4377 Missed Opportunities to Prevent Homicide: An Analysis of the National Violent Death Reporting System

An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2005. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics.2005.NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS began operation in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004 and four (California, Kentucky, New Mexico, and Utah) in 2005, for a total of 17 states. This report includes data from 16 states; data from California are not included in this report because NVDRS has been implemented only in a limited number of California cities and counties rather than statewide as in other states.For 2005, a total of 15,495 fatal incidents involving 15,962 violent deaths occurred in the 16 NVDRS states included in this report. The majority (56.1%) of deaths were suicides, followed by homicides and deaths involving legal interventions (29.6%), violent deaths of undetermined intent (13.3%), and unintentional firearm deaths (0.7%). Fatal injury rates varied by sex, race/ethnicity, age group, and method of injury. Rates were substantially higher for males than for females and for American Indians/Alaska Natives (AI/ANs) and blacks than for whites and Hispanics. Rates were highest for persons aged 20-24 years. For method of injury, the three highest rates were reported for firearms, poisonings, and hanging/strangulation/suffocation. Suicides occurred at higher rates among males, AI/ANs, whites, and older persons and most often involved the use of firearms in the home. Suicides were precipitated primarily by mental illness, intimate partner or physical health problems, or a crisis during the previous 2 weeks. Homicides occurred at higher rates among males and young adult blacks and most often involved the use of firearms in the home or on a street/highway. Homicides were precipitated primarily by an argument over something other than money or property or in conjunction with another crime. Similar variation was reported among the other manners of death and special situations or populations highlighted in this report.This report provides the first detailed summary of data concerning violent deaths collected by NVDRS. The results indicate that deaths resulting from self-inflicted or interpersonal violence occur to a varying extent among males and females of every age group and racial/ethnic population. Key factors affecting rates of violent fatal injuries include sex, age group, method of injury, location of injury, and precipitating circumstances (e.g., mental health and substance abuse). Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary.Accurate, timely, and comprehensive surveillance data are necessary for the occurrence of violent deaths in the United States to be understood better and ultimately prevented. NVDRS data can be used to track the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths and injuries at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states using NVDRS, with an ultimate goal of full national representation.

Statement of purpose In 2014, the National Violent Death Reporting System (NVDRS) was expanded from 18 to 32 states. This system now covers 50% of all violent deaths that occur in the US. NVDRS facilitates the pursuit of new state-level violence prevention partnerships while providing a wealth of data elements that could be used to better understand the complex nature of violent deaths. This panel session will detail next steps around expanding and discuss collaboration and partnerships that make programs successful. Methods/Approach A panel member from the CDC NVDRS program will provide an overview of current system and share future directions. Panel members from state NVDRS programs will provide presentations on state partnerships and innovative data uses or linkage projects that demonstrate utility of data. Partner organisations may also present their work. Results By the end of this session, participants will: 1) be aware of CDC NVDRS program, 2) understand future directions, 3) learn how state programs utilise data to better inform prevention programs, 4) exchange ideas around potential partnerships and collaboration, 5) learn about data methods that have been developed by programs to demonstrate program capabilities, and 6) learn about the Safe States Alliance NVDRS Special Interest Group (SIG). Conclusions Over 50,000 violent deaths occur in the US every year. NVDRS provides substantial information about these deaths for the 32 participating states. Injury programs need to take full advantage of the data to maximise prevention potential. Significance and contribution to the field Injury programs need to utilise data on violent deaths to better inform and direct prevention efforts. As more and more states collect data, injury programs need to develop strategies to incorporate violent death data into strategic partnerships.

