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Most research on mass murderers to date has focused on perpetrators of male sex, while research on perpetrators of female sex has been relegated to case reports and series. We aimed to more fully examine the phenomenon of female-perpetrated mass murder. We analyzed 1715 worldwide incidents of personal-cause mass murder from 1900 to 2019, identifying 105 (6%) events perpetrated by females. We defined mass murder as any event involving at least three fatalities, not including the perpetrator, using any method. We identified cases of mass murder from English-language databases of mass murder or murder in print or online. There were no significant differences in age and race between female and male perpetrators. Relative to males, female perpetrators were significantly less likely to employ firearms in their mass murders, using them in less than half of cases, compared to over 70% for males. The prevalence of psychotic signs and symptoms among female mass murderers was more than double that among males (25.7% vs. 12.5%, p < 0.01), while the rate of nonpsychotic psychiatric or neurological conditions was also much greater among female perpetrators (29.5% vs. 17.1%, p < 0.01). Over half of female perpetrators took or attempted to take their own lives. More than three-quarters of mass murders by females involved at least one family member as a victim. This study underscores sex-specific differences in the perpetration of mass murder and the need for further research to understand how insights about such dynamics might lead to the development of more effective and informed intervention policies., (© 2024 American Academy of Forensic Sciences.)

Objective: Stigma jeopardizes recovery and successful implementation of mental health services (MHS) globally. Despite cultural variation in how stigma manifests, few studies have examined how culture fundamentally impacts the concept of "personhood" in Latin America. Chile has expanded MHS, providing universal coverage for evaluation and treatment of first episode psychosis (FEP). We applied the "what matters most" (WMM) framework of stigma to identify culturally salient factors that shape or protect against stigma in urban Chile, identifying potential implications for MHS and recovery., Methods: In-depth interviews ( n = 48) were conducted with MHS users with psychotic disorders ( n = 18), their family members ( n = 15), and community members ( n = 15), from two urban regions in Chile. Interviews were coded and analyzed to identify WMM, how WMM shapes stigma, and how MHS can influence achieving WMM., Results: Traditional values emphasizing physical/social appearance, gender roles, family, and social connectedness are highly valued. Socioeconomic transitions have engendered capitalistic variations on traditional values, with increasing emphasis on professional careers for men and women, individualism, and independence. Psychotic disorders interfere with fulfillment of both traditional and capitalist values, thereby reinforcing stigma. However, MHS are seen as partially effective in enabling fulfillment of some goals, including employment, appearance, and independence, while often remaining insufficient in enabling capacity to achieve marriage and having a family., Conclusions and Implications for Practice: MHS that facilitate recovery by engaging users in services, such as pharmacotherapy, education/vocational rehabilitation, and family-centered care aligned with cultural values can mitigate stigma and facilitate recovery by enabling users to fulfill WMM. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Most research to date has focused on perpetrators of mass murder incidents. Hence, there is little information on victims. We examined 973 mass murders that occurred in the United States between 1900 and 2019 resulting in 5,273 total fatalities and 4,498 nonfatal injuries for a total of 9,771 victims (on average 10 victims per incident). Approximately 64% of victims of mass murder were White individuals, 13% were Black individuals, 6% were Asian individuals, and 14% were Latinx individuals. Given the higher number of nonfatal injuries per non-firearm mass murder event (11.0 vs. 2.8, p < .001), the total number of victims was only 50% higher for mass shootings (5,855 victims) vs. non-firearm mass murder events (3,916 victims). Among the 421 incidents of mass murder in the United States since 2000, Black, Asian, and Native American individuals were overrepresented among victims of mass shootings compared with their representation in the general U.S. population, and White individuals were underrepresented (all p ≤ .002). Findings of racial/ethnic differences were similar among victims of mass murder committed with means other than firearms for Black, Asian, and White individuals. These findings highlight different areas of victimology within the context of these incidents., (© Copyright 2023 Springer Publishing Company, LLC.)

