This systematic review of population based studies of homicide followed by suicide was conducted to examine the associations between rates of homicide-suicide, rates of other homicides and rates of suicide. The review analysed 64 samples, including the case of an outlier (Greenland) that were reported in 49 studies. There was a significant association between the rates of homicide-suicide and those of other homicides in studies from the U.S.A. Outside the U.S.A. there was no clear association between homicide-suicide and other homicide but there was modest but significant association between rates of suicide and homicide-suicide. Homicide-suicide appears to be closer in epidemiological terms to homicide than suicide in regions with high rates of homicide and measures to reduce homicide in these regions may also reduce homicide-suicide.