BIOMEDICAL SCIENCES INSTITUTE ABEL SALAZAR
INTIMATE FEMICIDE-SUICIDE IN PORTUGAL
Integrated Master in Medicine
2012/2013
Scientific Dissertation
Medical Research Article
Sara da Ponte Martins Graça de Matos
1Tutor: Teresa Magalhães MD, PhD
1,2Subtutor: Ana Rita Pereira MD, MSc
31
Biomedical Sciences Institute Abel Salazar, University of Porto, Porto, Portugal
2
National Institute of Legal Medicine and Forensic Sciences, North Branch, Porto, Portugal
3
National Institute of Legal Medicine and Forensic Sciences, South Branch, Lisboa, Portugal
Authors’ contacts:
Sara da Ponte Martins Graça de Matos Biomedical Sciences Institute Abel Salazar Largo Professor Abel Salazar 4099-003 Porto PORTUGAL Telephone: 00351 918901028 Email: mim07122@icbas.up.pt Teresa Magalhães National Institute of Legal Medicine and Forensic Sciences, North Branch Jardim Carrilho Videira, 4050-167 Porto PORTUGAL Telephone: 00351 222073850 Fax: 00351 222083978 Email: imlfmup@gmail.com
Ana Rita Pereira National Institute of Legal Medicine and Forensic Sciences, South Branch Rua Manuel Bento de Sousa, nº 3 1169-201 Lisboa PORTUGAL Telefone: 00351 218 811 800
Fax: 00351 218 864 493 Email: prinpereira@hotmail.com
ABSTRACT
Intimate partner femicide-suicide (F-S) is a rare phenomenon which carries a significant psychosocial impact. This study aims to contribute to the knowledge on intimate F-S, regarding characteristics of victims and perpetrators related to risk factors, and its forensic aspects. A retrospective study was conducted on intimate partner F-S cases in Portugal, from 2005-07, based on autopsy records, police reports and judicial decisions, in a total of 29 femicides (15 suicides and 14 suicide attempts). At the time of the event, the victims were mostly young and employed; the perpetrators were, on average, 50 years old, employed and owned a firearm. Their relationship was usually marriage, current, during less than 10 years, with children in common, without cohabitation and history of previous abuse by the same perpetrator. The event occurred on a residence, triggered by jealousy, with 1 case of mercy killing; in 14% other mortal victims were involved - 75% children. The method of death most used in F-S cases was gunshot trauma, for victims and perpetrators. For suicide attempts it was also gunshot trauma, while the victim was killed by sharp or chop trauma. The method of death, location and number of lethal lesions of the suicides were similar to the respective femicides. No victim presented wounds suggestive of repeated physical abuse or sexual assault. All perpetrators alive at the time of the trial were convicted. Support to men separated from their partner, who own a firearm and have history of mental illness is an important preventive measure.
KEYWORDS
Femicide-suicide, homicide-suicide, intimate partner violence, Portugal
RESUMO
O femicídio-suicídio (F-S) nas relações de intimidade é um fenómeno raro, com grande impacto psicossocial. O objetivo deste estudo foi contribuir para o conhecimento sobre esta temática, relativamente a características da vítima e perpetrador relacionadas com fatores de risco, e aspetos forenses associados. Foi realizado um estudo retrospetivo sobre casos de F-S em Portugal, de 2005-07, baseado em autópsias, processos judiciais e registos policiais, num total de 29 femicídios (15 suicídios e 14 de tentativas de suicídio). À data do evento as vítimas eram jovens e empregadas, e os perpetradores tinham em média 50 anos, eram empregados e possuíam arma de fogo. O tipo mais comum de relação foi o casamento, à data dos factos, com menos de 10 anos, filhos em comum e sem coabitação, e história de abusos prévios pelo mesmo
perpetrador. O evento ocorreu maioritariamente numa residência, despoletado por ciúmes, destacando-se 1 caso de mercy killing; em 14% houve outras vítimas - 75% crianças. O método mais usado para o femicídio seguido de suicídio foram as armas de fogo, para vítimas e perpetradores; nos casos de suicídio tentado, foram usadas armas de fogo para os perpetradores, mas armas brancas para as vítimas. O método, local e número de lesões mortais nos suicídios foram similares aos respetivos femicídios. Nenhuma vítima apresentava sinais de abuso físico repetido ou agressão sexual. Todos os perpetradores vivos à data do julgamento foram condenados. O apoio a homens separados da parceira, com posse de arma de fogo e doença mental é uma importante medida preventiva.
PALAVRAS-CHAVE
INTRODUCTION
Intimate partner violence (IPV) related femicide-suicide (F-S), concerns the homicide of a woman by her intimate partner who then takes his own life. Many studies have been showing that it is the most prevalent form of homicide-suicide (H-S), with the victim being more frequently a woman killed by her male partner due to jealousy or during an impending separation [1-3]. These events are considered the most extreme form of homicide in the context of IPV [1], a phenomenon that is responsible for a mortality rate of 0.44 per 100.000 women in Portugal [4]. Despite highly publicized by the media, intimate partner F-S is a rare event, but one that has a big psychosocial impact on families and communities [5]. Literature indicates worldwide rates that range from 18% to 40% of perpetrator suicide in the context of homicide in intimate relationships [6].
For this type of fatal events, where there are no living victims, it is usually difficult to find a reliable cause. To characterize this phenomenon, Marzuk et al [7] suggested two main groups: (a) the amorous-jealous subtype: it is the most common and occurs in young couples, generally driven by rage, jealousy and fear of a separation; (b) the mercy killing subtype: occurs in older individuals, where the perpetrator is typically the caregiver of his spouse, who is often bedridden due to ill health [1,7-9].
Previous studies show some trends on the characteristics of this phenomenon. The perpetrator is usually Caucasian, older than the victim [10,11] and the majority suffered from depression, unlike the perpetrators of homicide alone [9,10]. However, the proportion of perpetrators who suffer from depression varies broadly across studies and in most cases the psychological reports are not available [12]. H-S is often a premeditated and planned act – proven by the short time between the two deaths and the existence of a suicide notes [7,8]. It generally occurs in the victim’s home [1,13] and in many cases there’s also the homicide of a child [1,14]. The most important risk factor for intimate F-S is the existence of prior domestic violence [12]. Other important risk factors include the perpetrator’s access to a gun, previous homicide and/or suicide threats, partner’s estrangement, cohabitation with a stepchild and a marital (current or past) relationship [12]. It has been proved that the use of a gun is more prevalent in H-S cases than in homicide cases alone [12,13,15], being also a strong predictive factor of intimate F-S [1,12]. Only in a minority of cases the weapon used for the suicide is different than that of the homicide [1,3,16,17]. Regarding the suicide cases, the most frequent location of the fatal wound - normally a single one - are the head, face or neck; in homicides the head is the most common region, but multiple wounds are often observed [17].
