Child Murder by Parents a Psychiatric Review of Filicide

Other REGULAR ARTICLE

A Review of Maternal and Paternal Filicide

Journal of the American Academy of Psychiatry and the Police Online March 2007, 35 (1) 74-82;

Abstruse

Filicide, the murder of a child by a parent, is a multifaceted phenomenon with various causes and characteristics. This review of the existing literature delineates the present country of cognition regarding filicide and illustrates similarities and differences between offenses perpetrated by mothers and by fathers. The importance of numerous reports of an association betwixt filicide and parental pre‐existing psychiatric disorders is compounded by indications that a significant number of homicidal parents come to the attention of psychiatrists or other wellness professionals before the law-breaking occurs. As prevention implies the recognition of causes involved in particular situations, a ameliorate agreement of potentially fatal parental/familial dynamics leading to filicide could facilitate the identification of risk and enable effective intervention strategies.

The terms filicide, neonaticide, and infanticide have been used interchangeably in the literature on child homicide. Filicide is the murder of a child by a parent, while neonaticide specifies the killing of a child on the 24-hour interval of nascence. Although infanticide is oftentimes used to refer to child homicide, the term has medicolegal implications and applies mainly to the killing of a child under the historic period of 12 months by a mother who has non fully recovered from the furnishings of pregnancy and lactation and suffers some degree of mental disturbance.^1–3

Filicide is a relatively rare event. In Canada in 2004, 27 children were killed past their parents.⁴ Mothers and fathers (including stepparents) were equally responsible for killing their children. The parent afterward committed suicide in over 1‐fifth (22%) of these incidents.

We reviewed the existing literature to delineate the present state of knowledge regarding filicide perpetrated past either the mother or male parent. A better understanding of potentially fatal parental/familial dynamics leading to filicide could facilitate the identification of gamble and enable effective intervention strategies.

Classifying Filicide

In attempts to decide reasons for child murder by parents, several authors accept proposed full general classification systems that categorize cases based mostly on perceived motive or on the source of the impulse for the parent's homicidal act.^5–9 Resnick⁵ was the first to propose a classification based on motive: altruism, astute psychosis, unwanted kid, accident, and spousal revenge. In this model, altruistic filicide is characterized by the motive of relieving the kid of real or imagined suffering and includes murder associated with suicide. Acutely psychotic filicide involves parents who kill under the influence of astringent mental illness. In unwanted‐child filicide, the victim was never or is no longer desired by the parents. These filicides are usually committed due to illegitimacy or uncertain paternity. Accidental filicide is unintentional death due to kid corruption, generally following battered child syndrome, and spousal revenge filicide describes children who are killed to retaliate confronting or punish the parent'south mate.

Subsequent models proposed by Scott⁶ and d'Orban^vii focused on categorizing filicidal women with regard to the source of the impulse (parent, child, or situation) to kill the child. D'Orban modified Scott's nomenclature of maternal filicide past adding neonaticide to the categories of battering mothers, mentally ill mothers, retaliating women, unwanted children, and mercy killing. According to d'Orban'due south model, battering mothers kill their child in an impulsive act stemming from the victim's behavior, whereas retaliating women displace aggression from the mate onto the child. The category of mentally ill mothers incorporates all filicides committed in the context of psychotic disease or depression. Unwanted children are killed past the mother's passive neglect or active aggression, and mercy killing involves cases in which at that place was truthful suffering past the child, without apparent secondary proceeds by the mother.⁷

Guileyardo et al. ⁸ suggested a classification of filicides into 16 subtypes, based on pick of the master motive or cause. In an endeavour to incorporate clinical situation and motive, Bourget and Bradford⁹ proposed v major categories: pathological filicide, adventitious filicide, retaliating filicide, neonaticide, and paternal filicide. In this model, pathological filicide refers to cases in which the perpetrator near likely has a major psychiatric disease. The filicide probably has psychotic or altruistic motives, and includes extended homicide‐suicide. Accidental filicide includes death due to various forms of child abuse, including dilapidated‐child syndrome and Munchausen syndrome by proxy.^x,eleven Retaliating filicide is the murder of a child to punish a spouse, while neonaticide is ordinarily the result of an unwanted pregnancy. By including the classification of paternal filicide, Bourget and Bradford^nine were the first to recognize the importance of gender as a category in and of itself.

Although these classifications have been useful in identifying and describing filicide, various problems limiting a clear assay of causes have become axiomatic over time. I trouble has been the difficulty in accurately assigning i example to a specific group, due to considerable overlap between categories. Another limitation is that, to date, paternal filicide has attracted only limited research. Equally such, relevant factors such as the role of perpetrator gender differences have been excluded in analyses of filicide. In addition, the influence of perpetrator psychiatric illness has not been fully considered. In low-cal of these shortcomings, Bourget and Gagné¹² adult a nomenclature organisation that takes into business relationship several characteristics of filicide and associated circumstances, including parental motive, intent, and psychiatric disease. All types of filicide (i.due east., mentally ill, fatal abuse, retaliation, mercy, and other/unknown) are specified as existence either with or without intent, the conscious desire to kill. Mentally ill filicide refers to cases in which the offense is associated with a DSM‐Iv¹³ major Axis I mental illness active at the time of the filicide. The presence or absenteeism of psychosis as a determinant is documented in this category, as are cases of infanticide, a term used simply to business relationship for postpartum phenomena, hormonal influences, and other nonspecific mental disturbances in mothers who gave nascency within the twelvemonth. Fatal abuse filicide includes cases of child neglect and battered‐child and shaken‐infant syndromes. This type of filicide is committed without specific intent, and the result cannot meet the criteria for mentally ill filicide. In contrast, retaliating filicide is associated with specific intent to commit murder and tin can exist the result of anger or revenge. Mercy filicide is as well committed with specific intent to impale and occurs when the child has a severe, debilitating illness. The parent does non have psychosis, and the upshot is non meliorate deemed for by any other category. The category of other/unknown is used only when information is insufficient to let for an authentic classification and can include cases with multiple factors. This classification system also allows the inclusion of more specific information related to each example every bit needed, on the footing of actual instance prove. Cases of filicide tin be specified co-ordinate to whether they are associated with suicide/attempted suicide and substance use. Each case can also exist identified as predictable or unpredictable, with the aim of assisting in time to come prevention.¹²

General Characteristics of Filicide

Filicide is associated with diverse victim and perpetrator characteristics. The start twelvemonth of life appears to represent a critical period, with the risk greatest on the outset mean solar day of life.^14–19 Neonaticides are well-nigh always committed past mothers,²⁰ as are homicides during the offset week of life.^21–23 While mothers are overrepresented in cases of infanticide,²⁴ filicides that occur afterward the starting time calendar week of life are oftentimes committed by the father or stepfather, with fathers being the most frequent perpetrators of filicide in after childhood.^{17,23,25–28}

Although some studies have noted that mothers commit filicide more oftentimes than fathers,^{five,9,21,29–32} other enquiry has shown that paternal filicide is as common or more than common than maternal filicide.^{12,17,27,33–39} Reports of a higher proportion of maternal filicides about likely reflect the inclusion of neonaticides in some studies.¹⁷

Neonaticides involve an equal number of male and female victims.^27,40 Some studies have found that boys are overrepresented in victims between the ages of 4 and 15 years of historic period,^{23,27,38,41–43} but others take reported equal numbers of male and female filicide victims.^{xviii,25,26,44} Differences in sample size may in role account for these inconsistent findings. Mothers may be more than likely to kill girls and fathers to impale boys,^two,45 peculiarly boys over the age of fifteen years.^23,46 Younger victims may exist more than likely to have been physically abused by the parent.²⁷ Several studies have reported that victims of filicide are more often the beginning born.^{27,29,47–49}

Results of numerous studies indicate an association between filicide and parental psychiatric affliction, with major depression with psychotic features almost common.^{2,5,9,12,28–xxx,fifty–56} Bourget and Bradford⁹ noted that 31 per centum of parents who committed filicide had a diagnosis of major depression, compared with none of the perpetrators of nonparental homicide. In a review of 131 instance reports of filicide, Resnick⁵ establish that 75 percent of the parents displayed psychiatric symptoms, including major depression and schizophrenia, earlier the offense. A recent review of 85 filicide cases in Turkey⁵⁷ showed that nearly one-half of the perpetrators had diagnosed psychiatric disturbances, including schizophrenia (61%) and major depression (22%). In reviews of maternal and paternal filicide cases in Quebec between 1991 and 2001, Bourget and Gagné^12,28 establish that 85 percent of mothers and 56 per centum of fathers had diagnoses of major depressive disorder or schizophrenia/other psychosis.

Homicidal parents have high rates of suicide attempts, which are often serious and successful.^{two,12,28–30,38,fifty,58–sixty} Parents are more likely to commit suicide later on killing older children.^27,38,61,62 In Canada between 1993 and 2002, a parent committed suicide after murdering an infant in 4 percent of instances, while 60 percent of homicides against children aged 12 to 17 years ended in the suicide of the accused parent.⁶² The increase in filicide‐suicide events with the kid's historic period may exist related to differences in motives for filicides involving older versus younger children. Parental suicide attempts are not characteristic of neonaticide, unwanted child filicide, retaliating filicide, and fatal abuse filicide.^7,12,26,41 Fatal abuse filicide is generally regarded equally accidental and not premeditated; thus the ultimate "adventitious" death of the child is not the motive for the abuse.²⁸ While the term "fatal abuse" is not historic period specific, victims of fatal corruption filicide are oft immature, unwanted children.^5,7 Mental illness, and in detail depression, is a meaning finding in homicide‐suicide cases, including filicide‐suicide.^{12,28,38,61,63–65} Although results of some earlier studies indicate that mothers who kill their children are more than likely than fathers to commit suicide afterward the human action,^two,30,50 more recent studies accept constitute that fathers are more than oft perpetrators of filicide‐suicide.^{sixteen,17,46,61,63–68} Recent investigations note the importance of farther inquiry on filicide‐suicide,^61,69 given that parents who commit suicide after killing their kid represent a significant proportion of filicidal mothers (16%–55%)^12,38,46,68 and fathers (xl%–threescore%).^{2,28,43,68,70}

Maternal Filicide

Women who commit neonaticide are typically younger, are often unmarried, oft deny and/or muffle their pregnancies, have a lack of prenatal care, and have no plans for the care of the child.^{20,41,71–73} Overpeck et al. ⁷⁴ found that a marked risk factor for infant homicide was a 2nd child born to a mother under the age of twenty. Although fear has been noted equally an important factor in the motivation for neonaticide,^seventy the main motivator may be the undesirability of the child.^xx,72 Women who commit neonaticide evidence less depression, psychotic disease, or suicidal attempts than do mothers who have killed an older child^{seven,41,75,76} and are less likely to be hospitalized than are those who commit filicide.⁷¹ Prevention is seriously compromised by the fact that women who commit neonaticide rarely seek any help.^5,77

Mothers who commit filicide tend to exist married and to written report high levels of stress and a lack of support and resource at the time of the criminal offense.^5,7,ix,76,78 Multiple psychosocial stressors equally motivating factors for maternal filicide have been identified, including being the principal caregiver for at least one child, unemployment/financial bug, ongoing abusive developed relationships, conflict with family unit members, and limited social support.^{7,ix,12,78,79} Social isolation has also been noted as a gene mutual in women who killed their children,⁸⁰ as has a history of childhood abuse.⁷⁶

Depression or psychotic disease typifies mothers who killed older children.^{seven,75,76,78,81,82} In a recent report comparing characteristics of filicidal women with and without psychosis at the time of the law-breaking, Lewis and Bunce⁷⁹ reported that the psychotic women tended to be older and more educated than the nonpsychotic women and were more oftentimes divorced or separated but less commonly employed. The psychotic women were also more likely to take a history of substance abuse, psychiatric hospitalization, ongoing psychiatric treatment, and suicide attempts.