Mass murder, particularly mass shootings, constitutes a major, growing public health concern. Specific motivations for these acts are not well understood, often overattributed to severe mental illness. Identifying diverse factors motivating mass murders may facilitate prevention. We examined 1,725 global mass murders from 1900-2019, publicly described in English in print or online. We empirically categorized each into one of ten categories reflecting reported primary motivating factors, which were analyzed across mass murderers generally, as well as between U.S- and non-U.S.-based mass-shooters. Psychosis or disorganization related to mental illness were infrequently motivational factors (166; 9.6%), and were significantly more associated with mass murder committed using methods other than firearms. The vast majority (998, 57.86%) of incidents were impulsive and emotionally-driven, following adverse life circumstances. Most mass murderers prompted by emotional upset were found to be driven by despair or extreme sadness over life events (161, 16.13% within the category); romantic rejection or loss, or severe jealousy (204, 20.44% within the category); some specific non-romantic grudge (212, 21.24% within the category); or explosive, overwhelming rage following a dispute (266, 26.65% within the category). Results suggest that policies seeking to prevent mass murder should focus on criminal history, as well as subacute emotional disturbances not associated with severe mental illness in individuals with poor coping skills who have recently experienced negative life events.

Background: Affective polarization and stigma toward individuals with schizophrenia and toward immigrants in Argentina are not new despite its importance and dissemination. However, no research has been conducted taking into consideration political partisanship and attitudes toward these groups., Aims: Political polarization and attitudes toward socialization across party lines are studied in conjunction with attitudes toward immigrants and toward individuals with schizophrenia., Method: Individuals from Buenos Aires ( n  = 712) were surveyed for their political partisanship and their attitudes toward Peruvian and Bolivian immigrants, people with schizophrenia and partisans from the opposing political party. A modified version of the Bogardus scale was used., Results: Social distance was from highest to lowest toward people with schizophrenia, political opponents, and immigrants. Individuals with schizophrenia were strongly discriminated against by most participants: 86% would definitely or probably not want them to take care of their children, 83% would not want them to be their healthcare provider, and 81% would not want to marry them. Immigrants were comparatively not discriminated against: 10% would not want them to take care of their children, 8% would not want to receive health care from them, and 28% would not want to marry them. Cristina Fernández de Kirchner partisans showed the lowest level of discrimination toward these two groups, compared to Mauricio Macri partisans and to independent voters. However, the former group had greater discriminatory attitudes toward Mauricio Macri partisans than the latter., Conclusions: As compared to other discriminatory attitudes, discrimination toward persons with schizophrenia is widespread and pervasive. Lower levels of discrimination toward people with schizophrenia and toward immigrants would not predict attitudes toward the opposing political partisans.

This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users' perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system's incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

Aim: We sought to explore the complex phenomenological overlap between obsessive and compulsive symptoms (OCS), and attenuated positive symptoms among 156 young people at clinical high-risk (CHR) for psychosis., Methods: In order to explore the hypothesis that OCS of an implausible nature might optimally predict future transition to syndromal psychosis, ideas associated with obsessive and compulsive experiences elicited by clinical measures were thematically categorized as "plausible" or "implausible.", Results: While OCS were found to be common in our CHR sample, we did not find that implausible OCS themes were predictive of conversion., Conclusion: Given the absence of qualitative differences between OCS and early psychotic symptoms, we propose that clinicians encountering adolescent or young adult patients with new-onset OCD or OCS in the past year should monitor such symptoms for a minimum of 2 years to assess for the possible emergence of psychosis., (© 2020 John Wiley & Sons Australia, Ltd.)

Background: Few studies provide clear rationale for and the reception of adaptations of evidence-based interventions. To address this gap, we describe the context-dependent adaptations in critical time intervention-task shifting (CTI-TS), a manualized recovery program for individuals with psychosis in Rio de Janeiro, Brazil and Santiago, Chile. Implications of the adaptations - incorporating a task-shifting approach and modifying the mode of community-based service delivery - are examined from users' perspectives., Methods: A secondary analysis of in-depth interviews with CTI-TS users ( n = 9 in Brazil; n = 15 in Chile) was conducted. Using the framework method, we thematically compared how participants from each site perceived the main adapted components of CTI-TS., Results: Users of both sites appreciated the task-shifting worker pair to provide personalized, flexible, and relatable support. They wanted CTI-TS to be longer and experienced difficulty maintaining intervention benefits in the long-term. In Chile, stigma and a perceived professional hierarchy toward the task-shifting providers were more profound than in Brazil. Engagement with community-based services delivery in homes and neighborhoods (Chile), and at community mental health centers (Brazil) were influenced by various personal, familial, financial, and social factors. Uniquely, community violence was a significant barrier to engagement in Brazil., Conclusion: CTI-TS' major adaptations were informed by the distinct mental health systems and social context of Santiago and Rio. Evaluation of user experiences with these adaptations provides insights into implementing and scaling-up task-shifting and community-oriented interventions in the region through the creation of specialized roles for the worker pair, targeting sustained intervention effects, and addressing socio-cultural barriers., (© The Author(s) 2021.)

