Can we discriminate homicides-suicides and suicides from their risk factors?
Although rare, homicide-suicides are dramatic events. Both studied through the lens of suicidology and criminology, their hybrid nature tends hinder research and prevention efforts : are they to be considered as a subcategory of suicide or as a separate entity ? To clarify the question, we carried out a meta-analysis of the literature comparing homicide-suicide and suicide risk factors. The goal was to ascertain whether some of these factors could predict one or the other outcome with more specificity. The analysis included 13 references, and a mean number of cases of 262 homicides-suicides (± 802) and 59 539 suicides (± 32 117). Male gender, belonging to an ethnic or cultural minority and past legal issues predicted homicides-suicides more than suicides. Similarly, suicides were more likely to be preceded by a homicide when occurring at the home place, or when implying violent death methods. Conversely, physical health problems, as well as history of depression, suicide attempt or substance abuse increased the suicide risk in a greater extent than they did for homicide-suicide. Basing on these results, we suggest integrating the homicide-suicide/suicide duality in a single coherent model. Under this perspective, both events could be seen as the lethal result of a same critical psychic tension, mostly influenced by predisposing factors. The nature or the acting out would then depend on only some of these factors, so-called orienting factors. Implications of the model for research are discussed.