OBJECTIVE: To review the epidemiology, patterns, and major determinants of murder-suicide and to discuss the clinical and research strategies for identifying the individuals at greatest risk for this type of violence. DATA SOURCES: Data were obtained from English-language articles based on searches using MEDLINE (from 1966), PsychINFO (from 1967), and EMBASE (from 1974) programs. In addition, relevant articles, books, and monographs identified from the reference list of retrieved articles were reviewed. STUDY SELECTION: Case-control studies, descriptive epidemiologic surveys, and case series were chosen for review. DATA EXTRACTION: Because of the limited scope of the pertinent research literature, all data relevant to the incidence, demographics, circumstances, and precipitants of murder-suicide were summarized by the authors. DATA SYNTHESIS: Murder-suicide occurs with an annual incidence of 0.2 to 0.3 per 100,000 person-years and accounts for approximately 1000 to 1500 deaths yearly in the United States. The annual incidence of these events is relatively constant across industrialized nations and has not significantly changed over several decades. The principal perpetrators are young males with intense sexual jealousy, depressed mothers, or despairing elderly men with ailing spouses. The principal victims are female sexual partners or consanguineous relatives, usually young children. Clinical depression, specific motivations such as male sexual proprietariness or maternal salvation fantasies, and a history of previous suicide attempts are important in explaining underlying psychopathological mechanisms. CONCLUSIONS: Murder-suicide occupies a distinct epidemiological domain that overlaps with suicide, domestic homicide, and mass murder. These events may be categorized into one of only several phenomenologic typologies that share similar demographics, motivations, and circumstances. Despite the disruption of families and communities caused by murder-suicide, there are no standardized operational definitions, validated taxonomic systems, or national surveillance networks for these events, all of which are needed to develop prevention strategies.