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

Research in individuals at clinical high-risk (CHR) for psychosis has traditionally focused on the relationship between the severity of positive and negative symptoms and development of syndromal psychosis. In this study, we examined the temporal order of emergence of positive and negative symptoms in 116 CHR individuals who met criteria for the Attenuated Positive Symptom Syndrome defined in the Structured Interview for Psychosis-Risk Syndromes (SIPS). We found that positive symptoms emerged at a significantly younger age than negative symptoms with no significant differences between converters and non-converters. These findings may provide important information about the temporal phenomenology of CHR symptoms., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Few studies examined maternal attachment in childbirth-related postpartum posttraumatic stress disorder (PP-PTSD). We studied 685 postpartum women, assessing for PP-PTSD, non-childbirth PTSD, maternal attachment, pre-birth, birth, and post-birth factors. Attachment was lower in PP-PTSD than in non-childbirth PTSD and no PP-PTSD. Hierarchical regression showed that PP-PTSD predicted less maternal attachment above and beyond pre-birth psychiatric conditions, acute distress in birth, and lack of breastfeeding. Childbirth-induced posttraumatic stress may interfere with the formation of maternal attachment, warranting screening of at-risk women.

Objective: Recent studies document posttraumatic stress disorder (PTSD) symptoms in women following at-term deliveries with health baby outcomes. However, the notion that childbirth can trigger PTSD remains controversial, and the symptom clusters are mostly unknown. The objective of this study was to examine the clustering of childbirth-induced postpartum PTSD (PP-PTSD) symptoms in comparison to DSM-5 clusters., Methods: We examined the symptom presentation of childbirth-related postpartum PTSD (PP-PTSD) in a sample of 685 women. The majority of these women delivered at term. Peritraumatic stress reactions to childbirth and PP-PTSD symptoms were assessed approximately 3 months after delivery. A hierarchical cluster analysis was used to detect grouping of the PP-PTSD symptoms., Results: Childbirth-related peritraumatic stress was strongly and positively associated with PP-PTSD symptom severity. Cluster modeling revealed 4 distinguished symptom groups: reliving (some reexperiencing symptoms), namely nightmares and flashbacks; avoidance coupled with unwanted memories (other reexperiencing symptoms); negative cognitions and mood; and hyperarousal reactivity., Conclusions: Our findings show that the representation of symptoms of PTSD that develops following a stressogenic childbirth experience appears, for the most part, to resemble DSM-5 symptom clusters. More research integrating descriptive symptom assessment with biological measures is warranted to better characterize the symptom presentation of this neglected posttraumatic stress syndrome., (© Copyright 2018 Physicians Postgraduate Press, Inc.)

Background: Posttraumatic stress related with the childbirth experience of full-term delivery with health outcomes has been recently documented in a growing body of studies. The magnitude of this condition and the factors that might put a woman at risk for developing childbirth-related postpartum posttraumatic stress disorder (PP-PTSD) symptoms are not fully understood. Methods: In this systematic review of 36 articles representing quantitative studies of primarily community samples, we set to examine PP-PTSD prevalence rates and associated predictors with a focus on the role of prior PTSD and time since childbirth. Results: A significant minority of women endorsed PP-PTSD following successful birth. Acute PP-PTSD rates were between 4.6 and 6.3%, and endorsement of clinically significant PP-PTSD symptoms was identified in up to 16.8% of women in community samples of high quality studies. Negative subjective experience of childbirth emerged as the most important predictor. Endorsement of PTSD before childbirth contributed to PP-PTSD; nevertheless, women without PTSD also exhibited PP-PTSD, with acute rates at 4.6%, signifying a new PTSD onset in the postpartum period. Conclusion: Although the majority of women cope well, childbirth for some can be perceived as a highly stressful experience and even result in the development of PP-PTSD symptoms. More research is needed to understand postpartum adaption and childbirth-related posttraumatic stress outcomes.

With the growing interest in posttraumatic growth (PTG) and its predictors, this study examined the relationship between trauma-related guilt and PTG in a sample of veterans over time. Self-reported guilt, PTG, and posttraumatic stress disorder (PTSD) symptoms were measured in combat veterans and prisoners of war (POWs). Positive correlations were found between guilt, PTSD, and PTG levels. Hierarchical regression revealed that initial guilt levels predicted subsequent PTG controlling for initial PTSD in combat veterans but not in POWs. The findings suggest that posttraumatic growth can be facilitated by trauma-related guilt, underscoring the complex relationship between positive and negative trauma outcomes., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)