Suicide preceded by murder: the epidemiology of homicide-suicide in England and Wales 1988-92

Homicide-Suicide in Russia and Pakistan: Observations From Press Media Reports

This study compares the features of homicide-suicide in Russia and Pakistan. To understand this, we conducted a content analysis of news reports about homicide-suicide published in Pakistani and Russian newspapers between March 2020 and May 2023. We identified 35 and 104 homicide-suicide cases in Pakistani and Russian media, respectively. Men were three to five times more likely to commit homicide-suicides than women (3.16: 1 in Russia; 4.83: 1 in Pakistan). Accounting for over 65.73% of all homicide-suicides, spousal homicide-suicides and filicide-suicide were the most common homicide-suicides in both regions. Filicide-suicides were more often done by Russian women and extra-family homicide-suicides by Pakistani women. Reasons for homicide-suicides in Pakistani women were divorce or separation and in Russian women - mental disorders. With the difference of homicide in the victims, Pakistani victims were aged 15-30 years, while Russian were 31-45 years and 46 years and older. There were more similarities in homicide-suicides than differences.

A systematic review of literature on homicide followed by suicide and mental state of perpetrators

BACKGROUND

Homicide followed by suicide is rare, devastating and perpetrated worldwide. It is commonly assumed that the perpetrator had a mental disorder, raising concomitant questions about prevention. Though events have been reported, there has been no previous systematic review of the mental health of perpetrators.

AIMS

Our aims were twofold. First, to identify whether there are recognisable subgroups of homicide-suicides in published literature and, secondly, to investigate the relationship between perpetrator mental state and aspects of the incident.

METHODS

We conducted a systematic review of published literature on studies of homicide followed within 24 h by suicide or serious suicide attempt that included measures of perpetrator mental state.

RESULTS

Sixty studies were identified, most from North America or Europe. Methodologically, studies were too heterogeneous for meta-analysis. They fell into three main groups: family, mass shooter, and terrorist with an additional small mixed group. There was evidence of mental illness in a minority of perpetrators; its absence in the remainder was only partially evidenced. There was no clear association between any specific mental illness and homicide-suicide type, although depression was most cited. Social role disjunction, motive, substance misuse and relevant risk or threat behaviours were themes identified across all groups. Pre-established ideology was relevant in the mass shooter and terrorism groups. Prior trauma history was notable in the terrorist group.

CONCLUSION

Research data were necessarily collected post-incident and in most cases without a standardised approach, so findings must be interpreted cautiously. Nevertheless, they suggest at least some preventive role for mental health professionals. Those presenting to services with depression, suicidal ideation, relationship difficulties and actual, or perceived, changes in social position or role would merit detailed, supportive assessment over time.

Intimate Partner Homicide: Comparison Between Homicide and Homicide-Suicide in Portugal

Intimate partner homicide (IPH) is a tragic event. Studies involving the comparison between IPH and intimate partner homicide-suicide (IPH-S) are scarce, with few studies in Portugal about this issue. The current study aims to compare IPH and IPH-S perpetrators, the victim-perpetrator relationships dynamics, and homicide circumstances. The data was collected through the analysis of 78 judicial processes of IPH that occurred in Portugal, between 2010 and 2015. Of the cases, 51 were IPH, 20 were IPH-S cases, and seven were attempted suicide cases, being perpetrated in 84.6% (n = 66) for male perpetrators. Suicide after intimate homicide were all committed by men. All judicial processes analyzed refer to heterosexual relationships. Bivariate and multivariate analyses were performed to compare the groups concerning perpetrator and victim sociodemographic characteristics, victim-perpetrator dyadic dynamics, and crime circumstances. The results show mostly common trends between the two groups with some differentiating factors when compared individually (e.g., perpetrator professional status, criminal records). Regression logistic analysis showed no differences between IPH and IPH-S.

Unvollendet gebliebener Versuch eines erweiterten Suizids durch Stromeinwirkung in der Badewanne

Während sich heutzutage in westlichen Ländern erweiterte Suizide ganz überwiegend in (gescheiterten) Partnerbeziehungen ereignen, stellen Kindstötungen mit nachfolgendem Suizid eines Elternteils ein seltenes Ereignis dar. Vorgestellt wird der ungewöhnliche Fall eines versuchten Homizid-Suizides einer 36-jährigen Frau, die durch das Einbringen eines eingeschalteten Föhns in das Badewasser beabsichtigte, sich und ihre 7 Jahre alte Tochter zu töten. Während sich das Kind selbstständig aus der Wanne befreien und die Großeltern informieren konnte, wurde die Frau in benommenem Zustand von ihrem Vater vorgefunden. Beim Versuch, seine Tochter aus der Badewanne zu bergen, habe er einen Stromfluss verspürt. Bemerkenswerterweise haben alle 3 Personen ohne gesundheitlichen Schaden überlebt; sie wiesen keine Strommarken auf. Die ungewöhnliche Fallkonstellation, die elektrotechnischen Aspekte und die psychiatrische Vorgeschichte der Täterin, die zum Tatzeitpunkt unter dem Einfluss von Alkohol und eines sedierenden Mittels stand, werden unter Berücksichtigung der einschlägigen Literatur diskutiert.

