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Homicide-Followed-By-Suicide Incidents Involving Child Victims

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Homicide-Followed-By-Suicide Incidents Involving Child Victims Homicide-Followed-by-Suicide Incidents Involving Child Victims Joseph E. Logan, PhD, MHS; Sabrina Walsh, DrPH; Nimeshkumar Patel, MA; Jeffrey E. Hall, PhD, MSPH Objectives: To describe homicide-fol- were parents/caregivers. Eighty-one per- lowed-by-suicide incidents involving cent of incidents with paternal perpetra- child victims Methods: Using 2003-2009 tors and 59% with maternal perpetrators National Violent Death Reporting Sys- were preceded by parental discord. Fifty- tem data, we characterized 129 incidents two percent of incidents with maternal based on victim and perpetrator demo- perpetrators were associated with mater- graphic information, their relationships, nal psychiatric problems. Conclusions: the weapons/mechanisms involved, and Strategies that resolve parental conflicts the perpetrators’ health and stress-re- rationally and facilitate detection and lated circumstances. Results: These in- treatment of parental mental conditions cidents accounted for 188 child deaths; might help prevention efforts. 69% were under 11 years old, and 58% Key words: homicide-suicide, children were killed with a firearm. Approximately Am J Health Behav. 2013;37(4):531-542 76% of perpetrators were males, and 75% DOI: http://dx.doi.org/10.5993/AJHB.37.4.11 omicide-followed-by-suicide (hereafter re- of homicide-suicide victims are children, stepchil- ferred to as “homicide-suicide”) incidents dren, or foster children of the perpetrator.1 This Hare defined as violent acts during which finding indicates that research is needed to iden- a person kills one or more individuals and then tify factors that might prevent this form of violence commits suicide.1-3 These incidents account for against children from occurring. roughly 1000-1500 violent deaths annually in the A considerable amount of research has already United States, or 20-30 deaths weekly.3,4 Although been conducted on child homicides perpetrated by approximately 75% of homicide-suicide incidents parents.5-15 (The term parent is used throughout involve a male perpetrator killing a current or for- this article, although “parents” can be any legal mer female intimate partner,2 many homicide-sui- guardians.) The parent’s motives in these events cide incidents involve child victims.1,2 These types were initially classified into 5 categories, based of homicide-suicides include filicide-suicides (ie, on a framework developed by Resnick in 1969.5,7,8 incidents in which a parent kills his or her own These categories included altruism (ie, belief of re- children before committing suicide) and famili- lieving victims of real or imagined suffering), acute cide-suicide (ie, an individual kills multiple fam- psychosis (ie, killing under severe mental illness); ily members before committing suicide).5,6 Other unwanted child (ie, lack of tolerance for the child or terms used for specific types of homicides in these lack of desire to be a parent), unintentional death incidents include neonaticide (ie, killing a child from child abuse, and spousal or intimate partner on day of birth) and infanticide (ie, killing a child revenge.5,7,8 Other parental circumstances believed under the age of 12 months).5 Bossarte and col- to play a role in these incidents include lack of so- leagues (2006) estimated that approximately 14% cial support, unemployment or job-related prob- lems, and alcohol or illicit substance abuse.5,7,11,12 Previous studies have also found that the mo- Joseph E. Logan, Behavioral Scientist; Nimeshkumar Patel, IT Specialist, System Analyst and Data Manager; and Jeffrey tives and circumstances of homicides and homi- E. Hall, Behavioral Scientist, Centers for Disease Control and cide-suicides involving child victims often depend Prevention, National Center for Injury Prevention and Control, on which parent perpetrated the incident. For ex- Atlanta, GA. Sabrina Walsh, Assistant Professor, University ample, paternal perpetrators have been found to of Kentucky, Lexington, KY. Disclaimer: The findings and con- have more violent driven motives (eg, to abuse or clusions in this manuscript are those of the author(s) and do to retaliate against an intimate partner)10-12 and not necessarily represent the official position of the Centers for Disease Control and Prevention. to use more violent mechanisms or methods to Correspondence Dr Logan; [email protected] commit the homicide (eg, firearm, sharp object, Am J Health Behav.