中華心理衛生協會

 Purpose: Caregivers killing their charges due to their caregiving burden has become an issue of concern in the long-term care field. We explored the caregiving context and stress of elderly spousal caregivers to understand the factors related to the occurrence of such cases, including both caregiver-perpetrated homicide and homicide-suicide events. Methods: We conducted a content analysis of 10 official court judgments in Taiwan involving cases in which the care recipients were murdered by their caregivers, and the caregivers survived and were prosecuted through the criminal justice system. Among them, five of the defendants had attempted suicide. We also conducted in-depth interviews with the parties involved and key stakeholders in order to present a range of perspectives. Findings: Our analysis resulted in 5 key findings: (1) The physical and mental health status of caregivers and of their charges and their caregiving circumstances may serve as early indicators of high-burden care situations; (2) In contrast to the traditional concept of raising children as a safeguard in old age, six of the ten elderly spousal caregivers expressed a strong desire to bear caregiving responsibilities alone in order to avoid burdening their children; (3) Depressive symptoms and severe sleep disturbances among caregivers may be a critical warning sign, often preceding acts of violence. (4) The caregivers themselves exhibited both a reluctance to engage with and an insufficient understanding of the long-term care service system available in Taiwan. (5) The judiciary should separate the moral commitment of marriage from the practical responsibilities of caregiving to better recognize the caregiver's burden. Conclusion: The accumulation of caregiving stress can lead to caregiver homicide-suicide. We suggest that future research is needed to examine the interactive relationship between Taiwan's long-term care services and traditional culture so as to design policies that encourage families to begin discussing care arrangements before tragedy happens.