Because this is a complex and severe problem, more studies are needed on the subject; in Portugal, this is the first one performed through a forensic sample. The lack of information about this issue at a national level hampers the implementation of social measures and policy interventions that are necessary for the gradual decline of this phenomenon. In these cases the surveillance and alertness to the risk factors, specially by the health professionals that accompany these men and women, are vital for taking preventive actions [12].
The aim of this study was to contribute to improve the knowledge about intimate F-S cases, regarding some characteristics of female victims and male perpetrators related with risk factors, as well as some forensic aspects of femicide and related suicide or suicide attempt.
MATERIALS AND METHODS
A Portuguese national retrospective autopsy-based and judicial-proved study was conducted on IPV-related F-S or femicide-suicide attempt (F-SA), referring to a 3-year period.
In a first step, forensic autopsy cases were selected according to the following inclusion criteria: (a) woman; (b) aged 15 years or older; (c) violent death (excluding suicide and accident), suspected to have been perpetrated by a current or past male intimate partner (d) autopsy performed in the National Institute of Legal Medicine (INML); (e) between January 2005 and December 2007. After reviewing the correspondingly judicial decisions which were obtained from Public Prosecutors Offices and Courts, death cases proved to be related with an intimate relationship (n=62) were retained. To make sure that the criminal investigation and forensic cases were completed as well as judicial decisions were also determined, it was only possible to include cases that took place before 2007.
In a second and final step, from the totality of 62 cases, those which were followed by the suicide or suicide attempt of the perpetrator (which was considered within a week after the homicide incident [6]) were identified.
A detailed review of the autopsy reports of women victims of homicide, as well as the respective judicial decision was conducted (n=29). Also, a complete review of the autopsy report of men who committed suicide (n=15) and the police records of men who attempted suicide (n=14) was performed. Two groups were considered for the analysis: F-S and F-F-SA. A data set instrument was specifically made and then applied in a digital database (using the computer software Excel 2010 by Microsoft ®) built for this purpose.
The collected data was divided into the following sections: (a) characteristics of the involved victims and perpetrators; (b) characteristics of the intimate relationship; (c) characteristics of the circumstances surrounding the femicide and the suicide; (d) characteristics of the lethal and non-lethal lesions of the victims and perpetrators; (e) legal outcomes.
Due to the limited number of cases included, only descriptive statistical measures were used.
RESULTS
A total of 29 cases of IPV-related femicide associated with suicide or suicide attempt of the perpetrator were registered: 10 in 2005, 10 in 2006 and 9 in 2007. The rate of perpetrator suicide in the context of homicide in intimate relationships was 24.2%.
Characteristics of the victims and perpetrators
The characteristics of the female victims and male perpetrators at the time of the event, discriminated by group, are presented on table 1. In the majority of the variables, the numbers were similar in both groups.
The average age of the victims was 44 (with a range of 17 to 81 years old). Most of them were Portuguese, 3 being immigrants (2 from African countries of Portuguese official language [PALOP] and 1 from Ukraine). All women were living in Portugal at the time of the event, half of them in the two major cities – Lisbon (n=10, 34.5%) and Porto (n=4, 13.8%). The majority were employed (44.8%) while in 34.5% of the cases they were students, housewives or retired (“other”). Concerning substance abuse and psychiatric history there was scarce information: in only 1 case a drug abuse problem was identified and in 2 cases there was a history of psychiatric problems, all of them from the F-SA group.
On average, perpetrators were 50 years old and most of them were Portuguese, 2 being immigrants (1 PALOP and 1 from Ukraine). Most were actively working, but data was missing in 31% of the cases. Regarding their occupation, we found the following relevant: 2 police officers (1 retired), a captain of the Portuguese army and a hunter. Concerning substance abuse and psychiatric history there was also scarce information: in only 5 cases (of the F-SA group) it was possible to confirm a history of a psychiatric problem. There were not any registers of previous suicide attempts or family history of suicide in any of the perpetrators’ records. Regarding the perpetrators who didn’t consummate the suicide, during the trial, psychiatric evaluation was conducted in 4 cases (13.8%), but 86.2% of the total number of cases had no information on that.
Table 1. Characteristics of the victims (V) and perpetrators (P) F-S n (%) F-SA n (%) Total n (%) V P V P V P Age Average Minimum Maximum 45 21 81 50 26 75 43 17 80 50 20 76 44 17 81 50 20 76 Country of origin Portugal PALOP Other 14 (93.3) 0 1 (6.7) 14 (93.3) 0 1 (6.7) 12 (85.7) 2 (14.3) 0 13 (92.9) 1 (7.1) 0 26 (89.7) 2 (6.9) 1 (3.4) 27 (93.1) 1 (3.4) 1 (3.4) Employment status Employed Other Unemployed Unknown 7 (46.7) 5 (33.3) 0 3 (20.0) 5 (33.3) 1 (6.7) 2 (13.3) 7 (46.7) 6 (42.9) 5 (35.7) 1 (7.1) 2 (14.3) 8 (57.1) 1 (7.1) 3 (21.4) 2 (14.3) 13 (44.8) 10 (34.5) 1 (3.4) 5 (17.2) 13 (44.8) 2 (6.9) 5 (17.2) 9 (31.0) History of substance abuse Alcohol Abuse Drug Abuse No Unknown 0 0 2 (13.3) 13 (86.7) 0 0 0 15 (100) 0 1 (7.1) 2 (14.3) 11 (78.6) 4 (28.6) 0 1 (7.1) 9 (64.3) 0 1 (3.4) 4 (13.8) 24 (82.8) 4 (13.8) 0 1 (3.4) 24 (82.8) Psychiatric history Yes No Unknown 0 1 (6.7) 14 (93.3) 0 0 15 (100) 2 (14.3) 2 (14.3) 10 (71.4) 5 (35.7) 0 9 (64.3) 2 (6.9) 3 (10.3) 24 (82.8) 5 (17.2) 0 24 (82.8)
Data on perpetrators’ firearm possession and criminal records is detailed on table 2. Information about firearm possession was missing in 41.4% of the cases but, even so, 58.6% of the perpetrators owned a firearm, legally or illegally. Legal possession was more prevalent in the F-S group (40%), and illegal possession in the F-SA group (28.6%); however, in this group, data was missing in 64.3% of the cases. In 20.7% of the cases there was no information affirming whether the possession was legal or illegal.
