies 5 or more years after implementation were generally small in magnitude and had considerable uncertainty. The policy class with the highest probability of reducing firearm deaths was child-access prevention laws, estimated to reduce overall firearm mortality by 6% (80% credible interval [CrI], -2% to -9%). The policy class with the highest probability of increasing firearm deaths was stand-your-ground laws, estimated to increase firearm homicides by 6% (80% CrI, 0% to 13% increase). Estimates of association of implementing multiple firearm restrictions with subsequent changes in firearm mortality yielded larger effect sizes. Moving from the most permissive to most restrictive set of firearm policies was associated with an estimated 20% reduction in firearm deaths (80% CrI, 10% to 28% reduction), with a 0.99 probability of any reductions in firearm death rates., Conclusions and Relevance: In this comparative effectiveness study of state firearm policies, the joint effect estimates of combinations of firearm laws were calculated, showing that restrictive firearm policies were associated with substantial reductions in firearm mortality. Although policymakers would benefit from knowing the effects of individual policies, the estimated changes in firearm mortality following implementation of individual policies were often small and uncertain.

Introduction: This study analyzed the contribution of firearms to pregnancy-associated mortality from homicide and suicide., Methods: This was a retrospective cohort study using the Centers for Disease Control and Prevention's National Violent Death Reporting System from 2008 to 2019. Women aged 15-44 years who died by suicide (intentional self-harm) and homicide where a firearm was involved were included. Persons without known pregnancy status were excluded. Pregnancy-associated deaths were defined as those that occurred during pregnancy or within 1 year of pregnancy (early and late postpartum). Sociodemographic characteristics and social and circumstantial differences were compared between pregnancy-associated and nonpregnant-associated deaths. Data analysis was conducted in 2022-2023., Results: A total of 1,803 homicide and 1,929 suicide deaths from firearms were included. Twenty-two percent (n=388) and 11% (n=212) of firearm homicides and suicides, respectively, were pregnancy associated. Victims of pregnancy associated homicide were predominantly Black (54.8%), were single (76%), and had high school diploma or equivalent degree (41.2%). Victims of pregnancy-associated suicide were predominantly White (80.5%). Among pregnancy-associated homicides and suicides, deaths occurred more frequently during pregnancy (63.4% and 40.3%). Pregnancy-associated homicides more frequently occurred in the victim's home than nonpregnancy-associated homicides (51.5% vs 46.7%, p=0.02) and was related to ongoing conflict or violence between a current or former partner (61.6% vs 51.9%, p<0.001). Pregnancy-associated suicides more frequently occurred in those who experienced intimate partner violence within a month of death than non-pregnancy-associated suicide (4.2% vs 1.3%, p=0.005)., Conclusions: Although there are differences in demographic characteristics between victims, interpersonal violence is associated with both pregnancy-associated homicides and suicides where a firearm was involved., (Copyright © 2024 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The Mind after Midnight hypothesis proposes that nocturnal wakefulness increases the risk for dysregulated behaviors. Prior studies highlight a greater risk for suicide at night after adjusting for population wakefulness. How this risk varies hour to hour, differs across subgroups, or applies to other behaviors is unknown., Methods: Data on 78,647 suicides and 50,526 homicides from the National Violent Death Reporting System were combined with population wakefulness data for 2003-2017 from the American Time Use Survey. Hourly incident risk ratios (IRRs) were estimated after adjusting for population wakefulness. Two-way analysis of variances identified significant time-by-subgroup interactions that were quantified in post hoc analyses., Results: Suicide counts peaked at 12:00 PM, while homicide counts peaked at 10:00- 11:00 PM. Adjusting for demographics and population wakefulness revealed a 5-fold greater risk for suicide at 3:00 AM (aIRR: 5.20 [4.74-5.70]) and an 8-fold greater risk for homicide at 2:00 AM (aIRR: 8.04 [6.35-10.2]). Hourly risk for suicide varied by age, ethnicity, blood alcohol level, and current partner conflict. Hourly risk for homicide varied by sex and blood alcohol level., Conclusions: Risk for suicide and homicide is greater at night than expected based on the number of people awake at that time. Nighttime risk was greater among young adults and those intoxicated with alcohol, but not among those with a history of suicidal ideation or attempts. Further research should evaluate mechanisms of risk and confirm these findings at an individual level., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

Extended suicide, a specific type of homicide-suicide event, has severe social consequences yet remains lacking systematic research. This retrospective study investigated 51 cases of extended suicide involving mental disorders in central China with aim of better understanding risk factors for such events and guiding prevention strategies. Over an 8-year period from 2015 to 2022, cases were collected from forensic institutions, and demographic characteristics, case details, and psychiatric data were recorded. The 51 incidents involved 51 perpetrators and 79 victims, with more female perpetrators (58.8%) and more female victims (54.4%). The average age of the perpetrators was 36.1, and most were married (88.2%). Almost all of the victims were family members of the perpetrator, like the most numerous children (64.6%), followed by spouses (24.1%). The most common homicide mode of death was mechanical asphyxia (38.0%), followed by sharp devices (36.7%) and drug poisoning (16.5%). Depressive disorders (76.5%) were the most common diagnosis of mental disorder for perpetrators. The study analyzed the unique characteristics of extended suicide to enrich such data. These findings help strengthen the screening and identification of potential perpetrators and victims to prevent such cases from occurring., Competing Interests: Declaration of competing interest The authors have no conflicts to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: This study aimed to investigate mortality and years of life lost (YLL) due to suicide and homicide in children aged 10-19 years in southern Iran from 2004 to 2019. Study Design: A cross-sectional study., Methods: The data on all deaths due to suicide and homicide in Fars province were obtained from the population-based electronic death registration system (EDRS). Crude mortality rate and YLL were calculated. The joinpoint regression method was used to examine the trend., Results: During the study period, 563 cases of suicide and 218 cases of homicide in children aged 10-19 have occurred. The total number of YLL due to suicide was 9766 in men and 6261 in women. According to the joinpoint regression analysis, the trend of YLL due to suicide was increasing in males. In other words, the annual percent change (APC) was 4.8% (95% CI 0.4 to 9.5, P =0.036). Additionally, there was a constant trend in females, and APC was 2.7% (95% CI -2.0 to 7.7, P =0.241). The number of YLL due to homicide was 4890 in males and 1294 in females. The trend of YLL due to homicide was stable in males and females. In other words, APC was -1.6% (95% CI -5.6 to -2.6, P =0.422) in males and -2.7% (95% CI -10.0 to 5.2, P =0.467) in females., Conclusion: Based on the findings of this study, the trend of mortality rate and YLL due to suicide in men has been increasing and it has been stable in women. Moreover, the trend of mortality due to homicide was stable for both males and females. Therefore, it is necessary to take preventive actions., (© 2024 The Author(s); Published by Hamadan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

