A MIXED METHODS STUDY OF HOMICIDE FOLLOWED BY SUICIDE

Background Homicide-suicides are rare events in which an individual commits a homicide and then takes his or her own life. Despite extensive media coverage and a recent increase in research in this field, our understanding of these events is limited as most studies are descriptive. There is little reliable evidence regarding mental illness in individuals who commit homicide-suicide. Aims The central aim of this study was to examine the role of mental illness in cases of homicide-suicide. The objectives were to: (1) determine the prevalence of mental illness; (2) describe the characteristics of perpetrators and victims, and the circumstances of the offence; (3) examine the psychopathology of perpetrators prior to the offence.MethodThe research design was a mixed methods study of homicide-suicide. Quantitative and qualitative techniques were used to examine a national consecutive case series, in England and Wales, between 1st January 2006 and 31st December 2008. The sample contained 60 cases. Descriptive statistical analysis and a thematic framework analysis were undertaken on documents obtained from coroners, the police, GP medical records, records of mental health services contact and newspaper articles. The social, behavioural, offence and clinical characteristics of these incidents were reported.Results Most of these offences were committed by men (53, 88%). The average age of perpetrators was 44 years (range 18-85). The overwhelming majority of these incidents involved close family members, mainly current or former intimate partners and/or the children of the perpetrator. Over half of the perpetrators had previously been diagnosed with mental health problems by a GP, most commonly depression. The incident was, in most cases, preceded by an actual separation from an intimate partner, or the perpetrator perceived separation to be imminent. The emotional responses to the loss of the relationship included: anger; frustration; humiliation; jealousy; desire for revenge; hopelessness, guilt and remorse. Poor coping strategies were observed, with many having a history of previous self-harm or suicide attempts, and difficulty controlling their aggression. Despite the high proportion of lifetime mental illness, few had been in recent contact with their GP for psychological problems prior to the incident. In the majority of cases, incidents involving mentally ill perpetrators were reported responsibly in newspapers. However, there were instances in which journalists sensationalised the incidents and provided stereotypical portrayals of the perpetrator.Conclusion The findings from this study add valuable empirical qualitative data to the literature. These incidents occur in the context of existing and challenging common social issues, such as intimate partner violence, child custody disputes, an ageing population, and mental disorder. The evidence from this study shows that these perpetrators had an extreme reaction to an interpersonal crisis resulting in severe emotional distress. Perpetrators from vulnerable groups had complex needs and exhibited previous poor coping strategies that may put them at increased risk. However, prevention is difficult as these are rare events and though under distress, these individuals were less likely to seek help from services. More research is required to identify risk factors in targeted sub-groups of homicide-suicide, such as intimate partner, filicide-suicide and elderly homicide-suicide, in the context of social, economic and clinical problems.