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PURPOSE: Homicide mortality rates have historically been higher among African-Americans (AAs) than whites in the US. There has been a significant decrease in homicide mortality in New York City (NYC) during the past decade. We were interested in determining how disparities in homicide mortality between racial/ethnic groups have changed during that time and if drugs played a role in these changes.METHODS: All homicides in the NYC Office of Chief Medical Examiner records for 1990–1998 were identified. We calculated annual age and race standardized rates of homicide with positive toxicology. We calculated proportions of white, AA, and Hispanic decedents with positive cocaine, opiates, cannabis, and alcohol toxicology for each year in the period.RESULTS: Between 1990 and 1998, overall homicide rate decreased from 28.6 to 6.92 per 100,000 (75.8%). In 1990, the homicide rates among AAs and Hispanics were 9.5 and 8.2 times greater than among whites respectively. In 1998, homicides among AAs and Hispanics were 7.9 and 3.8 times greater than among whites. Proportion of homicide decedents with positive toxicology was stable and similar for all three groups between 1990-98 (range: 74.6% to 89.2%). The proportion of homicide decedents with positive cocaine toxicology declined, the proportion of decedents with positive cannabis toxicology increased, and the proportion of opiate and alcohol positive decedents was stable during the period. Changes in proportions of drug-positive homicide decedents were similar for all drugs for whites, AAs, and Hispanics between 1990–1998.DISCUSSION: Although overall homicide rates in NYC declined between 1990–98, there remained substantial disparities in homicide rates between whites, AAs, and Hispanics at the end of the decade. Proportions of homicide deaths with positive toxicology changed similarly in all three racial/ethnic groups. Factors other than drug use likely account for the persisting racial/ethnic disparities in homicide rates in NYC. [Copyright &y& Elsevier]

Objective: The authors assessed the suicide rates of New York City police officers during a recent period., Method: The authors reviewed death certificates of active New York City police officers who died from 1977 through 1996 (N=668); age-, gender-, and race-specific suicide rates among New York City police officers and the city's residents were determined., Results: The police suicide rate was 14.9 per 100,000 person-years, compared with a demographically adjusted suicide rate of New York City residents of 18.3 per 100,000 person-years. Suicide rates among male police officers were comparable to their reference population. Female police officers had a higher risk of suicide than female residents of New York, but the number of suicides of female police officers was small., Conclusions: The rate of suicide among New York City police officers is equal to, or even lower than, the suicide rate of the city's resident population.

Objective: The authors determined the risk of suicide during pregnancy., Method: The autopsy reports of all female residents of New York City, 10-44 years old, who committed suicide from 1990 to 1993 were assessed for pregnancy. These data were compared with age-adjusted and race-adjusted standardized mortality ratios for women, which were calculated by using population data from the 1990 U.S. Census as well as data obtained from the New York City Health Department on the number of live births, spontaneous abortions, and induced abortions., Results: The standardized mortality ratio for suicide during pregnancy was 0.33; that is, the number of suicides of pregnant women was only one-third of that expected., Conclusions: Despite the mood swings and stresses associated with pregnancy and impending childbirth, pregnant women have a significantly lower risk of suicide than women of childbearing age who are not pregnant.

Final Exit was a best-selling book that recommended poisoning and suffocation by plastic bag as lethal means of suicide for those with terminal medical illnesses. The authors sought to determine whether the number of suicides involving these methods increased in the United States in 1991, the year the book was published, compared with 1990. Suicidal asphyxiations involving a plastic bag increased 30.8%, from 334 to 437, and poisonings increased 5.4%, from 3,143 to 3,314. There was no change in the number of suicides involving each of the other methods or in the total number of suicides between 1990 and 1991. These ecological data support, but cannot conclusively prove, the hypothesis that Final Exit influenced the choice of lethal means of suicidal individuals.

Objective: To review the epidemiology, patterns, and major determinants of murder-suicide and to discuss the clinical and research strategies for identifying the individuals at greatest risk for this type of violence., Data Sources: Data were obtained from English-language articles based on searches using MEDLINE (from 1966), PsychINFO (from 1967), and EMBASE (from 1974) programs. In addition, relevant articles, books, and monographs identified from the reference list of retrieved articles were reviewed., Study Selection: Case-control studies, descriptive epidemiologic surveys, and case series were chosen for review., Data Extraction: Because of the limited scope of the pertinent research literature, all data relevant to the incidence, demographics, circumstances, and precipitants of murder-suicide were summarized by the authors., Data Synthesis: Murder-suicide occurs with an annual incidence of 0.2 to 0.3 per 100,000 person-years and accounts for approximately 1000 to 1500 deaths yearly in the United States. The annual incidence of these events is relatively constant across industrialized nations and has not significantly changed over several decades. The principal perpetrators are young males with intense sexual jealousy, depressed mothers, or despairing elderly men with ailing spouses. The principal victims are female sexual partners or consanguineous relatives, usually young children. Clinical depression, specific motivations such as male sexual proprietariness or maternal salvation fantasies, and a history of previous suicide attempts are important in explaining underlying psychopathological mechanisms., Conclusions: Murder-suicide occupies a distinct epidemiological domain that overlaps with suicide, domestic homicide, and mass murder. These events may be categorized into one of only several phenomenologic typologies that share similar demographics, motivations, and circumstances. Despite the disruption of families and communities caused by murder-suicide, there are no standardized operational definitions, validated taxonomic systems, or national surveillance networks for these events, all of which are needed to develop prevention strategies.

Responses from 760 directors of residency training showed that almost three-fourths of them do not give preference to students from graded schools when selecting residents and that over three-fourths of the directors rated the performance of pass-fail students equal to that of graded students. However, when their responses were analyzed in relation to the characteristics of their programs, it became apparent that there was a greater likelihood of giving preference and higher ratings of performance to graded students if the programs were in medicine, surgery, or obstetrics/gynecology; if they filled all of their positions in the match; and if they were located in the West or South. In addition, there were differences between specialties in regard to how they valued various types of information in the selection of residents in the absence of grades as well as general dissatisfaction with the accuracy and quantity of nongraded information submitted to them.

Residency training directors have noted considerable variability in the quality of deans' letters sent by medical schools on behalf of graduating students. A total of 212 deans' letters from 103 U.S. medical schools received by a large psychiatric residency program were rated by two of the authors. Of these, 26.9 percent were judged excellent, 49.5 percent average, and 23.6 percent poor. Excellent letters were characterized by detailed personal and academic comments; verbatim statements for each clinical clerkship; tactful , yet explicit, remarks about problems; and internal consistency. Poor letters were generally short regardless of content, offered global impressions about clerkship performance by fusing remarks from several different clerkships without identifying sources, or omitted important information that was quickly evident to the discriminating interviewer. Recommendations are offered for authors and readers of deans' letters and to medical students.

Criminal homicide has increased steadily during the past two decades to account today for more than 1 percent of deaths in the United States. After providing background information on the rates and patterns of homicide in the U.S., the author uses the literature to present a twofold discussion of factors affecting the incidence of homicide: those that act as a deterrence to crime, such as punishment, and environmental and biological factors that can interact in a complex way to produce violence and murder. Examples of these latter factors include firearms, drug and alcohol abuse, genetics, race, psychiatric disorders, metabolic states, the economy, geographic region, the media, and political instability.