As the awareness on violent deaths from guns, drugs, and suicides emerges as a public health crisis in the United States, attempts to prevent injury and mortality through nursing research are critical. The National Violent Death Reporting System provides public health surveillance of US violent deaths; however, understanding the National Violent Death Reporting System's research utility is limited. The purpose of our rapid review of the 2019-2023 literature was to understand to what extent artificial intelligence methods are being used with the National Violent Death Reporting System. We identified 16 National Violent Death Reporting System artificial intelligence studies, with more than half published after 2020. The text-rich content of National Violent Death Reporting System enabled researchers to center their artificial intelligence approaches mostly on natural language processing (50%) or natural language processing and machine learning (37%). Significant heterogeneity in approaches, techniques, and processes was noted across the studies, with critical methods information often lacking. The aims and focus of National Violent Death Reporting System studies were homogeneous and mostly examined suicide among nurses and older adults. Our findings suggested that artificial intelligence is a promising approach to the National Violent Death Reporting System data with significant untapped potential in its use. Artificial intelligence may prove to be a powerful tool enabling nursing scholars and practitioners to reduce the number of preventable, violent deaths.

66 Latino and African American Adolescent and Young Adult Homicide Mortality Peak: Data From the National Violent Death Reporting System 2005-2008

The US does not have a unified system for surveillance of violent deaths. This report describes the National Violent Death Reporting System (NVDRS), a system for collecting data on all...

In 2013, more than 57,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 17 U.S. states for 2013. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2013. NVDRS collects data from participating states regarding violent deaths obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 17 states that collected statewide data for 2013 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, North Carolina, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) from a single incident. For 2013, a total of 18,765 fatal incidents involving 19,251 deaths were captured by NVDRS in the 17 states included in this report. The majority (66.2%) of deaths were suicides, followed by homicides (23.2%), deaths of undetermined intent (8.8%), deaths involving legal intervention (1.2%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1%). (The term legal intervention is a classification incorporated into the International Classification of Diseases, Tenth Revision [ICD-10] and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Suicides occurred at higher rates among males, non-Hispanic whites, American Indian/Alaska Natives, persons aged 45-64 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, or physical health problem or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged 15-44 years; rates were highest among non-Hispanic black males. Homicides primarily were precipitated by arguments and interpersonal conflicts, occurrence in conjunction with another crime, or were related to intimate partner violence (particularly for females). A known relationship between a homicide victim and a suspected perpetrator was most likely either that of an acquaintance or friend or an intimate partner. Legal intervention death rates were highest among males and persons aged 20-24 years and 30-34 years; rates were highest among non-Hispanic black males. Precipitating factors for the majority of legal intervention deaths were another crime, a mental health problem, or a recent crisis. Deaths of undetermined intent occurred at the highest rates among males and persons aged <1 year and 45-54 years. Substance abuse and mental or physical health problems were the most common circumstances preceding deaths of undetermined intent. Unintentional firearm death rates were higher among males, non-Hispanic whites, and persons aged persons aged 15-19 and 55-64 years; these deaths were most often precipitated by a person unintentionally pulling the trigger while playing with a firearm or while hunting. This report provides a detailed summary of data from NVDRS for 2013. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected persons aged <65 years, males, and certain minority populations. For homicides and suicides, intimate partner problems, interpersonal conflicts, mental health problems, and recent crises were primary precipitating factors. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, Utah Violent Death Reporting System (VDRS) data were used to develop policies that support children of intimate partner homicide victims, Colorado VDRS data to develop a web-based suicide prevention program targeting middle-aged men, and Rhode Island VDRS data to help guide suicide prevention efforts at workplaces. The continued development and expansion of NVDRS to include all U.S. states, territories, and the District of Columbia are essential to public health efforts to reduce the impact of violence.

