Epidemiology of Mass Shootings in the United States.

This in-depth review delves into the multifaceted realm of mass shootings and explores their epidemiology from a psychological perspective. The article presents a comprehensive examination of the prevalence, perpetrator and victim profiles, motives, and contributing factors associated with mass shootings. By investigating the intricate relationship between masculinity, domestic violence, military service, social media, fame-seeking, suicidal ideation, mental illness, and firearms, this article sheds light on the multifaceted nature of mass shootings. Moreover, it discusses the importance of implementing effective prevention strategies to address this growing public health concern. The findings from this review serve as a valuable resource for researchers, practitioners, policy makers, and the community at large, facilitating a deeper understanding of mass shootings and fostering the development of evidence-based solutions to prevent these tragic incidents.

US Mass public shootings since Columbine: victims per incident by race and ethnicity of the perpetrator.

White individuals in the United States (US) have historically had disproportionate access to firearms. The real-life availability of firearms, including those most lethal, may still be greater among White populations, manifesting in the number of victims in shootings. We compared the severity of US mass public shootings since Columbine by race and/or ethnicity of the perpetrator using The Violence Project Database of Mass Shooters, assessing fatalities (minimum four), total victims, type, and legal status of guns used. We used data visualization and Quasi-Poisson regression of victims minus four - accounting for truncation at 4 fatalities - to assess fatality and total victim rates comparing Non-Hispanic (NH) White with NH Black shooters, using winsorization to account for outlier bias from the 2017 Las Vegas shooting. In 104 total mass public shootings until summer 2021, NH White shooters had higher median fatalities (6 [IQR 5-9] versus 5 [IQR 4-6]) and total victims (9 [IQR 6-19] versus 7 [IQR 5-12]) per incident. Confidence intervals of NH Black versus NH White fatalities rate ratios (RR) ranged from 0.17-1.15, and of total victim RRs from 0.15-1.04. White shooters were overrepresented in mass public shootings with the most victims, typically involving legally owned assault rifles. To better understand the consequences when firearms are readily available, including assault rifles, we need a database of all US gun violence. Our assessment of total victims beyond fatalities emphasizes the large number of US gun violence survivors and the need to understand their experiences to capture the full impact of gun violence.

Communication of Intent to Do Harm Preceding Mass Public Shootings in the United States, 1966 to 2019.

Importance: Understanding the motivation of a mass shooter's intent to do harm can help practitioners and policy makers develop more effective intervention strategies. Objective: To examine the prevalence of communication of intent to do harm, known as leakage, in a sample of 170 mass public shooters from 1966 to 2019; the characteristics of perpetrators who do and do not leak their plans; and whether leakage is a form of fame-seeking behavior or a cry for help among individuals who are in crisis or suicidal. Design, Setting, and Participants: This cross-sectional study included perpetrators who killed 4 or more people in a public space from 1996 to 2019 and were included in a comprehensive database of US mass shootings. That database was built from August 2017 to December 2019, and analysis took place from January to May 2021. Main Outcomes and Measures: Leakage was identified and coded using publicly available records. Any communication to a third party of an intent to do harm prior to the shooting was coded as leakage. Logistic regression models were used to examine the risk factors associated with leakage. Models estimating leakage were examined to assess the 2 hypothesized pathways to leakage (the cry-for-help model and the fame-seeking model). Results: The 170 participants in this sample included 166 (97.7%) male perpetrators and 3 (2.3%) female perpetrators, with a mean (SD) age of 34 (12) years. Overall, 161 participants had known race and ethnicity: 11 (6.8%) Asian individuals, 35 (21.7%) Black individuals, 14 (8.7%) Latinx individuals, 7 (4.4%) Middle Eastern individuals, 3 (1.9%) Native American individuals, 89 (55.3%) White individuals, and 2 (1.2%) individuals with other race and ethnicity. Overall, 79 mass shooters (46.5%) leaked their plans. Of perpetrators who leaked their plans, 35 (44.3%) leaked specific plans about a mass shooting, and 44 (55.1%) leaked nonspecific plans about generalized violence. The study findings indicate that leakage was associated with receiving counseling (odds ratio, 7.0; 95% CI, 2.0-24.8) and suicidality (odds ratio, 3.7; 95% CI, 1.0-13.6), suggesting that leakage may best be characterized as a cry for help from perpetrators prior to their act. Conclusions and Relevance: In this study, nearly half of the perpetrators of mass shootings leaked their plans. Leakage was associated with receiving counseling and suicidality. Leakage is a critical moment for mental health intervention to prevent gun violence. Opportunities to report threats of violence need to be increased. Traditional threat assessment models focused on specific threats of violence may miss critical opportunities for intervention.