Incomplete homicide-suicide in Hunan China from 2010 to 2019: characteristics of surviving perpetrators

BACKGROUND

The mental and psychological conditions of the individuals involved in homicide followed by suicide (H-S) are still unclear, especially in China. Information on these aspects cannot be accurately obtained due to the death of perpetrators. This study aims to demonstrate the characteristics of incomplete H-S with surviving perpetrators, which provide the possibility to obtain detailed mental and psychological information.

METHODS

This study explores incomplete H-S events occurred in Hunan, China from 2010 to 2019, in which the surviving perpetrators received a forensic psychiatric assessment. Three aspects of information, i.e., the subject's demographic, clinical and criminal information, were recorded and analysed.

RESULTS

125 incomplete H-S incidents involved 166 victims were found in the current study. A total of 112 (89.6%) perpetrators were diagnosed with mental disorders, but only 56 of them had a history of consultation due to mental problems, and only one of them adhered to treatment. In most cases, the motivation is related to the psychopathological states, with the most common diagnosis being major depression, followed by schizophrenia. Gender difference was significant among the subjects: females were more likely to have a suicidal history, to be diagnosed as major depression and to be motivated by delirious altruism and family problems.

CONCLUSIONS

This study indicated that psychopathology might be a predisposing factor, which highlighted the importance of mental state assessment for the population involved in incomplete H-S. A clearer understanding of the role of mental disorders might be helpful for the intervention of H-S.

Neuropathological Changes in the Brains of Suicide Killers

BACKGROUND

Homicide combined with subsequent suicide of the perpetrator is a particular form of interpersonal violence and, at the same time, a manifestation of extreme aggression directed against oneself. Despite the relatively well-described individual acts of homicide and suicide, both in terms of psychopathology and law, acts of homicide and subsequent suicide committed by the same person are not well-studied phenomena. The importance of emotional factors, including the influence of mental state deviations (psychopathology), on this phenomenon, is discussed in the literature, but still there is relatively little data with which to attempt neuropathological assessments of the brains of suicide killers. This paper is dedicated to the issue based on the neuropathological studies performed.

METHODS

We analyzed a group of murder-suicides using histochemical and immunohistochemical methods.

RESULTS

The results of our research indicate the presence of neurodegenerative changes including multiple deposits of ß-amyloid in the form of senile/amyloid plaques and perivascular diffuse plaques.

CONCLUSIONS

Neurodegenerative changes found in the analyzed brains of suicide killers may provide an interesting starting point for a number of analyses. The presence of neurodegenerative changes at such a young age in some murderers may suggest preclinical lesions that affect cognitive functions and are associated with depressed moods.

Patients Threatening Harm to Others Evaluated in the Emergency Department under the Florida Involuntary Hold Act (Baker Act)

OBJECTIVES

This study describes the specific threats of harm to others that led to the use of the Baker Act, the Florida involuntary hold act for emergency department (ED) evaluations. The study also summarizes patient demographics, concomitant psychiatric diagnoses, and emergent medical problems.

METHODS

This is a retrospective review of 251 patients evaluated while on involuntary hold from January 1, 2014 through November 30, 2015 at a suburban acute care hospital ED. The data that were collected included demographic information, length of stay, reason for the involuntary hold, psychiatric disorder, substance use, medical illness, and violence in the ED. The context of the homicidal threat also was collected.

RESULTS

We found that 13 patients (5.2%) were homicidal. Three patients had homicidal ideations alone, whereas 10 made homicidal threats toward others. Of the 10 making homicidal threats, 7 named a specific person to harm. Ten of the 13 homicidal patients (76.9%) also were suicidal. Eleven patients (84.6%) had a psychiatric disorder: 9 patients (69.2%) had a depressive disorder and 8 patients (61.5%) had a substance use disorder. Eight patients had active medical problems that required intervention in the ED.

CONCLUSIONS

We found that three-fourths of patients expressing homicidal threats also were suicidal. The majority of patients making threats of harm had a specific plan of action to carry out the threat. It is important to screen any patient making homicidal threats for suicidal ideation. If present, there is a need to implement immediate management appropriate to the level of the suicidal threat, for the safety of the patient. Eighty-five percent of patients making a homicidal threat had a previously documented psychiatric disorder, the most common being a depressive disorder. This finding differs from previous studies in which psychosis predominated. More than 60% of homicidal patients had an unrelated medical disorder requiring intervention. It is important not to overlook these medical disorders while focusing on the psychiatric needs of the patient; most of our homicidal patients proved to be cooperative in the ED setting.

Intimate Partner Homicide Suicide: a Mini-Review of the Literature (2012-2018)

RECENT FINDINGS

In homicide-suicide (HS), a perpetrator kills at least one victim and then commits suicide within a time frame, which is not consistently described in the literature. Most HS happen in an intimate partner relationship (HS-IP), but data about this phenomenon are still scant and poorly systematized.

PURPOSE OF REVIEW

To assess the research papers published about HS-IP from 2012 to 2018 in Pubmed and Scopus. Article selection followed the PRISMA flow diagram. Information was extracted from the selected articles and tabulated. The 22 eligible articles focusing on different types of HS, including HS-IP, suggest that HS-IPs are predominantly committed by men, usually married, cohabiting, or recently separated from their partner, with a medium-low employment status; the victim is usually the current or former female partner. Heterogenity of HS makes it difficult to generalize the results. Implications emerge for the need to target domestic violence and firearm regulation.

Nitrogen inhalation suicide pacts

Suicide pacts usually result in simultaneous deaths by mutual arrangement. While nitrogen and helium gas inhalation are being increasingly used in solitary suicide attempts, for some reason they have been rarely utilised in suicide pacts. A search of autopsy files at Forensic Science SA over a 15-year period (2003-2017) was undertaken to determine how often this method of joint suicide occurs. Only two cases were found. Case 1 comprised a 64-year-old husband and wife (who had a history of multiple sclerosis). They were found deceased in a vehicle with two empty cylinders of nitrogen gas. Case 2 comprised an 87-year-old man (who had a history of ischaemic heart disease) and his 81-year-old wife who were found deceased with plastic bags over their heads, with plastic tubes connecting the bags to opened cylinders of nitrogen. The deaths in all cases were due to nitrogen-induced asphyxiation, in the latter instance augmenting plastic-bag asphyxia. Although suicide pacts have previously usually involved carbon-monoxide toxicity or drug overdose, it is possible that dissemination of information on the use of inert gases in individual suicide attempts may alter the methods used in future.

Homicide-Suicide in Cuyahoga County, Ohio, 1991-2016

Research on homicides followed by suicides has relied heavily on small samples and relatively short time spans of data. This study helps to fill this gap by examining 26 years of homicide-suicide data from Cuyahoga County, Ohio, between 1991 and 2016. The main data source for the study is medical examiner files. Analyses of the data indicate the rate of homicide-suicide in Cuyahoga County is consistent with other studies but fluctuates considerably across years studied. The majority of victims are female while perpetrators are overwhelmingly male. Black people are overrepresented as victims and offenders. Use of drugs and/or alcohol leading up to the incident is common among perpetrators. Both the homicides and suicides were overwhelming committed with firearms. When comparing our results to the typology of murder-suicides developed by Marzuk, Tardiff, and Hirsch (JAMA 1992;267:3179), we find amorous jealousy is a significant motivating factor in a many cases, including those involving nonintimate partners. Our findings underscore the importance of widespread use of lethality assessment instruments.

Mood disorders and violence: a new focus

Violent behaviour in people with a psychiatric disorder causes great public concern and leads to stigma for people with mental illness. There is good evidence for a correlation between schizophrenia and increased rates of violence but any association between mood disorders and violence has been comparatively overlooked. It appears that there may be more evidence relating mood disorders and violence than many clinicians realise. This article highlights the difficulties in assessing this, summarises what is known and discusses what this means for clinical practice.

Suicidal and Aggressive Ideation Associated with Feelings of Embitterment

BACKGROUND

Mental disorders can be associated with suicidal or aggressive ideation and behavior, especially in the context of embitterment. The aim of this study is to investigate the types, prevalence, and dangerousness of aggressive and suicidal ideations associated with embitterment.

METHODS

When therapists from the department of behavioral medicine detected signs of embitterment, aggression, or suicidal thoughts in their patients, they routinely filled out a questionnaire on aggressive ideation, assessed the embitterment, and contacted a senior psychiatrist. Additionally, patients answered an embitterment scale.

RESULTS

There were 127 patients (3.84% of all patients) with suicidal and/or aggressive ideation. They had an increased score of 2.93 (SD 0.74) on the embitterment scale, associated with personal vilification (62.7%), breach of trust (30.2%), public humiliation (25.4%), death/loss (5.6%), or attacks by another person (14.3%). We found that 83.5% of the patients harbored aggressive ideations; in 94.1% of this group, these were directed against the person who had caused the problem, 88.3% wanted to inflict severe damage, 38.8% to harm another person, 31.5% showed suicidal ideation, and 3.2% had fantasies of murder-suicide. Only 34.3% of the patients reported spontaneously about their current aggressive ideation. The limitations of the study are that the data come from an inpatient sample and patients were identified according to clinical judgement.

CONCLUSION

Aggressive ideation is regularly associated with embitterment. This deserves the attention of therapists for the prevention of aggressive acts.

Familial Vehicular Murder-Suicide

A certain number of single-vehicle crashes into stationary roadside objects such as trees are thought to be occult suicides. However, is it possible that some cases of multiple deaths within a family in similar crashes are due to unrecognized familial murder-suicides? A 39-year-old woman and her 11-year-old daughter are reported who died of injuries following a vehicle impact with a tree. Unusual behavior of the mother leading up to the crash, and assessment at the scene, raised the possibility of this being a nonaccidental event. However, difficulties in retrospectively determining the intent of a driver in a vehicle crash, and the nonrecording of, or lack of separate coding for murder-suicides on registers, make determination of the incidence of these types of events extremely difficult. It may be that this is a subcategory of murder-suicide that is underdiagnosed and so is not being registered on central motor vehicle crash databases.

Comparing Homicide-Suicides in the United States and Sweden

Research on homicides followed by suicides has largely relied on very localized samples and relatively short time spans of data. As a result, little is known about the extent to which patterns within cases of homicide-suicides are geographically specific. The current study seeks to help fill this gap by comparing twenty years of homicide-suicide data for Sweden and a large U.S. county. Although some of the underlying patterns in the two countries are similar (e.g., decreasing rates), a number of important differences emerge, particularly with respect to incidence, weapons used, perpetrator age, and relationship of the perpetrator to the victim.

Predictors of suicide attempts after violent offences in schizophrenia spectrum disorders

The aim of this survey was to identify predictors of suicide attempts that immediately followed a violent crime in patients with schizophrenia. Documentations of patients diagnosed with schizophrenia and released in a 10 years period from the National Institute of Forensic Psychiatry were reviewed. Twenty-six out of 223 patients attempted suicide after the violent crime. The young age of the victim, and living in partnership were those factors differentiating suicidal violent offenders from their non-suicidal counterparts.

Newspaper reporting of homicide-suicide and mental illness

Aims and method To explore the portrayal of homicide-suicide in newspaper articles, particularly how mental illness was reported. We carried out a qualitative study in England and Wales (2006-2008). Data from newspaper articles obtained via the LexisNexis database were used to examine a consecutive series of 60 cases. Results A fascination with extreme violence, vulnerable victims and having someone to blame made homicide-suicides newsworthy. Some offenders were portrayed in a stereotypical manner and pejorative language was used to describe mental illness. The findings showed evidence of inaccurate and speculative reference to mental disorder in newspaper reports. Clinical implications The media should avoid speculation on people's mental state. Accurate reporting is essential to reduce stigma of mental illness, which may in turn encourage people to seek help if they experience similar emotional distress.

Child homicide victims in forensic autopsy in Taiwan: A 10-year retrospective study

BACKGROUND

Child homicides are critical medico-legal issues worldwide. Data on the characteristics of these cases in Asia are limited. This study aimed to describe the characteristics of child homicides in Taiwan.

METHODS

A retrospective analysis of forensic autopsy records of child homicide victims (aged 0-17 years) in Taiwan, during a 10-year period between 2001 and 2010, was carried out. The age, sex, relationship with the perpetrator(s), injury patterns of the victims, and causes of death were analyzed.

RESULTS

In all, 193 child homicide autopsies were identified. There were 38 (19.7%), 82 (42.5%), 25 (13.0%), and 48 (24.9%) homicide victims aged under 1, 1-5, 6-12, and 13-17 years, respectively. One-hundred boys (mean age: 8.4±7.0) and 93 girls (mean age: 3.7±4.3) were included. A female predominance was noted among the victims aged 0-5. Blunt force (53.4%) was the most frequent method of injury, followed by suffocation/strangulation (20.2%) and sharp force (13.0%). Bruise (64.8%) and brain injury (45.1%) were the most common types of injuries. The cranium (62.2%) and face (60.6%) were the most frequently injured body regions. The distribution of fatal injuries varied among victims in different age groups. Neurogenic shock, asphyxia, and hemorrhagic shocks were most common in victims aged 0-5, 6-12, and 13-17, respectively. The most frequent causes of death included blunt force head injury (40.4%), suffocation/strangulation (20.2%), and sharp force lung trauma (7.3%). The type of offenders, injury methods, types of injuries, distribution of injuries, mechanism of death, and causes of death were significantly different among victims of different age groups. Eighteen (9.33%) victims displayed no external evidence of trauma.

CONCLUSIONS

The patterns of injuries, mechanism of death, and causes of death were different among victims of different age groups. A female predominance was noted among the victims aged 0-5. Complete forensic autopsy is necessary to identify child homicide. This report will help forensic examiners and forensic pathologists recognize the signs of child homicide and serve as a working basis for these professionals.

A retrospective study of murder-suicide at the Forensic Institute of Ghent University, Belgium: 1935-2010

Murder followed by suicide (M-S) is a rare phenomenon that has been studied in several countries. Previous studies show that offenders of M-S are predominately men who live in an intimate relationship. Amorous jealousy is often the trigger to commit M-S. Shooting is the most common way to kill a partner and/or children. In general, women are likely to become victims. The aim of this study was to identify M-S and detect patterns of M-S in the district of Ghent and the surrounding areas, since no research on this event was conducted in Belgium. Over a period of 75 years, a total of 80 M-S incidents was recorded involving 176 individuals. Eighty-six percent of the offenders were males and 14% were females. Murder-suicides were mostly completed with firearms. The main motive for offenders to execute M-S is amorous jealousy (56%), followed by familial, financial, or social stressors (27%). In addition, three types of M-S were selected (e.g., spousal murder-suicides, filicide-suicides, and familicides-suicides). Our results suggest differences in these types of M-S in which younger couples' intentions were amorous jealousy; as for older couples the prominent motive was mercy killing; most likely women killed their children and only men committed familicides. Finally a study of the evolution during this period was carried out.

