Homicide–suicide: practical implications for risk reduction and support services at primary care level

Homicide–suicide (HS) has been defined as homicide committed by a person who subsequently commits suicide within one week of the homicide. In most cases it occurs within 24 hours. HS is a public health problem, victimising not only those directly involved in the act, but also family, friends, acquaintances, colleagues, witnesses and investigators. The literature and findings of recent South African research regarding HS are discussed to highlight the practical implications for risk reduction at primary care level and to address the provision of support services after HS cases. It has been consistently found that depressed men have the highest risk of committing HS, especially if they also abuse alcohol and have problematic personality traits/disorders, in the context of domestic violence or a problematic relationship. Delusional jealousy, although not a frequent finding, is a great risk for HS. The breakdown of an intimate relationship, with a recent or pending separation (real or imagined), has consistently been found to be the most common contributing factor to HS. Primary health care practitioners are likely to be the first contact that these individuals or families might have with the healthcare system. Through a better understanding of risk factors involved in HS, prevention may be enhanced in clinical practice. HS has far-reaching effects and healthcare practitioners can offer support and treatment to people traumatised by these events