Men, Masculinities, and Murder-Suicide

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.

The specifics of homicide-suicide in France

BACKGROUND

Homicide and suicide are two causes of violent death. This study focuses on situations in which these two types of violent death occur at the same time, known as homicide-suicide.

AIM

The aim of this study is to review the circumstances surrounding homicide-suicides as well as the features of the victims and perpetrators in France at a recent period. The article characterizes homicide-suicides by comparing them with simple homicides in order to determine whether they exhibit distinctive characteristics and significant links.

METHODOLOGY

The data analyzed are based on detailed police operational information collected about 1622 homicides that occurred in France in 2019 and 2020. After presenting the characteristics of all homicide-suicides, this article specifically compares those that take place within the family, whether they result in the suicide of the perpetrator or not, using bivariate tests (chi-square). The tests are based on a distinction between domestic homicide-suicides within a couple and between other family members.

RESULTS

Analysis shows that 7 % of them were followed by the suicide of the perpetrator (203 cases). Almost all of them take place within family (91 %), and most often within the couple (60 %). Apart from couple configurations, familial homicide-suicides target the children (21 %) or parents (5 %) of the perpetrators. The perpetrators are mainly men, while most of the victims are women. Analysis revealed significant links between certain variables and suicide (or attempted suicide by the alleged perpetrator) in the context of couple homicide: the modus operandi, the spatio-temporal setting, the gender and average age of the victim and history of domestic violence suffered by the victim, as well as all the variables relating to the alleged perpetrator (age, gender, police and psychiatric history, alcohol consumption, etc.). Among other family members, these variables do not have a significant influence on whether the perpetrator commits suicide following the homicide. Perpetrators of domestic homicide-suicides are less likely to be under the influence of alcohol (8 %), to be known to the police (19 %), and to have a psychiatric history (11 %) than those who do not commit suicide following the homicide (respectively 41 %, 54 %, 22 %). There is also less record of domestic violence when the perpetrator commits suicide (20 %) than when they do not (48 %).

CONCLUSIONS

Homicide-suicides are to some extent similar to simple couple homicides. Women are therefore overrepresented among domestic homicide victims; likewise, they are also overrepresented among the victims of homicide-suicides, which are mostly committed in family circumstances. The most significant risk factors are the presence of firearms in the household and history of domestic violence within the couple.

RECOMMENDATIONS

The results suggest two areas for action: the screening (interpersonal conflicts, alcohol, depression, domestic violence, presence of a firearm) and the prevention of intra-family homicides. Prevention should focus on screening specific elements: the presence of a firearm, domestic violence, interpersonal conflicts, depression, and alcohol. Prevention could also take place with elderly people at the end of their lives.

Linking suicide and social determinants of health in South Korea: An investigation of structural determinants

Introduction

Studies have shown that suicide is closely related to various social factors. However, due to the restriction in the data scale, our understanding of these social factors is still limited. We propose a conceptual framework for understanding social determinants of suicide at the national level and investigate the relationships between structural determinants (i.e., gender, employment statuses, and occupation) and suicide outcomes (i.e., types of suicide, places of suicide, suicide methods, and warning signs) in South Korea.

Methods

We linked a national-level suicide registry from the Korea Psychological Autopsy Center with the Social Determinants of Health framework proposed by the World Health Organization's Commission on Social Determinants of Health.

Results

First, male and female suicide victims have clear differences in their typical suicide methods (fire vs. drug overdose), primary warning signs (verbal vs. mood), and places of death (suburb vs. home). Second, employees accounted for the largest proportion of murder-suicides (>30%). The proportion of students was much higher for joint suicides than for individual suicides and murder-suicides. Third, among individuals choosing pesticides as their suicide method, over 50% were primary workers. In terms of drug overdoses, professionals and laborers accounted for the largest percentage; the former also constituted the largest proportion in the method of jumping from heights.

Conclusion

A clear connection exists between the investigated structural factors and various suicide outcomes, with gender, social class, and occupation all impacting suicide.

Risk Factors for Intimate Partner Femicide-Suicide in Italy: An Ecological Approach

The present study investigated the intimate partner femicide (IPF) and intimate partner femicide-suicide (IPFS) perpetrators' individual, relational, and contextual characteristics by analyzing, within the ecological approach, femicide cases that occurred in Italy from 2010 to 2019. On the topic, to date, scant studies examined possible differences between IPF and IPFS risk factors, and no studies have analyzed these factors by adopting an ecological systems model perspective. To this aim, archival research was carried out. Of a total of 1.207 femicides, 409 were IPF, and 227 were IPFS. Perpetrators' age, level of employment, law enforcement membership, mental and/or physical illnesses, use of psychoactive substances, previous crimes, previous violent relationships, presence of children, previous violence in the couple, inability to accept the end of the relationship, quarrels and conflict, jealousy and the psychophysical illnesses of both authors and victims, as well as the use of firearms and victim's request for help were analyzed. The results underlined the existence of different risk factors contributing to the IPF perpetrators' decision to commit suicide such as perpetrators' age, law enforcement membership, and firearm availability. These findings stress the need for specific risk assessment and management strategies for IPFS perpetrators.