Homicide-suicide in Ghana: perpetrators, victims, and incidence characteristics

Homicide-suicide in the industrialized West has been studied for many years. Yet, only limited scholarly research currently exists on the subject in Africa and other non-Western societies. The aim of the present descriptive study was to investigate homicide-suicides in contemporary Ghana. A content analysis of homicide-suicide reports in a major Ghanaian daily newspaper during 1990 to 2009 was conducted. The results overwhelmingly support findings in the literature, suggesting that homicide-suicides are extremely rare events in Ghana. The overwhelming majority of reported homicide-suicides were committed by males, with females substantially more likely to be the homicide victims. The offenders and victims were generally of low socioeconomic status. Most homicide-suicides involved victims and offenders who were intimately acquainted as family members. The majority of cases involved men who killed their wives on suspicion of infidelity; the next largest category involved men who murdered wives who threatened divorce or separation. The principal homicide and suicide methods were shooting with firearms, hacking with machetes, and stabbing with knives. The findings of the study are discussed in relation to Ghana's patriarchal family system and ideology and present socioeconomic issues in the country. This study recommends further research on this subject in Ghana and other African countries. This is necessary to further an understanding of homicide-suicide as a phenomenon, as well as a necessary prelude to the development and implementation of effective preventive programs.

Fatal intimate partner violence against women in Portugal: a forensic medical national study

Intimate partner violence (IPV) is an important cause of women's health and socio-familial severe problems, the most extreme being the victims' homicide. This is the first nationwide Portuguese autopsy-based and judicial-proven study about female intimate partner homicide. At least 62 women over 15 years old were killed by current or former men-intimate partners, corresponding to an IPV-related female mortality rate of 0.44/100.000 women; intimate partner violence was the reason of homicide in 60.8% of all autopsied women. The typical Portuguese victim showed to be a young adult woman, employed, killed by a current husband in a long-term relationship, usually with children in common and with a history of previous IPV. The typical Portuguese perpetrator showed to be older than the victim, employed, owning a firearm and without criminal records. At the time of the fatal event 59.7% of the relationships were current. In 57.9% of the former relationships women were killed during the 1st year after its terminus. Near half of the perpetrators attempted or committed suicide afterward. Most women were killed by gunshot wounds (45.2%), especially in the thorax (48.4%), with multiple fatal injuries; 56.5% also presented non-fatal injuries. The detection of prior IPV and the risk evaluation seems to be fundamental to decrease these fatal outcomes, but also, the prevention of perpetrators' alcohol abuse and carrying weapons. This work emphasizes the need to deepen the research on this issue, aiming to contribute to prevent both fatal and non-fatal IPV-related cases.

Murder followed by suicide: filicide-suicide mothers in Italy from 1992 to 2010

The international literature shows that in 40-50% of the cases, homicides-suicides involving children under the age of 10 are committed by mothers. Here, we report some results on homicides-suicides, in the mother-child relationship, occurred in Italy between 1992 and 2010. We examined 36 cases of filicide-suicide mothers by consulting the archives of RAI, daily newspapers, and the ANSA news agency. We focused on: mothers and children's age, place of residence, date and place of the murder, number and sex of the murdered children, and modality of the homicide-suicide. At the time of the homicide-suicide, the average age of mothers was 35.4. The number of children killed by each mother was one, except in seven cases. All the women had underestimated psychopathological disorders and only six women were regularly treated. The dynamics and characteristics of the events were much more similar to suicides than homicides, so we can consider them as "extensive suicides."

Internet comments elicited by media portrayal of a familicide-suicide case

BACKGROUND

Events of extraordinary violence attract media attention. Recently, much media reporting has moved to the Internet, giving readers the possibility to comment online.

AIMS

To analyze the content of public cognitions and the emotional tonality of attitudes expressed in spontaneous Internet comments on a familicide-suicide case reported in the Estonian media.

METHODS

A content analysis is based on the comments of 6,333 readers following media coverage. Descriptive statistics were used for quantitative data analysis.

RESULTS

Of all comments, 27.6% were without manifest content. Manifest content categories were "value judgments" (35.2%), "risk and protective factors" (27.2%), and "critics of media portrayal" (10.0%). As to emotional tonality, the comments were most often angry (34.5%), ironic (24.7%), or neutral (23.3%). "Critics of media portrayal" had the most clearly pronounced emotional tonality, the majority being angry or approving. Comments about "value judgments" were most frequently anguished.

CONCLUSIONS

An analysis of Internet comments can provide valuable information about value judgments and attitudes in society. From an ethical and preventive perspective, similar homicide and suicide stories should not be open for unmoderated public discussion. Nevertheless, the study represents an original methodological approach for such research and also provides some guidance for public relations campaigns.