OUR PAPER IN THE CURRENT issue of Journal1 makes the case that male veterans of conflicts prior to Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) have an age- and race-adjusted suicide risk that is modestly, but not significantly, higher than risk among male nonveterans. Our estimate is consistent with findings from prior military cohort studies2–6 but not with findings from Kaplan et al. 2007,7 who, using the same underlying data set, found a statistically significant and greater than 2-fold increase in suicide risk among male veterans. Because both our study and Kaplan's use the National Health Interview Survey-National Death Index (NHIS-NDI) linked database (and we attempted, unsuccessfully, to replicate Kaplan's findings), our study unavoidably challenges the validity of Kaplan's. Unfortunately, Robert Gibbons, PhD, declined the opportunity to adjudicate between our findings8 and concludes that “there is no way to comment on the accuracy” of the 2 sets of results, despite his and our inability to replicate the higher risk observed by Kaplan et al. Clearly, had Gibbons requested the datasets and analytic code from both published studies, it would have been possible to ascertain whether differences in the analytic datasets, analytic strategy, or simple human error explained these differences. Because Gibbons chose not to undertake this effort, the most transparent way to resolve the issue is for the NHIS to conduct a reanalysis and report the findings. We have done so and urge Kaplan to do the same. Instead of offering the specific findings of his own reanalysis of the current NHIS-NDI data set, Gibbons uses his editorial to explore rates of suicide among men identified by the National Violent Death Reporting System (NVDRS)9 as current or former members of the US military. We feel obliged to respond to this new analysis, both because our long involvement with the development of NVDRS (C. B. and D. A. codirected its pilot and are familiar with its strengths and limitations) leads us to question whether the NVDRS can currently identify veterans with accuracy and because Gibbons conflates 3 important but distinct issues in his analysis: suicide risk among veterans of OIF/OEF, risk among younger veterans (irrespective of conflict), and risk among those recently separated from active military duty (irrespective of conflict and age). NVDRS is a rich dataset, but without linking NVDRS records to Department of Defense (DOD) data to determine which decedents were truly veterans (according to the same definition used in the US veteran population estimates), findings from NVDRS are problematic when used to answer questions about suicide risk among veterans. In short, suicide decedents categorized by NVDRS as having served in the military will correctly include current active duty personnel (which Gibbons attempts to adjust for, as we demonstrate next) but may also incorrectly include persons who never served as active duty personnel, such as decedents who, at the time of death, were current or former National Guard or Reserves but were never activated, civilians serving in the military, or people in training for the military. Because this overestimation occurs only among decedents, it leads to overestimates of risk among veterans, particularly among the youngest cohort, for whom it is also problematic to separate out recency of service from age–group related effects. To his credit, Gibbons tries to subtract out known active duty suicides from suicides identified as ever having served. However, as exemplified by the ways in which he distributes active duty suicides across NVDRS versus non-NVDRS states (and across age strata), Gibbons makes assumptions that further bias his estimates. For example, Gibbons distributes active duty suicides evenly across NVDRS and non-NVDRS states, despite the fact that several of the states with the largest active duty populations are non-NVRDS states. The estimate of the risk of veteran suicide among the youngest age group may be further exaggerated because Gibbons distributes the military suicides according to the age distribution of military enrollment rather than according to the observed distribution of military suicides by age group (which would attribute a greater proportion of suicides, approximately half, to the youngest age stratum).10 Mitigating this bias, to some extent, is the fact that Gibbons subtracts out all active duty suicides, including those that occured abroad, when, in fact, deaths abroad are not counted in NVDRS statistics. Understanding the risk of suicide among recently separated veterans, especially veterans of the Iraq and Afghanistan conflicts, is of pressing concern given the unprecedented increase in rates of suicide in the active US armed forces since 2005. This issue, however, is not relevant to the discrepancies between our study and Kaplan's, both of which used (NHIS) data based on interviews that not only do not specify period of service but also took place before these wars began. Moreover, the issue cannot be resolved using unlinked NVDRS data. It can be answered, however, if data routinely collected by the DOD are linked to NVDRS data or to the NDI. Indeed, Kang and Bullman2,4–6 have published first-rate analyses along these lines on select populations of veterans. Following their lead, data from the DOD, the NDI, and the NVDRS could readily be linked not only retrospectively (DOD, NDI), allowing resolution of the historical issue of suicide risk among veterans remote from military service but also prospectively (DOD, NDI, NVDRS, and possibly VHA), thus providing an ongoing surveillance system that would enable policymakers and health care providers to make decisions aimed at saving lives based on unbiased risk assessment.

