Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Sabrina Brown, DrPH, MPH

Committee Member

Steven Fleming, PhD, AM, MPA

Committee Member

Glyn Caldwell, MD, MS



Homicide-followed-by-suicide or homicide-suicides were examined to understand the dynamics of acting outwardly and inwardly violent in a single incident. The purpose of this study was to identify if specific circumstances had an association with the number of victims per homicidesuicide incident. This study addresses an important public health issue by encouraging an accurate viewpoint of homicide-suicide in order to properly program prevention efforts.


Using the restricted access data (RAD) from 17 National Violent Death Reporting System (NVDRS) states, we characterized 1904 homicide-suicide incidents through qualitative and quantitative analysis based on victim and suspect demographic information, method of injury, and circumstantial information. Linear and logistic regression modeling was utilized to better understand the association with the victim count and the number of circumstances per incident as well as type of circumstance in a homicide-suicide incident.


Suspects were predominantly white, male, and 35-54 years of age, with the main method of injury being a firearm. We also identified ratios of victim to suspect sex and race in an incident. Female victim to male suspect made up the majority of homicide-suicide incidents (N=1568, 67.8%). Similar to sex, we identified ratios of victim to suspect race and found that most incidents occurred when the victim and suspect shared the same race. For every circumstance of family violence, an increase in the number of victims per incident can be expected. The odds of a single homicide-single suicide (two total victims) were greatest when family violence preceded 5 or was a part of the incident while the odds of a mass fatality (four or more total victims per incident) were greatest when the victim and suspect had some type of relationship.


This study provides insight into understanding homicide-suicide. The number of circumstances per incident did not have a significant relationship to the number of victims per incident; however, specific circumstances, like family violence and having a relationship between victim and suspect, did prove to be statistically significantly related to the number of victims per incident. As these homicide-suicide incidents do occur rarely, it is important to understand mass fatality in a homicide-suicide incident as an event that is not typically consistent with random acts of violence, even though this is overstated in the media. The results from this study show that there are enough distinctions between homicide-suicide, suicide only, and homicide only incidents that prevention efforts should be approached differently. Numbers do matter in homicide-suicide incidents and further research is warranted to better prepare, prevent, and respond to homicide-suicide incidents in the United States.

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