KL Hon, CHY Chan, L Chan

Dear editor,

Filicide is an intentional act of murdering one's own child.¹ There are very few medical reports on this tragic crime in Hong Kong and no accurate and up-to-date local statistics on filicide. It appears that cases may appear in clusters from time to time. According to the reports of social media, limited information about the physical and psychosocial well-being of the children involved was found (Table 1).

We have summarised cases involving filicide and possible risk factors pertinent to the city of Hong Kong in 2017-2018. These cases involved children of parents of both sexes and mostly under the age of 12. It is believed that these cases would be attributed to multi-dimensional factors; nevertheless, psychosocial risk factors are often described in social media and may be clues for interventions.^1-7 According to the media record in 2017-2018, psychosocial factors such as psychiatric morbidity of parents, postpartum depression and adverse life situation such as marital discord, single parenthood, unwanted pregnancy or financial strain appear to be the presenting issues for filicide in Hong Kong (Table 1).

Filicide is not rare in developed countries. Indeed, it is the third leading cause of death amongst American children 5 to 14 years old; and parents were responsible for 61% of children murders under the age of 5 years.⁵ There have been scanty Hong Kong data on filicide in the literature. Modes of filicide included predominantly jumping from height, charcoal burning, poisoning, dumping the baby corpus into rubbish bins and occasionally stabbing or strangulation. Unlike overseas, none of these cases involve firearms in Hong Kong.

Nationwide systematic collection of data on filicide with suicide may bring new insights to the problem. There have been escalating numbers of PubMed publications on the subject matter. Depression in terms of loneliness, helplessness or hopelessness might be one of the psychological conditions that the parents or caregivers who committed filicides, as they might perceive that nobody would be able or trustworthy enough to take care for the children if they committed suicide.^1-3 In a densely populated city, people are physically close but emotional distant. Mental health support remains thin in Hong Kong and is no substitute for a strong social support network.

Meanwhile, most of the people in Hong Kong are not highly aware of their own and others' mental health, especially for parents and primary caregivers. Further, it is uncertain if they may be concerned about social stigmatisation of help-seeking in times of need. In general, many choose to deal with emotional disturbances through suppression, distraction and avoidance. It is advisable for the medical professionals to work hand in hand with the social workers and psychological counselors for the best interest of the children and families by adopting a systemic perspective in healthcare settings.

An official registry can be set up to understand local factors and changing patterns pertinent to filicide, and to enable and implement preventive measures. A multi-dimensional and systemic screening tool for filicide risks is called for to better characterize cases for preventive purposes.^6,7 It would be helpful if health care providers could be vigilant of the emotional state of parents or caregivers and address their psychosocial needs in order to prevent future tragic incidents.

References

1. Hon KL. Dying with parents: an extreme form of child abuse. World J Pediatr. 2011;7:266-8.

2. Mariano TY, Chan HC, Myers WC. Toward a more holistic understanding of filicide: a multidisciplinary analysis of 32 years of U.S. arrest data. Forensic Sci Int. 2014;236:46-53.

3. Cheung PT. Maternal filicide in Hong Kong, 1971-85. Med Sci Law. 1986;26:185-92.

4. Pae CU. Filicide: needing psychiatrists' attention. Psychiatry Investig 2014;11:214-5.

5. Friedman SH, Horwitz SM, Resnick PJ. Child Murder by Mothers: A Critical Analysis of the Current State of Knowledge and a Research Agenda. Am J Psychiatr 2005;162:1578-87.

6. Lehoczki Á, Lukács-Miszler K. Major psychiatric disorders and filicide: a descriptive analysis of filicides perpetrated by women with psychotic mental illness. Psychiatr Hung 2013;28:145-58.

7. Mugavin ME. A meta-synthesis of filicide classification systems: Psychosocial and psychodynamic issues in women who kill their children. J Forensic Nurs 2005;1:65-72.