Information about criminal records was only available regarding the F-SA group (because in the F-S group cases were filed due to the death of the offender, so the criminal investigation was less detailed): the majority of the perpetrators did not had any prior records (57.1%) while 1 had a previous conviction of IPV-related crime.
Table 2. Perpetrators’ firearm possession and criminal records F-S n (%) F-SA n (%) Total n (%) Firearm possession (n=29) Legal Illegal Legal and/or Illegal
Unknown 6 (40.0) 0 6 (40.0) 3 (20.0) 1 (7.1) 4 (28.6) 0 9 (64.3) 7 (24.1) 4 (13.8) 6 (20.7) 12 (41.4) Criminal records (n=29)
Yes (IPV-related crimes) Yes (other crimes)
No Unknown 0 0 0 15 (100) 1 (7.1) 2 (14.3) 8 (57.1) 3 (21.4) 1 (3.4) 2 (6.9) 8 (27.6) 18 (62.1)
Characteristics of the intimate relationship
The characteristics of the intimate relationship between the victim and the perpetrator at the time of the fatal event are shown on table 3. The most common type of relationship was marriage in both F-S (53.3%) and F-SA (42.9%) groups. In the majority of the cases there was a current relationship, but while most of them in F-S group were not living together (n=9, 60%), in the F-SA group they were living together (n=8, 57.1%). Regarding former relationships (n=11), the elapsed time between the separation and the fatal outcome was less than 1 year in 54.5% of the cases (data was missing in 18%). Considering both groups, the length of the relationship was less than 10 years in 34.5%, although data was missing on 51.7% of the cases. In both groups, in the majority of the cases there were children in common (48.3%) between the victim and the perpetrator, and in most cases (51.7%), children were living in the same household as the victim, whether they were children in common, children or stepchildren of the perpetrators. In 55.2% of the cases a history of previous abuse (physical, psychological and/or sexual) against the victim by the same perpetrator was recorded.
Table 3. Characteristics of the intimate relationship F-S n (%) F-SA n (%) Total n (%) Nature (n=29) Marriage Common-law Dating Extramarital 8 (53.3) 4 (26.7) 2 (13.3) 1 (6.7) 6 (42.9) 4 (28.6) 2 (14.3) 2 (14.3) 14 (48.3) 8 (27.6) 4 (13.8) 3 (10.3) Status (n=29) Current Former 8 (53.3) 7 (46.7) 10 (71.4) 4 (28.6) 18 (62.1) 11 (37.9)
Time elapsed between the separation and the
fatal event (n=11) <1 ]1-10] >10 Unknown 3 (42.9) 0 2 (28.6) 2 (28.6) 3 (75.0) 1 (25.0) 0 0 6 (54.5) 1 (9.1) 2 (18.2) 2 (18.2) Length (years) (n=29) ]0, 10] ]10-20] >20 Unknown 4 (26.7) 0 0 11 (73.3) 6 (42.9) 2 (14.3) 2 (14.3) 4 (28.6) 10 (34.5) 2 (6.9) 2 (6.9) 15 (51.7) Children in common (n=29) Yes No Unknown 8 (53.3) 5 (33.3) 2 (13.3) 6 (42.9) 7 (50.0) 1 (7.1) 14 (48.3) 12 (41.4) 3 (10.3)
Underage children living in the household (n=29) Yes No Unknown 8 (53.3) 6 (40.0) 1 (6.7) 7 (50.0) 6 (42.9) 1 (7.1) 15 (51.7) 12 (41.4) 2 (6.9) History of previous abuse (n=29) Yes No Unknown 8 (53.3) 0 7 (46.7) 8 (57.1) 2 (14.3) 4 (28.6) 16 (55.2) 2 (6.9) 11 (37.9)
Characteristics of the circumstances surrounding the femicide, suicide and suicide attempt
In most of the variables concerning the circumstances of the fatal events the numbers were similar in the two studied groups.
The majority of the fatal events in both groups took place during Spring (n=9, 31%), Summer and Winter (n=7, 24.1% each), with May and July being the most frequent months chosen for the suicide events. Most cases in both groups occurred in the week-end period (n=14, 48.3%). The suicide occurred most commonly right after the femicide (n=9, 60%); in 2 cases it occurred 1 to 2 hours later (13%), also in 2 cases, 3 to 4 hours later (13%) and in 1 case 5 days later; data was missing in 1 case.
Other characteristics of the circumstances surrounding the femicides, suicides and suicide attempts are listed on table 4.
Most frequently, in both groups, the femicide took place in a residence (65.5%): the house where the victim and the perpetrator both lived (n=11, 37.9%), or either the victim’s or the perpetrator’s residence (n=3, 10.3% each); the second most common place was a public place (27.6%); in the remaining cases (6.9%), 1 took place in a vehicle and another one in the victim’s workplace. Also, the suicides, as well as the suicide attempts, usually took place in a residence (51.7%): the house where the victim and the perpetrator both lived (n=11, 37.9%), or either the victim’s or the perpetrator’s residence (n=2, 6.9% each); the second most common place was a public place (31.0%), and in 1 F-S case the suicide was consummated in the victim’s workplace. In 80% (n=12) of the cases the suicide happened in the same location as the respective femicide.
In only 8 cases (27.6%) the victim had a survival time and was admitted to a hospital after the crime, having died there. In 2 cases the perpetrator who committed suicide survived less than 24 hours (13.3%), and in 1 case, more than 24 hours (6.7%).
In most cases concerning the F-S group, the femicide was triggered by jealousy (which included a suspicion of the victim’s infidelity) and a sense of ownership by the male. In the F-SA group, there was not a predominance of a particular motivation, with the same number of cases (n=4) for each: jealousy, separation or threat of separation and conflicts (conjugal, financial, familiar or children custody problems).