The majority of sharp-force fatalities with stab and/or incised wounds are homicides. However, suicidal sharp-force fatalities with stab and/or incised wounds are also reported. Thus, distinguishing suicidal stab and/or incised wounds from homicidal stab and/or incised wounds is significant from the forensic perspective. This scoping review primarily summarizes the existing research findings on the differentiation of suicide from homicide in sharp-force fatalities with stab and/or incised wounds. The literature was systematically searched on February 28, 2023, using the PubMed database. A search string formed by a combination of keywords related to suicide, homicide, and stab and incised wounds yielded 23 records. After applying the eligibility criteria, six records/studies met the inclusion criteria and were included in the present scoping review. Results showed that the predictive strength of various parameters, either individually or collectively, in diagnosing the manner of sharp-force fatality as suicide or homicide is not always hundred percent accurate. Some of the important predictors of the homicidal manner of death in sharp-force fatalities include clothing damage, presence of defense injuries, presence of injuries caused by another type of violence other than sharp-force, vertically oriented chest stabs, and sharp-force injuries in the head and back anatomical sites. Some of the important predictors of the suicidal manner of death in sharp-force fatalities include the presence of tentative injuries, sharp-force injuries to the wrist, and the presence of a suicide note., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

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., (© 2024 The Authors. Criminal Behaviour and Mental Health published by John Wiley & Sons Ltd.)

Background: Firearm violence is a growing public health problem causing death globally. With easy accessibility to firearms, suicides, homicides, and homicide-suicides have increased among security officers, especially in developing countries affected by long-standing civil wars/political insurgencies. No study has explored firearm violence in East African countries. This study describes the press media reporting of suicides, homicides, and homicide-suicides among security officers in two East African countries (Uganda and Kenya)., Methods: Due to the absence of suicide databases among East African countries, the present study reviewed press media reports. We utilized content analysis of suicides, homicides, and homicide-suicides reports among security forces. Relevant media reports between January-2020 and May-2023 were searched. Using ANOVA and chi-square tests, we tested for statistical differences in characteristics between victims and perpetrators., Results: Among the 56 perpetrated reports, most of them were homicides 44.64% (n = 25/56), 30.36% (n = 17/56) were homicide-suicides, and 25% (n = 14/56) were suicides. Perpetrators' age ranged from 21 to 47 years, majority being males [53/56 (94.64%)]. Victims were 58, mostly Ugandans [41/58 (73.21%)] with a mean age of 33.5 ± 8.81 years. Among the three main outcomes, statistically significant difference existed by country (χ 2  = 23.88, p < 0.001), and perpetrators' age (F = 8.59, p = 0.005). There was a significant difference between perpetrators and the number of victims lost by age of victims (F = 10.37, p = 0.002). Among victims, type of security of perpetrator and citizenship of victims (χ 2  = 24.18, p < 0.001) showed statistical difference with Ugandans having more victims to army officers while Kenyans to police officers. Brief incident descriptions pointed towards relationship dysfunctions, alcohol/substance abuse, intentional harm, and financial disagreements, as the potential causes. Only two perpetrators were reported to have mental health-related conditions., Conclusion: This study shows that media reported firearms-related suicides, homicides, and homicide-suicides among security forces commonly involve males. Perpetrators in Uganda are mainly army officers while in Kenya the perpetrators are mostly police officers. Mental health conditions were not frequently reported among perpetrators. We recommend strengthening and enforcing gun regulation policies among security officers to curb this growing problem in these countries. Routine screening of mental health problems to enable early interventions is recommended among security officers., (© 2023. The Author(s).)

