Evidence-Based Reviews

COVID-19 and the risk of homicide-suicide among older adults

Current Psychiatry. 2021 February;20(2):14-18 | doi:10.12788/cp.0090

Elias Ghossoub, MD, MSc

Mary-Lee T. Wakim, MD

Rita Khoury, MD

Identify patients who are at risk, and implement measures to protect them.

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References

1. Christodoulou H. LOCKDOWN ‘MURDER-SUICIDE’ OAP, 71, ‘stabbed wife to death then killed himself as he worried about coping with coronavirus lockdown.’ The Sun. Updated April 4, 2020. Accessed December 22, 2020. https://www.thesun.co.uk/news/11327095/coronavirus-lockdown-murder-suicide-cambridge/
2. Farberov S. Illinois man, 54, shoots dead his wife then kills himself in murder-suicide because he feared they had coronavirus - but tests later show the couple were NOT ill. Updated April 6, 2020. Accessed December 22, 2020. https://www.dailymail.co.uk/news/article-8191933/Man-kills-wife-feared-coronavirus.html
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On March 25, 2020, in Cambridge, United Kingdom, a 71-year-old man stabbed his 71-year-old wife before suffocating himself to death. The couple was reportedly anxious about the coronavirus disease 2019 (COVID-19) pandemic lockdown measures and were on the verge of running out of food and medicine.¹

One week later, in Chicago, Illinois, a 54-year-old man shot and killed his female partner, age 54, before killing himself. The couple was tested for COVID-19 2 days earlier and the man believed they had contracted the virus; however, the test results for both of them had come back negative.²

Intimate partner homicide-suicide is the most dramatic domestic abuse outcome.³ Homicide-suicide is defined as “homicide committed by a person who subsequently commits suicide within one week of the homicide. In most cases the subsequent suicide occurs within a 24-hour period.”⁴ Approximately one-quarter of all homicide-suicides are committed by persons age ≥55 years.^5,6 We believe that during the COVID-19 pandemic, the risk of homicide-suicide among older adults may be increased due to several factors, including:

physical distancing and quarantine measures. Protocols established to slow the spread of the virus may be associated with increased rates of depression and anxiety⁷ and an increased risk of suicide among older adults⁸
increased intimate partner violence⁹
increased firearm ownership rates in the United States.¹⁰

In this article, we review studies that identified risk factors for homicide-suicide among older adults, discuss the impact the COVID-19 pandemic has had on these risks, and describe steps clinicians can take to intervene.

A review of the literature

To better characterize the perpetrators of older adult homicide-suicide, we conducted a literature search of relevant terms. We identified 9 original research publications that examined homicide-suicide in older adults.

Bourget et al¹¹ (2010) reviewed coroners’ charts of individuals killed by an older (age ≥65) spouse or family member from 1992 through 2007 in Quebec, Canada. They identified 19 cases of homicide-suicide, 17 (90%) of which were perpetrated by men. Perpetrators and victims were married (63%), in common-law relationships (16%), or separated/divorced (16%). A history of domestic violence was documented in 4 (21%) cases. The authors found that 13 of 15 perpetrators (87%) had “major depression” and 2 perpetrators had a psychotic disorder. Substance use at the time of the event was confirmed in 6 (32%) cases. Firearms and strangulation were the top methods used to carry out the homicide-suicide.¹¹

Cheung et al¹² (2016) conducted a review of coroners’ records of homicide-suicide cases among individuals age ≥65 in New Zealand from 2007 through 2012. In all 4 cases, the perpetrators were men, and their victims were predominantly female, live-in family members. Two cases involved men with a history of domestic violence who were undergoing significant changes in their home and social lives. Both men had a history suggestive of depression and used a firearm to carry out the homicide-suicide.¹²

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COVID-19 and the risk of homicide-suicide among older adults

References

A review of the literature

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