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

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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Late-life psychiatric disorders

Early recognition and effective treatment of late-life psychiatric disorders is crucial. Unfortunately, depression in geriatric patients is often underdiagnosed and undertreated.²⁰ Older adults have more frequent contact with their primary care physicians, and rarely consult mental health professionals.^21,22 Several models of integrated depression care within primary care settings have shown the positive impact of this collaborative approach in treating late-life depression and preventing suicide in older individuals.²³ Additionally, because alcohol abuse is also a risk factor for domestic violence and breaking the law in this population,^24,25older adults should be screened for alcohol use disorders, and referred to treatment when necessary.

Take steps to keep patients safe

In the context of the COVID-19 pandemic, there are several steps clinicians need to keep in mind when interacting with older patients:

Screen for depressive symptoms, suicidality, and alcohol and substance use disorders. Individuals who have tested positive for COVID-19 or who have been in contact with a carrier are a particularly vulnerable population.
Screen for domestic violence and access to weapons at home.⁴ Any older adult who has a psychiatric disorder and/or suicide ideation should receive immediate intervention through a social worker that includes providing gun-risk education to other family members or contacting law-enforcement officials.²⁶
Refer patients with a suspected psychiatric disorder to specialized mental health clinicians. Telemental health services can provide rapid access to subspecialists, allowing patients to be treated from their homes.²⁷ These services need to be promoted among older adults during this critical period and reimbursed by public and private insurance systems to ensure accessibility and affordability.²⁸
Create psychiatric inpatient units specifically designed for suicidal and/or homicidal patients with COVID-19.

Additionally, informing the public about these major health issues is crucial. The media can raise awareness about domestic violence and depression among older adults; however, this should be done responsibly and with accuracy to prevent the spread of misinformation, confusion, fear, and panic.²⁹

Bottom Line

The mental health burden of the coronavirus disease 2019 pandemic has significantly impacted individuals who are older and most vulnerable. Reducing the incidence of homicide-suicide among older adults requires timely screening and interventions by primary care providers, mental health specialists, social workers, media, and governmental agencies.

Related Resources

Saeed SA, Hebishi K. The psychiatric consequences of COVID-19: 8 studies. Current Psychiatry. 2020;19(11):22-24,28-30,32-35.
Schwab-Reese LM, Murfree L, Coppola EC, et al. Homicidesuicide across the lifespan: a mixed methods examination of factors contributing to older adult perpetration. Aging Ment Health. 2020;20:1-9.