In 4 cases (13.8%) there were other mortal victims involved, having all of those deaths occurred when the perpetrator afterwards committed suicide, namely: a 3-year-old son, an 8-year-old son, an 11-year-old stepson of the perpetrator, as well as 2 neighbors (both in the same event).
In 6 of the cases, the perpetrator left a suicide note (40%), which was available to the study in only 5 cases: all of them clarified the motivation for the fatal events and had instructions about what was to be done about the perpetrator’s possessions. The notes were addressed to: the would-be victim (n=1) explaining the motives for the perpetrator’s suicide; the perpetrator’s son and stepdaughter (n=1); and to a colleague (n=1); in 2 notes it wasn’t specified to whom it was addressed. In 2 cases there were records confirming that the perpetrator suffered from a known minor physical condition that apparently was cause of significant anxiety.
Table 4. Characteristics of the circumstances surrounding the femicide (F), suicide (S) and suicide attempt (SA)
F-S n (%) F-SA n (%) Total n (%) F S F SA F S/SA Place Residence Public place Other Unknown 9 (60.0) 5 (33.3) 1 (6.7) 0 8 (53.3) 5 (33.3) 1 (6.7) 1 (6.7) 10 (71.4) 3 (21.4) 1 (7.1) 0 7 (50.0) 4 (28.6) 0 3 (21.4) 19 (65.5) 8 (27.6) 2 (6.9) 0 15 (51.7) 9 (31.0) 1 (3.4) 4 (13.8) Survival time Yes No 3 (20.0) 12 (80.0) 3 (20) 11 (73) 5 (35.7) 9 (64.3) - - 8 (27.6) 21 (72. 4) - - Alleged motivation Jealousy (Threat of) separation
Conflicts 9 (50.0) 5 (27.8) 4 (22.2) 4 (33.3) 4 (33.3) 4 (33.3) 13 (43.3) 9 (30.0) 8 (26.7) Other mortal victims (n=4)
Children of the perpetrator Stepchildren of the perpetrator Non-children 2 (50.0) 1 (25.0) 1 (25.0) 0 0 0 2 (50.0) 1 (25.0) 1 (25.0)
Characteristics of the lethal and non-lethal lesions of the victims and perpetrators
Table 5 presents the chief characteristics of the lethal and non-lethal lesions found on the femicide (n=29) and suicide (n=14) autopsy reports, as well as the characteristics of the non-lethal lesions regarding the suicide attempts (n=14) which were collected from the official police reports.
Table 5. Characteristics of the lethal lesions in homicides and suicides and non-lethal lesions in suicide attempts
F-S n (%) F-SA n (%) Total n (%) F S F SA F SA M e tho d Gunshot trauma Shotgun Handgun Rifle
Sharp or chop trauma
Knife/razor/dagger Axe Blunt trauma Blunt objects Transportation vehicles Asphyxia Manual strangulation Hanging Heat trauma Gas inhalation Unknown 11 (73.3) 4 5 2 2 (13.3) 2 0 1 (6.7) 1 0 0 0 0 1 (6.7) 0 0 11 (73.3) 4 6 1 1 (6.7) 1 0 2 (13.3) 0 2 1 (6.7) 0 1 0 0 0 5 (33.3) 5 0 0 6 (40.0) 5 1 1 (6.7) 1 0 2 (13.3) 2 0 0 0 0 4 (28.6) 3 1 0 2 (14.3) 2 0 3 (21.4) 0 3 1 (7.1) 0 1 0 1 (7.1) 3 (21.4) 16 (55.2) 9 5 2 8 (27.6) 7 1 2 (6.9) 2 0 2 (6.9) 2 0 1 (3.4) 0 0 15 (51.7) 7 7 1 3 (10.3) 3 0 5 (17.2) 0 5 2 (6.9) 0 2 0 1 (3.4) 3 (10.3) Lo c a tio n* Head Face Neck Thorax Abdomen1 Upper limbs Lower limbs NA Unknown 10 (31.3) 9 (28.1) 3 (9.4) 6 (18.8) 2 (6.2) 1 (3.1) 1 (3.1) 0 0 10 (38.5) 4 (15.4) 4 (15.4) 4 (15.4) 2 (7.7) 2 (7.7) 2 (7.7) 0 0 2 (10.0) 0 5 (25.0) 9 (45.0) 3 (15.0) 0 1 (5.0) 0 0 0 0 3 (21.4) 0 0 2 (14.3) 0 1 (7.1) 8 (57.1) 12 (23.1) 9 (17.3) 8 (15.4) 15 (28.8) 5 (9.6) 1 (1.9) 2 (3.8) 0 0 10 (23.3) 5 (11.6) 7 (16.3) 4 (9.3) 2 (4.7) 4 (9.3) 2 (4.7) 1 (2.3) 8 (18.6) Num be r 1 2-9 ≥ 10 NA/NC 7 (46.7) 5 (33.3) 2 (13.3) 1 (6.7) 9 (60.0) 3 (20.0) 2 (13.3) 1 (6.7) 6 (42.9) 6 (42.9) 2 (14.3) 0 - - - - 13 (44.8) 11 (37.9) 4 (13.8) 1 (3.4) - - - - NA/NC: Non applicable/non countable
*These variables are not mutually exclusive
1In this analysis “Abdomen” includes lumbar and pelvic regions
All female victims were subjected to a forensic autopsy. In order of frequency, the lethal lesions that were found were due to:
a) Gunshot trauma (55.2%) specially involving a shotgun; taking in consideration only the F-S group, it totals 73.3%;
b) Sharp and chop trauma (27.6%), caused either by a knife/razor/dagger or an axe; it was the most frequent method used in the F-SA group (40%);
c) Blunt trauma (6.9%): 1 using a stone and another a metal bar; d) Asphyxia by manual strangulation (6.9%);
e) Thermal trauma with heat burns (3.4%).
The most frequent location of the victim’s mortal wounds was, regarding the F-S cases, the head (31.3%) followed by the face (28.1%), while in the F-SA group it was the thorax (45%) followed by the neck (25%).
Most of the victims presented one single lethal injury (n=13), in 11 cases between 2 to 9 lethal injuries and in 4 cases more than 10 - regarding deaths by asphyxia the number of lethal lesions was counted as 1; in the thermal trauma deaths it was considered not countable.