Familicide in Italy: An Exploratory Study of Cases Involving Male Perpetrators (1992-2015)

This article adds to the literature on familicide by providing specific insights from the Italian experience. It presents results of an exploratory investigation into male-perpetrated familicides in Italy between 1992 and 2015. Familicide is defined as the killing of the spouse or intimate partner, and at least one child, at the hand of the other spouse/partner. Incidents of familicide were collated from newspaper reports. We identified 90 cases, resulting in 207 deaths. On average, perpetrators were middle aged (M = 46.8; age ranging from 25 to 76), and most (n = 66; 73%) committed, or attempted to commit, suicide. While significant contributory roles were played by health problems and financial worries, the origin of the primary emotional upset for the killers tended to be interpersonal conflicts involving their partners. For those cases with available information (n = 56; 62%), six types of familicide were also identified on the basis of the murderer's homicidal motivations. Most frequent were three circumstances. Fifteen cases concerned the "doubly-protective familicide" (which corresponds to the "suicide-by-proxy"), characterized by the preservation of the family in the face of a presumed catastrophic event. Triggers included the killer's financial distress, health troubles, or anxiety associated with other personal problems. Thirteen cases referred to "doubly-punitive familicide," whose distinctive feature, in addition to punishing the partner because of her estrangement, her infidelity, or other disputes, is to directly involve the child(ren) in the punitive homicidal act. The children are viewed as contributory factors to the killer's stress, or are considered to be in league with the mother. Twelve cases exemplified "indirectly-punitive familicide" (also termed "murder-by-proxy"), in which the victimized child(ren) are killed as an extension of the partner. Overall, this typology provides a more nuanced conceptualization of familicide occurrences than those examined in previous research.

Murder-Suicides Perpetrated by Adolescents: Findings from the National Violent Death Reporting System

OBJECTIVE

Murder-suicide is a rare and especially tragic form of violence. Nascent literature has characterized murder-suicide perpetrated by adults, but no study has focused on adolescents who perpetrated murder-suicide.

METHOD

This study evaluated all cases of murder-suicide perpetrated by persons under age 21 who were included in the National Violent Death Reporting System, and categorized each incident using Joiner's perversion of virtue framework of murder-suicide.

RESULTS

Forty-seven incidents of murder-suicide perpetrated by adolescents were identified, representing 56 victims. Most cases did not have sufficient information to be categorized within a particular perversion of virtue. Among the 20 cases who did have sufficient detail to be categorized, incidents were identified as perversions of self-control (n = 11), justice (n = 8), and mercy (n = 1). Most perpetrators were male, and the majority of victims were female. Additional victim, perpetrator, and incident characteristics are described.

CONCLUSIONS

Our findings extend previous work by employing a coding system based on a theoretically derived framework for categorizing "genuine" murder-suicide and related behavior among adolescents. This study also characterized the nature of this complex and tragic sequence of behavior among adolescents, who are at elevated risk of suicide, and who may benefit from prevention efforts that effectively address means safety, suicidality, and intimate partner violence.

Is familicide a distinct subtype of mass murder? Evidence from a Swiss national cohort

BACKGROUND

Familicide is defined as the killing of a whole family and, numerically, a form of "mass murder" (more-or-less three simultaneous killings). Switzerland has a lower rate of homicide than most other countries but a comparatively high share of homicides within the family.

AIM

The aim of this study is to describe a complete national sample of familicides and compare them with other types of mass murders in the country over the same period.

METHODS

All cases of three or more unlawful homicides in one event in Switzerland between 1972 and 2015 were identified from court records and socio-demographic, criminological, and psychological variables were extracted. Given small numbers, we rely on narrative comparisons.

RESULTS

There were 20 familicides in the 43-year study, with 82 victims between them as well as six felony-associated mass murders accounting for 19 victims and nine public mass murders with 44 victims. Only one familicide was a woman; mean age was 39.5 years (range 19-57 years). Most were in employment. Only four had a prior psychiatric history. Nine had a history of violent or intrusive behaviour, but a prior criminal conviction was rare. In all but one case there was evidence of psychosocial stressors; eight men were facing separation from a spouse. Just over half used guns, but only three used army weapons. The main difference between the familicides and the other mass killers was the much higher rate of suicide among the familicides.