Murder-suicide in the province of Milan, Italy: criminological analysis of cases 1990-2009

Murder-suicide is a relatively rare event, and familicide is rarer still. However, it is certainly not unknown, and has been described in the scientific literature from both a socio-criminological and pathological-forensic perspective since the last century. In a civilized urban area such as Milan and province, where there is a general reduction in the homicide rate, homicide-suicide occurs almost exclusively within the family, and has specific features that differentiate it from other types of homicide, whether connected with general criminality or organized crime. This article analyses the quantitative and qualitative features of cases of homicide-suicide occurring in Milan and province between 1990 and 2009 (20 years), considering temporal aspects and the development of the events, the weapons used, and the epidemiological and psychopathological features of the perpetrators and their victims.

Suicidal and violent behaviour in mood disorders: A major public health problem. A review for the clinician

Abstract Suicide attempt, and particularly completed suicide are relatively rare events in the community, but they are very common among psychiatric patients. Since over 90% of suicide victims suffer from (mostly untreated) current major mental disorders (particularly from major depressive episode), psychiatric risk factors are the clinically most useful predictors, especially if psychosocial and demographic risk factors are also pesent. Violent behaviours associated with mood disorders constitute a related yet independently also important aspect of this illness, and assessment and management of violence is a key component of everyday psychiatric practice. While most people with current mental disorder are not violent, violence is more common among seriously mentally ill individuals than in healthy persons. This is particularly true for untreated schizophrenics and untreated patients with major mood disorders, first of all in the cases of comorbid substance use disorders, mainly among those with current mania or postpartum depression. Although specific clinical studies are lacking, it is very lilely that successful acute and long-tem treatment of mood disorders can reduce the risk of violent behaviour in this patient population.

Homicide-suicide in Durban, South Africa

This study investigated homicide-suicide in Durban, South Africa, for the years 2000 to 2001. The incidence was 0.89 per 100,000, higher than the international average. A majority of perpetrators (91%) and victims (87%) were Black African, proportional to their representation in the population. Perpetrators were typically men (in 95% of cases), older than, and intimate partners (in 75% of cases) of the female victims (in 100% of cases). Average ages of perpetrators and victims were 32 and 27, respectively. The security sector was overrepresented as an employment category for perpetrators. A firearm was used in 87% of the homicides and 80% of the suicides. The individuals involved in homicide-suicides in Durban are similar to homicide-suicide perpetrators and victims in industrialized countries. The fact that homicide-suicides in South Africa, as in most countries, involve almost exclusively men killing female intimates confirms the importance of examining and challenging social norms enabling male violence against women.

Homicide followed by suicide: a comparison with homicide and suicide

Homicide-suicides are a rare yet very serious form of lethal violence which mainly occurs in partnerships and families. The extent to which homicide-suicide can be understood as being primarily a homicide or a suicide event, or rather a category of its own is examined. In total, 103 homicide-suicides were compared to 3,203 homicides and 17,751 suicides. These are all events that took place in the Netherlands in the period 1992 to 2006. Logistic regression analyses show that homicide-suicides significantly differ from both homicides and suicides with regard to sociodemographic and event characteristics. The findings suggest that homicide-suicide might be considered as a distinct phenomenon from both homicide and suicide.

Domestic homicide followed by parasuicide: a comparison with homicide and parasuicide

Homicide-suicides are a rare yet very serious form of interpersonal violence that occur mainly in partnerships and families. As both perpetrator and victim die in a homicide- suicide, data sources in previous studies typically lack detailed information. This study overcomes this limitation by making use of homicides followed by a suicide attempt of the perpetrator (homicide-parasuicides). The authors examine to what extent these homicide-parasuicides can be understood as being primarily an expression of homicidal or of suicidal behavior. In total, 77 homicide-parasuicides are compared to 430 homicides and 161 parasuicides. The results show that homicide-parasuicides constitute a different category of lethal violence with regard to demographic, individual, and event-related characteristics. Subanalyses of homicide-parasuicides involving women and children reveal similar differences. The finding that a large majority of the perpetrators were mentally ill, dependent on the victim, and killed when faced with separation from the victim may suggest that increased monitoring of this group might have preventive value.

An empirical study of characteristics and types of homicide-suicides in Hong Kong, 1989-2005

BACKGROUND

Clinical classification of types of homicide-suicide (HS) was proposed, but no information on empirical-based classification and prevalence of different types of HS was available. This paper aimed to empirically classify HS events into different clusters and to discuss specific evidence-based prevention initiatives.

METHOD

Data of HS offenders from Coroner's Court were analyzed through a two-step cluster analysis. Number of clusters and appropriate allocations of cases were obtained. External background variables were tested through post hoc tests to explore the differences among clusters.

RESULTS

Two hundred and thirty-one people died in 98 episodes in the study period (1989-2005). The majority of HS offenders were male (n=68, 68.7%) and aged 30-49 (n=62, 62.6%). Domestic killing was the major type of HS in which over 60% of the homicide motivation was related to spousal conflicts or altruistic reasons. Spouses (n=46, 46.5%) and children (n=47, 47.5%) were predominantly the victims. The common killing methods included chopping with weapons (n=33, 33.3%) and charcoal burning (n=22, 22.2%). Six clusters of HS were derived from the cluster analysis and were further reduced to four major classes. Four major classes were dispute, conflicts in a relationship, altruistic, and mental illness. These classes could be differentiated by methods of homicide and suicide, gender of perpetrator, relationship with victim, and indebtedness.