Autopsies were performed in 14 male perpetrators; in 1 case it was not possible to ascertain if an autopsy was conducted due to lack of information. However, some information regarding the lethal lesions on that suicide case was available on police reports. In order of frequency, the lethal lesions described were due to:
a) Gunshot trauma (73.3%), particularly using handguns;
b) Blunt trauma (13.3%), namely involving transportation vehicles: running against a moving train (n=1) and a car fall from a cliff (n=1);
c) Sharp trauma (6.7%), caused by a dagger; d) Asphyxia by hanging (6.7%).
The most frequent location of the mortal wounds was the head (38.5%), followed by the face, thorax and neck (15.4% each). Most of the perpetrators (n=9) presented 1 single lethal lesion. In 2 cases hesitation wounds were also found (13.3%) - a single wound in each case.
Comparing lethal lesions presented in the victims and perpetrators: in 11 cases (78.6%) the method used for the suicide was the same as the one used for the femicide, and mostly gunshot trauma; in 7 of the cases (50%) the location of the mortal lesions was coincident with the ones found on the respective homicide victim - in 2 cases it was partially coincident (14.3%) and in 6 cases it was not coincident (42.9%), with the most common location being the head; in 9 cases the perpetrator and the victim showed the same number of lethal lesions (60%), which was usually a single lesion.
In order of frequency, the method chosen for the attempted suicide of the perpetrator (related to non-lethal lesions) was:
b) Blunt trauma (21.4%), namely involving transportation vehicles: jumping in front of moving vehicles (n=2) – cars in 1 case and a train in the other - and moving a car against a static object (n=1);
c) Sharp trauma (14.3%), involving a knife; d) Asphyxia by hanging (7.1%);
e) Gas inhalation (7.1%), by cutting the gas tube from the stove and leaving the respective tap open.
The most frequent location of the wounds was the neck (20%) followed by the upper limbs (13.3%) – the location of the lesions in the case of the gas inhalation was considered not applicable. Data was missing in 57.1% of the cases. Information on the number of non-lethal lesions was not recorded in any case.
From the total of 29 femicide victims, 15 cases (51.7%) also presented acute non-lethal IPV-related lesions, contemporary with the homicide, found on the forensic autopsies and specially correspondingly to the F-SA group (64.3%), which are shown on table 6.
Table 6. Characteristics of the non-lethal lesions of the victims
F-S n (%) F-SA n (%) Total n (%) Acute non-lethal lesions Yes No 6 (40.0) 9 (60.0) 9 (64.3) 5 (35.7) 15 (51.7) 14 (48.3) Method Sharp trauma Blunt trauma Gunshot trauma 2 (33.3) 2 (33.3) 2 (33.3) 5 (50.0) 4 (40.0) 1 (10.0) 7 (43.8) 6 (37.5) 3 (18.8) Location* Head Face Neck Thorax Abdomen Upper limbs Lower limbs 0 0 3 (7.3) 0 1 (2.4) 4 (9.8) 0 5 (15.2) 6 (18.2) 5 (15.2) 6 (18.2) 2 (6.1) 7 (21.2) 2 (6.1) 5 (12.2) 6 (14.6) 8 (19.5) 6 (14.6) 3 (7.3) 11 (26.9) 2 (4.9) Number 1 2-9 ≥ 10 0 5 (83.3) 1 (16.7) 1 (11.1) 4 (44.4) 4 (44.4) 1 (6.7) 9 (60.0) 5 (33.3) *These variables are not mutually exclusive
These lesions were mostly caused by sharp trauma (43.8%), followed by blunt trauma (37.5%). The most frequent location of the wounds was the upper limbs (26.9%),
neck (19.5%) and thorax (14.6%). In 9 cases, 2 to 9 non-lethal wounds were found (60%). Defense wounds were present in 8 cases (27.6%). None of the victims presented wounds in a healing stage (which would suggest reiterated physical abuse), nor injuries related to sexual assault.
Legal outcomes
All F-S cases were filed, as well as 2 cases in the F-SA group, due to death of the defendant before the trial. However, in all these cases, there was enough evidence to affirm that the perpetrator was, indeed, the current or former intimate partner of the victim.
From the remaining F-SA cases (n=12), 41.7% (n=5) of the convictions were given at the Trial Court, 16.7% (n=2) at the Court of Appeal and 41.7% (n=5) at the Supreme Court; in 1 case the perpetrator was convicted to security measures, while the remaining perpetrators were convicted by the crime of murder: 41.7% (n=5) of qualified murder and 33.3% (n=4) of simple murder. In 25% (n=3) of the cases there were also convictions by other crimes (illegal weapon possession and murder of other victims). Most perpetrators were sentenced to between 10 to 15 years of prison (n=10, 83.3%) and 1 case to less than 10 years.
DISCUSSION
This study examined 29 cases of intimate femicide that occurred during a 3-year period, of which 15 were followed by the suicide and 14 by the suicide attempt of the perpetrator.
The rate of perpetrator suicide in the context of homicide in intimate relationships was 24.2%. Literature indicates worldwide rates that range from 18% to 40% [6].
Several findings of this study were similar to those of previous research on intimate partner F-S, F-SA and H-S in general, namely: the age of the victim; the employment status and history of alcohol abuse of the perpetrator in the F-SA group; the nature of the relationship at the time of the event; the history of previous IPV; the place of the suicide events; the alleged motivation; the method used for femicides and suicides; the location and number of lethal lesions and the existence of defense wounds in the victims.
Characteristics of the victims, perpetrators and their intimate relationship
The average age of all victims in the present study was 44 years old, suggesting a greater risk of this phenomenon for young women, which was also established in other studies [6,11,12,18]. In both the F-S and F-SA groups the average age of the perpetrators was 50 years old, which is consistent with information found on earlier research [2,11,13,18]; however, 2 others studies on intimate partner F-S [6,19] - one conducted in South Africa and another one in Australia - both found a bigger prevalence of young perpetrators (under 40 years old), which could be explained by different demographics. In contrast, a Portuguese study showed that males who committed isolated suicide were usually older (specifically more than 65 years old) [20].
Studies show that most of the female victims were employed at the time of the event [6,12,19], which was similar to this study (44.8%). Also, most perpetrators who attempted suicide were employed (57.1%), confirming findings from previous data [6,12,19]. Regarding the perpetrators who committed suicide, data was missing in 46.7% of the cases, rendering it difficult to draw conclusions; however, a study showed that the majority of males who commit suicide in Portugal do not have any economic activity [20].
