We have been witnessing an unsettling rash of murder-suicides involving mass murders in Alabama, New York, and North Carolina as well as many across the country involving entire families, older couples where men are devoted caregivers, and younger couples where domestic violence and the need to control become lethal.

The fact that unsuspecting, innocent people are killed before an individual's final act of self-destruction, fuels the public's sense of confusion, horror, sadness, and helplessness in dealing with these violent tragedies.

The Violence and Injury Prevention Program at the University of South Florida has been conducting research on murder-suicides, also called homicide-suicides, since 1994. We know that roughly 50,000 Americans die from homicide and suicide every year, and 1,500-2,500 are murder-suicide deaths. The perpetrator is usually a man who kills one or more people, usually a woman, before committing suicide within 24 hours of the homicide. Over 70 percent of murder-suicides involve couples. About 10 percent involve several family members, 6 percent involve infants and children, 10 percent involve non-family members, and 4 percent are mass killings. People age 55 and older appear to have higher murder-suicide rates than persons under age 55.

We also know that every homicide and suicide has a purpose or meaning, and a murder-suicide also makes sense to the perpetrator whose purpose and motivations usually become clear during investigation. Perhaps some basic information will help clarify that murder-suicide is not a senseless act.

First, a person who commits suicide after murder feels completely helpless and hopeless and has made the decision to die. The murder-suicide is intentional and well-planned, often weeks, months, and sometimes years in advance. The perpetrator has carefully considered and prepared the lethal agenda. Motivations may vary, including hopelessness, desperation, unendurable psychological pain, perceived injustice accompanied by the need for revenge, and a need to control in the context of other losses. Firearms are the method of choice.

Second, the vast majority of suicidal people, including those who commit murder-suicide, have serious, untreated psychiatric illnesses, and these are conditions that can be detected, diagnosed and successfully treated in most cases. The National Institute of Mental Health has estimated that more than 90 percent of those who die by suicide (homicidal or not) have disabling and untreated psychiatric disorders. If our country had an effective system of mental health care, it is estimated that at least 16,000 lives could be saved each year. Perhaps a significant number of homicide victims could be saved as well.

Third, media stories about murder-suicides are often not helpful and enlightening. Story details can be hurtful to families of the perpetrator and victims who are co-victims struggling to make sense of the sudden violence. Colorful language such as a "crazed gunman," "monster," "madman," or "disgruntled employee who goes postal," do not contribute to the public's understanding of the underlying psychiatric illnesses. Making assertions that somebody should have seen the mental illness and sought help can have a double edge and be hurtfully judgmental.

Fourth, the decision to die by suicide after homicide is made long before the killing occurs. In most cases, there are many observable warning signs of mental illness in the behaviors of potential murder-suicide perpetrators. The Violence and Injury Prevention Program has been monitoring the frequency and clinical patterns of murder-suicides, identifying risk factors, training professionals, and providing educational materials for the general public, including traumatic grief resources for survivors.

Perpetrators of murder-suicide have four core characteristics: psychiatric illnesses or disturbed thinking, an intense attachment to the victim or victims (which may include pets), a need to control or exert responsibility to maintain control over a situation(s), and a belief that something is threatening the integrity of their attachment to the victim(s).

Can murder-suicides be prevented? The answer is yes, many of them can be prevented, but only if suicidal people and those thinking of harming others and then themselves can be identified before they act, and if they get appropriate mental health care to ease their psychological pain and suffering. In addition to the training programs at USF, the QPR Institute offers a broad range of training programs to educate professionals and teach people in all walks of life how to "Question, Persuade, and Refer" a suicidal or homicidal-suicidal person for further evaluation and care. We are dedicated to developing a country of caring citizens and developing resources in the community. Many lives depend on it.

Donna Cohen is a professor in the Louis de la Parte Florida Mental Health Institute and head of the Violence and Injury Prevention Program, University of South Florida in Tampa. Paul Quinnett is president and CEO of the QPR Institute in Spokane, Wash.