Homicide-suicide and the role of mental disorder: A national consecutive case series.

There is a lack of robust empirical research examining mental disorder and homicideÐsuicide. Primary care medical records are seldom used in homicideÐsuicide 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 homicideÐsuicides were recorded. Data sources included coronerÕs 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 homicideÐsuicide directly, but they can reduce risk generally, via the treatment of depression and recognising the risks associated with domestic violence.