Group Aggression.

Group aggression is an important concern for societies around the world. The field of intergroup relations, a sub-field of social-psychology, offers critical insight into the emergence of group conflict and aggression. This review examines the most influential theoretical frameworks from the field of intergroup relations, namely realistic conflict theory, relative deprivation theory, social identity theory, social dominance theory, and deindividuation theory. Associated empirical findings regarding groups synonymous with aggression, such as street gangs, hate groups, rebel and insurgent groups, and terrorist organizations, are explored. This review thus provides a critical overview of the current state of the field. It concludes with implications for the future of intergroup aggression research, drawing on integrated theories that account for both personal and situational factors.

Developing an Understanding of Victims and Violent Offenders: The Impact of Fostering Empathy.

This study explores the consequences of fostering empathy-for both victims and perpetrators-after large-scale violent events. Participants ( N = 834) read a description of a school shooting and were randomly assigned to one of six conditions revealing varying amounts of background information about the victim and the perpetrator of violence. The impact of empathy on reactions toward the victim and perpetrator were then assessed. Empathy for the perpetrator could be fostered with increased information about his background, resulting in recommendations of increased leniency. Fostering empathy for the victim promoted positive community responses, including increased intentions to engage in helping behavior and make charitable donations. The degree to which participants could make sense of the violent event was also associated with decreases in blame and anger toward the perpetrator. Potential implications of the findings for news media and community coping strategies are explored.

How often and how consistently do symptoms directly precede criminal behavior among offenders with mental illness?

Although offenders with mental illness are overrepresented in the criminal justice system, psychiatric symptoms relate weakly to criminal behavior at the group level. In this study of 143 offenders with mental illness, we use data from intensive interviews and record reviews to examine how often and how consistently symptoms lead directly to criminal behavior. First, crimes rarely were directly motivated by symptoms, particularly when the definition of symptoms excluded externalizing features that are not unique to Axis I illness. Specifically, of the 429 crimes coded, 4% related directly to psychosis, 3% related directly to depression, and 10% related directly to bipolar disorder (including impulsivity). Second, within offenders, crimes varied in the degree to which they were directly motivated by symptoms. These findings suggest that programs will be most effective in reducing recidivism if they expand beyond psychiatric symptoms to address strong variable risk factors for crime like antisocial traits.

Supervision practices in specialty mental health probation: What happens in officer-probationer meetings?

As the correctional population continues to increase, probation agencies struggle to adequately supervise offenders with unique needs, including those with mental disorder. Although more than 100 U.S. probation agencies have implemented specialty mental health case-loads, little is known about their practices. Based on detailed observations of 83 audio-taped meetings, we examined interactions between probationers and officers in a prototypic specialty agency, focusing on the extent to which practices comport with evidence-based risk reduction principles. We found that specialty officers (a) more frequently discussed probationers' general mental health than any individual criminogenic need, (b) chiefly questioned, directed, affirmed, and supported (rather than confronted) probationers, and (c) relied more heavily on neutral strategies and positive pressures (e.g., inducements) rather than negative pressures (e.g., threats of incarceration) to monitor and enforce compliance. Implications for "what works" to promote community integration for probationers with mental disorder are discussed.

If you want to know, consider asking: how likely is it that patients will hurt themselves in the future?

