Skip to main content
Log in

Suicide and Additional Homicides Associated with Intimate Partner Homicide: North Carolina 2004–2013

Journal of Urban Health Aims and scope Submit manuscript

Cite this article


Intimate partner homicide (IPH) is a critical public health and safety issue in the USA. In this study, we determine the prevalence and correlates of perpetrator suicide and additional homicides following intimate partner homicide (IPH) in a large, diverse state with high quality data. We extract IPHs from the North Carolina Violent Death Reporting System for 2004–2013 and identify suicides and other homicides that were part of the same incidents. We analyze the likelihood (in odds ration form) of perpetrator suicide and additional homicides using logistic regression analysis. Almost all IPH-suicide cases were by men with guns (86.6%). Almost one-half of IPHs committed by men with guns ended with suicide. Male-perpetrated IPH incidents averaged 1.58 deaths if a gun was used, and 1.14 deaths otherwise. It is well-known that gun access increases the chance that a violent domestic relationship will end in death. The current findings demonstrate that gun IPH is often coupled with additional killings. As suicidal batterers will not be deterred from IPH by threat of punishment, the results underline the importance of preemption by limiting batterers’ access to guns.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others


  1. Because some IPH included more than one additional victim, these percentages do not add to 100%.

  2. This result is not reported in the table but reflects a logistic regression of the relationship between relationship status “spouse” and the odds of being killed in a homicide suicide. The results control for age, racial, and ethnic status.


  1. Fox JA, Zawitz MW. Homicide trends in the United States. Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics; 1999.

    Google Scholar 

  2. Petrosky E, Blair JM, Betz CJ, Fowler KA, Jack SPD, Lyons BH. Racial and ethnic differences in homicides of adult women and the role of intimate partner violence-United States, 2003-2014. MMWR Morb Mortal Wkly Rep. 2017;66(28):741–6.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Violence Policy Center. When men murder women: an analysis of 2014 homicide data. Washington, D.C.: Violence Policy Headquarters September; 2016.

  4. Smith SG, Fowler KA, Niolon PH. Intimate partner homicide and corollary victims in 16 states: National Violent Death Reporting System, 2003–2009. Am J Public Health. 2014;104(3):461–6.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Logan J, Hill HA, Black ML, Crosby AE, Karch DL, Barnes JD, et al. Characteristics of perpetrators in homicide-followed-by-suicide incidents: National Violent Death Reporting System—17 US States, 2003–2005. Am J Epidemiol. 2008;168(9):1056–64.

    Article  PubMed  CAS  Google Scholar 

  6. Morton E, Runyan CW, Moracco KE, Butts J. Partner homicide-suicide involving female homicide victims: a population-based study in North Carolina, 1988-1992. Violence Vict. 1998;13(2):91–106.

    Article  PubMed  CAS  Google Scholar 

  7. Koziol-McLain J, Webster D, McFarlane J, Block CR, Ulrich Y, Glass N, et al. Risk factors for femicide-suicide in abusive relationships: results from a multisite case control study. Violence Vict. 2006;21(1):3–21.

    Article  PubMed  Google Scholar 

  8. Federal Bureau of Investigation. Serial murder: multi-disciplinary perspectives for investigators. Behavioral Analysis Unit; 2005. Accessed March 12, 2018.

  9. Everytown for Gun Safety. Mass shootings in the United States: 2009-2016. New York City, NY: Everytown For Gun Safety Headquarters; April 2017.

  10. Campbell JC, Webster D, Koziol-McLain J, Block C, Campbell D, Curry MA, et al. Risk factors for femicide in abusive relationships: results from a multisite case control study. Am J Public Health. 2003;93(7):1089–97.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gerney A, Parsons C. Women under the gun. Cent Am Prog. June 2014. Accessed October 16, 2017.

  12. Dahlberg LL, Ikeda RM, Kresnow M. Guns in the home and risk of a violent death in the home: findings from a national study. Am J Epidemiol. 2004;160(10):929–36.

    Article  PubMed  Google Scholar 

  13. Zeoli AM, McCourt A, Buggs S, Frattaroli S, Lilley D, Webster DW. Analysis of the strength of legal firearms restrictions for perpetrators of domestic violence and their association with intimate partner homicide. Am J Epidemiol. 2017;

  14. Saltzman LE, Mercy JA, O’Carroll PW, Rosenberg ML, Rhodes PH. Weapon involvement and injury outcomes in family and intimate assaults. JAMA. 1992;267(22):3043–7.