Problem/condition: In 2020, approximately 71,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 48 states, the District of Columbia, and Puerto Rico in 2020. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics., Period Covered: 2020., Description of System: NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2020. Data were collected from 48 states (all states with exception of Florida and Hawaii), the District of Columbia, and Puerto Rico. Forty-six states had statewide data, two additional states had data from counties representing a subset of their population (35 California counties, representing 71% of its population, and four Texas counties, representing 39% of its population), and the District of Columbia and Puerto Rico had jurisdiction-wide data. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident., Results: For 2020, NVDRS collected information on 64,388 fatal incidents involving 66,017 deaths that occurred in 48 states (46 states collecting statewide data, 35 California counties, and four Texas counties), and the District of Columbia. In addition, information was collected for 729 fatal incidents involving 790 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 66,017 deaths, the majority (58.4%) were suicides, followed by homicides (31.3%), deaths of undetermined intent (8.2%), legal intervention deaths (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged ≥85 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) persons had the highest suicide rates among all racial and ethnic groups. Among both males and females, the most common method of injury for suicide was a firearm. Among all suicide victims, when circumstances were known, suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 35-44 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. When circumstances were known, the three most frequent circumstances reported for legal intervention deaths were as follows: the victim's death was precipitated by another crime, the victim used a weapon in the incident, and the victim had a substance use problem (other than alcohol use).Other causes of death included unintentional firearm deaths and deaths of undetermined intent. Unintentional firearm deaths were most frequently experienced by males, non-Hispanic White (White) persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger. The rate of deaths of undetermined intent was highest among males, particularly among AI/AN and Black males, and among adults aged 30-54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances., Interpretation: This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2020. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black male victims. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death., Public Health Action: Violence is preventable, and states and communities can use data to guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, the Colorado Violent Death Reporting System (VDRS), Kentucky VDRS, and Oregon VDRS have used their VDRS data to guide suicide prevention efforts and generate reports highlighting where additional focus is needed. In Colorado, VDRS data were used to examine the increased risk for suicide among first and last responders in the state. Kentucky VDRS used local data to highlight how psychological and social effects of the COVID-19 pandemic might increase risk for suicide, particularly among vulnerable populations. Oregon VDRS used their data to develop a publicly available data dashboard displaying firearm mortality trends and rates in support of the state's firearm safety campaign. Similarly, states participating in NVDRS have used their VDRS data to examine homicide in their state. Illinois VDRS, for example, found that state budget cuts were associated with notable increases in homicides among youths in Chicago. With an increase of participating states and jurisdictions, this report marks progress toward providing nationally representative data., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Despite promising results from individual-level studies, state-level studies of the effectiveness of comprehensive background-check (CBC) policies in reducing firearm fatalities have yielded null results in multiple states. These prior studies focused on CBC laws adopted in the 1990s, when record keeping was far less complete. We estimated the effect of the implementation of CBC policies on state-level firearm homicide and suicide rates in states implementing CBC policies from 2013 to 2015 (Colorado, Delaware, Oregon, and Washington). We compared age-adjusted firearm homicide and suicide rates, measured annually from 15 years prior to policy implementation until 2019, in each treated state to rates in control groups constructed using the synthetic control group method. Differences in firearm homicide rates for Colorado, Oregon, and Washington post treatment were all small (0.09 to 0.18 per 100,000 residents per year) and not well distinguished from natural variation. Oregon had on average 0.80 per 100,000 fewer firearm suicides per year than did synthetic Oregon post treatment. However, these results were inconsistent across modeling approaches and not well distinguished from natural variation. Our models produced poor fit for Delaware. Coupled with previous null results from Indiana, California, Maryland, Pennsylvania, and Tennessee, the present results suggest that extending background check requirements to private transfers alone and implementing these policies as is currently done is not sufficient to achieve significant state-level reductions in firearm fatalities., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

Importance: Homicide is a leading cause of death among children in the US., Objective: To examine trends in child homicide rates and characteristics most commonly associated with these deaths., Design, Setting, and Participants: In this cross-sectional study, the study team used National Vital Statistics System WONDER mortality data for 38 362 homicide victims aged 0 to 17 years for 1999 to 2020 and National Violent Death Reporting System data for child homicide victims for 2003 to 2019 in 45 states, Washington, DC, and Puerto Rico. WONDER data are based on death certificates for US residents. National Violent Death Reporting System data include characteristics of violent deaths, linking information from death certificates, and law enforcement, coroner, and medical examiner reports., Exposures: Child homicide was defined using underlying cause-of-death codes U01 to U02, X85 to Y09, and Y87.1 from the International Classification of Diseases, Tenth Revision, Clinical Modification., Main Outcomes and Measures: Trends in homicide rates per 100 000 children were tested using joinpoint regression analysis; differences in rates from 2019 to 2020 were evaluated using z tests. Circumstances of child homicides were described., Results: This study included 38 362 homicide victims (69.4% male). The overall child homicide rate (per 100 000 children) has increased annually, on average 4.3% since 2013, with a precipitous rise from 2019 to 2020 (2019 rate, 2.2; 2020 rate, 2.8; overall increase of 27.7%). Homicide rates recently increased significantly for boys (2018 rate, 2.9; 2020 rate, 4.1; overall increase of 16.1%), 6- to 10-year-olds (2014 rate, 0.5; 2020 rate, 0.8; overall increase of 5.6%), 11- to 15-year-olds (2018 rate, 1.3; 2020 rate, 2.2; overall increase of 26.9%), 16- to 17-year-olds (2018 rate, 6.6; 2020 rate, 10.0; overall increase of 19.0%), Black children (2012 rate, 5.9; 2018 rate, 6.8; 2020 rate, 9.9; overall increase of 16.6% from 2018 to 2020), Hispanic children (2014 rate, 1.6; 2020 rate, 2.2; overall increase of 4.7%), children in the South (2013 rate, 2.1; 2020 rate, 3.5; overall increase of 6.4%), and in rural (2011 rate, 1.8; 2020 rate, 2.4; overall increase of 3.2%) and urban areas (2013 rate, 1.9; 2020 rate, 2.9; overall increase of 4.4%). Since 1999, homicide rates have decreased for girls (1999 rate, 1.9; 2020 rate, 1.5; overall decrease of 1.4%), infants (1999 rate, 8.7; 2020 rate, 6.6; overall decrease of 1.3%), 1- to 5-year-olds (1999 rate, 2.1; 2020 rate, 1.8; overall decrease of 1.0%), Asian or Pacific Islander children (1999 rate, 2.0; 2020 rate, 0.5; overall decrease of 4.4%), White children (1999 rate, 1.5; 2020 rate, 1.3; overall decrease of 0.7%), and children in the Northeast (1999 rate, 2.0; 2020 rate, 1.7; overall decrease of 1.4%). Homicides of children 10 years or younger were most commonly precipitated by abuse/neglect, perpetrated by parents/caregivers. Homicides of 11- to 17-year-olds were most commonly precipitated by crime and arguments and perpetrated by someone known to them, especially friends and acquaintances., Conclusions and Relevance: The decline in homicide rates for some geographic and child demographic groups is encouraging; however, rates recently increased across several subpopulations, with some racial and ethnic disparities persisting for more than 20 years. More targeted strategies are needed to (1) protect 6- to 10-year-olds, 11- to 17-year-olds, and children in certain geographic areas and (2) urgently address firearm violence, racism, and inequities at the root of youth violence.

