Crime and punishment--the suicide pact.

Interviews with four suicide pact survivors, date from two cases in the literature, and review of 54 clinical vignettes of murder-suicide revealed the following of suicide pacts with survivors. First, the instigator is the deceased partner and is more likely to be the male member of the pair, to be psychiatrically ill with a depression, and to have a history of previous suicidal behavior. Second, the survivor is more likely the woman and cooperator, is not likely to be psychiatrically ill, and has shown no previous suicidal behavior. There are striking similarities between noncriminal murderers, perpetrators of murder-suicide, and instigators of suicide pacts: depression is the most common psychiatric illness in all three groups. The clinician must assay the "murder risk" as well as the "suicide risk" in depressed patients.