Perinatal Risk Factors for Neonaticide and Infant Homicide: Can we Identify those at Risk?

Domestic violence as a risk factor of maternal filicide

PURPOSE

This paper will investigate precursors to maternal filicide, focusing on domestic violence. While psychosis is often well described, less frequently explored are the connections between prior trauma, domestic violence, depression, and filicide. We will discuss reasons why a woman may not disclose domestic violence and suggest possible areas for intervention.

METHODS

We present a case involving domestic violence, its impact on mental health, and eventual filicide. We then present an alternative scenario of the same case where filicide is considered, but is avoided.

RESULTS

The case of the mother who experienced domestic violence and was accused and sentenced for filicide is seen in greater relief by presenting the case in an alternative scenario with effective interventions. It is clear the availability and the ability to access community supports, such as obstetric and pediatric screening, psychiatric treatment, domestic violence shelters, intimate partner violence outreach services, parenting support groups, and hospital social work case management, tragedies such as filicide can be prevented.

CONCLUSION

Traumatic early childhood experiences predispose people to a stress-response system that is more prone to inactivity and impulsivity. This can cause women in domestic violence relationships to stay, limit their options for family planning, become increasingly depressed, not seek community support, and risk impulsive action of harming their child. This risk can be mitigated by building stable relationships with their medical team, treating depression, connecting with home visitation programs, and being empowered to access contraception.

Filicide by mentally ill maternal perpetrators: a longitudinal, retrospective study over 30 years in a single Northern Italy psychiatric-forensic facility

Characterization of mentally ill maternal perpetrators of filicide assigned to a single psychiatric-forensic facility, including previous access to mental health services. A cross-sectional, retrospective analysis of medical records and legal documentation of maternal filicide patients at a single psychiatric-forensic facility (1990-2021) was performed. Socio-demographic, relationship, psychopathological, and criminological characteristics were collected. Data were compared according to previous perpetrators' access to mental health services or not and access within 1 year prior to filicide or not. All 55 detainees (mean age 34.8 ± 6.2 years) were included. There were 64 victims; 15 (23%) were ≤ 1 year old and most (77%) were single victims. Some mothers had history of violence/abuse (29%), an aggressive parent (45%), and violent relationships with their intimate partner (46%) and were socially isolated (49%). Most crimes were motivated by altruism (53%). Women had attempted suicide in 39% of filicide cases. Previous psychiatric diagnoses were available for 56%; 71% had accessed services for ≤ 1 year. Patients unknown to mental health services were less likely Italian, with children below preschool age and with no history of physical abuse/violence, aggressive parent, or suicide attempts. Patients lost to mental health services (> 1 year) were less likely Italian or assuming psychopharmacological therapy, were in shorter relationships, and were mostly diagnosed with personality disorders. Female perpetrators of filicide are often unknown/lost to mental health services prior to the crime. Multifactorial historical and current characteristics aid in identifying mothers at risk. Communication of the availability of mental health services must be multi-lingual.

Psychological and Ethical Challenges of Introducing Whole Genome Sequencing into Routine Newborn Screening: Lessons Learned from Existing Newborn Screening

As a psychologist and an ethicist, we have explored empirically newborn screening consent and communication processes. In this paper we consider the impact on families if newborn screening uses whole genome sequencing. We frame this within the World Health Organization's definition of health and contend that proposals to use whole genome sequencing in newborn screening take into account the ethical, practical and psychological impact of such screening. We argue that the important psychological processes occurring in the neonatal phase necessitate a clear justification that providing risk information at this stage provides a health benefit. We illustrate how research on current newborn screening can inform whole genome sequencing debates, whilst highlighting important gaps. Obtaining explicit, voluntary, and sufficiently informed consent for newborn screening is challenging, however we stress that such consent is ethically and legally appropriate and psychologically and practically important. We conclude by outling how this might be done.

Neonaticides in the United States-2008-2017

Objective

This study examines factors associated with homicide in the first 24 hours of life (i.e., neonaticide) in the United States.

Methods

National Vital Statistics System (NVSS) linked birth-infant death data, for 50 states and the District of Columbia, from 2008 through 2017, were used to examine characteristics associated with neonaticide. National Violent Death Reporting System (NVDRS) data were used to examine circumstances of neonaticides that occurred in 14 states. Circumstances of neonaticides are described, and rates for maternal and infant characteristics are presented as rates per 100,000 person-years.