In our study, 6.9% of the victims had a history of mental illness, but in 82.8% data was missing so it was not possible to draw any conclusions. A previous study showed that H-S are often characterized by a female victim without history of psychiatric disorder and a male perpetrator who suffers from a depressive illness with personality disorder [10]. Regarding history of mental illness there was a total lack of information in reports for F-S perpetrators. Among the perpetrators who attempted suicide, 35.7% had a history of mental illness, which is considered a risk factor for intimate partner H-S [8,10,21] but also
for isolated suicide attempts [22]. Data show that psychiatric disease is present in 91% of individuals who commit suicide [23] and that depression is more frequent among F-S perpetrators, rather than in those who commit homicides alone [10].
Regarding history of substance (alcohol and/or drug) abuse, in the majority of the cases (82.8%) there was no data regarding the victims and it was missing in all F-S cases. Conversely, 28.6% of the F-SA’s perpetrators had a history of alcohol abuse, and there was 1 case with records on alcohol and drug abuse, corroborating previous findings that show that male alcohol abuse is a risk factor for H-S [10]. Studies also show, however, that illicit drug abuse is not as prevalent in H-S as in homicide alone [8,10,12]. Previous research also revealed that drug abuse is a risk factor for isolated suicide attempts [22].
Earlier studies show that the perpetrators’ easy access to guns is a major risk factor for intimate partner femicide [6,12,24,25]. In this study, 58.6% of the perpetrators were in the possession of firearms, which can partially be explained by their occupation and activities. Legal possession was more prevalent in the F-S group (40%), while in the F-SA group data was missing in most (64.3%) of the cases. In previous research, higher rates of access to firearms by the perpetrators of F-S and F-SA were found (80.6% and 58.6%, respectively) [12] while another study demonstrated F-S perpetrators’ legal firearm possession rates of 75% [6].
There was no data available about previous criminal records of the perpetrators who committed suicide. On the F-SA group, a minority (n=3) had a criminal record, being, in 1 case, related to IPV. This is consistent with studies that have been showing that the perpetrators of F-S generally have a low rate of criminal behavior [8,26].
Most women were killed by their marital partners, including former or current husbands (53.3% in the F-S group and 42.9% in the F-SA), as opposed to the remaining non-marital partners, conclusions also drawn in other studies [12,14,19]. This was not consistent with findings of a South-African study that shows a stronger likelihood of a woman being killed by a non-marital partner in F-S events [6], which can be explained in the light of different relationship lifestyles between countries. The fact that in 37.9% of the cases the victims and the perpetrators had a former relationship show that a considerable risk for H-S remains even after their separation; in fact, we found that in 2 F-S cases, more than 10 years had passed since the end of the relationship. Regarding isolated suicide cases, a Portuguese study showed that males who committed suicide are more frequently divorced or widowed [20], which contrasts with our findings.
At the time of the event most victims from the F-S group (60%) didn’t cohabitate with the perpetrator; the opposite was found in the F-SA group, with 57.1% of the cases involving cohabitation. Our results are not in accordance with other data that shows that
intimate F-S is more common in cohabitating relationships [6,12]. Even so, a previous study also showed a low prevalence of cohabitation (31%) at the time of the event in H-S [27]. As a matter of fact, the lowest rates of this phenomenon occur in dating relationships [6,12], and in the present study only 4 of these cases were found.
According to our findings, the length of the relationships was less than 10 years in most cases (34.5%) where data was available. It is consistent, to some extent, with a Chicago study that demonstrated that 50% of the female victims were in a relationship for less than 2 years [24]. In the F-S group we found that in most cases (53.3%) there were children in common; in the F-SA group there were no children in common in 50%. This contrasts with findings of an Indian study that shows that the fact of not having children in common was a risk factor for intimate partner physical and sexual abuse [28]. In both groups, we found that underage children were living in the same household as the victim at the time of the event in most of the cases (51.7%), data not consistent with previous findings [12].
Most of the victims (55.2%) we studied had a history of previous IPV perpetrated by the partner who committed the homicide, with similar numbers in both groups. Comparable findings were also present in other studies, suggesting history of IPV as a risk factor for F-S [10,27,29,30]. However, physical healing injuries suggestive of non-recent IPV, or injuries related to sexual assault, were not found in the autopsy of any of the victims.
Characteristics of the femicide and suicide’s circumstances and of the lethal and non-lethal lesions of the victims and perpetrators
Studies show that there is a homicide peak during summer months and in the weekend [31,32]; in our study, most fatal events on both groups took place during Spring (31%), followed by Summer and Winter (24.1% each) and in the weekend (66.7%). It was shown that male suicide in Portugal was more prevalent during the months from February to August [20], a finding that we also confirm for the F-S group, with the most common months being May and July.
The place of most of the events (femicide, suicide and suicide attempt) was the house where the victim and the perpetrator both lived. It was shown in previous research that a residence is also the most frequent location of isolated suicides [33]. However, one study showed that H-S events occurred more frequently in either the victim or in the perpetrator’s home [14], which was the second most frequent location found in our study. Another study showed that most of the F-SA events occurred in the victim’s home, but only in 29% of the F-S cases, with more than one-third of F-S occurring in a public place
and F-SA groups. In most cases in our study the suicide and the homicide took place in the same location, data also found in another article [14].
Regarding the motivation, most of the events in the F-S group (50%) occurred due to jealousy and sense of possessiveness by the perpetrator, corroborating previous studies [7,8,12,14,34]. Other articles showed that the precipitating event was the fear of abandonment by the perpetrator [35] and that the depression that follows a separation may trigger the event [36]. In our study, separation or threat of separation was the second most frequent motive found in the F-S cases (30%). Previous research showed that being separated or divorced is a risk factor for isolated suicide attempts [22]. Regarding the F-SA group, there was no predominance of a particular motive. We found only one case of mercy killing (belonging to the F-SA group); other studies also found this phenomenon to be a rare occurrence among the F-S events [14] and one case similar to ours was reported in a Danish study [18].
Previous articles state that the existence of other mortal victims is not common in intimate femicides [24,37]. We found 4 cases, most of them children. It was also found in previous research that children are frequently killed in H-S events [14], being the second most common victims [37], which is comparable with our findings. One of the possible explanations for these deaths, all of them in the F-S group, can be a desire of the perpetrator to not leave orphaned children behind.