Prevalence of homicide-suicides is difficult to determine in Greece due to the lack of a national tracking system. The aim of this study was to estimate the prevalence of the homicide-suicide incidents in Greece over the past 13 years, and to determine the circumstances under which they occurred, as well as the characteristics of perpetrators and victims. Two Internet search engines (google and yahoo), as well as the search engine of the major national news websites, were surveyed to identify the number of homicide-suicide cases that occurred in Greece from January 2008 to December 2020. Over the study period, 36 homicide-suicide incidents occurred in Greece, resulting in 36 suicides and 41 homicides. The above incidents reflect an annual homicide-suicide rate of 0.02 cases per 100,000 inhabitants. Most perpetrators were male (88.9%), whereas most victims were female (80.6%). Spousal-consortial cases accounted for 52.7% and familial cases for 41.7% of the total number of incidents. The use of firearms (mostly shotgun) was the most common method of homicide and suicide (58.3% and 63.9%, respectively). Women killed only their children, while men committed homicide and suicide mainly in the context of a former or current intimate partnership with the victim. Our results are in line with international homicide-suicide data. The establishment of a national surveillance system for homicides-suicides would be of paramount importance as it would facilitate accurate recording, identification of risk factors and characteristics of potential victims and perpetrators and it could ultimately be an aid to the prevention of such tragic events.

Importance: Youth firearm-related deaths are a public health crisis in the US. The association between county-level poverty and the risk of firearm-related deaths among youth is unknown, however., Objective: To examine the association between county-level poverty concentration and firearm-related mortality rates in US youth., Design, Setting, and Participants: This cross-sectional study analyzed US firearm fatalities in children and young adults aged 5 to 24 years that occurred between January 1, 2007, and December 31, 2016. Data were obtained from the Centers for Disease Control and Prevention's Compressed Mortality File, and annual intercensal county population data were obtained from the US Census Bureau. Data analyses were conducted between November 1, 2019, and June 30, 2020., Exposures: County-level poverty was categorized into 5 groups: 0% to 4.9%, 5% to 9.9%, 10% to 14.9%, 15% to 19.9%, and ≥20% of the population living below the federal poverty level., Main Outcomes and Measures: The main outcomes were firearm-related deaths in total and by specific intent (homicide, suicide, and unintentional) per 100 000 youths over the entire study period. Multivariable negative binomial regression models were used to analyze the association between firearm-related mortality rates and county poverty concentration, controlling for demographic variables, urbanicity, and statewide firearm prevalence. Adjusted incidence rate ratios (IRRs) were calculated, and statewide firearm prevalence was estimated. The population-attributable fraction (PAF) and years of potential life lost for each intent were calculated., Results: A total of 67 905 firearm-related deaths among youth (predominantly composed of 60 164 male individuals [88.6%]) from 2007 to 2016 were analyzed. Of these deaths, 42 512 were homicides (62.6%), 23 034 were suicides (33.9%), and 1627 were unintentional (2.4%). Firearm-related mortality risk increased in a stepwise manner with increasing county poverty concentration. Compared with counties with the lowest poverty concentration, counties with the highest poverty concentration had an increased rate of total firearm-related deaths (adjusted IRR, 2.29; 95% CI, 1.96-2.67), homicides (adjusted IRR, 3.55; 95% CI, 2.80-4.51), suicides (adjusted IRR, 1.45; 95% CI, 1.20-1.75), and unintentional deaths (adjusted IRR, 9.32; 95% CI, 2.32-37.4). The PAF was 0.51 (95% CI, 0.43-0.57) for all firearm-related deaths, 0.66 (95% CI, 0.57-0.73) for homicides, 0.30 (95% CI, 0.17-0.42) for suicides, and 0.86 (95% CI, 0.46-0.97) for unintentional deaths. This calculation translated to 34 292 firearm-related deaths that would not have occurred if all counties had the same risk as counties with the lowest poverty concentration. A total of 3 833 105 years of potential life lost was observed., Conclusions and Relevance: This study found an association between firearm-related mortality rates among youth and county-level poverty concentration. With more than half of firearm-related deaths and two-thirds of firearm-related homicides potentially associated with living in an area with a high concentration of poverty, a multidimensional strategy to reduce poverty and firearm-related deaths is urgently needed.

