Family Can Hurt You the Most: Examining Perpetrators in Multiple Casualty Events

Introduction: Recently, multiple-homicide events, particularly mass shootings, have become a focus of media attention. We hypothesize that many multiple homicides are related to domestic conflict and suicidality. Materials and methods: We analyzed multiple-homicide events (involving two or more victims)in the National Violent Death Reporting System from 2003 to 2015, including those that were followed by suicide of the perpetrator. We characterized circumstances of these events and compared victims with those found in single-homicide events. Results: We identified 2425 multiple-victim incidents involving a total of 5424 homicide victims (9.3% of all homicide victims in National Violent Death Reporting System). Of these events, 14.1% (n = 341)were homicides followed by suicide of the perpetrator. Many multiple homicides involved intimate partners or family members of the victims (n = 741, 30.6%). Few of these events were related specifically to a mental health crisis (n = 39, 2.3%), resulting in the deaths of multiple strangers. Even in mass homicide events (more than four victims), many involved the death of an intimate partner or family member of the perpetrator (n = 14/31, 45.2%). Risk of homicide-suicide increased as the number of victims in the incident increased. Conclusions: In our examination of multiple-homicide events, we found that many involve the death of the intimate partner and/or family members of the perpetrator, even for events with more than four victims. Although the scenario of a perpetrator with mental health issues going on a “shooting rampage” and murdering multiple strangers is commonly invoked in mass homicide incidents, it is rare overall.