CONCLUSIONS

Familicides in Switzerland appear to be rare suicidal acts, generally carried out by previously successful and apparently stable middle-aged men with often an inconspicuous psychiatric history or criminal record, differing considerably from other groups of mass killers. Expert responses, like the recently established multidisciplinary "threat management boards" in Switzerland, should bear in mind that the likely competent men involved may be good at covering their intent even from themselves.

Meaning-Centered Men's Groups: Initial Findings of an Intervention to Enhance Resiliency and Reduce Suicide Risk in Men Facing Retirement

Objectives: To assess the preliminary effectiveness of Meaning-Centered Men's Groups (MCMG), a 12-session existentially-oriented, community-based, psychological group intervention designed to enhance psychological resiliency and prevent the onset or exacerbation of suicide ideation among men who are concerned about or struggling with the transition to retirement.Methods: We recruited 30 men (n= 10 per group), 55 years and older (M= 63.7, SD= 4.1) from community settings to participate in a course of MCMG to be delivered in a community center. Participants completed eligibility, pre-, mid-, and post-group assessments of suicide ideation and psychological risk and resiliency factors.Results: Participants experienced significant increases in attitudinal sources of meaning in life, psychological well-being, life satisfaction, retirement satisfaction, and general health, and decreases in depression, hopelessness, loneliness, and suicide ideation.Conclusions: Preliminary findings suggest that MCMG is a novel men's mental health intervention that may help to enhance psychological well-being and potentially reduce the severity or prevent the onset of symptoms of depression, hopelessness, and suicide ideation.Clinical Implications: Upstream psychological interventions may serve an important role in mental health promotion and suicide prevention with potentially vulnerable individuals facing challenging life transitions.

Association between different stages of precollege school bullying and murder-related psychological behaviors among college students in Anhui Province, China

Little is known about the relationship between precollege school bullying and murder-related psychological behaviors. The present study aims to examine that relationship in Chinese college students using a cross-sectional study. Self-report data were collected from 4034 college students in Anhui Province using a proportional stratified cluster sampling method. Four types of school bullying (i.e., physical, verbal, relational, and cyber) with bullies and victims and two periods (i.e., primary and secondary) were measured. The prevalence rates of murderous ideation, plans, preparation, and attempts were 6.9%, 2.5%, 1.8%, 1.4%, respectively. Different stages of precollege cyber bullying were associated with murder-related psychological behaviors for both bullies (primary: AORs = 2.78 to 15.67; secondary: AORs = 2.43 to 9.99; both periods: AORs = 2.26 to 14.04) and victims (primary: AORs = 2.87 to 16.57; secondary: AORs = 1.89 to 4.49; both periods: AORs = 3.68 to 21.48). A dose-response relationship was found, such that college students with a bullying perpetration index of two types and more were more likely to have murder-related psychological behaviors than those who were not bullied. Notably, both primary and secondary school bullying, especially cyber forms, were more likely to be associated with murder-related psychological behaviors. Therefore, it is necessary to develop school bullying preventive measures beginning in primary school.

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.

Suicide in the Elderly: A Multidisciplinary Approach to Prevention

Suicide in the elderly is a growing problem. The elderly population is increasing, and elderly patients have multiple issues that place them at higher risk of suicidality. These issues include physical illnesses, mental illness, loss of functional status, isolation, and family, financial, and social factors. Access to firearms is another significant risk factor, because elderly patients are more likely to use firearms in suicide attempts; interventions to reduce firearms mortality may save lives. Tackling the difficult problem of suicide in the elderly may require a multidisciplinary, community-based series of interventions.

"Do You Want to Go Forward or Do You Want to Go Under?" Men's Mental Health in and Out of Prison

More than 11 million people are currently imprisoned worldwide, with the vast majority of incarcerated individuals being male. Hypermasculine environments in prison are often tied to men’s health risks, and gathering information about mental health is fundamental to improving prison as well as community services. The purpose of the current study was to describe the connections between masculinities and men’s mental health among prisoners transitioning into and out of a Canadian federal correctional facility. Two focus groups were conducted with a total of 18 men who had recently been released from a federal correctional facility. The focus group interviews were analyzed to inductively derive patterns pertaining to men’s mental health challenges and resiliencies “on the inside” and “on the outside.” Participant’s challenges in prison related to heightened stresses associated with being incarcerated and the negative impact on preexisting mental illness including imposed changes to treatment regimens. Men’s resiliencies included relinquishing aggression and connecting to learn from other men “on the inside.” Mental health challenges “on the outside” included a lack of work skills and finances which increased the barriers that many men experienced when trying to access community-based mental health services. Mental health resiliencies employed by participants “on the outside” included self-monitoring and management to reduce negative thoughts, avoiding substance use and attaining adequate exercise and sleep. The current study findings offer practice and policy guidance to advance the well-being of this vulnerable subgroup of men in as well as out of prison.