Psychosis and suicide attempts are not characteristic of women who fatally abuse their children.^12,79,83 Personality disorders and intense psychosocial stress at the time of the fatal abuse are common.^6,7,75,76,84 Parental separation in childhood and marital violence have been identified as cofactors in fatal kid corruption by mothers, and many perpetrators of fatal abuse have a history of corruption in their childhood.²⁶ Although fatal‐abuse filicide can exist the result of an isolated event, it oft occurs following recurrent corruption.^{35,43,79,85,86} Population studies have found that one in 2 fatally abused children accept been victims of prior abuse.^26,43,86

Retaliating maternal filicide is rare.^{5–7,9,12,78,79} Women who commit retaliating filicide typically have personality disorders and a high incidence of suicide attempts.^6,9 Marleau and Laporte⁸⁷ noted the possibility of a relationship betwixt maternal motivation for filicide and victim gender. These authors speculated that daughters are at increased risk in donating situations, while sons are more at risk in retaliatory situations. Loomis⁸⁸ also reported that mothers kill their sons to seek revenge on their mates.

Mental Illness in Maternal Filicide

The prevalence of serious mental disorders has been noted often in studies of maternal filicide, with low and psychosis reported near ofttimes.^{five–7,9,12,29,38,40,threescore,61,76,78,79,83,89,90} Resnick^v institute that 67 percent of the 88 filicidal mothers were psychotic and that major depression and schizophrenia/psychosis were more common in mothers than in fathers. McKee and Shea⁷⁸ noted that of the 20 women in their sample, forty percent had diagnosed psychotic or paranoid disorders and 25 percent had major depression at the fourth dimension of the offense. In the study by Bourget and Gagné,¹² 67 percentage of the 27 filicidal mothers had a diagnosis of major depressive disorder and 15 percent had diagnosed schizophrenia. Lewis and Bunce⁷⁹ reported that the most common diagnoses of the 55 filicidal women in their sample were schizophrenia (48%), major depressive disorder with psychotic features (34.5%), and personality disorder (67%). In a review of the psychiatric history of 10 mothers who had committed filicide‐suicide, Hatters Friedman et al. ⁶¹ found show of depression or depressive symptoms in 70 percent of the women and of psychosis in 30 percent.

Few studies have specifically examined the influence of mental illness in filicide.^79,89,91 Lewis and Bunce⁷⁹ establish that, compared with nonpsychotic women who have killed their children, psychotic women were more than likely to kill multiple victims and to attempt suicide at the time of the filicide. This study extended the authors' previous findings⁸⁹ that psychotic mothers were more likely than nonpsychotic mothers to use a weapon (pocketknife or gun) to kill their children. Stanton et al. ⁹¹ also noted that violent methods of killing narrate mentally ill filicidal mothers. They investigated half dozen women who had DSM‐Iv¹³ diagnoses that included major depressive disorder, schizophrenia, and schizoaffective disorder (either manic or depressed phases before the filicide). All the women used violent methods of killing and killed older children, with more than one child killed in several cases. The authors found that the women who were manic earlier the filicide had displayed a lack of premeditation and had developed delusions within a twenty-four hour period before the offense. In contrast, the depressed women reported thinking well-nigh their ain and their children's deaths days or weeks beforehand. The authors suggested that relevant features of maternal filicide in the context of major mental illness may be disorganized thinking and unstable mental land.⁹¹

Paternal Filicide

Despite findings that men commit filicide every bit oftentimes as or more ofttimes than women,^{17,27,33–39,92} paternal filicide has attracted limited research. Few of the studies investigating paternal filicide^{ii,v,half dozen,36,46,93,94} employed large samples of fathers, limiting the generalizability of results. Bourget and Gagné²⁸ reviewed data from 77 cases of paternal filicide in Quebec over a 10‐year period and previous reports of child homicide by fathers.^{2,five,26,27,43,57,66,95,96} The review revealed several factors regarding victims, method of killing, and filicidal motive that seem to exist characteristic of paternal filicide (Table 1).

