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Psychotic symptoms in mass shootings v. mass murders not involving firearms: findings from the Columbia mass murder database

Published online by Cambridge University Press:  17 February 2021

Gary Brucato ,
Paul S. Appelbaum ,
Hannah Hesson ,
Eileen A. Shea ,
Gabriella Dishy ,
Kathryn Lee ,
Tyler Pia ,
Faizan Syed ,
Alexandra Villalobos  and
Melanie M. Wall
...Show all authors
Gary Brucato
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Paul S. Appelbaum
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Hannah Hesson
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Eileen A. Shea
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Gabriella Dishy
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Kathryn Lee
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Tyler Pia
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Faizan Syed
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Alexandra Villalobos
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Melanie M. Wall
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Jeffrey A. Lieberman
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
Ragy R. Girgis*
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY 10032
*
Author for correspondence: Ragy R. Girgis, E-mail: rg2290@cumc.columbia.edu
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Abstract

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.

Keywords

mass shootingsmass murderpsychosismental illnessfirearmsemi-automatic
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 15 , November 2022 , pp. 3422 - 3430
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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