title: A statewide case-control study of spousal homicide-suicide in older persons.
abstract: OBJECTIVE
  Homicide-suicides are rare relative to suicides and homicides, but these lethal events are an emerging public health concern. They have a mortality count similar to meningitis, pulmonary tuberculosis, influenza, and viral hepatitis, and the rate may be increasing in the United States, especially among older persons. The goal of this case-control study was to identify factors that differentiate older married men who commit homicide-suicide from those who commit suicide only.
  
  
  METHODS
  A total of 20 spousal homicide-suicides involving persons age 55 years and older were ascertained in Florida between January 1, 1998 and December 31, 1999 from medical examiner records. Two suicide controls were matched to each homicide-suicide perpetrator by age, race, marital status, method of death, and medical examiner district. Perpetrator groups were compared on sociodemographic characteristics, medical variables, and autopsy findings.
  
  
  RESULTS
  Homicide-suicide perpetrators displayed significantly more domestic violence or were caregivers for their wives, in contrast to suicide perpetrators, who had health problems and were receiving care from their spouses. Both groups of perpetrators had reported depressed mood, and there were no differences in sociodemographic factors.
  
  
  CONCLUSIONS
  Depression plays a significant role in both homicide-suicide and suicide, but the associated factors are different: we see caregiving strain in perpetrators of homicide-suicide, and living with physical health disorders as a care-recipient in men who commit suicide. Marital conflict is a significant factor in some spousal homicide-suicides.
authors.affiliation: Mental Health and Behavioral Science, Miami VA Health Care System, 1201 NW 16th St. (116A), Miami, FL 33125, USA. julie.malphurs@med.va.gov
authors.forename: Julie E
authors.initials: JE
authors.lastname: Malphurs
authors.forename: Donna
authors.initials: D
authors.lastname: Cohen
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003863:Depression / Q000523:psychology; D005260:Female; D005431:Florida / Q000453:epidemiology; D006304:Health Status; D006708:Homicide / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D018454:Spouses / Q000523:psychology*; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data