Homicide-suicide among the elderly an emerging public health concern

A study by University of South Florida researcher Donna Cohen and Julie Malphurs of the Miami Veteran’s Administration Health Care System recently published in the American Journal of Geriatric Psychiatry shows homicide-suicide among the elderly to be "an emerging public health concern."

"Homicide-suicide events are rare relative to homicide and suicide," said Cohen, a professor at the Louis de la Parte Florida Mental Health Institute (http://www.fmhi.usf.edu/institute/about.html). "But the rate is increasing, especially among older persons."

The object of the study, explained Cohen, was to identify the factors (age, race, method of death) that differentiate older married men who kill their wives from older married men who commit suicide only. Researchers examined case facts in 20 spousal homicide/suicides in Florida involving men over age 55 over a two year period (1998 through 1999) and compared those men to older men who only committed suicide.

"We found that the men who committed homicide against their wives and then suicide either displayed more domestic violence against their wives or they were were caregivers to their wives," said Cohen. "Those who committed suicide were more likely to have health problems themselves and were receiving care from their wives. Men in both categories had suffered depression. "

According to Cohen, depression played a role in both kinds of events, but the factors in homicide/suicide cases included the caregiving strain.

"The men who killed their wives and then themselves were generally older than their wives, who were probably unknowing victims," concluded Cohen. "These events were not altruistic or based on suicide pacts. Their motivations are complex. Ours was the first study to case-control test the hypothesis that the difference between homicide/suicide and suicide alone in older men will differ on psychosocial factors."

The study found that 25 percent of homicide/suicide perpetrators had a history of domestic violence while only five percent of the control suicide only subjects had such a history. Forty percent of homicide/suicide perpetrators were caregivers for their wives but none of the suicide subjects were caregivers. All of the homicide/suicide perpetrators used a firearm. Nationally, 72 percent of older men who commit suicide use a gun.

Cohen emphasized that depression played a significant role in both cases, as did medical illness, which contributed to 60 to 90 percent of suicides in older persons.

"The interaction between factors, such as marital-relationship variables and illness should be examined in future studies," said Cohen, who also serves as the director of the Clinical Division of the American Association of Suicidology, an organization dedicated to the understanding and prevention of suicide. "The aging population will challenge researchers, clinicians and other health care professionals to identify these factors and then design appropriate interventions for this vulnerable group."