Some studies define F-S as a premeditated and cautiously planned act [7,34], supported bythe existence of suicide notes and the fact that the suicide of the perpetrator and the homicide of his intimate partner occur within a short time interval [7]. This is confirmed in our study, where suicide notes were present in 40% of the cases, and the period of time between the two occurrences was mostly very short (less than one hour in 60%). In two F-S cases, the perpetrator suffered from a known physical condition which caused him substantial anxiety; this could be an additional factor contributing to the perpetrator’s emotional strain, leading to the occurrence of the fatal events.
Most victims in the F-S group were killed by gunshot (73.3%), especially handguns, whereas in the F-SA cases, sharp and chop trauma were more frequent (40%). These findings are consistent with the ones of a previous study [8]. This difference in the chosen method can be explained by the fact that the one used for the subsequent suicide was also most frequently gunshot (73.3%). A study on suicide in Portugal demonstrated that firearms were responsible for only 11.1% of the suicides on men [38], which is not in accordance with our findings. The prevalent use of handguns in suicides was also demonstrated in previous research [33] and the common use of firearms in suicides can be explained by their very high lethality [39] and because it requires little preparation [40]. An European study on suicide methods demonstrated that suicides in Portugal had a
great proportion of jumping from a high place and a low proportion of using a moving object [41]. We only found 1 case of suicide by jumping from a high place, involving a car fall from a cliff; however, we did find 1 case of death by running against a moving train. In 78.6% of the cases the method of death used for the suicide and the homicide was the same. The lower percentage of firearm use in the attempted suicides (28.6%) when compared to the F-S group (73.3%) can be explained by their more impulsive nature as opposed to the more carefully planned H-S events. Other methods may reflect this inherent impulsivity; for example, we found 2 cases of attempted suicides by jumping in front of moving vehicles. The method chosen may also reflect the underlying magnitude of the suicidal intent; for instance, hanging (1 suicide attempt case in our study) carries a high suicide mortality as opposed to cutting (2 in our study) [42].
In the F-SA group, most female victims were fatally injured in the thorax (45%), while in the F-S group the most frequent location was the head (31.3%) as in the suicide cases (38.5%), which is consistent with previous studies [43]. Various studies also showed that head, face and thorax were the most common locations of fatal wounds on female homicide victims [44,45], which can be explained by the fact that these anatomical regions contain vital organs.
In 44.8% of the cases a single lethal lesion was found on the female victims. Our findings were consistent with an study on female homicides that concluded that single lesions were more frequent [44]. One Swedish study showed that the presence of more than ten wounds (13.8% of the cases in our study) carried a lower probability that the perpetrator and victim were strangers to each other [46]. Defense lesions were found in 27.6% of the cases, consistent with findings of a study on homicidal deaths in general (33%) [45].
Legal outcomes
Few articles have been published on the role of forensic evidence on legal outcomes. A South-African study on female homicides showed that police basic investigations were the key factors for convictions, which were more likely when an a murder weapon was found, a history of IPV was known, or when the woman was killed in her home, and were achieved for nearly half of those prosecuted [47]. These figures generally contrast with our research, in which every perpetrator who was alive at the time of the trial was convicted.
The maximum prison sentence in Portugal is 25 years for qualified murder [48]. Most perpetrators were convicted of qualified (41.7%) and simple (33.3%) murder, and sentenced to between 10 and 15 years of prison (83.3%), which is in accordance with the
Portuguese law. In only 1 case the perpetrator was considered inimputable and convicted to security measures.
Limitations of the study, recommendations in intimate femicide-suicide cases and further research
The major limitation of this study was the reduced number of cases available; however, it was made based in a national setting (related to the population of Portugal) and there is a lack of national studies in this matter. It was only possible to include cases occurred until 2007 in order to obtain all records and legal documents necessary for the study.
Another limitation was the lack of documented information on official police reports, namely related to the history of substance abuse, mental illness, previous suicide attempts, criminal records or family history of suicide, that precluded a thorough characterization of the victims and perpetrators.
A fundamental method for the prevention of femicide-suicide is the availability of mental health resources for abusive partners who are experiencing depression [12]. Earlier studies found that the men frequently didn’t receive appropriate treatment for depression [49], or that the treatment alone was not sufficient [33].
The high prevalence of use of firearms in femicide-suicides shows the importance of health workers’ training on anticipating these events in the presence of firearm possession, especially in patients with mental illness [50]. Also, law restriction to firearms is very important, particularly in those cases where there is an increased risk of H-S - for example, when there’s a history of domestic violence or the subject has threatened to commit suicide [1,12]. Stronger legislation on domestic violence may be an area of intervention, with programs that help men dealing with separation and anger [1].
It would be interesting to study whether perpetrators in the F-S group had shown previous attempts or a family history of a self-destructive act, both being risk factors for suicide [51]. Although it would also be important to study more thoroughly the F-SA cases, due to the difficulty in obtaining the data this was not possible. Future studies could focus in these occurrences, and, for instance, see if there is a significant difference between these and F-S events, or if they’re both variants of the same phenomenon.
CONCLUSIONS
The present study is the first national study on intimate partner femicide-suicide, based in forensic autopsies and police records and proved by judicial decisions.
