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J Pediatr. 2020 Jan 31. pii: S0022-3476(19)31724-X. doi: 10.1016/j.jpeds.2019.12.045. [Epub ahead of print]

Homicidal Ideation among Children and Adolescents: Evidence from the 2012-2016 Nationwide Emergency Department Sample.

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School of Social Work, Saint Louis University, St. Louis, MO; Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea.
School of Social Work, Wayne State University, Detroit, MI.
Department of Sociology, Iowa State University, Ames, IA.
School of Social Work, Saint Louis University, St. Louis, MO. Electronic address:



To assess the prevalence and behavioral, sociodemographic, and psychiatric/psychological correlates of homicidal ideation among a sample of children and adolescents.


We employed descriptive and multivariate logit models of homicidal ideation using data from the 2012-2016 Nationwide Emergency Department Sample from the Healthcare Cost and Utilization Project. This study was conducted with data from emergency departments in the US, and we used a sample of (N = 17 041 346) children and adolescents between the ages of 5 and 17 years.


Pediatric homicidal ideation is rare with a prevalence estimate of 0.09%; however, its prevalence increases substantially from age 5 years to age 15 years when it peaks, and then declines through the end of adolescence. Conduct disorders conferred 1483% increased odds, attention deficit hyperactivity disorder conferred 616% increased odds, and other behavioral and emotional disorders increased a 2-fold to nearly 4-fold increased liability for homicidal ideation net the effects of sex, age, urban residence, insurance status, and zip code median household income.


In the wake of homicide tragedies, it is often the case that numerous behavioral and clinical red flags were present in the developmental history of the perpetrator, but these were overlooked. Identifying children and adolescents who present with homicidal ideation is a crucial pediatric and public health matter that can inform prevention and behavioral interventions that forestall lethal violence.


attention deficit hyperactivity disorder; conduct disorder; correlates; prevalence

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