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Shanna and Lionel Desmond hold their daughter Aaliyah in a photo from the Facebook page of Shanna Desmond.The Canadian Press

The Canadian Forces wouldn't commit Thursday to examining how it handled an Afghanistan war veteran suspected of killing his family and then himself, as Nova Scotia began investigating how the province's medical system dealt with the mentally ill soldier.

Lionel Desmond, who was an infantryman with the 2nd Battalion of the Royal Canadian Regiment in Gagetown, N.B., was suffering with post-traumatic stress disorder when he was released from the army 18 months ago. Relatives said his deployment to Afghanistan in 2007 left an indelible mark on the husband and father and he struggled to control his anger and overcome nightmares and flashbacks.

His deteriorating mental state was taking a toll on his marriage to nurse Shanna Desmond, her sister, Shonda Borden, said Thursday. Gunshots erupted Tuesday inside the couple's modest home in the rural community of Upper Big Tracadie in northeastern Nova Scotia.

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When the gunfire stopped, four people lay dead: Mr. Desmond's wife, their 10-year-old daughter, Aaliyah, his mother, Brenda Desmond, and Mr. Desmond, whom police suspect shot himself.

Autopsies are being done to confirm the cause of the deaths.

The apparent triple murder-suicide has shocked the country and the military community. Nova Scotia Premier Stephen McNeil said the "unspeakable loss" has prompted the provincial government to investigate what health services were offered to the former corporal and whether protocols were followed. But Defence Minister Harjit Sajjan and the Canadian Forces would not say whether a board of inquiry will be held to examine what medical care and support was offered to the ailing soldier by the military's health system.

Prime Minister Justin Trudeau's press secretary, Cameron Ahmad, deferred questions about an inquiry to Veterans Affairs. The department and Minister Kent Hehr's press secretary did not respond Thursday to questions on whether Veterans Affairs will hold a review.

While boards of inquiry are conducted in the suicides of active-duty soldiers, reviews are not mandatory when veterans die. The National Defence Act, however, gives the defence minister the authority to order an inquiry into such a tragedy.

"Given the RCMP's investigation is ongoing and that this tragic situation just occurred, it would be premature to discuss such matters at this time," Canadian Forces spokesman Daniel Lebouthillier said in an e-mail. "We must let the RCMP's investigative process unfold."

Military Ombudsman Gary Walbourne said that, at the "absolute minimum," Veterans Affairs should do a full file review to examine its interactions with Mr. Desmond. He noted a review may uncover gaps that could help other vulnerable soldiers and veterans.

NDP Veterans Affairs critic Irene Mathyssen said she would support a review, if it's backed by the family. Mr. Desmond is among at least 72 Canadian soldiers and veterans who have taken their lives after deploying on the Afghanistan mission, a continuing Globe and Mail investigation has found.

"We need to know what is going on with our veterans so that we can make sure that the services are there. And in this case, something went wrong. Something terrible went wrong," said Ms. Mathyssen, who is a member of the all-party Standing Committee on Veterans Affairs, which is currently examining mental health and suicide prevention.

Relatives said Mr. Desmond, 33, sought medical care just days before the tragedy. On New Year's Day, he checked himself into St. Martha's Regional Hospital in the nearby town of Antigonish because of his frayed mental state, said Catherine Hartling, an aunt of Shanna Desmond.

He was apparently told that he couldn't be treated until the hospital had his medical records. After sleeping on a cot overnight, he left in the morning, Ms. Hartling said.

"They should have made sure Lionel never left the hospital," she said. "Why would they let the man leave the hospital? They said if he needs help, get back in touch with the hospital. What kind of bullshit is that?"

Mr. Desmond's sister-in-law, Shonda Borden, said he was desperate for help. The shootings occurred the day after he left St. Martha's hospital.

"He constantly had voices in his head. He constantly had replays of what happened in Afghanistan," said Ms. Borden, who flew in from Regina to be with family at her mother's house, next door to the Desmond home. "He just wanted peace. That's all he wanted."

Inside her mother's home, a small group of family and friends gathered Thursday to share their grief. They huddled in the kitchen as the television played. In Upper Big Tracadie, many families have been here for generations.

"The community is one big family – from the Bordens to the Desmonds to the Lawrences, the Jones – we're all one big family. So we always had each other's back, no matter what. So this is going to affect the community majorly. It just kills," Ms. Borden said.

Mr. Desmond talked with his sister-in-law about his struggles with PTSD. He told her grim details about picking up dead bodies and detached heads while in Afghanistan.

Ms. Borden said she spoke to her sister, Shanna, the day she was killed on Jan. 3. Her sister felt frustrated lately in her relationship with Mr. Desmond. At the time of the shooting, the couple was spending time apart because of fighting and Mr. Desmond's frequent outbursts, Ms. Borden said. He was staying at his grandparents in nearby Lincolnville, about 10 minutes up the road.

"He was never violent towards her [Shanna] or to his daughter, Aaliyah. He would go outside and throw things, but never towards them, ever," his sister-in-law said.

Ms. Borden said Mr. Desmond suffered from horrible dreams and once, in the middle of the night, tried to choke his wife.

"He thought he was in Afghanistan and she calmed him down," Ms. Borden recollected. "We all knew that he needed help and we all tried to give him help, but what are we really going to do? That's for the military and the health-care [system] to do," she added. "He's a victim. They all are victims."

Mr. Desmond was talking to a "psych" doctor in Halifax, Ms. Borden said. He had previously spent time in a rehabilitation facility in Montreal, according to relatives. The Canadian Forces and Veterans Affairs won't comment on what treatment was offered to Mr. Desmond due to privacy reasons.

Ms. Borden is frustrated that no one in the military has contacted her yet about the shootings. "I haven't heard a thing," she said tearfully. On Twitter, the Prime Minister expressed condolences to the family and community.

Mr. Desmond talked about his health struggles on his Facebook page. The Afghanistan war veteran said he'd been told he had post-concussion disorder as well as PTSD.

In a Dec. 3 post – one month before the shootings – he wrote that: "I'm truly sorry for freaking out at my wife/daughter and people who know me … I'm not getting a lawyer. I'm getting my life back."

He added: "I apologize for anything out [of] my control. I will fix it. If not, I'll live with it."

With reports from The Canadian Press