title: Homicide-suicide and the role of mental disorder: a national consecutive case series.
abstract: There is a lack of robust empirical research examining mental disorder and homicide-suicide. Primary care medical records are seldom used in homicide-suicide research. The aims of this study were to describe the characteristics of offenders and victims; determine the prevalence of mental disorder and contact with mental health services and examine adverse events prior to the offence.
  
  
  
  This was a mixed-methods study based on a consecutive case series of offences in England and Wales occurring between 2006 and 2008. 60 homicide-suicides were recorded. Data sources included coroner's records, police files, General Practice (GP) and specialist mental health records, and newspaper articles.
  
  
  
  The results show that most victims were spouse/partners and/or children. Most perpetrators were male (88 %) and most victims were female (77 %). The incidents were commonly preceded by relationship breakdown and separation. 62 % had mental health problems. A quarter visited a GP for emotional distress within a month of the incident. Few had been in recent contact with mental health services before the incident (12 %). Self-harm (26 %) and domestic violence (39 %) were common.
  
  
  
  In conclusion, GPs cannot be expected to prevent homicide-suicide directly, but they can reduce risk generally, via the treatment of depression and recognising the risks associated with domestic violence.
authors.affiliation: The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. sandra.m.flynn@manchester.ac.uk.
authors.forename: Sandra
authors.initials: S
authors.lastname: Flynn
authors.affiliation: Institute of Population Health, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.affiliation: The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
authors.forename: Louis
authors.initials: L
authors.lastname: Appleby
authors.affiliation: The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Shaw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D019548:Crime Victims / Q000706:statistics & numerical data*; D017579:Domestic Violence / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D013405:Suicide / Q000706:statistics & numerical data*; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
keywords: Depression; Family violence; Homicide; Homicide–suicide; Mental illness; Suicide