Objective: To estimate the prevalence of pregnancy-associated deaths due to drugs, suicide, and homicide nationwide from 2010 to 2019., Methods: Using U.S. death certificate records from 2010 to 2019 for 33 states plus the District of Columbia, we identified pregnancy-associated deaths using the pregnancy checkbox and International Classification of Diseases, Tenth Revision codes, calculated pregnancy-associated death ratios, and categorized deaths by cause, timing relative to pregnancy, race or ethnicity, and age., Results: Of 11,782 pregnancy-associated deaths identified between 2010 and 2019, 11.4% were due to drugs, 5.4% were due to suicide, and 5.4% were due to homicide, whereas 59.3% were due to obstetric causes and the remaining 18.5% were due to other causes. Drug-related deaths, suicide, and homicide accounted for 22.2% of pregnancy-associated deaths. All three causes of death increased over the study period, with drug-related pregnancy-associated deaths increasing 190%. Homicide during pregnancy and drug-related deaths, suicides, and homicide in the late postpartum period (43-365 days) accounted for a larger proportion of all deaths in these time periods than the contribution of these causes to all deaths among females of reproductive age. Pregnant and postpartum people identified as non-Hispanic American Indian or Alaska Native were at highest risk of drug-related and suicide death, and people identified as non-Hispanic Black were at highest risk of homicide., Conclusion: Deaths due to drug use, suicide, and homicide constitute more than one fifth of all deaths during pregnancy and the first year postpartum. Drug-related deaths and homicides have increased over the past decade. Substantial racial and ethnic inequities in these deaths exist., Competing Interests: Financial Disclosure Alison Gemmill reports money was paid to her from the World Health Organization and Avenir Health. The other authors did not report any potential conflicts of interest., (Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: People in prison have an extremely high risk of suicide. The aim of this paper is to describe all suicides in the Norwegian prison population from 2000 to 2016, during and following imprisonment; to investigate the timing of suicides; and to investigate the associations between risk of suicide and types of crime., Methods: We used data from the Norwegian Prison Release study (nPRIS) including complete national register data from the Norwegian Prison Register and the Norwegian Cause of Death Register in the period 1.1.2000 to 31.12.2016, consisting of 96,856 individuals. All suicides were classified according to ICD-10 codes X60-X84. We calculated crude mortality rates (CMRs) per 100,000 person-years and used a Cox Proportional-Hazards regression model to investigate factors associated with suicide during imprisonment and after release reported as hazard ratios (HRs)., Results: Suicide accounted for about 10% of all deaths in the Norwegian prison population and was the leading cause of death in prison (53% of in deaths in prison). The CMR per 100,000 person years for in-prison suicides was 133.8 (CI 100.5-167.1) and was ten times higher (CMR = 1535.0, CI 397.9-2672.2) on day one of incarceration. Suicides after release (overall CMR = 82.8, CI 100.5-167.1) also peaked on day one after release (CMR = 665.7, CI 0-1419.1). Suicide in prison was strongly associated with convictions of homicide (HR 18.2, CI 6.5-50.8) and high-security prison level (HR 15.4, CI 3.6-65.0). Suicide after release was associated with convictions of homicide (HR 3.1, CI 1.7-5.5)., Conclusion: There is a high risk of suicide during the immediate first period of incarceration and after release. Convictions for severe violent crime, especially homicide, are associated with increased suicide risk, both in prison and after release., (© 2021. The Author(s).)

Understanding why different nations have different homicide and suicide rates has been of interest to scholars, policy makers and the general public for years. Multiple theories have been offered, related to the economy, presence of guns and even exposure to violence in video games. In the current study, several factors were considered in combination across a sample of 92 countries. These included income inequality (Gini index), Human Capital Index (education and employment), per capita gun ownership and per capita expenditure on video games. Results suggest that economic factors primarily were related to homicide and suicide cross-nationally. Video game consumption was not a major indicative factor (other than a small negative relationship with homicides). More surprisingly, per capita gun ownership was not an indicator factor cross-nationally. The results suggest that a focus on economic factors and income inequality are most likely to bear fruit regarding reduction of violence and suicide., (© 2021 International Union of Psychological Science.)

California's Mental Health Services Act (MHSA) substantially expanded funding of county mental health services through a state tax, and led to broad prevention efforts and intensive services for individuals experiencing serious mental disorders. We estimated the associations between MHSA and mortality due to suicide, homicide, and acute effects of alcohol. Using annual cause-specific mortality data for each US state and the District of Columbia from 1976-2015, we used a generalization of the quasi-experimental synthetic control method to predict California's mortality rate for each outcome in the absence of MHSA using a weighted combination of comparison states. We calculated the association between MHSA and each outcome as the absolute difference and percentage difference between California's observed and predicted average annual rates over the postintervention years (2007-2015). MHSA was associated with modest decreases in average annual rates of homicide (-0.81/100,000 persons, corresponding to a 13% reduction) and mortality from acute alcohol effects (-0.35/100,000 persons, corresponding to a 12% reduction). Placebo test inference suggested that the associations were unlikely to be due to chance. MHSA was not associated with suicide. Protective associations with mortality due to homicide and acute alcohol effects provide evidence for modest health benefits of MHSA at the population level., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Murder-suicides are defined as the murder of at least one person and the suicide of the offender following the murder. The intention to commit suicide must be primary. In most cases, a male offender kills a female victim after a separation. The current analysis was the first analysis of the typology of murder-suicides in Berlin. We analyzed the autopsy files of the Institute for Forensic Medicine of the Charité University Medicine Berlin and of the City Institute for Forensic Medicine Berlin. We performed descriptive and statistical analyses of cases between 2005 and 2013. We identified 17 murder-suicides. All 17 offenders were male, and 20 of the victims (90%) were female. The offenders used firearms in the majority of the cases. In seven cases, the victims and offenders were at least 80 years old. The average age of the offenders was 63 years. Disease was the motive in 6 cases involving older offenders. Our study might support the development of prevention strategies. In this regard, it is important to build a database for murder-suicides in Germany and other countries, to formulate a uniform definition of murder-suicide, to carry out nationwide interdisciplinary studies on this topic and to improve the existing health care structures, especially for older adults and people with depression.

