Mental Illness in Homicide-Suicide: A Review — (Journal of the American Acadamy of Psychiatry and the Law)

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Journal of the American Acadamy of Psychiatry and the Law 40:4:462468 (December 2012)

Homicide followed by suicide (H-S) is a lethal event in which an individual kills another individual and subsequently dies by suicide. This article presents a review of research carried out in Asia, Australia, Canada, Europe, and the United States of America over the past 60 years on the prevalence of mental illness among the perpetrators of H-S. Analysis of the available data indicated a great disparity in the results of the different studies. Overall, depression was the most frequent disorder reported (about 39% of the cases in the 20 studies that assessed depressive disorders), followed by substance abuse (about 20% in 10 studies) and psychosis (about 17% in 11 studies). This review, therefore, indicated that mental illness plays an important role in H-S. The prevention of these events depends on the identification and treatment of psychiatric disorder in potential perpetrators.

Studies on H-S are scarce, and most were performed in the United States. The most extensive studies have focused on Australia, England and Wales, Fiji, Hong Kong, Italy, the Netherlands,12 and the United States.5 There have also been studies of smaller regions: London and other regions of the United Kingdom; Paris; regions of Finland; Durban, South Africa; and, in the United States, Chicago, North Carolina, and Oklahoma.


Rosenbaum, in a study performed in the city of Albuquerque, New Mexico, reported that depression was present in 75 percent of the perpetrators of spousal H-S in the period 1978 to 1987. In 48 spousal H-Ss by elderly perpetrators in Florida from 1988 to 1994, Cohen et al. found that 41 percent of the perpetrators had a mental disorder, most often depression. In the same region for the period 1998 to 1999, Malphurs and Cohen5 found that 65 percent of 20 perpetrators had a depressed mood before the crime.

Koziol-McLaine et al.38 found that 50 percent of 67 cases of femicide-suicide (men killing women and then taking their own lives) during the period 1994 to 2000 had a psychiatric disorder. Bossarte et al.4 found a prevalence of 11 percent for current mental illness and 7.2 percent for a history of mental illness in 209 cases of H-S in the period 2003 through 2004. Barber et al.42 found that [at least] 15 percent of 74 perpetrators of H-S in the period 2001 through 2002 had been using antidepressants. Logan et al.43 found a prevalence of 13.7 percent for mental illness in 408 perpetrators for the period 2003 through 2005.

In a study in New Hampshire, Campanelli and Gilson36 found 16 cases of H-S over six years (1995–2000) with a prevalence of mental illness of 69 percent. In Cleveland from 1958 through 2002, Hatters Friedman et al.37 found that 84 percent of 30 perpetrators of filicide-homicide had a history of mental illness. In North Carolina from 1988 through 1992, Morton et al.20 found the presence of a history of mental illness in 15 percent of the perpetrators, some of whom were also substance abusers.

In Quebec, Canada, from 1988 through 1990, Buteau et al.33 reported the presence of mental disorders in 67 percent of 39 cases of H-S, of which 31 percent were receiving psychopharmacological treatment. Bourget and Gagné35 reported a prevalence of 91 percent for mental disorders in 11 cases of maternal filicide-suicide in Quebec from 1991 through 1998. Léveillée et al.40 studied 38 cases of filicide-suicide in Quebec from 1986 through 1994 and found that 37 percent of the perpetrators had psychiatric disorders, primarily depression and substance abuse


The 30 studies reviewed herein include 2,431 cases of homicide-suicide…

In five studies, there were no distinctions between different diagnoses. In other studies, the degree of overlap between disorders was unclear, and the studies differed in their definition of mental illness. However, depression was the most frequent psychiatric disorder reported (in about 39% of the offenders in the 20 studies that assessed depressive disorders), followed by substance abuse (about 20% of the offenders in 10 studies) and psychosis (about 17% of the offenders in 11 studies).

In the three studies of elderly subjects, mental illness was found in a greater percentage of the offenders (68%), with a high prevalence of depression (in 60% of the offenders).