Table 1

Characteristics of Paternal Filicide Relative to Maternal Filicide

In that location is a high frequency of completed or attempted suicides by fathers after they take committed homicides.^{16,17,27,38,43,61,63,66,67} The likelihood of suicide may increase in instances involving multiple sibling victims^28,43 and with older victims.²⁷ In a written report of 32 cases of child homicide in the U.S. Air Force, Lucas et al. ²⁷ found that the probability of homicide/suicide increased equally the age of the victim increased; 13 percentage of filicides involving younger children (between 1 and 4 years of historic period) ended in the perpetrator'southward suicide, while 50 percentage of incidents involving older children (between 4 and xv years of age) did.

Fathers are frequently perpetrators of fatal‐corruption filicide, which is usually the result of battered‐child syndrome and rarely involves a psychotic disorder or suicide attempt.^{v,6,9,26,28,97} Previous family violence is often a cofactor in cases of fatal abuse and in other paternal filicides.^{26–28,43,98} Perpetrators are probable to have a personal history of abuse in babyhood, particularly in paternal filicides involving infants under one year of age.^26,27,66,93

The presence of significant life stressors has been reported past filicidal fathers, including financial difficulties, impending marital breakdown, and fright of separation.^27,66,99 Some paternal filicides reportedly have occurred in the backwash of arguments concerning marital infidelity,^66,96 and being separated at the time of the criminal offence has been noted to be an important precipitating cistron.^27,66,67

A high proportion of filicidal fathers have low socioeconomic status.^57,66,93,96 Many filicidal fathers are unemployed and have below‐average education levels.^57,66,81,93 Social isolation and/or a lack of social support are also commonly reported in paternal filicide.^66,93

Motivational factors noted for paternal filicide include attempts to control the kid's behavior, and misinterpretation of the child's beliefs.^5,66,93 In an investigation of five paternal filicides, Palermo¹⁰⁰ pointed out that all of the men felt a sense of personal inadequacy and had a lack of parenting skills and coping mechanisms. Several studies show a high incidence of related substance corruption/dependence.^{ix,27,38,66,93}

Mental Illness in Paternal Filicide

In an investigation of coroners' files pertaining to 20 fathers who had committed filicide‐suicide, Hatters Friedman et al. ⁶¹ institute bear witness of a psychiatric history of psychosis in 25 percentage and of depressive affliction in 50 percent of the fathers. Bourget and Gagné²⁸ noted a similar rate of psychiatric disease in their examination of coroners' files pertaining to lx filicidal men; the presence of psychosis was established in 30 pct of the fathers, and 52 percent of the men had major depressive disorders. Others have reported comparably college frequencies of psychotic symptoms amongst filicidal fathers.^5,66,93 In his review, Resnick^five classified 44 percent of the 43 filicidal men equally psychotic and 33 per centum as depressed with psychotic features. Campion et al. ⁹³ noted that xi of the 12 filicidal men in their sample had psychiatric disorders, with seven (64%) of the men suffering either astute or chronic psychosis at the time of the offense. Marleau et al. ⁶⁶ found that 7 of 10 homicidal fathers had, at the fourth dimension of the offense, an Axis I disorder co-ordinate to DSM‐3‐R¹⁰¹ criteria, including four with mood disorder, one with dysthymic disorder, one with schizophrenia, and one with psychosis. Four (57%) of the offenders were actively psychotic at the time of the offense. Viii of the men had personality disorders that have been associated with paternal filicide.^6,12 Six of the men attempted suicide soon after the offense.⁶⁶