Purpose: This study examines the differences in suicide, homicide, and all-cause mortality between transgender and cisgender Veterans Health Administration (VHA) patients. Methods: VHA electronic medical record data from October 1, 1999 to December 31, 2016 were used to create a sample of transgender and cisgender patients ( n  = 32,441). Cox proportional hazard regression was used to evaluate differences in survival time (date of birth to death date/study end). Death data were from the National Death Index. Results: Transgender patients had more than twofold greater hazard of suicide than cisgender patients (adjusted hazard ratio [aHR] = 2.77, 95% confidence interval [CI] = 1.88-4.09), especially among younger (18-39 years) (aHR = 3.35, 95% CI = 1.30-8.60) and older (≥65 years) patients (aHR = 9.48, 95% CI = 3.88-23.19). Alternatively, transgender patients had an overall lower hazard of all-cause mortality (aHR = 0.90, 95% CI = 0.84-0.97) compared with cisgender patients, which was driven by patients 40-64 years old (aHR = 0.78, 95% CI = 0.72-0.86) and reversed by those 65 years and older (aHR = 1.17, 95% CI = 1.03-1.33). Conclusion: Transgender patients' hazard of suicide mortality was significantly greater than that of cisgender VHA patients.

Although lockdown measures to stop COVID-19 have direct effects on disease transmission, their impact on violent and accidental deaths remains unknown. Our study aims to assess the early impact of COVID-19 lockdown on violent and accidental deaths in Peru. Based on data from the Peruvian National Death Information System, an interrupted time series analysis was performed to assess the immediate impact and change in the trend of COVID-19 lockdown on external causes of death including homicide, suicide, and traffic accidents. The analysis was stratified by sex and the time unit was every 15 days. All forms of deaths examined presented a sudden drop after the lockdown. The biggest drop was in deaths related to traffic accidents, with a reduction of 12.22 deaths per million men per month (95% CI: -14.45, -9.98) and 3.55 deaths per million women per month (95% CI:-4.81, -2.30). Homicide and suicide presented similar level drop in women, while the homicide reduction was 2.5 the size of the suicide reduction in men. The slope in homicide in men during the lock-down period increased by 6.66 deaths per million men per year (95% CI:3.18, 10.15). External deaths presented a sudden drop after the lockdown was implemented and an increase in homicide in men was observed. Falls in mobility have a natural impact on traffic accidents, however, the patterns for suicide and homicide are less intuitive and reveal important characteristics of these events, although we expect all of these changes to be transient., (Copyright © 2020 Elsevier Inc. All rights reserved.)

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.

Objectives. To estimate and compare the effects of state background check policies on firearm-related mortality in 4 US states. Methods. Annual data from 1985 to 2017 were used to examine Maryland and Pennsylvania, which implemented point-of-sale comprehensive background check (CBC) laws for handgun purchasers; Connecticut, which adopted a handgun purchaser licensing law; and Missouri, which repealed a similar law. Using synthetic control methods, we estimated the effects of these laws on homicide and suicide rates stratified by firearm involvement. Results. There was no consistent relationship between CBC laws and mortality rates. There were estimated decreases in firearm homicide (27.8%) and firearm suicide (23.2%-40.5%) rates associated with Connecticut's law. There were estimated increases in firearm homicide (47.3%), nonfirearm homicide (18.1%), and firearm suicide (23.5%) rates associated with Missouri's repeal. Conclusions. Purchaser licensing laws coupled with CBC requirements were consistently associated with lower firearm homicide and suicide rates, but CBC laws alone were not. Public Health Implications. Our results contribute to a body of research showing that CBC laws are not associated with reductions in firearm-related deaths unless they are coupled with handgun purchaser licensing laws.

Background. There is debate whether policies that reduce firearm suicides or homicides are offset by increases in non-firearm-related deaths. Objectives. To assess the extent to which changes in firearm homicides and suicides following implementation of various gun laws affect nonfirearm homicides and suicides. Search Methods. We performed a literature search on 13 databases for studies published between 1995 and October 31, 2018 (PROSPERO CRD42019120105). Selection Criteria. We included studies if they (1) estimated an effect of 1 of 18 included classes of gun policy on firearm homicides or suicides, (2) included a control group or comparison group and evaluated time series data to establish that policies preceded their purported effects, and (3) provided estimated effects of the policy and inferential statistics for either total or nonfirearm homicides or suicides. Data Collection and Analysis. We extracted data from each study, including study timeframe, population, and statistical methods, as well as point estimates and inferential statistics for the effects of firearm policies on firearm deaths as well as either nonfirearm or overall deaths. We assessed quality at the estimate (study-policy-outcome) level by using prespecified criteria to evaluate the validity of inference and causal identification. For each estimate, we derived the mortality multiplier (i.e., the ratio of the policy's effect on total homicides or suicides; expressed as a change in the number of deaths) as a proportion of its effect on firearm homicides or suicides. Finally, we performed a meta-analysis to estimate overall mortality multipliers for suicide and homicide that account for both within- and between-study heterogeneity. Main Results. We identified 16 eligible studies (study timeframes spanning 1977-2015). All examined state-level policies in the United States, with most estimating effects of multiple policies, yielding 60 separate estimates of the mortality multiplier. From these, we estimated that a firearm law's effect on homicide, expressed as a change in the number of total homicide deaths, is 0.99 (95% confidence interval = 0.76, 1.22) times its effect on the number of firearm homicides. Thus, on average, changes in the number of firearm homicides caused by gun policies are neither offset nor compounded by second-order effects on nonfirearm homicides. There is insufficient evidence in the existing literature on suicide to indicate the extent to which the effects of gun policy changes on firearm suicides are offset or compounded by their effects on nonfirearm suicides. Authors' Conclusions. State gun policies that reduce firearm homicides are likely to reduce overall homicides in the state by approximately the same number. It is currently unknown whether the same holds for state gun policies that significantly reduce firearm suicides. The small number of studies meeting our inclusion criteria, issues of methodological quality within those studies, and the possibility of reporting bias are potential limitations of this review. Public Health Implications. Policies that reduce firearm homicides likely have large benefits for public health as there is little evidence to support a strong substitution effect between firearm and nonfirearm homicides at the population level. Further research is needed to determine whether policies that produce population-level reductions in firearm suicides will translate to overall declines in suicide rates.