™ 2013;37(4):531-542 531 Homocide-Followed-by-Suicide Incidents Involving Child Victims strangulation).10,12 Paternal perpetrators have also or a subcontracted entity, such as a medical ex- been associated with killing older children5,13 and aminer’s office, where data are gathered and coded committing familicide.2,7,10,13 Maternal perpetrators by trained abstractors. The abstractors also sum- have been found to have altruistic motives, to have marize the narratives written by law enforcement mental disorders (eg, schizophrenia/psychoses, and coroner or medical examiner investigators. major depression), and to use less lethal/violent Data may be manually extracted from reports or means of killing, such as drug poisoning.5,10,14 Ma- imported electronically from other systems (eg, Bu- ternal perpetrators have also been found to more reau of Vital Statistics death certificate files). All likely commit neonaticide.5,15 data are reviewed by the abstractor to ensure ac- Building on this body of research, more studies curacy of the codes and adherence to the NVDRS are still needed to comprehensively describe ho- coding manual.19 The NVDRS has been described micide-suicide incidents that involve child victims in further detail elsewhere.17,19 as well as the perpetrators involved to help focus initiatives aimed at reducing this form of violent Case Finding behavior.16 Furthermore, comprehensively char- Case identification was conducted from an NV- acterizing the perpetrators’ life-stress related pre- DRS database that was updated through June ceding circumstances and their actions in the time 2011. Homicide and suicide incidents for 2003 to leading up to the incidents based on the narratives 2009 were first identified by the manners of death written by law enforcement and coroner/medical that these incidents were assigned by the state NV- examiner agents who investigated the incidents DRS data abstractors. (The abstractor manner of might help improve knowledge on how to intervene death is determined by the manners of death re- before violence occurs. Using data from one of the ported on the various data sources and the exter- largest and most comprehensive multistate violent nal cause of death International Classification of death surveillance systems, we explored this realm Diseases, tenth revision codes listed on the death of research. certificates.) Homicide-suicide incidents were de- fined as suicide incidents in which the perpetrator METHODS committed at least one homicide within one calen- Study Population dar day prior to his or her suicide death. Similar We used 2003-2009 data from the National Vio- case definitions of homicide-suicides have been lent Death Reporting System (NVDRS). This sur- used in other studies.1,2,7 The homicide-suicide veillance system captures details on incidents of incidents were further selected based on whether violent deaths using data from multiple sources. the incident included child victims (ie, those who Statewide data collection for the NVDRS began in were under the age of 18 years). Between 2003 and 2003 in 7 states (ie, Alaska, Maryland, Massachu- 2009, we identified 131 homicide-suicide incidents setts, New Jersey, Oregon, South Carolina, and that involved child victims. We excluded 2 incidents Virginia). Six states were added in 2004 (ie, Colo- that had perpetrators who were also under the age rado, Georgia, North Carolina, Oklahoma, Rhode of 18 years to obtain a more clear understanding of Island, and Wisconsin), and 3 states were added in incidents perpetrated by adults. Our final analysis 2005 (ie, Kentucky, New Mexico, and Utah). Cali- included 129 incidents, 129 perpetrators, and 188 fornia also began collecting data in 4 counties in child victims. 2005; however, they were excluded from our anal- yses because they did not collect data statewide. Variables For these data years, a total of 16 US states were Standard NVDRS variables. The child victims, included in our analyses making this study one of the perpetrators, and the incidents were charac- the largest multistate studies to explore this type terized using standard details captured in NVDRS. of violence. The child victims were characterized based on their demographic characteristics (ie, race/ethnic- Data Source ity, sex, and age), their relationships to the per- NVDRS captures information on all homicides, petrators (eg, child of perpetrator, other relative of suicides, legal intervention deaths, unintentional perpetrator), and the weapons/mechanism used in firearm deaths, and deaths of undetermined in- their homicide deaths. The perpetrators were char- tent.17-19 This system includes information on the acterized based on their demographic information victims, the suspected perpetrators and their re- (ie, race/ethnicity, sex, and age, and marital sta- lationships to the victims, the weapons involved, tus) and their relationship to the child victims. and the circumstances leading up to the injury (Two variables were used to determine maternal event.17 All information is linked by incident in and paternal perpetrators. A victim-suspect-rela- NVDRS so that violent events that involve
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