Discussion

The literature is replete with statements regarding the demand for further research to enable a ameliorate understanding of filicide. This review allows a comparison of filicides perpetrated past mothers and fathers. A significant proportion of both male and female person perpetrators take depression and/or psychosis. Personality disorders, particularly borderline personality disorder, are also frequently seen in both men and women. Other similarities between men and women who commit filicide include (1) the presence of pregnant life stressors; (two) social isolation and lack of social back up; and (3) a history of abuse in childhood. Table 1 outlines some of the factors that characterize paternal filicide. Additional factors that differentiate filicidal fathers from filicidal mothers are: (1) fathers rarely commit neonaticide; (2) filicidal fathers are commonly older; (3) filicidal fathers are more probable to have a history of violence toward their children; and (4) more than fathers who commit filicide also commit suicide.

Several factors forbid a more in‐depth analysis of maternal and paternal filicide. For example, studies differ regarding inclusion criteria for the age of victims, limiting an examination of potentially relevant characteristics of filicide relative to the victim's age. Another concerns differences amidst studies that distinguish between neonaticide and filicide and those that refer to filicide as an overall category that could include neonaticide. Clearer guidelines for research in this surface area would allow for a more conclusive analysis of characteristics relevant to maternal and paternal filicide, specially given that neonaticides are rarely committed past fathers. A third limitation concerns reports that indicate that more victims of filicide are offset‐born children. In the absence of data for comparative purposes, it is not clear whether first‐born children are more probable to be victims proportionate to the percent of kickoff‐borns. Clarification is farther hampered by the fact that nascency society of filicide victims is infrequently reported in the literature. Finally, few studies distinguish between filicides committed past biological parents and those committed past stepparents.

Some contradictory reports regarding rates of mental disease in filicidal offenders may be explained by differences in report type. Findings based on general population studies of coroners' files are likely to differ from those reported in studies of psychiatric populations or correctional populations. For instance, a study of paternal filicide with a prison sample is likely to show a high incidence of fatal child abuse and a lower incidence of psychosis, whereas research conducted in a psychiatric hospital would probably show a higher incidence of psychosis and less fatal child abuse. Reviews of coroners' files, which examine every filicide that occurs in a given region over a menstruum of time, could analyze the prevalence of mental illness in parents who have committed kid homicide. However, few such studies accept been conducted to date, and fewer still take reported rates of mental disease in filicide offenders. Table 2 displays results of three recent coroners' studies of parents who committed filicide and filicide‐suicide.^12,28,61

Table two

Rates of Mental Illness and Parental Motives in Filicide and Filicide‐Suicide: Comparing of Coroners' Studies

Some researchers accept noted a lower rate of mental illness in paternal offenders compared with maternal offenders, thought to correspond to a higher rate of fatal kid abuse by fathers.^v,38,97 The college rate of fatal abuse by fathers may give the impression that few filicidal fathers are mentally ill. However, this view is changing in the face of recent studies.^28,66 Marleau et al. ⁶⁶ recorded no incident of fatal abuse filicide, and noted that all 10 men in their report had a psychiatric disorder at the time of the offense. Similarly, in a review of 77 paternal filicide cases, Bourget and Gagné²⁸ found a high proportion of mental illness (64%) and a comparatively lower number of fatal corruption cases (25%). Whether the findings of a higher proportion of mental disease in filicidal fathers are attributable to improved information drove and larger samples, refined diagnostic methods with use of standardized criteria, or changing values or a reflection of societal changes with fathers taking on increased responsibilities in child care remain interesting avenues to exist explored.