Introduction: death from injuries is a global public health problem. Ninety percent occur in low- and middle-income countries like Nigeria. This study aimed to determine the burden and demographic characteristics of injury-related death in Enugu, Nigeria., Methods: this is a retrospective study of injury-related deaths in Enugu over a 7-year period. Standardized forms were used to collect data from autopsy reports archived in the Forensic Unit of Enugu State University Teaching Hospital, Enugu and a descriptive analysis of collected data performed., Results: of the Coroner deaths examined in the period reviewed, 1,067 (86.9%) were injury-related. The male-to-female ratio was 5.2: 1. Mean age of victims was 34.2 ± 14.3years and range was 8 months to 86 years. Most victims (56.7%) aged 21-40 years. Accidents accounted for most deaths (53.2%) followed by homicide (44.3%). Road traffic deaths (51.4%), cult/gang violence (20.8%) and robbery (14.7%) were the commonest. Suicide (0.5%) and domestic violence (0.7%) were the least. More females died in domestic incidents while more males died in all other circumstances. Firearm (56.7%) was the most common weapon followed by knife (19%). Knife and wood (28.7% each) were the commonest weapons in domestic violence. Generally, fatal incidents occurred more in the day-time (65.5%). Most robberies (80.4%) occurred at night. Most cult/gang killings (75.2%) and robberies (81.7%) occurred in public places and at homes respectively., Conclusion: injury is the highest source of Coroner's death in Enugu. Efforts to curb it are insufficient. A definitive policy on the prevention and management of injury-related deaths is needed., Competing Interests: The authors declare no competing interests., (Copyright: Samuel Robsam Ohayi et al.)

Background: Death during pregnancy and postpartum in the United States is an issue of urgent and growing concern. Mortality from obstetric-related causes is on the rise, and pregnancy-associated homicide remains a leading cause of death. It is unknown how the context in which women live contributes to their risk of obstetric or violent death during pregnancy and the postpartum period. This study aimed to quantify incidence of mortality from obstetric-related causes and violent death during pregnancy and up to 1-year postpartum, and to identify associations between state-level violent crime rates and incidence of pregnancy-related mortality and pregnancy-associated homicide. Materials and Methods: We conducted a retrospective, ecologic analysis of all pregnancy-associated homicides in 17 states participating in the National Violent Death Reporting System from 2011 to 2015. Pregnancy-related mortality was identified by International Classification of Diseases-10 code for underlying cause of death in death records issued in the same states and years, data provided by the National Center for Health Statistics. We characterized decedents of both violent and nonviolent maternal death ( n  = 174 and 1,617, respectively). Five-year mortality ratios (deaths per 100,000 live births) were estimated for both pregnancy-related mortality and pregnancy-associated homicide in every state. Poisson regression models estimated associations between violent crime and maternal death, adjusting for area-level socioeconomic conditions. Results: Both pregnancy-related mortality and pregnancy-associated homicide ratios were higher in states with higher rates of violent crime (relative risk [RR] = 1.05, 95% confidence interval [CI] = 1.01-1.12; RR = 1.17, 95% CI = 1.01-1.34, respectively). Conclusion: Broad population-wide violence prevention efforts may help reduce incidence of maternal mortality from both obstetric and violent causes.

Canada implemented a series of laws regulating firearms including background and psychological screening, licensing, and training in the years 1991, 1994, and 2001. The effects of this legislation on suicide and homicide rates were examined over the years 1981 to 2016. Models were constructed using difference-in-difference analysis of firearms and non firearms death rates from 1981 to 2016. In addition, negative binomial regression was used to test for an association between rates of suicide by Canadian Province and firearms prevalence, using licensing rates as a proxy for prevalence. No associated benefit from firearms legislation on aggregate rates of male suicide was found. In men aged 45 to 59 an associated shift from firearms suicide after 1991 and 1994 to an increase in hanging resulted in overall rate ratios of 0.994 (95%CI, 0.978,1.010) and 0.993 (95%CI, 0.980,1.005) respectively. In men 60 and older a similar effect was seen after 1991, 1994, and 2001, that resulted in rate ratios of 0.989 (95%CI, 0.971,1.008), 0.994 (95%CI, 0.979,1.010), and 1.010 (95%CI, 0.998,1.022) respectively. In females a similar effect was only seen after 1991, rate ratio 0.983 (95%CI, 0.956,1.010). No beneficial association was found between legislation and female or male homicide rates. There was no association found with firearm prevalence rates per province and provincial suicide rates, but an increased association with suicide rates was found with rates of low income, increased unemployment, and the percentage of aboriginals in the population. In conclusion, firearms legislation had no associated beneficial effect on overall suicide and homicide rates. Prevalence of firearms ownership was not associated with suicide rates. Multifaceted strategies to reduce mortality associated with firearms may be required such as steps to reduce youth gang membership and violence, community-based suicide prevention programs, and outreach to groups for which access to care may be a particular issue, such as Aboriginals., Competing Interests: The authors have declared that no competing interests exist. None of the authors are members of any organization other than the indicated University appointment at McMaster University Canada, as well as the Professional Organizations: Fellow of the Royal College of Medicine Canada and American Board of Emergency Medicine. There are no competing interests in this group.