Our main conclusions were:
1. A total of 29 IPV-related femicide cases occurred during a 3-year period in Portugal: 15 followed by suicide and 14 by a suicide attempt;
2. The rate of perpetrator suicide in the context of homicide in intimate relationships was 24.2%;
3. Several of our findings were consistent with previous research on intimate partner F-S, F-SA and H-S, specifically: the age of the victim; the employment status and history of alcohol abuse of the perpetrator in the F-SA group; the nature of the relationship at the time of the event; history of previous IPV; the place of the suicide events; the alleged motivation; the method used for femicides and suicides; the location and number of lethal lesions and the existence of defense wounds in the victims;
4. Due to the lack of information it was difficult to draw conclusions, namely on some of the perpetrators’ social, clinical and criminal aspects (history of substance abuse, mental illness, criminal records, previous suicide attempts and family history of suicide);
5. Some characteristics of the suicides after femicide and isolated suicides are apparently not overlapping: the perpetrators of F-S are generally older, employed, in a former or current marriage and not widowed, and commit suicide by gunshot instead of jumping from a high place, unlike the perpetrators of isolated suicides;
6. The profile of the victim of IPV related F-S is a young women (44 years old) and employed; the perpetrator is, on average, 50 years old, employed and owns a firearm; the perpetrator whoattempts suicide has no previous criminal record, a history of mental illness in 35.7% and of alcohol abuse in 28.6%;
7. The relationships were mostly marital, current, lasting less than 10 years, with children in common and a history of previous IPV; in former relationships, more than half of the events occurred less than 1 year after the separation;
8. Most of the suicides occurred shortly after the femicide and in 40% with a suicide note; the fatal and non-fatal events frequently occurred in a residence, triggered by jealousy and involving other mortal victims in 14%, most of them children;
9. The suicides that follow a femicide were often a premeditated act;
10. The most common cause of death in the F-S group was gunshot trauma, for victims and perpetrators, and both were most frequently fatally injured in the head. The method of death, the location and the number of lethal lesions of the perpetrator were usually the same of the respective homicide victim;
11. The method most commonly used for the suicide attempts was also gunshot trauma, while the victim was mostly killed by sharp and chop trauma; victims were typically injured in the head and the perpetrators in the neck;
12. Acute non-lethal IPV-related lesions were often found in the victims of the F-SA group (64.3%);
13. None of the victims presented wounds suggestive of reiterated physical abuse or sexual assault;
14. All the perpetrators alive at the time of the trial were convicted, most of them by the crime of murder and sentenced to 10-15 years of prison.
Potential areas for intervention are the improvement of the availability of mental health resources for abusive partners, an anticipation of these events in the presence of firearm possession and its restriction, and a stronger legislation on domestic violence.
ACKNOWLEDGEMENTS
This work would not be possible without the help of many people.
I would like to express my gratitude to Prof. Teresa Magalhães (MD, PhD), for all the suggestions and invaluable assistance.
Deepest appreciation is also due to Dr. Ana Rita Pereira (MD), for her essential guidance and availability to help.
I would also like to thank Dr. Maria João Alves and Dr. Ricardo Escada, for facilitating all the bureaucratic work.
Special thanks are due to all the judicial employees whose help was fundamental for obtaining all the data needed.
I am especially grateful to my family, friends and Artur for all the love, support and understanding.
ETHICAL STANDARDS
All ethical issues were respected.
CONFLICT OF INTEREST
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Please use no more than three levels of displayed headings. Abbreviations
Footnotes
Footnotes can be used to give additional information, which may include the citation of a reference included in the reference list. They should not consist solely of a reference citation, and they should never include the bibliographic details of a reference. They should also not contain any figures or tables.
Footnotes to the text are numbered consecutively; those to tables should be indicated by superscript lower-case letters (or asterisks for significance values and other statistical data). Footnotes to the title or the authors of the article are not given reference symbols.
Always use footnotes instead of endnotes. Acknowledgments
Acknowledgments of people, grants, funds, etc. should be placed in a separate section before the reference list. The names of funding organizations should be written in full.
REFERENCES
Citation
Reference citations in the text should be identified by numbers in square brackets. Some examples:
1. Negotiation research spans many disciplines [3].
2. This result was later contradicted by Becker and Seligman [5]. 3. This effect has been widely studied [1-3, 7].
Reference list
The list of references should only include works that are cited in the text and that have been published or accepted for publication. Personal communications and unpublished works should only be mentioned in the text. Do not use footnotes or endnotes as a substitute for a reference list. The entries in the list should be numbered consecutively.
Journal article
Gamelin FX, Baquet G, Berthoin S, Thevenet D, Nourry C, Nottin S, Bosquet L (2009) Effect of high intensity intermittent training on heart rate variability in prepubescent children. Eur J Appl Physiol 105:731-738. doi: 10.1007/s00421-008-0955-8
Ideally, the names of all authors should be provided, but the usage of “et al” in long author lists will also be accepted:
Smith J, Jones M Jr, Houghton L et al (1999) Future of health insurance. N Engl J Med 965:325–329
Article by DOI
Slifka MK, Whitton JL (2000) Clinical implications of dysregulated cytokine production. J Mol Med. doi:10.1007/s001090000086
Book
South J, Blass B (2001) The future of modern genomics. Blackwell, London
Book chapter
Brown B, Aaron M (2001) The politics of nature. In: Smith J (ed) The rise of modern genomics, 3rd edn. Wiley, New York, pp 230-257
Online document
Cartwright J (2007) Big stars have weather too. IOP Publishing PhysicsWeb. http://physicsweb.org/articles/news/11/6/16/1. Accessed 26 June 2007
Dissertation
Trent JW (1975) Experimental acute renal failure. Dissertation, University of California
Always use the standard abbreviation of a journal’s name according to the ISSN List of Title Word Abbreviations, see
www.issn.org/2-22661-LTWA-online.php
For authors using EndNote, Springer provides an output style that supports the formatting of in-text citations and reference list.
EndNote style (zip, 2 kB)
Authors preparing their manuscript in LaTeX can use the bibtex file spbasic.bst which is included in Springer’s LaTeX macro package.
TABLES
All tables are to be numbered using Arabic numerals.
Tables should always be cited in text in consecutive numerical order.
For each table, please supply a table caption (title) explaining the components of the table.
Identify any previously published material by giving the original source in the form of a reference at the end of the table caption.
Footnotes to tables should be indicated by superscript lower-case letters (or asterisks for significance values and other statistical data) and included beneath the table body.
ARTWORK AND ILLUSTRATIONS GUIDELINES
For the best quality final product, it is highly recommended that you submit all of your artwork – photographs, line drawings, etc. – in an electronic format. Your art will then be produced to the
highest standards with the greatest accuracy to detail. The published work will directly reflect the quality of the artwork provided.
Electronic Figure Submission
Supply all figures electronically.
Indicate what graphics program was used to create the artwork.
For vector graphics, the preferred format is EPS; for halftones, please use TIFF format. MS Office files are also acceptable.
Vector graphics containing fonts must have the fonts embedded in the files.
Name your figure files with "Fig" and the figure number, e.g., Fig1.eps. Line Art
Definition: Black and white graphic with no shading.
Do not use faint lines and/or lettering and check that all lines and lettering within the figures are legible at final size.
All lines should be at least 0.1 mm (0.3 pt) wide.
Scanned line drawings and line drawings in bitmap format should have a minimum resolution of 1200 dpi.
