Homicide followed by suicide and mental disorders

When an individual kills others and then themself, the rest of us tend to presume the perpetrator must have been mentally ill.

Alexis Theodorou and colleagues have just published their investigation of the extent to which this is true1.  They did a systematic review of published research into the state of mind of people who kill others and then, very soon after, die by suicide. This was one of the first projects to be supported by Crime in Mind seed corn funding, so we are particularly delighted to see it in print and that it has received such a warm welcome in the field.

Adam Lankford, Professor of Criminology and Criminal Justice at the University of Alabama, USA, in an accompanying editorial2, highlights the key underlying paradox:

While mental illness is often one of the major discussion points in the aftermath of [mass] murder-suicide, it is surprisingly understudied.

Adam’s own work has also been directed at trying to change that, as he describes in books, for example The Myth Of Martyrdom: What Really Drives Suicide Bombers, Rampage Shooters, And Other Self-Destructive Killers, and in many papers. He poses the key question that most of us, Alexis and team included, want answering:

Where and when are the opportunities for prevention?

Sandra Flynn, at the University of Manchester, UK, who worked for many years on the UK National Confidential Inquiry into Suicide and Homicide until the homicide component was unaccountably abandoned, presents a companion editorial3. She calls for future research of these tragedies to be more driven by psychological theory.

Alexis and his colleagues recognise the difficulties of collecting accurate information about mental states when the starting point for inquiry is usually the terrible event itself. Having reviewed a wide variety of material, they recommend adopting a systematised approach to data collection, ideally worldwide, and that it should routinely include formal psychological post-mortems.

Although they found over 60 studies that could be included in their review, there was little common ground in approaches to identifying mental disorder. A further key concern was that, while its presence may be recorded, clear documentation of its absence is often missing. ‘Significant negatives’ are as important to prevention planning as clear positive risk factors. Other balance is provided by emphasising that the weight of evidence to date comes from studies of family tragedies, and yet social role disjunction, motive, substance misuse and relevant risk or threat behaviours were themes identified as relevant across all groups. Trauma history is prominent in the terrorist groups.

Although Alexis and colleagues emphasise that their main recommendations have to be for more research – and they suggest some specifics – they add:

‘we suggest that there is sufficient evidence to make clinicians aware of the need for interventions and risk management around the intersection of mental disorder, loss, sense of rejection, social alienation, substance misuse and indicators of risk of previous harm to self or others.’

How can we now build on this study? We would welcome advice and support in doing so.

1  Theodorou A, Sinclair H, Ali S, Sukhwal S, Bassett C and Hales H. (2024)  A systematic review of literature on homicide followed by suicide and mental state of perpetrators. Criminal Behaviour and Mental Health 34 (1): 10-53.  https://doi.org/10.1002/cbm.2322

2 Lankford A. (2024) Studying mental disorders among perpetrators of mass murder-suicide: Methodological challenges and promising avenues for new research. Criminal Behaviour and Mental Health 34 (1): 1-6. https://doi.org/10.1002/cbm.2323

3 Flynn S. (2024) Understanding homicide-suicide, next steps in research.  Criminal Behaviour and Mental Health 34 (1): 7-9.  https://doi.org/10.1002/cbm.2325

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Research can transform lives. We want to support discoveries about what helps people with mental disorder who have been victims of criminal behaviour, or perpetrators of criminal behaviour, and their families, and the clinicians and others who treat them and, indeed, the wider community when its members are in contact with these problems. More effective prevention is the ideal, when this is not possible, we need more effective, evidenced interventions for recovery and restoration of safety.

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Pamela Taylor

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