Although self-harming behavior is a common and costly problem for psychiatric inpatients released from the hospital, standardized tools that assess patients' risk for self-harm are rarely used in clinical settings. In this study of dually diagnosed psychiatric inpatients (N = 147), we assessed the utility of patients' self-perceptions of risk in predicting self-harm in the community. Patients' self-perceptions of risk predicted self-harm 8 weeks after discharge from the hospital (Lag 1; area under the curve [AUC] = 0.75). Self-perceptions of risk at the 8-week interview also predicted self-harm 2 months later (Lag 2; AUC = 0.72). Self-perceived risk added predictive utility above and beyond scores on a measure of depression and seemed to capture changes in risk state over time. The results suggest that inpatients can accurately perceive their own risk and therefore may be important collaborators in the risk management process.

Correctional policy for offenders with mental illness: creating a new paradigm for recidivism reduction.

Offenders with mental illness have attracted substantial attention over the recent years, given their prevalence and poor outcomes. A number of interventions have been developed for this population (e.g., mental health courts). They share an emphasis on one dimension as the source of the problem: mental illness. Their focus on psychiatric services may poorly match the policy goal of reducing recidivism. In this article, we use research to evaluate (a) the effectiveness of current interventions, and(b) the larger viability of psychiatric, criminological, and social psychological models of the link between mental illness and criminal justice involvement. We integrate theory and research to offer a multidimensional conceptual framework that may guide further research and the development of efficient interventions that meaningfully reduce recidivism. We hypothesize that the effect of mental illness on criminal behavior reflects moderated mediation (i.e., the effect is direct in the case of one subgroup, but fully mediated in another); and that the effect of mental illness on other "recidivism" is partially mediated by system bias and stigma. We use this framework to propose three priorities for advancing research, articulating policy, and improving practice.

Analyzing offense patterns as a function of mental illness to test the criminalization hypothesis.

OBJECTIVE: Programs for offenders with mental illness seem to be based on a hypothesis that untreated symptoms are the main source of criminal behavior and that linkage with psychiatric services is the solution. This study tested this criminalization hypothesis, which implies that these individuals have unique patterns of offending. METHODS: Participants were 220 parolees; 111 had a serious mental illness, and 109 did not. Interview data and records were used to reliably classify offenders into one of five groups, based on their lifetime pattern of offending: psychotic, disadvantaged, reactive, instrumental, or gang- or drug-related affiliation. The distributions of those with and without serious mental illness were compared. RESULTS: A small but important minority of offenders with a mental illness (7%, N=8) fit the criminalization hypothesis, in that their criminal behavior was a direct result of psychosis (5%, N=6) or comprised minor "survival" crimes related to poverty (2%, N=2). However, the reactive group contained virtually all offenders with a mental illness (90%, N=100) and the vast majority of offenders without a mental illness (68%, N=74), suggesting that criminal behavior for both groups chiefly was driven by hostility, disinhibition, and emotional reactivity. For most offenders with a mental illness in the reactive group, crime was also driven by substance dependence. CONCLUSIONS: Offenders with serious mental illness manifested heterogeneous patterns of offending that may stem from a variety of sources. Although psychiatric service linkage may reduce recidivism for a visible minority, treatment that targets impulsivity and other common criminogenic needs may be needed to prevent recidivism for the larger group.

D-cycloserine augmented exposure therapy for obsessive-compulsive disorder.

BACKGROUND: D-cycloserine (DCS), a glutamatergic partial N-methyl-d-aspartate (NMDA) agonist, can facilitate extinction learning related to cued fear in animals and humans. We predicted that DCS would accelerate obsession-related distress reduction in patients with obsessive-compulsive disorder (OCD) undergoing extinction-based exposure therapy. METHODS: We administered DCS (125 mg) or placebo in a double-blind fashion to individuals with OCD approximately 2 hours before each exposure session. RESULTS: D-cycloserine decreased both the number of exposure sessions required to achieve clinical milestones and the rate of therapy dropout. After four exposure sessions, patients in the DCS group reported significantly greater decreases in obsession-related distress compared with the placebo group; however, after additional sessions, the placebo group tended to catch up. CONCLUSIONS: D-cycloserine augmentation has the potential to increase the efficiency, palatability, and overall effectiveness of standard exposure therapy for OCD.