Problem/ConditionIn 2014, approximately 59,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC’s National Violent Death Reporting System (NVDRS) regarding violent deaths from 18 U.S. states for 2014. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics.Reporting Period Covered2014.Description of SystemNVDRS collects data from participating states regarding violent deaths. Data are obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 18 states that collected statewide data for 2014 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) into a single incident.ResultsFor 2014, a total of 22,098 fatal incidents involving 22,618 deaths were captured by NVDRS in the 18 states included in this report. The majority of deaths were suicides (65.6%), followed by homicides (22.5%), deaths of undetermined intent (10.0%), deaths involving legal intervention (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1%). The term “legal intervention” is a classification incorporated into the International Classification of Diseases, Tenth Revision (ICD-10) and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement. Suicides occurred at higher rates among males, non-Hispanic American Indian/Alaska Natives (AI/AN), non-Hispanic whites, persons aged 45–54 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, substance abuse, or physical health problem or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged <1 year and 15–44 years; rates were highest among non-Hispanic black and AI/AN males. Homicides primarily were precipitated by arguments and interpersonal conflicts, occurrence in conjunction with another crime, or related to intimate partner violence (particularly for females). When the relationship between a homicide victim and a suspected perpetrator was known, it was most often either an acquaintance/friend or an intimate partner. Legal intervention death rates were highest among males and persons aged 20–44 years; rates were highest among non-Hispanic black males and Hispanic males. Precipitating factors for the majority of legal intervention deaths were alleged criminal activity in progress, the victim reportedly using a weapon in the incident, a mental health or substance abuse problem, an argument or conflict, or a recent crisis. Deaths of undetermined intent occurred more frequently among males, particularly non-Hispanic black and AI/AN males, and persons aged 30–54 years. Substance abuse, mental health problems, physical health problems, and a recent crisis were the most common circumstances preceding deaths of undetermined intent. Unintentional firearm deaths were more frequent among males, non-Hispanic whites, and persons aged 10–24 years; these deaths most often occurred while the shooter was playing with a firearm and were most often precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded.InterpretationThis report provides a detailed summary of data from NVDRS for 2014. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected persons aged <65 years, males, and certain minority populations. The primary precipitating factors for homicides and suicides were intimate partner problems, interpersonal conflicts, mental health and substance abuse problems, and recent crises.Public Health ActionNVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, North Carolina VDRS data were used to improve case ascertainment of pregnancy-associated suicides, Wisconsin VDRS data were used to develop the statewide suicide prevention strategy, and Colorado VDRS data were used to develop programs and prevention strategies for suicide among veterans. The continued development and expansion of NVDRS to include all U.S. states, territories, and the District of Columbia are essential to public health efforts to reduce the impact of violence.

How the NVDRS provides a foundation for successful violence prevention In public health, as in the rest of our lives, the value and importance of the things we do are...

Objectives: This paper describes a new surveillance system called the National Violent Death Reporting System (NVDRS), initiated by the United States Centers for Disease Control and Prevention. NVDRS’s mission is...

“Police agencies throughout the country are realizing the potential of comprehensive, integrated databases for crime fighting and crime prevention. Using data more effectively allows police to do their job better...