Male suicide among construction workers in Australia: a qualitative analysis of the major stressors precipitating death

Background

Suicide rates among those employed in male-dominated professions such as construction are elevated compared to other occupational groups. Thus far, past research has been mainly quantitative and has been unable to identify the complex range of risk and protective factors that surround these suicides.

Methods

We used a national coronial database to qualitatively study work and non-work related influences on male suicide occurring in construction workers in Australia. We randomly selected 34 cases according to specific sampling framework. Thematic analysis was used to develop a coding structure on the basis of pre-existing theories in job stress research.

Results

The following themes were established on the basis of mutual consensus: mental health issues prior to death, transient working experiences (i.e., the inability to obtain steady employment), workplace injury and chronic illness, work colleagues as a source of social support, financial and legal problems, relationship breakdown and child custody issues, and substance abuse.

Conclusion

Work and non-work factors were often interrelated pressures prior to death. Suicide prevention for construction workers needs to take a systematic approach, addressing work-level factors as well as helping those at-risk of suicide

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4500-8) contains supplementary material, which is available to authorized users.

School shootings during 2013-2015 in the USA

BACKGROUND

Data on the factors associated with school shootings in the USA are limited. The public conversation has often suggested several factors that may be linked to these events, however with little empirical support. Aiming to fill this gap, we describe the characteristics of school shooting incidents in the USA between 2013 and 2015 and explore whether four factors that represent domains of firearm policy, educational policy and epidemiological risk factors for intentional firearm injuries-background check (BC) policies, per capita mental health expenditures (MHE), K-12 education expenditure (KEE) and urbanicity-were associated with school shootings during this period.

METHODS

We searched LexisNexis, a newspaper and broadcast media databases for school shooting incidents from 1 January 2013 to 31 December 2015. Presence of BC laws was extracted from legal information in LexisNexis. State-level covariates of per capita MHE (2013), KEE (2013) and urbanicity (2010) rates were obtained from publicly available data sources. We used negative binomial regression models accounting for clustering by state to explore unadjusted associations between the BC laws, state-level covariates and school shootings to report IRR and 95% CI.

RESULTS

We documented 154 school shootings (35, 55 and 64 each year). In unadjusted models, BC for firearm purchase (IRR=0.55, 95% CI 0.39 to 0.76), ammunition purchase (IRR=0.11, 95% CI 0.05 to 0.27), log per capita MHE (IRR=0.58, 95% CI 0.37 to 0.90), log per-capita KEE (IRR=0.09, 9% CI 0.02 to 0.29) and urbanicity (IRR=0.97, 95% CI 0.96 to 0.99) were associated with school shooting.

CONCLUSIONS

School shootings are less likely in states with BC laws, higher MHE and KEE, and with greater per cent urban population.

Understanding Homicide-Suicide

Homicide-suicide is the phenomenon in which an individual kills 1 or more people and commits suicide. Research on homicide-suicide has been hampered by a lack of an accepted classification scheme and reliance on media reports. Mass murder-suicide is gaining increasing attention particularly in the United States. This article reviews the research and literature on homicide-suicide, proposing a standard classification scheme. Preventive methods are discussed and sociocultural factors explored. For a more accurate and complete understanding of homicide-suicide, it is argued that future research should use the full psychological autopsy approach, to include collateral interviews.

Stigma in Male Depression and Suicide: A Canadian Sex Comparison Study

Stigma in men's depression and suicide can restrict help-seeking, reduce treatment compliance and deter individuals from confiding in friends and family. In this article we report sex comparison findings from a national survey of English-speaking adult Canadians about stigmatized beliefs concerning male depression and suicide. Among respondents without direct experience of depression or suicide (n = 541) more than a third endorsed the view that men with depression are unpredictable. Overall, a greater proportion of males endorsed stigmatizing views about male depression compared to female respondents. A greater proportion of female respondents endorsed items indicating that men who suicide are disconnected, lost and lonely. Male and female respondents with direct personal experience of depression or suicide (n = 360) strongly endorsed stigmatizing attitudes toward themselves and a greater proportion of male respondents indicated that they would be embarrassed about seeking help for depression.

Current Trends in the study of Gender Norms and Health Behaviors

Gender norms are recognized as one of the major social determinants of health and gender norms can have implications for an individual's health behaviors. This paper reviews the recent advances in research on the role of gender norms on health behaviors most associated with morbidity and mortality. We find that (1) the study of gender norms and health behaviors is varied across different types of health behaviors, (2) research on masculinity and masculine norms appears to have taken on an increasing proportion of studies on the relationship between gender norms and health, and (3) we are seeing new and varied populations integrated into the study of gender norms and health behaviors.