Fledgling psychopathy meets social determinants of health: Evidence of childhood homicidal ideation among pediatric emergency department patients

Purpose: Homicide is a leading cause of death among adolescents in the United States, yet criminological research on homicidal ideation is limited. The present study examines the role of social determinants of health (SDoH) and fledgling psychopathy among children and adolescent with emergency department diagnoses of homicidal ideations. Methods: A large sample (n = 35,419,403) of 5-to-14-year-olds admitted to emergency departments in the United States between the fourth quarter of 2015 and the end of 2017 was utilized for this analysis. Logistic regression models and predictive margins were used to assess the relationship between SDoH and fledgling psychopathy on homicidal ideation. Results: A greater number of reported SDoH (one: aOR = 5.38, p < 0.001; two: aOR = 7.21, p < 0.001; three or more: 14.83, p < 0.001), ADHD (aOR = 4.77, p < 0.001), conduct disorder (aOR = 8.25, p < 0.001) and fledgling psychopathy (aOR = 14.62, p < 0.001) were positively associated with a homicidal ideation diagnosis, with the greatest odds present for patients who reported three or more SDoH and had a conduct disorder diagnosis or met the criteria for fledgling psychopathy. Conclusions: Efforts to improve SDoH may be effective targets for behavioral interventions to reduce homicidal ideation in children and the risk of lethal violence perpetration.