Background: Nursing resources can have a protective effect on patient outcomes, but nurses and nursing scope of practice have not been studied in relation to injury outcomes. The purpose of this study was to examine whether scope of practice and ease of practice laws for nurse practitioners and registered nurses are associated with suicide and homicide rates in the United States., Methods: This state-level analysis used data from 2012 to 2016. The outcome variables were age-adjusted suicide and homicide rates. The predictor variables were NP scope of practice by state (limited, partial, or full) and RN ease of practice (state RN licensure compact membership status). Covariates were state sociodemographic, healthcare, and firearm/firearm policy context variables that have a known relationship with the outcomes., Results: Full scope of practice for NPs was associated with lower rates of suicide and homicide, with stronger associations for suicide. Likewise, greater ease of practice for RNs was associated with lower suicide and homicide rates., Conclusions: Findings suggest that nurses are an important component of the healthcare ecosystem as it relates to injury outcomes. Laws supporting full nursing practice may have a protective effect on population health in the area of injuries and future studies should explore this relationship further.

Objective: To assess the effect of a permanent gun-carrying restriction on gun-related mortality in Colombia between 2008 and 2014, and determine differences in the effect of the restriction by place of death and sex., Methods: In 2012, Bogotá and Medellín introduced a permanent gun-carrying restriction. We compared gun-related mortality rates in these cities (intervention cities) with the rates in all other Colombian cities with more than 500 000 inhabitants (control cities). We used data from the Colombian National Department of Statistics to calculate monthly gun-related mortality rates between 2008 and 2014 for intervention and control cities. We used a differences-in-differences method with fixed effects to assess differences in gun-related mortality in intervention and control cities before and after the introduction of the gun-carrying restriction. We stratified effects by place of death (public area or residence) and sex. We made robustness checks to test the assumptions of the models., Findings: Gun-related deaths in the control and intervention cities decreased between 2008 and 2014; however, the decrease was greater in the intervention cities (from 20.29 to 14.93 per 100 000 population; 26.4%) than in the control cities (from 37.88 to 34.56 per 100 000 population; 8.8%). The restriction led to a 22.3% reduction in the monthly gun-related mortality rate in Bogotá and Medellín. The reduction was greater in public areas and for males. Robustness checks supported the assumptions of the models., Conclusion: The permanent restriction on carrying guns reduced gun-related deaths. This policy could be used to reduce gun-related injuries in urban centres of other countries with large numbers of gun-related deaths., ((c) 2020 The authors; licensee World Health Organization.)

Introduction: Custody-related death is an internationally key sensitive issue with respect to Human Rights. The causes of death and associated factors in this vulnerable population vary according to country and region. The present study attempted to analyze the different causes of custody-related deaths and associated factors and identify the areas of intervention for prevention of such deaths., Material and Methods: This retrospective study was conducted using files of custody-related deaths in the Department of Forensic Medicine of Shri V. N. Government Medical College, Yavatmal, Maharashtra State (India). A total of 108 cases were autopsied by the Department during the period of 2000-2018. We used a pre-formed proforma to extract data from files of these cases; the data obtained tabulated and coded in to charts, following which they were analyzed in detail., Results: Male preponderance (105) was observed, with there only being 3 female cases (Male: Female ratio 1:0.028). The most common age group among deaths in police custody/action was 31-40 years whereas; age group of 41-50 years was most common among prisoners. A majority of deaths occurred due to natural causes (69.44%); among these, 89.33% were prisoners, with cardiac causes being the most common. Many individuals died due to cardiac causes were brought dead at tertiary care hospital. Suicides were a common cause of unnatural deaths among individuals in police custody/action. The majority of victims committed suicide in police custody did so by hanging. All cases of suicide by insecticide poisoning were observed in police action, and hanging was the only cause of suicide in prison. Blunt force injuries were frequent cause of homicide in police custody, which were result of force used by police during interrogation., Conclusion: Lack of knowledge regarding the causes of death and careless attitude towards the suicidal behavior and, the health and welfare of detainees are avoidable reasons for custody-related deaths., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Objective: We investigated whether high school students reporting easy access to guns were more likely to die prematurely from either suicide, homicide, or an accidental death., Method: Based upon the National Longitudinal Study of Adolescent to Adult Health, we contrasted those reporting easy access to guns, n = 5,185, 25%, with the remaining 75% (n = 15,589) on various sociodemographic characteristics, behaviors, and premature mortalities., Results: We found higher rates of suicides, homicides, and accidental deaths among those reporting easy access to guns at Wave 1 or Wave 2. This was only true for males. Those with easy access to guns were more likely to share common sociodemographic characteristics, came from two-parent homes where children had strong and close relationships with parents, where children were more likely to get into fights, do delinquent misdeeds, and engage in other risk-taking behaviors such as increased drinking, drug use, and riding motorcycles. Logistic regression analysis showed easy access to guns remained a significant predictor of premature mortalities when sex, family income differences, risk-taking, and delinquency were used as covariates., Conclusions: This study supports previous research and carves out new ground showing easy access to guns acts synergistically with other lifestyle differences to diminish youth life chances., (© 2019 The American Association of Suicidology.)

This study analyzes postmortem records from 260 homicide cases autopsied by the Department of Forensic Medicine in Rome from 2000 to 2014. The victims were mainly males (74%) and young (61% aged from 21 to 50 years). Although the victims were mostly Italians, the number of foreign victims (33%) has increased since 1990, primarily due to immigration. The offenders frequently used firearms (39%), particularly in multiple murders. An increase in blunt (20%) and sharp force (32%) weapons was also seen. The primary crime scene was residential (42%), and the head was the most frequently injured body region. Male victims occurred frequently in the context of organized crime (7.6%). In family or intimate-sexual relationships, women were the majority of victims (8%). Forensic pathologists play an important role during investigation. They should consider all the information available to them, including autopsy information, crime scene information, and crime investigation data., (© 2019 American Academy of Forensic Sciences.)