Results

Among neonaticide victims in NVSS (N = 81), those of mothers who are young, unmarried, non-Hispanic, Black, and have lower education levels, are at an increased risk of neonaticide. Further, among mothers in NVDRS who committed neonaticide (N = 42), 66.7% were known to have given birth at a residence, without medical assistance. Approximately three-fourths (73.8%; n = 31) concealed their pregnancy, with 35.7% (n = 15) disposing of their infants in a trash receptacle after giving birth. Additionally, more than half of neonaticide victims were tested for alcohol, opioids, amphetamines, and cocaine, but a relatively small number tested positive for these substances.

Conclusions

Results highlight the importance of identifying factors that elevate risk to neonates so these deaths can be prevented. As such, many mothers who commit neonaticide are young, unmarried, and conceal their pregnancy; thus, programs that prevent teen pregnancy, decrease shame and stigma associated with birth to young mothers, and provide support and resources to pregnant women, may help prevent neonaticide.

Personality structure and attachment models of women who kill their children. A systematic review on maternal filicide

BACKGROUND

A mother's ability to attune with her child is crucial in structuring one's attachment style and personality. Both dimensions shape mother-child interactions, and they are therefore likely to impact on the risk of filicide. Numerous risk factors for filicide have been identified, but personality and attachment look relatively understudied.

OBJECTIVE

We focused on filicide mothers' personality and states of mind regarding attachment to shed new light on this phenomenon, for the purpose of an improved and earlier identification of at-risk maternities.

METHODS

A systematic review of five electronic databases was performed. All studies on filicide, infanticide or neonaticide were included in the search, regardless of the study design or the socio-demographic characteristics of the offenders.

RESULTS

Twelve original articles were found to be eligible for the systematic review. The data were categorized in personality and attachment related, and then by study design. Only two studies performed comparisons with control groups, and only three reported data about psychodiagnostic/neuropsychiatric tests or questionnaires. Personality diagnoses were strongly heterogeneous (mostly pertaining to cluster B and C), and not supported by statistically significant evidence. Attachment was examined by only one study, which showed that the most frequent states of mind regarding attachment were unresolved/unclassifiable (U/CC).

CONCLUSIONS

Despite their pivotal importance in determining relational patterns in an individual, both personality and attachment are almost unacknowledged across the literature about maternal filicide. It is thus advisable to further focus on them, carrying out structured and validated assessments, to better define the causes of this dramatic event.

Ambivalence toward mothers who kill: an examination of 45 U.S. cases of maternal neonaticide

Public opinion about neonaticide (the killing of a newborn within the first 24 hours of life) has varied across time and cultures. Some nations have passed legislation on behalf of maternal offenders with the assumption that childbirth, a time of unique biological change, may lead to mental disturbance. The United States, however, makes no such distinction; offenders are prosecuted under general homicide laws. Nevertheless, U.S. courts often consider a mother's emotional and physical condition prior to and during delivery. This study includes 44 female offenders and 45 infant deaths and highlights society's ambivalence toward neonaticide offenders. The authors suggest that this ambivalence may be attributed to: (1) the perception that an offender's emotional and physical turmoil during the birth and homicide reduces her culpability; (2) the sentiment that neonaticide offenders are more "redeemable" than other offenders; and (3) the uncertainty about the personhood of a fetus or newborn.

Neonaticides may be more preventable and heterogeneous than previously thought - neonaticides in Finland 1980-2000

Neonaticide is a sad and infrequent crime with possibly a high level of underreporting. The aim of this study was to examine the circumstances of neonaticide, and whether there are subtypes of offenders, or suggestions for prevention. The study was retrospective and register-based using comprehensive nation-wide material of all cases of suspected neonaticide during 1980-2000 in Finland. Out of the 50 suspected cases, 32 women were included in the final analyses as neonaticide offenders. Most women (91%) had concealed their pregnancy, which was not the first for 66%. Most (66%) were not quite sure why they had offended, and the most frequent (63%) method of operation was neglect. Four women were diagnosed psychotic and formed a specific group. We concluded that there might be specific subgroups of offenders - even though our small population limited conclusions. Furthermore, prevention might be heightened. We call for international joint projects for enlarged material to enable grouping, as well as education and discussion among the public and the professionals to prevent neonaticide, unify its jurisprudence and improve the treatment of the offenders.

Misdiagnosing cystic fibrosis in the era of gene analysis: case reports

We present a scenario of how gene analysis plays a confusing role in the diagnosis of cystic fibrosis (CF). One of the two siblings we are presenting here was initially misdiagnosed as having CF, based on the two CF gene mutations identified by gene analysis. A CF gene study on the other sibling years later, however, led to further investigation and eventually to a change of diagnosis. As interesting and important as gene analysis is in CF, one must always look at each patient in the big picture. Included in the picture, in addition to the state-of-the-art genotype, is the phenotype, or (to simplify) the back-to-basic clinical manifestations.