Murder-Suicide, Domestic Violence...Common threads in violence against self and others

The murder-suicide that took place at Virginia Tech on Monday on a lot of people's minds right now.  Certainly on mine.  So sad.

This event was mentioned several times at a conference I attended parts of today on "Multidisciplinary perspectives on partner violence".   In fact, one of the key speakers, Sandra M. Stith, Ph.D., is a faculty person at Virginia Tech.  She gave a marvelous talk about work she and her colleagues are doing with high conflict couples in multicouple groups.   Before speaking, she made poignant comments about her decision to speak at the conference instead of heading home.   It was clear from listening to her speak that she deeply understood the close connection between prevention of different forms of violence.

Which bring us straight to the topic of suicide.   Catherine Cerulli, a faculty member in our department and one of the conference organizers, gave a powerful presentation titled, "Domestic Violence as a risk factor for suicide and murder-suicide."   As I listened to this talk and to others today, the connection between violence and suicide was unmistakable.  The take home message for assessment is this:  we need to think about violence when we hear suicide, and suicide when we hear about violence.  History of trauma or DV are not just statistical risk factors.   They are intertwined and interrelated in substantive and clinically meaningful ways.  Cate played a horrific tape of a 911 call that illustrated this in a visceral way.  A woman with a past history of suicide attempts, ends up involved in the death of her violent male partner--which occurs during the 911 call.  (It is not clear if she actively stabbed him or just held the knife and he impaled himself).   The relationship between different kinds of risk (violence against partner and violence against self) is so complicated as to be practically indistinguishable.

So...a few free associated questions related to clinical assessment:

When we see a depressed youth with suicidal risk, are we asking enough about violence in the home (past or present, witnessed or experienced)?
When we see DV, how thorough are we about suicide assessment?
When we see suicidal individuals (especially men) who have some antisocial features are we thinking about their potential for violence against others, including (especially) against intimate others?
Are we remembering that involvement with the criminal justice system puts people at greater risk for suicide?

Murder-suicide like the one the country has experienced this week is not a statistical coincidence--it teaches us something about the heart and processes behind both.