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A Mixed Methods Study of Homicide Followed by Suicide

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A Mixed Methods Study of Homicide Followed by Suicide A MIXED METHODS STUDY OF HOMICIDE FOLLOWED BY SUICIDE A thesis submitted to the University of Manchester for the degree of doctor of philosophy in the Faculty of Medical and Human Sciences 2013 SANDRA FLYNN SCHOOL OF MEDICINE TABLE OF CONTENTS TABLE OF CONTENTS .......................................................................................................................... 1 LIST OF TABLES .................................................................................................................................. 10 LIST OF BOXES .................................................................................................................................... 11 LIST OF FIGURES ................................................................................................................................ 11 LIST OF ABBREVIATIONS................................................................................................................... 12 ABSTRACT ........................................................................................................................................... 14 DECLARATION ..................................................................................................................................... 15 COPYRIGHT STATEMENT ................................................................................................................... 16 ACKNOWLEDGEMENTS ...................................................................................................................... 17 THE AUTHOR ........................................................................................................................................ 18 PUBLICATIONS .................................................................................................................................... 18 ORAL PRESENTATION OF THESIS .................................................................................................... 19 CHAPTER 1: BACKGROUND HOMICIDE ........................................................................................... 20 1.1 Chapter preface ........................................................................................................ 20 1.2 Definition of homicide ................................................................................................ 20 1.3 Rates of homicide in the general population............................................................. 20 1.3.1 UK homicide rate ............................................................................................ 20 1.3.2 International homicide rates ........................................................................... 21 1.4 Method of homicide ................................................................................................... 21 1.5 Socio-demographic characteristics ........................................................................... 23 1.5.1 Gender ............................................................................................................ 23 1.5.2 Age ................................................................................................................. 23 1.5.3 Marital status .................................................................................................. 25 1.5.4 Ethnicity .......................................................................................................... 25 1.5.5 Unemployment ............................................................................................... 26 1.5.6 Alcohol and drug misuse ................................................................................ 26 1.6 Mental illness and homicide ...................................................................................... 27 1.6.1 Affective disorder ............................................................................................ 28 1.6.2 Schizophrenia ................................................................................................. 29 1 1.6.3 Personality disorder ........................................................................................ 30 1.6.4 Substance dependence/misuse ..................................................................... 32 1.6.5 Contact with mental health services ............................................................... 32 1.7 Homicide prevention in the general population ........................................................ 33 1.8 Homicide prevention in mental health patients ......................................................... 34 1.9 Chapter summary ..................................................................................................... 35 CHAPTER 2: BACKGROUND ON SUICIDE ........................................................................................ 36 2.1 Chapter preface ........................................................................................................ 36 2.2 Definition of suicide ................................................................................................... 36 2.3 Rates of suicide in the general population ................................................................ 36 2.3.1 UK suicide rate ............................................................................................... 37 2.3.2 International suicide rates .............................................................................. 37 2.4 Method of suicide ...................................................................................................... 37 2.5 Socio-demographic characteristics ........................................................................... 40 2.5.1 Gender ............................................................................................................ 40 2.5.2 Age ................................................................................................................. 40 2.5.3 Marital status .................................................................................................. 43 2.5.4 Ethnicity .......................................................................................................... 43 2.5.5 Unemployment ............................................................................................... 44 2.6 Previous suicide attempts ......................................................................................... 45 2.7 Familial suicide ......................................................................................................... 46 2.8 Adverse life events .................................................................................................... 46 2.9 Mental illness and suicide ......................................................................................... 47 2.9.1 Prevalence of mental illness in suicide........................................................... 47 2.9.2 Affective disorder ............................................................................................ 47 2.9.3 Schizophrenia ................................................................................................. 48 2.9.4 Personality disorder ........................................................................................ 48 2.9.5 Substance misuse and dependence .............................................................. 49 2.9.6 Contact with mental health services ............................................................... 49 2.10 Suicide prevention in the general population ............................................................ 50 2 2.11 Chapter summary ..................................................................................................... 51 CHAPTER 3: BACKGROUND ON HOMICIDE-SUICIDE ..................................................................... 53 3.1 Chapter preface ........................................................................................................ 53 3.2 Definition of homicide-suicide ................................................................................... 53 3.3 UK homicide-suicide rate .......................................................................................... 54 3.4 International homicide-suicide rates ......................................................................... 54 3.5 Method of homicide and suicide ............................................................................... 57 3.6 Location of homicide and suicide .............................................................................. 57 3.7 Socio-demographic characteristics of homicide-suicide offenders ........................... 57 3.7.1 Gender ............................................................................................................ 57 3.7.2 Age ................................................................................................................. 58 3.7.3 Ethnicity .......................................................................................................... 58 3.8 Characteristics of victims .......................................................................................... 59 3.9 Mental illness and homicide-suicide ......................................................................... 59 3.9.1 Mental illness at the time of the offence ......................................................... 60 3.9.2 Contact with mental health services ............................................................... 62 3.9.3 Prescribed antidepressant medication ..........................................................
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