    Article  PubMed  CAS  Google Scholar 

  15. Biden JR. Violence against women: the congressional response. Am Psychol. 1993;48(10):1059–61.

    Article  PubMed  Google Scholar 

  16. Raissian KM. Hold your fire: did the 1996 Federal Gun Control Act Expansion reduce domestic homicides? J Policy Anal Manag. 2016;35(1):67–93.

    Article  Google Scholar 

  17. Vigdor ER, Mercy JA. Do laws restricting access to firearms by domestic violence offenders prevent intimate partner homicide? Eval Rev. 2006;30(3):313–46.

    Article  PubMed  Google Scholar 

  18. Bossarte RM, Simon TR, Barker L. Characteristics of homicide followed by suicide incidents in multiple states, 2003–04. Inj Prev. 2006;12(Suppl 2):ii33–8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dobash RP, Dobash RE. Who died? The murder of collaterals related to intimate partner conflict. Violence Women. 2012;18(6):662–71.

    Article  Google Scholar 

  20. Comstock RD, Mallonee SR, Kruger E, Rayno K, Vance A, Jordan F. Epidemiology of homicide-suicide events: Oklahoma, 1994-2001. J Forensic Med. 2005;26(3):229–35.

    Google Scholar 

  21. Hanzlick R, Koponen M. Murder-suicide in Fulton County, Georgia, 1988-1991. Comparison with a recent report and proposed typology. Am J Forensic Med Pathol. 1994;15(2):168–73.

    Article  PubMed  CAS  Google Scholar 

  22. Barber CW, Azrael D, Hemenway D, Olson LM, Nie C, Schaechter J, et al. Suicides and suicide attempts following homicide: victim–suspect relationship, weapon type, and presence of antidepressants. Homicide Stud. 2008;12(3):285–97.

    Article  Google Scholar 

  23. Moracco KE, Clark KA, Espersen C, Bowling JM. Preventing firearms violence among victims of intimate partner violence: an evaluation of a new North Carolina law. Final Rep Submitt Natl Inst Justice Pac Inst Res Eval Chap Hill NC; 2006. Accessed 10 Aug 2016.

  24. Malphurs JE, Cohen D. A newspaper surveillance study of homicide-suicide in the United States. Am J Forensic Med Pathol. 2002;23(2):142–8.

    Article  PubMed  Google Scholar 

  25. Lund LE, Smorodinsky S. Violent death among intimate partners: a comparison of homicide and homicide followed by suicide in California. Suicide Life Threat Behav. 2001;31(4):451–9.

    Article  PubMed  CAS  Google Scholar 

  26. Nathan AJ. At the intersection of domestic violence and guns: the public interest exception and the Lautenberg amendment. Cornell Rev. 1999;85:822.

    Google Scholar 

  27. Campbell JC, Webster DW, Glass N. The danger assessment: validation of a lethality risk assessment instrument for intimate partner femicide. J Interpers Violence. 2009;24(4):653–74.

    Article  PubMed  Google Scholar 

  28. Messing JT, Campbell JC, Snider C. Validation and adaptation of the danger assessment-5: a brief intimate partner violence risk assessment. J Adv Nurs. 2017;73(12):3220–30.

    Article  PubMed  Google Scholar 

  29. Messing JT, Campbell J, Sullivan Wilson J, Brown S, Patchell B. The lethality screen: the predictive validity of an intimate partner violence risk assessment for use by first responders. J Interpers Violence. 2015;32:205–26.

    Article  Google Scholar 

Download references


We are grateful to Scott Proescholdbell and Shana Geary from the North Carolina Department of Health and Human Services for their support during this project. We also thank Kristin Goss, members of the LBT Writing Group, and anonymous reviewers at the Journal of Urban Health for their insightful comments and suggestions.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Sierra Smucker.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smucker, S., Kerber, R.E. & Cook, P.J. Suicide and Additional Homicides Associated with Intimate Partner Homicide: North Carolina 2004–2013. J Urban Health 95, 337–343 (2018).

Download citation

  • Published:

  • Issue Date:

  • DOI: