The coronavirus 2019 (COVID-19) pandemic has prompted concerns about an increased risk for psychological distress, broadly and suicide mortality, specifically; it is, as yet, unclear if these concerns will be realized, but they are plausible.
The authors demonstrate why researchers, clinicians, policymakers and other public health stakeholders should be vigilant to the potential increases in murder-suicide in the wake of the COVID-19 pandemic.
During the COVID-19 pandemic, there have been reports of increased gun sales, alcohol sales, intimate partner violence and child neglect/abuse. These factors give one serious pause regarding the potential for murder-suicide, especially in the context of other pandemic-related stressors (e.g. loneliness, economic stress, health anxiety).
This paper highlights pandemic-related factors that might spur increased murder-suicide and encourages murder-suicide prevention efforts to take place alongside other pandemic-related public health interventions.
Joiner, T.E., Lieberman, A., Stanley, I.H. and Reger, M.A. (2020), "Might the COVID-19 pandemic spur increased murder-suicide?", Journal of Aggression, Conflict and Peace Research, Vol. 12 No. 3, pp. 177-182. https://doi.org/10.1108/JACPR-05-2020-0502Download as .RIS
Emerald Publishing Limited
Copyright © 2020, Emerald Publishing Limited
Public Significance Statement: There are myriad stressors associated with the COVID-19 pandemic that might result in increased murder-suicide. Researchers, clinicians, policymakers and other public health stakeholders should be vigilant to the potential increases in murder-suicide in the wake of the COVID-19 pandemic.
We and others have suggested that the coronavirus 2019 (COVID-19) pandemic has the potential for adverse effects regarding suicide (Reger et al., 2020). There are reports of increased call activity to suicide hotlines (Chuck, 2020), and activity at the Crisis Text Line has recently doubled, with a vast majority of texters (∼77%) attributing distress specifically to COVID-19 (Da Silva, 2020). Increased risk of suicide mortality may be because of pandemic-driven factors, such as loneliness, economic stress, decreased access to community and religious support, barriers to mental health treatment, widespread anxiety (widely shared and possibly thereby amplified), medical problems, stress on health-care professionals (who had elevated suicide rates even pre-COVID-19), and markedly increased firearm sales. Moreover, in the Northern Hemisphere, there is a well-characterized annual peak in suicide rates in late spring-early summer (Christodoulou et al., 2012), likely to overlap with peak COVID-19 morbidity and mortality. As noted by Reger et al. (2020), it is also possible that the pandemic will decrease suicides, via mechanisms such as people pulling together, increased fear of death and value of life.
It is thus, as yet, unclear if concerns regarding suicide will be realized, but they are plausible, and there are reasons to worry about a potential increase in murder-suicides, as well. Though less frequent than both murder and suicide, per se, the rate of murder-suicide occurs at 0.2-0.3 per 100,000 per year (Eliason, 2009). Given that around 2% of suicides are murder-suicides, and the USA is likely to face approximately 50,000 suicides this year (Centers for Disease Control and Prevention (CDC), 2020), we are likely to see around 1,000 murder-suicides in 2020, resulting in a total death count in the low 2000s.
Indeed, stipulating that there is concern about suicide may necessarily entail concern about murder-suicide, as murder-suicide is often viewed as a subspecies of suicide (McPhedran et al., 2018; Joiner, 2014). Several characteristics of murder-suicide overlap with those of suicide-only, including status in the labor force, mental health status, relationship status (i.e. separated or widowed) and problems with alcohol and drug use (as well as specific alcohol use prior to the event). Importantly, these shared characteristics differ from cases of murder-only, and no specific similarities were found between cases of murder-only and murder-suicide (McPhedran et al., 2018).
Joiner (2014) argued for a “perversion of virtue” account of murder-suicide, such that eventual murder-suicides were once plans for suicide only, but then transformed over time into murder-suicide. These transformations are more likely to occur in those with certain personality dynamics (i.e. narcissism) than in others, and the process involves a line of thought that one’s own death is a necessity, that one’s own death is contrary to virtue if absent the death of others, and that therefore the virtuous act is to kill others before killing oneself. It hardly needs reiterating that in reality these incidents are very far from virtuous and thus the term “the perversion of virtue”.
An exemplar scenario is a despondent man contemplating his suicide in the wake of a romantic rejection, reasoning that the rejection was not his fault and thus it would be unjust if it were only he who was killed. He then kills the source of the rejection before killing himself; the virtue in question in this example is justice.
Other virtues can also be invoked in murder-suicides. A review of 131 cases of child murder found that 38% of total filicides had altruistic motives, often stemming from plans of suicide, as well (Resnick, 1969). For example, filicides associated with suicide included parents who claimed “they could not abandon their children when they killed themselves (Resnick, 1969, p. 329),” furthering both the argument that murder-suicide is a subset of suicide and that murder-suicide involves a perversion of virtue.
In the case of COVID-19, consider a single parent who, in the wake of social isolation and unprecedented stress, decides on her own suicide. Before ending her own life, however, and overcome by the dread of her children living without her in a continually cruel world, she perverts mercy and murders them. She believes that not only their deaths are warranted but also they are actually necessary and virtuous. Duty (regularly involved in late-life spousal incidents) and glory (involved in mass shootings as a prelude to suicide) are two additional virtues that, when perverted, may culminate in murder-suicide.
Beyond these theoretical accounts of murder-suicide related to the COVID-19 pandemic, there are also real, tragic examples that have already been reported in the media. For instance, an Illinois man who reportedly feared he and his partner had succumbed to COVID-19 fatally shot his partner before dying from a self-inflicted gunshot wound (BBC News, 2020). In Pennsylvania, a man who reportedly lost his job because of the COVID-19 pandemic shot at his girlfriend four times, striking her once, then shot and killed himself (Burke, 2020).
As illuminated by these examples, even more so than suicides in the USA, murder-suicides are very likely to be enacted with a firearm. Approximately 50% of US suicides are by firearm (CDC, 2020); the corresponding figure for US murder-suicides is far higher, with a lower bound estimate of 80% (Joiner, 2014). Under COVID-19 pandemic conditions, interest in obtaining a firearm has surged: March 2020 – during which the USA declared a national emergency – was the second-busiest month on record for gun sales in the USA Collins and Yaffe-Bellany (2020).
There are also reports of pandemic-related increases in intimate partner violence (IPV; Barr et al., 2020). This increase may be explained by Eriksson and Mazerolle’s (2013) general strain theory, which suggests that the killing of intimate partners occurs in response to adverse experiences and emotions, losing something positively valued, or being prevented from achieving one’s goals (Eriksson and Mazerolle, 2013). Given the combination of stay-at-home orders (current and anticipated if there is a resurgence of COVID-19), unemployment and increased gun access, IPV is potentially pernicious. Pandemic-related stress may exacerbate the potential for IPV, especially among those who are already at-risk. For example, following an unexpected layoff, an individual may be forced to cope with economic distress in a small apartment, among family with dysfunctional relationships and pre-existing psychiatric conditions without space or time to be alone. Usual social, community, and mental health supports are not available, and the duration of the pandemic is unknown, compounding concerns. Illustratively, a murder-suicide in Goodyear, AZ during the COVID-19 pandemic was reported to be specifically related to a domestic violence incident (USA Today, 2020).
Likewise, there have been reports of increased cases of severe child neglect and abuse. However, because the COVID-19 pandemic has closed schools, there are fewer opportunities for mandated reporters to monitor at-risk children and to detect nascent child neglect or abuse spurred by pandemic-related stress. Health experts thus warn of the heightened risk for pandemic-related neglect/abuse and attendant underreporting (MacNeil, 2020). Parental abusers of their children are substantially more likely than parental non-abusers to kill their children under any conditions (Friedman and Resnick, 2007); under stay-at-home conditions, closed schools and thus fewer mandatory reporters, more guns, more stress, etc. murder-suicides perpetrated by parents on their children are an extreme concern.
There are reports of pandemic-related surges in the sale of alcohol, as well. Like suicides, murder-suicides involve alcohol much more rarely than as conceived in the popular imagination. Approximately a quarter of suicide decedents have alcohol in their blood at the time of death (any alcohol, never mind at high levels; Anestis et al., 2014)). There is evidence that the same holds for murder-suicide perpetrators, and that, if anything, they tend to have less alcohol in their systems at the time of death than do suicide decedents (again any alcohol; Joiner (2014)). Nevertheless, given the increase in gun sales, IPV, child abuse, stress, and spare time at home, an additional increase in alcohol sales gives one pause for serious concern.
Murder-suicide prevention opportunities
Despite challenges, there are opportunities. On the logic that murder-suicide is a form of suicide, it follows that the principles of suicide prevention should prevent murder-suicides, as well. These principles include increased means safety (especially for, but not limited to, firearms), social closeness (even at a physical distance), access to robust treatment for mental disorders (e.g. via telehealth) and publicizing high-quality crisis resources such as the National Suicide Prevention Lifeline (e.g. 1-800-273-TALK) and Crisis Text Line, both of which remain open and we encourage those in distress to use.
More specific to murder-suicide, should a clinician intuit  its potential (e.g. a sense of dangerousness and foreboding; unblinking, uncommunicative patient; the “thousand-yard stare”; Joiner et al., 2016), a judicious attempt should be made to directly inquire about risk of harm to self and to others. To bolster this direct risk assessment, and consistent with the logic of the “perversion of virtue” model of murder-suicide, queries should be made on patients’ opinions and views on the topics of justice, mercy, duty and glory. For instance, a clinician may state, “It appears that something’s on your mind, but I see that you don’t want to talk about these problems. Let’s shift gears then; what if we talked for a while about the positive? In particular, I would be interested to know your views on positive qualities like honor, justice, mercy, duty, and heroism.”
For example, one might consider what could have happened had a clinician asked Seung-Hui Cho, the perpetrator of the horrific murder-suicide at Virginia Tech, about his views on justice. Months before the tragedy, Cho came to the attention of health care professionals at the university and met their questions with an unblinking silence. While it is quite possible that he would not have elaborated on his sense of isolation from others or social functioning, the topic of justice may have been one to spark passion and discussion, as it was a preoccupation of Cho’s and the prevailing motive for the atrocity (Joiner, 2014). For an individual preoccupied with something as momentous as causing others’ death as well as suicide, all for the sake of a virtue (even if perverted), silence in reply to a question about these topics may be unlikely. It is quite possible that a question like this may puzzle patients – valuable information in itself. Perplexed reactions to this question are somewhat reassuring; a knowingness, however expressed, less so.
Furthermore, as noted above, IPV or other domestic disputes often precipitate a murder-suicide. In this regard, law enforcement officers and other first responders (e.g. emergency medical technicians, paramedics, firefighters) serve on the frontlines of murder-suicide prevention efforts as gatekeepers. Gatekeepers are community members who are trained to identify warning sides for suicide – and, by extension, murder-suicide – and to refer individuals to mental health services when necessary (Hom et al., 2015). Law enforcement officers who have undergone gatekeeper training report improved knowledge about and confidence with suicide prevention practices (Marzano et al., 2016). As such, murder-suicide prevention strategies in the near- and long-term should include the training of first responders as gatekeepers.
The COVID-19 pandemic has spurred psychosocial stressors that are linked to suicide, broadly, and murder-suicide, specifically. There are opportunities to enhance suicide (and therefore murder-suicide) prevention services during this crisis; the implementation of public health strategies to mitigate the spread of COVID-19 should involve, in parallel, public health efforts to prevent suicide and murder-suicide.
We endorse and echo the Meehlian skepticism about clinical intuition (Meehl, 1954), and yet suggest that, given evolved, non-verbal, subconscious communication of mortal threat signals in social and other species, if ever there were a time that one’s gut may speak truth, it is when one is interviewing an imminent murder-suicide perpetrator.
Anestis, M.D., Joiner, T., Hanson, J.E. and Gutierrez, P.M. (2014), “The modal suicide decedent did not consume alcohol just prior to the time of death: an analysis with implications for understanding suicidal behavior”, Journal of Abnormal Psychology, Vol. 123 No. 4, pp. 835-840, doi: 10.1037/a0037480.
Barr, L. Mallin, A. and Stone, A. (2020), “With families quarantined together, some police fear rise in domestic violence”, ABC News, available at: https://abcnews.go.com/US/families-quarantined-police-fear-rise-domestic-violence/story?id=69885016
BBC News (2020), “Coronavirus fears linked to Illinois pair’s murder-suicide”, BBC News, available at: www.bbc.com/news/world-us-canada-52192842
Burke, M. (2020), “Pennsylvania man upset over coronavirus shoots girlfriend and kills himself, police say”, NBC News, available at: www.nbcnews.com/news/us-news/pennsylvania-man-upset-over-coronavirus-shoots-girlfriend-kills-himself-police-n1173881
Centers for Disease Control and Prevention (CDC) (2020), “WISQARS: web-based injury statistics query and reporting system”, available at: www.cdc.gov/injury/wisqars/index.html
Christodoulou, C., Douzenis, A., Papadopoulos, F.C., Papadopoulou, A., Bouras, G., Gournellis, R. and Lykouras, L. (2012), “Suicide and seasonality”, Acta Psychiatrica Scandinavica, Vol. 125 No. 2, pp. 127-146, doi: 10.1111/j.1600-0447.2011.01750.x.
Chuck, E. (2020), “Hard for helpers, too’”: faced with their own coronavirus fears, crisis hotline counselors answer surge in calls”, NBC News, available at: www.nbcnews.com/news/us-news/hard-helpers-too-faced-their-own-coronavirus-fears-crisis-hotline-n1176301
Collins, K. and Yaffe-Bellany, D. (2020), “About 2 million guns were sold in the US as virus fears spread”, The New York Times, available at: www.nytimes.com/interactive/2020/04/01/business/coronavirus-gun-sales.html
Da Silva, C. (2020), “Crisis helpline sees surge in messages from young people anxious over coronavirus”, Newsweek, available at: www.newsweek.com/crisis-helpline-sees-surge-messages-young-people-anxious-over-coronavirus-1494260
Eliason, S. (2009), “Murder-suicide: a review of the recent literature”, Journal of the American Academy of Psychiatry and the Law Online, Vol. 37 No. 3, pp. 371-376.
Eriksson, L. and Mazerolle, P. (2013), “A general strain theory of intimate partner homicide”, Aggression and Violent Behavior, Vol. 18 No. 5, pp. 462-470.
Friedman, S.H. and Resnick, P.J. (2007), “Child murder by mothers: patterns and prevention”, World Psychiatry, Vol. 6 No. 3, pp. 137-141.
Hom, M.A., Stanley, I.H. and Joiner, T.E. (2015), “Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: a review of the literature”, Clinical Psychology Review, Vol. 40, pp. 28-39, doi: 10.1016/j.cpr.2015.05.006.
Joiner, T.E. (2014), The Perversion of Virtue: Understanding Murder-Suicide, Oxford University Press.
Joiner, T.E., Hom, M.A., Rogers, M.L., Chu, C., Stanley, I.H., Wynn, G.H. and Gutierrez, P.M. (2016), “Staring down death: is abnormally slow blink rate a clinically useful indicator of acute suicide risk?”, Crisis, Vol. 37 No. 3, pp. 212-217, doi: 10.1027/0227-5910/a000367.
McPhedran, S., Eriksson, L., Mazerolle, P., De Leo, D., Johnson, H. and Wortley, R. (2018), “Characteristics of homicide-suicide in Australia: a comparison with homicide-only and suicide-only cases”, Journal of Interpersonal Violence, Vol. 33 No. 11, pp. 1805-1829.
MacNeil, S. (2020), “Doctor warns of child abuse risks during pandemic, economic downturn”, NBC Montana, available at: https://nbcmontana.com/news/local/dr-warns-of-child-abuse-risks-during-pandemic-economic-downturn
Marzano, L., Smith, M., Long, M., Kisby, C. and Hawton, K. (2016), “Police and suicide prevention: evaluation of a training program”, Crisis, Vol. 37 No. 3, pp. 194-204, doi: 10.1027/0227-5910/a000381.
Meehl, P.E. (1954), Clinical versus Statistical Prediction: A Theoretical Analysis and a Review of the Evidence, University of MN Press.
Reger, M.A., Stanley, I.H. and Joiner, T.E. (2020), “Suicide mortality and coronavirus disease 2019 – a perfect storm?”, JAMA Psychiatry, doi: 10.1001/jamapsychiatry.2020.1060.
Resnick, P.J. (1969), “Child murder by parents: a psychiatric review of filicide”, American Journal of Psychiatry, Vol. 126 No. 3, pp. 325-334.
USA Today (2020), “Goodyear police identify 3 who died in double murder-suicide”, AZCentral, available at: www.azcentral.com/story/news/local/southwest-valley/2020/05/26/goodyear-police-identify-3-who-died-double-murder-suicide/5258746002/
About the authors
Thomas E. Joiner, is based at the Department of Psychology, Florida State University, Tallahassee, Florida, USA
Amy Lieberman is based at the Department of Psychology, Florida State University, Tallahassee, Florida, USA
Ian H. Stanley is based at the Department of Psychology, Florida State University, Tallahassee, Florida, USA
Mark A. Reger is based at the VA Puget Sound Health Care System, Seattle, Washington, USA