Table 1


        Relationship + motive
        Relationship between victim and perpetrator (spousal, familial, etc.)
        Motivation of perpetrator (jealousy, altruism, revenge, etc.)
Major patterns
        Most common type, accounting for 50% to 75% of all homicide-suicides. Involves a male recently estranged from his partner. Relationship often characterized by domestic abuse, multiple separations, and reunions.
    Consortial-physically ailing
        The perpetrator is usually an elderly man in poor health, an ailing spouse, or both. Health problems have typically resulted in financial difficulties. Depression is frequent. The motive may involve altruism or despair about the future. Suicide notes are often left describing an inability to cope with poor health and finances.
        About 40% to 60% of fathers and 16% to 29% of mothers commit suicide immediately after murdering their children. An infant is more likely to be killed by the mother. A mother who kills a neonate is unlikely to commit suicide. Further subtypes of filicide-suicide are based on motives such as psychosis, altruism, and revenge.
        Committed by a depressed senior man of the household. Associated precipitating stressors include marital problems, finances, or work-related problems. He may view his action as an altruistic "delivery" of his family from continued hardships. He may also suspect marital infidelity and be misusing substances.
    Adversarial Homicide-Suicide (extrafamilial)
        Involves a disgruntled ex-employee, a bullied student, or a resentful, paranoid Ioner. He externalizes blame onto others and feels wronged in some way. He is likely to have depression and exhibit paranoid and/or narcissistic traits. Occasionally, he may experience actual persecutory delusions. He uses a powerful arsenal of weapons and has no escape planned.
  • Adapted from Marzuk et al.12