January 1, 1999

Untreated depression in elderly men can have deadly consequences. The rate of homicide-suicides among elderly couples is rising annually especially in retirement states such as Florida, according to Donna Cohen, Ph.D., a professor of psychiatry and behavioral sciences, in the department of aging and mental health at the University of South Florida, Tampa.

The typical murder-suicide case involves a depressed husband who shoots his ailing wife. In half the cases, she suffers from Alzheimer's, Parkinson's, or cancer or has a combination of health problems, and the husband is also in poor health, Cohen told Psychiatric News.

She believes that the vast majority of these women did not want to die on the basis of medical examiner reports documenting signs of a struggle and conversations with relatives.

"These are not acts of love but of desperation. The husband who is often caring for his sick wife becomes depressed and despondent about a future of pain or illness or a separation involving going to a nursing home or an assisted-living facility," said Cohen.

Results of her study published in the March issue of the American Journal of Psychiatry show that the rate of homicide-suicides among elderly couples age 55 and up in west-central Florida rose between 1988 and 1994 from .12 per 100,000 to .47 per 100,000.

Cohen and her colleagues studied 171 homicide-suicide events by age group (over and under age 55) and region in Florida (west-central and southeast) between 1988 and 1994. Complete medical examiner files were obtained, and 160 variables were coded from the reports to compare features and clinical characteristics by age group and region.

The researchers found that among the elderly in west-central Florida, the perpetrator and the victim were ill or in failing health more than half the time. Pain and suffering were reported for 25 percent of the perpetrators and 33 percent of the victims. Physical violence was rare, but verbal discord was reported for 15 percent of the elderly couples.

The study also found that most elderly perpetrators had mental health problems and were not receiving treatment. Among those in west-central Florida, 37 percent were depressed, 11 percent were abusing alcohol or drugs, 15 percent had talked about suicide, and 4 percent had previously attempted suicide. Only one of the older perpetrators tested positive for antidepressants, despite reports of depression, caregiver stress, and suicidal ideation, according to the article.

"This is striking because most of the elderly perpetrators visited their primary care physicians within two weeks of committing the lethal act," said Cohen. "We need to do a better job of educating the medical community about depression and suicidal ideation in the elderly."

She noted that as people live longer, increasing the likelihood of comorbidity, frailty, and disability, spousal caregivers will continue to be at high risk for depression and other psychiatric disorders.

"We have found that it is not uncommon for spouses to wish a wife or husband who is very sick with dementia, cancer, or other chronic illnesses to be dead. But most are afraid or unwilling to talk about these wishes," said Cohen. "If one or both have talked about the desire to die, even as a joking reference, and there is a gun in the house, the risk for homicide-suicide is real."

Christopher Colenda, M.D., chair of APA's Council on Aging, echoed the importance of screening for depression especially among elderly men over the age of 65, who have a higher risk of suicide.

He told Psychiatric News, "Depression is not a normal part of aging. Signs of hopelessness and despair and comments about suicide need to be taken seriously by health care providers."