CONCLUSIONS

Financial problem, dispute and domestic violence are significant precipitants of HS in Hong Kong. Those people associated with the precipitating factors should be the targets for intervention and prevention.

Characteristics of perpetrators in homicide-followed-by-suicide incidents: National Violent Death Reporting System--17 US States, 2003-2005

Homicide-followed-by-suicide (referred to as "homicide-suicide") incidents are rare events but can have a profound impact on families and communities. A better understanding of perpetrator characteristics and how they compare with those of other homicide suspects and suicide decedents might provide insight into the nature of these violent acts. This report is based on 2003-2005 data from 17 US states participating in the National Violent Death Reporting System, a unique, incident-based, active surveillance system that integrates data on violent deaths from multiple sources. Of the 408 homicide-suicide incidents identified, most incidents were committed with a firearm (88.2%) and perpetrated by males (91.4%), those over 19 years of age (97.6%), and those of white race (77.0%); however, just over half of filicide (killing of children)-suicides (51.5%) were perpetrated by females. Over 55% of male homicide-suicide perpetrators versus 26.4% of other male suicide decedents had prior intimate partner conflicts (P < 0.001). In fact, having a history of intimate partner conflicts was even common among homicide-suicide perpetrators who did not victimize their intimate partners. Recognition of the link between intimate partner conflicts and homicide-suicide incidents and strategies involving collaboration among the court/legal and mental health systems might prevent these incidents.

Homicide-suicide (dyadic death), homicide, and firearms use in England and Wales

Homicide-suicide forms a distinct form of homicide. An analysis of cases in the Yorkshire and Humberside region of England between 1991 and 2005 revealed 37 episodes with 42 victims. Previous studies have shown a high rate of use of firearms. Over the last 2 decades firearms legislation has become more restrictive. In this study all assailants were male, mean age 46.8 years. The commonest method of homicide was strangulation (36%) with 16% killed by firearms. This is a reduction compared with a previous study in the same region. All killers who shot their victims killed themselves with firearms. There were no multiple killings with firearms in this study and no stranger killings. Hanging was the commonest method of suicide. During the same period the use of firearms as a method of homicide increased in England and Wales with handguns, the most common weapon. Nationally, suicide after homicide has remained at a similar rate over the half century and is an uncommon phenomenon. Firearms use remains low in both homicide and homicide-suicide episodes in England, and further analysis is required to determine changes in patterns of killing.

Homicide–suicide—An event hard to prevent and separate from homicide or suicide

Suicide preceded by homicide is a rare but tragic event that often shocks the whole community. Annual rates show considerable variation, though not as great as the incidence of homicides. Within the industrialized nations, Finland's prevalence rates for homicide-suicide have been mid-range. The National Suicide Prevention Project recorded and carefully analysed all suicides committed in Finland during a 12-month period. In this material of almost 1400 suicides, 10 verified homicide-suicide cases were found. The perpetrator was male in all but one case, and all the victims were family, 9/10 being spouses and/or children. The most typical homicide-suicide seemed to be a man shooting a family member during a separation process. No perpetrator was found suffering from a psychotic disorder but three had major depression. The homicide-suicides were compared with the suicides and statistically significant differences emerged in two variables: shooting was more often the method used in the homicide-suicide cases, which, furthermore, were more likely to involve a divorce or recent rupture in another long-term intimate relationship. Sharing few common variables with either homicide or suicide, homicide-suicide appears to be a distinct phenomenon whose prevention would seem to be extremely difficult on the individual level. Since shooting is the most common method of homicide-suicide, firearm licenses should be more restricted.

Suicide terrorists: are they suicidal?

Are suicide terrorists suicidal? A review of the worldwide literature on suicide terrorism uncovered five published empirical studies describing data collected from potential suicide terrorists or the surviving friends and families of deceased terrorists. The many discrepancies uncovered between suicide terrorists and other suicides on key factors known to underpin suicidality, suggest that such terrorists are not truly suicidal and should not be viewed as a subgroup of the general suicide population. Nonetheless, methods developed by suicidologists, such as the psychological autopsy, will help increase our understanding of the individual and group factors that underpin suicide terrorism.

Characteristics of homicide followed by suicide incidents in multiple states, 2003-04

OBJECTIVE

To calculate the prevalence of homicide followed by suicide (homicide/suicide) and provide contextual information on the incidents and demographic information about the individuals involved using data from a surveillance system that is uniquely equipped to study homicide/suicide.

METHODS

Data are from the National Violent Death Reporting System (NVDRS). This active state-based surveillance system includes data from seven states for 2003 and 13 states for 2004. The incident-level structure facilitates identification of homicide/suicide incidents.

RESULTS

Within participating states, 65 homicide/suicide incidents (homicide rate = 0.230/100,000) occurred in 2003 and 144 incidents (homicide rate = 0.238/100,000) occurred in 2004. Most victims (58%) were a current or former intimate partner of the perpetrator. Among all male perpetrators of intimate partner homicide 30.6% were also suicides. A substantial proportion of the victims (13.7%) were the children of the perpetrator. Overall, most victims (74.6%) were female and most perpetrators were male (91.9%). A recent history of legal problems (25.3%), or financial problems (9.3%) was common among the perpetrators.

