Addressing Mental Health Needs of Secondary Homicide Survivors through a Social Determinants of Health Framework

• Published date: 01 November 2023
• DOI: http://doi.org/10.1177/10887679231163099
• Author: Lauren A. Magee,Daniel Semenza,Sami Gharbi,Sarah E. Wiehe
• Date: 01 November 2023
• Subject Matter: Special Issue Articles

https://doi.org/10.1177/10887679231163099

Homicide Studies

2023, Vol. 27(4) 435 –453

© 2023 SAGE Publications

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DOI: 10.1177/10887679231163099

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Special Issue Article

Addressing Mental Health

Needs of Secondary Homicide

Survivors through a Social

Determinants of Health

Framework

Lauren A. Magee1, Daniel Semenza2,3 ,

Sami Gharbi4, and Sarah E. Wiehe4

Abstract

Drawing on a social determinants of health framework, death records and Medicaid

data were linked at the individual and family level to examine mental health outcomes

among secondary homicide survivors in the 12 months following a homicide of a

loved one. Results indicate secondary homicide survivors are significantly more likely

to have a mental health diagnosis in the 12 months following a homicide—particularly

youth family members. Violence prevention in local communities must be aligned

with the provision of critical victims’ services and access to mental health care to

protect all residents exposed to the harmful ripple effects of homicide.

Keywords

homicide, secondary victims, co-victims, mental health, social determinants of health

1O’Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis,

Indianapolis, IN, USA

2Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, NJ, USA

3New Jersey Gun Violence Research Center, Rutgers University, New Brunswick, NJ

4Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine,

Indianapolis, IN, USA

Corresponding Author:

Lauren A. Magee, O’Neill School of Public and Environmental Affairs, Indiana University Purdue

University –Indianapolis, 801 W. Michigan Street, BS4058, Indianapolis, IN 46202, USA.

Email: lamagee@iu.edu

1163099HSXXXX10.1177/10887679231163099Homicide StudiesMagee et al.

research-article2023

436 Homicide Studies 27(4)

Introduction

Firearm homicide is a public health crisis in the United States (U.S.). In 2021, there

were an estimated 21,000 firearm homicides in the U.S. and an 8.3% increase from

2020 (Simon, 2022). Exposure to community firearm violence is a modifiable social

condition and fundamental cause of population health disparities that disproportion-

ately harms disadvantaged communities of color in the U.S. (Fowler et al., 2009;

Kravitz-Wirtz et al., 2022; Smith et al., 2020; Wright et al., 2017). Chronic exposure

to the direct and indirect trauma of firearm violence increases health inequities, and

unhealed trauma often leads to future involvement in violence as both a victim and

offender (Magee et al., 2022; Semenza & Stansfield, 2021a, 2021b; Whitehill et al.,

2014). Firearm homicide is now the leading cause of death among children in the U.S.

and secondary exposure to firearm homicide is particularly harmful to child develop-

ment (Fowler et al., 2009; Lee et al., 2022; Sharkey et al., 2014). Yet despite known

resultant health disparities and the recent increase in firearm homicides, little research

has examined mental health outcomes and healthcare utilization among secondary

homicide survivors (i.e., family members of homicide victims).

To address the lack of research in this area, we draw on a social determinants of

health framework to examine adverse mental health outcomes among family members

of homicide victims. To date, it has been methodologically challenging to systemati-

cally examine the health needs of secondary homicide survivors due to difficulties in

combining disparate criminal justice and healthcare data sources. We leverage a novel

dataset of secondary homicide survivors using linked Medicaid and death records for

420 family members of homicide victims to analyze differences in mental health out-

comes and healthcare utilization before and after a household member died due to

homicide events in Marion County, Indiana, which are disproportionately caused by a

firearm. We assess the individual and demographic factors associated with greater

healthcare utilization with mental health diagnoses following secondary homicide vic-

timization. The results provide insight into opportunities to connect individuals with

trauma informed services. We then discuss policy implications and how our data link-

ing strategy can be useful for future research in this area.

Background

Firearm Violence Exposure as a Social Determinant of Health

An array of powerful social and economic factors shapes population health in modern

societies (Marmot & Wilkinson, 2005). Beyond individual behaviors like smoking,

diet, substance use, and exercise that influence long-term and chronic health outcomes,

structural inequalities function as upstream “causes of causes” that drive individual

health habits and contribute to large-scale health outcomes (Braveman & Gottlieb,

2014; Marmot & Allen, 2014). These fundamental determinants of population health

include access to education, healthcare, quality employment and working conditions,

sufficient income, and healthy physical environments (Marmot & Allen, 2014). A