Violent workplace deaths among health care workers (HCWs) remain understudied in the extant literature despite the potential for serious long-term implications for staff and patient safety. This descriptive study summarized the number and types of HCWs who experienced violent deaths while at work, including the location in which the fatal injury occurred. Cases were identified from the Centers for Disease Control and Prevention's National Violent Death Reporting System between 2003 and 2016. Coded variables included type of HCW injured, type of facility, and location within the facility and perpetrator type among homicides. Frequencies were calculated using Excel. Among 61 HCW deaths, 32 (52%) were suicides and 21 (34%) were homicides; eight (13%) were of undetermined intent. The occupations of victims included physicians (28%), followed by nurses (21%), administration/support operations (21%), security and support services (16%), and therapists and technicians (13%). Most deaths occurred in hospitals (46%) and nonresidential treatment services (20%). Within facility, locations included offices/clinics (20%) and wards/units (18%). Among homicide perpetrators, both Type II (perpetrator was client/patient/family member) and Type IV (personal relationship to perpetrator) were equally common (33%). Suicide was more common than homicide among HCW fatal injuries. Workplace violence prevention programs may want to consider both types of injuries. Although fatal HCW injuries are rare, planning for all types of violent deaths could help minimize consequences for staff, patients, and visitors.

Back to table of contents Previous article Next article Professional NewsFull AccessCDC to Build System To Track Violent DeathsEve KupersaninEve KupersaninSearch for more papers by this authorPublished Online:1 Mar 2002https://doi.org/10.1176/pn.37.5.0013Each year approximately 50,000 Americans die violent deaths. To learn more about homicides, suicides, and unintentional gun deaths and ultimately stop them, the Just the Facts Campaign is working to build broad-based support for a National Violent Death Reporting System (NVDRS).The NVDRS is a new initiative of the Centers for Disease Control and Prevention (CDC) that will provide for the first time a uniform, detailed state-based data system, which is hoped to guide strategies that prevent violent deaths.A number of health organizations, such as APA, are joining together to request federal support for the project. In December 2001, Congress approved the first funding for the NVDRS—$1.5 million for fiscal year 2002.Suicide accounts for 30,000 of those deaths, while other deaths result from assaults, child abuse, domestic violence, and youth violence, according to Martha Witwer, M.P.H., M.S.W., executive director of the HELP Network. The network includes more than 120 medical and professional organizations committed to reducing the number of deaths caused by handguns. In addition to APA, HELP’s membership includes the American Academy of Child and Adolescent Psychiatry, the American Medical Association, and the American Academy of Pediatrics.Current tracking systems lack data on the circumstances leading up to each death and other important details, such as the type of weapon involved in the killing and place of death, according to Witwer.Another problem is that there is no integrated system to collect information on violent deaths. “Death certificates provide some information on violent deaths, while police, crime labs, and medical examiners collect other information that can fill in the details about such deaths,” Witwer noted.The goal is for the NVDRS to connect data from these and other systems to get a full picture of each death and the circumstances surrounding it. It doesn’t reinvent the wheel but instead aims to get input from different agencies and to compile the data in a uniform way. The cost of building such a system, which initially may involve up to 20 states, is about $10 million, and the cost for 50 states to maintain the system would be twice that figure each year.At a meeting in May 2000, representatives from the FBI, the Bureau of Justice Statistics, and the U.S. Surgeon General’s Office agreed that the NVDRS should be coordinated and funded by the federal government and maintained by the CDC. Last year more than 60 organizations from the fields of medicine, public health, child welfare, youth violence, and domestic violence prevention signed letters to members of Congress requesting support for the system.According to David Fassler, M.D., chair of APA’s Council on Children, Adolescents, and Their Families, the goal of the campaign is to increase awareness and recognition about the problems associated with violence in the United States and work together to develop effective solutions. Fassler is the APA representative to the Just the Facts Campaign and a member of its National Speakers Bureau.“There is a need to collect strong and accurate data and to think about violence as a public health problem,” said Fassler. He added that health professionals, schools, families, and entire communities can work together to come up with effective solutions.Stressing the powers of prevention, Fassler said, “Most kids who get involved in serious violence have had signs and symptoms for years. We need to do a better job of getting to them earlier and making sure they get comprehensive evaluations and the appropriate interventions.”Fassler also said he is concerned about the incidence of suicide in adolescents and, lately, an increase in the number attributable to firearms.Two smaller-scale tracking systems would serve as models for NVDRS. One is the Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration, which collects information in all 50 states on fatal automobile accidents. Policymakers have used FARS data to bring about safety interventions such as child-restraint laws and campaigns against drunken driving.The other is the National Violence Injury Statistics System at the Harvard Injury Control Research Center. The program is now piloting a data collection protocol in which 13 sites across the country collect information on violent deaths and nonfatal injury data. For instance, if a person commits suicide, data on his or her mental health history and prior attempts are collected. Other factors noted are health status, relationship problems, job stresses, and the presence or absence of a suicide note.U.S. Surgeon General David Satcher, M.D., also called for better data collection on suicides in his National Strategy for Suicide Prevention, released last May (Psychiatric News, June 1, 2001).The Web site of the Help Network is www.helpnetwork.org, and the Just the Facts Web site is www.jtfcampaign.org. ▪ ISSUES NewArchived

