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Caretaker Strain
Homicide-Suicide in Elderly a Growing Concern
June 1, 2005 Homicide-suicides are rare, but the
rate among older persons is increasing as older men in declining health
and suffering from depression kill their wives, for whom they are
caretakers, and then kill themselves, says a new study.
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The study by University of South Florida researcher
Donna Cohen and Julie Malphurs of the Miami Veterans 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. 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 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.
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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.
About Louis de la Parte Florida Mental Health
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