CONCLUSIONS

The results support earlier research documenting the importance of intimate partner violence (IPV) and situational stressors on homicide/suicide. These results suggest that efforts to provide assistance to families in crisis and enhance the safety of IPV victims are needed to reduce risk for homicide/suicide. The consistency of the results from the NVDRS with those from past studies and the comprehensive information available in the NVDRS highlight the promise of this system for studying homicide/suicide incidents and for evaluating the impact of prevention policies and programs.

Mentally abnormal homicide in New Zealand as defined by legal and clinical criteria: a national study

BACKGROUND

Homicides by people with mental illness have been studied using either clinical or legal categorization of the homicide as abnormal. No previous study has employed both definitions in the same population.

METHOD

A retrospective study of all homicides in New Zealand between 1988 and 2000 considered mentally abnormal homicide using a legal definition (when the courts deemed a contribution of mental illness was present) and a clinical definition (defined as the presence of a discharge diagnosis from inpatient mental health treatment) of 'mentally abnormal'. Rates, characteristics and time trends were investigated.

RESULTS

Of the 844 cases, 7.1% met legal criteria for being mentally abnormal, while 7.7% had ever received a diagnosis for a psychotic illness, and a further 14.5% had been admitted to a psychiatric hospital for any other reason. The majority (60%) of perpetrators with a psychotic diagnosis received a mental health disposition from the court. Of these, 60% were first diagnosed with their psychotic illness prior to the homicide, while 28% were first diagnosed at the time of the offence and a further 12% after imprisonment. Of all those who received a psychotic diagnosis, 89% had post-conviction admissions or a mental health disposition.

CONCLUSION

Legal and clinical definitions of mentally abnormal homicide detect similar rates of mentally abnormal homicide, but illustrate somewhat different dimensions of the relationship between mental illness and homicide.

Epidemiology of Homicide-Suicide Events

In Oklahoma, all nonnatural deaths must be reported to the Office of the Chief Medical Examiner (ME), whose trained investigators report cause of death using a centralized, statewide, standardized reporting system. The purpose of this study was to determine temporal trends of Oklahoma homicide-suicide events and characterize the epidemiology of these events. By reviewing all ME reports of homicides and suicides from 1994 through 2001, we identified 73 homicide-suicide events resulting in 73 suicides and 89 homicides. Suicidal perpetrators of homicide-suicide events were most often white men aged >or=30 years who killed a current or ex-spouse or intimate partner. Homicide victims tended to be younger women the same race as their killer. Firearms were the predominant method of death in both homicides and suicides, with handguns used most frequently. Divorce/estrangement was the main contributing factor to these events, and the most common relationship type was possessive. The existence of a statewide, centralized, and computerized ME system and the ability to access the detailed information in the ME narratives were critical to identifying homicide-suicide events and obtaining the type of detailed information necessary to fully investigate these events.

Differential suicide rates in typologies of child sex offenders in a 6-year consecutive cohort of male suicides

Earlier research identified 3 typologies of Child Sex Offenders [CSO] with high rates of suicide. To test this finding suicide rates of 3 types of CSO were compared in a 6-year cohort of regional suicides. All male suicides were identified from Coroners" inquest files and CSO data drawn from police records to calculate CSO suicide rates. The results show that suicide in "Multi-criminal" CSO is 12 times higher than the general population but not statistically significantly. Two significant results were "Sex Only" CSO suicides were 183 times the general population and 15 times the Multi-criminal CSO rates, with no suicides amongst the Violent CSO's. Implications for suicide prevention and child protection are presented.

Homicide–suicide in Hong Kong, 1989–1998

This study provides the first systematic research of homicide-suicide (HS) in a Chinese society. Data were drawn from the HK Homicide Monitoring Data-base computer file derived from investigation and death reports held by the HK Police Force and the Coroner's Court. During the 10-year study period, 56 events involving 133 deaths were identified. The majority of offenders were males (75%) and most victims were female (64%). The mean age of offenders and victims were 41.9 and 32.3 years, respectively. Spouses and lovers comprised the majority of victims (46.4%) followed by child victims (36%). Most HS events were motivated by separation or termination of marital or sexual relations (39%), economic reasons (25%) and other domestic disputes (20%). The most frequent modes of killing were strangulation/suffocation (26%), stabbing/chopping (24%), followed by gassing/poisoning (14%) and falling from height (14%). The commonest of suicide was falling from height (48%). It was followed by gassing/poisoning (22%) and strangulation/suffocation (13%). Depression (18.3%) was found to be the commonest mental disorder. Most offenders were from low-socio-economic background. Two-third were unemployed and 76.6% had 9 or less years of education. HS in HK were distinguished from those reported in the western literature in respect to the high relevance of economic factors, the absence of mercy killing between old couples, a higher percentage of pedicide-suicides and the infrequent use of firearms.