To evaluate the National Violent Death Reporting System (NVDRS) as a surveillance system for homicides by law enforcement officers. We assessed sensitivity and positive predictive value of the NVDRS "type of death" variable against our study count of homicides by police, which we derived from NVDRS coded and narrative data for states participating in NVDRS 2005 to 2012. We compared state counts of police homicides from NVDRS, Vital Statistics, and Federal Bureau of Investigation Supplementary Homicide Reports. We identified 1552 police homicides in the 16 states. Positive predictive value and sensitivity of the NVDRS "type of death" variable for police homicides were high (98% and 90%, respectively). Counts from Vital Statistics and Supplementary Homicide Reports were 58% and 48%, respectively, of our study total; gaps varied widely by state. The annual rate of police homicide (0.24/100,000) varied 5-fold by state and 8-fold by race/ethnicity. NVDRS provides more complete data on police homicides than do existing systems. Expanding NVDRS to all 50 states and making 2 improvements we identify will be an efficient way to provide the nation with more accurate, detailed data on homicides by law enforcement.

Mental health morbidity is a proximal factor in suicide. Using the research domain criteria (RDoC) framework to investigate sex and age differences in psychopathology at the time of death may provide better characterization than focusing on clinical diagnosis alone. To (1) evaluate whether token-based and large language model scoring of RDoC can be successfully applied to law enforcement and coroner or medical examiner death narratives in the US National Violent Death Reporting System (NVDRS), and (2) investigate sex and age differences in clinically relevant scores to illuminate underidentified dimensions of mental health dysfunction proximal to suicide. This cross-sectional study drew on death records in the restricted-access 2020 to 2021 NVDRS. Participants were limited to suicide decedents aged 12 years and older from all 50 states whose death record included a law enforcement and coroner or medical examiner death narrative of 20 words or more. Analyses were conducted between May 2024 and September 2025. Sex and age of decedents. RDoC symptom scores; mental health status measures in death records (mental health diagnosis, current depressed mood, and alcohol or drug misuse). Using both a token-based system and a large language model approach, law enforcement and coroner or medical examiner narratives of 72 585 suicide decedents were scored (mean [SD] age, 46.3 [19.3] years; 57 770 [80.6%] male). Both methods were previously validated with psychiatric electronic health records. To validate this approach, token density and large language model scores were compared with current NVDRS mental health status measures. Both scoring methods correlated with precoded measures and demonstrated levels of neurobehavioral dysfunction at the time of death similar to psychiatric inpatients on admission. Sex- and age-related differences in clinically relevant dysfunction showed the highest levels among female vs male and younger vs older decedents after adjusting for demographic confounding. This cross-sectional study of suicide decedents found that information relevant to RDoC domains is encoded in NVDRS death narratives and can be extracted using large language models. The approach used here observed more pervasive neurobehavioral dysfunction among suicide decedents than that captured by currently employed NVDRS measures of mental health.