The importance of the numerous reports of an association between filicide and pre‐existing psychiatric disorders is compounded past indications that a significant number of homicidal parents come to the attending of psychiatrists or other health professionals before the criminal offense.^{5,7,12,26–28,61,78,79,85,98} Results of two studies bespeak that filicidal parents' virtually frequent reason for contacting agencies was concern over their mental health.^26,98 Perpetrators of filicide involving older children (aged 4–fifteen years) reported the highest frequency of prior mental health contact.²⁷ D'Orban⁷ plant that 77 percentage of maternal offenders were in contact with social workers or psychiatric services before the offense. Bourget and Gagné^12,28 noted that nigh one-half of the filicidal women and men in their samples had had previous contact with doctors, psychiatrists, and/or other professionals. Lewis and Bunce⁷⁹ reported that nearly all of the psychotic women in their report were in ongoing psychiatric treatment at the fourth dimension of the offense, and that significantly more than psychotic women compared with nonpsychotic women voiced concerns about their children to their family unit inside ii weeks before the offense.

As prevention implies the recognition of causes involved in each particular situation, a better understanding of potentially fatal parental or familial dynamics leading to filicide could facilitate the identification of risk and enable effective intervention strategies. To date, the about effective identification and prevention strategies still imply the need for a instance‐by‐case approach. 1 cannot emphasize enough the importance of existence vigilant, especially in offset‐line psychosocial, medical, or legal service delivery, for those who work with parents undergoing a crisis. The beginning‐line emergency dr., family medico, or any professional trained in the medical and mental health fields should not hesitate and must fifty-fifty consider it a duty to evaluate carefully the mental condition, including any thought of suicide, extended suicide, or homicide, of a depressed or psychotically ill parent.

Professionals who provide prenatal health intendance should be alert to the possible risk of neonaticide earlier the pregnancy comes to term. During prenatal and postnatal care, it would not exist difficult for clinicians to enquire a few questions that would probe a parent's attitude toward infants and children without incrimination. Given that up to one‐quarter of child victims killed by their mothers are beneath the age of one (Bourget, unpublished data, 2006) and that mothers in the postpartum period often consult their physician in follow‐up or bring the babe for postnatal care and vaccination, the family unit physician or pediatrician may at times be the simply medical contact with a depressed mother.

Key pieces of information that could betoken the presence of filicidal ideation tin be obtained by questioning a parent most his or her mood and the presence of other depressive symptoms and how they are coping with their child. If a parent reveals that he or she is depressed or is showing distress or decompensation, clinicians should specifically inquire about the child, and if there is so reason for a higher index of suspicion, should ask virtually thoughts of suicide and of harming the child. The importance of gleaning this information is underscored past indications that mothers who take committed filicide‐suicide had been thinking about the human activity for months or even years before an actual effort.¹⁰²

Depressed parents with suicidal ideation should be asked directly their thoughts on the touch of their suicide on their child's future and should be provided with the necessary treatment and back up. The clinician may consider calling on the other parent or any significant relative for collateral information on the psychosocial milieu and evaluate his or her potential for protective interest. The preservation of integrity of the child takes precedence over any ethical concerns when the clinician has reasonable grounds to suspect that the child is likely to exist harmed by the caregiving parent or by the parent's failure or neglect in caring for the child.

Several countries, including the Usa and Canada, have enacted legislation to provide child protective agencies with powers to intervene when suspicions ascend that the child is at gamble. Whenever possible, consent must be sought from the parent to share information for the protection of the child; however, absence or refusal to give consent should not preclude the clinician's taking appropriate actions when mandated by police or otherwise dictated by his or her duty to care. In those cases in which there is no stated intent merely evidence exists of serious risk factors that merit further exploration, a psychiatric hospitalization may exist indicated to assess and monitor run a risk. The professional working in family unit police, separation, divorce, or kid custody proceedings could also practise vigilance in identifying those emotionally disturbed client parents who are involved in strained marital relationships and threatened or actual separations. Finally, given the present state of cognition showing the high rates of psychopathology in parents who impale their children, forensic psychiatrists and other professionals in the forensic field should proceed a loftier index of suspicion for the presence of mental illness when they examine a filicide offender.

• American Academy of Psychiatry and the Police force

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