How doctors should react to domestic violence.

A palpable alarm echoed throughout Hong Kong when two young children were chopped to death and another critically wounded by their father before he hanged himself on 20 January 2002. Domestic violence in the form of homicide, suicide, spouse battering, and child abuse are among the most common social and mental health problems worldwide. Such incidents are but the tip of an invisible iceberg of less severe domestic violence, suicide attempts, and emotional distress. The latter, recent research confirms, clusters with psychopathology, which may in turn fuel domestic violence. In a meta-analysis conducted, the prevalence of mental health problems among battered women was 63.8% in 11 studies of post-traumatic stress disorder (PTSD)—a psychophysiologically distressing anxiety disorder that follows exposure to a major traumatic stressor—47.6% in 18 studies of depression, 17.9% in 13 studies of suicidal behaviour, 18.5% in 10 studies of alcohol abuse, and 8.9% in four studies of drug abuse. Homicide, followed by suicide and parasuicide, seems particularly common in Asian societies where the restrictive welfare system and moral values pertaining to filial piety and intra-familial dependency contribute to distressed individuals’ decision to die in tandem with their family members. Historical accounts bear witness to this longstanding pattern in Chinese communal life.