Commentary: Homicide-Suicide in the Caribbean Maisha K. Emmanuel, MB, BS, and Michael H. Campbell, PhD With the exception of Guyana and Trinidad, suicide rates in the Caribbean are relatively low compared with those in other countries. Homicide rates, however, have increased over the past 15 years, especially in Jamaica and Trinidad. The link between suicide, homicide, and homicide followed by suicide (H-S) is not well established. A newspaper review of H-S events in a selection of Caribbean territories revealed a surprising number of these events. Characteristics of perpetrators were similar to those documented in the literature. The authors agree with Roma et al. that national tracking systems for H-S are needed. Empirical research on this topic in the Caribbean is also desperately needed. J Am Acad Psychiatry Law 40:469 –71, 2012 Roma et al. 1 produced a laudable contribution to the understanding of international patterns of homicide- suicide (H-S) with a particular focus on the etiolog- ical role of mental illness. We note, however, that the authors did not reference data from the Caribbean. Although this might imply a weakness in the scope of their analysis, it is not a criticism of the article, per se, but more a reflection of the paucity of published research on the Caribbean. At present, coverage of the topic in the region is limited to studies of each phenomenon separately or to anecdotal evidence found in media reports. Existing data suggest that suicide rates in the English-speaking Caribbean, with the exception of Guyana and Trinidad (Table 1), are relatively low in comparison with those reported in other regions. Relatively low suicide rates among persons of African decent have been documented elsewhere, as well. 3 The factors contributing to higher suicide rates in Trinidad and Guyana are not fully understood. Hutchinson has documented higher suicide rates among Indo-Trinidadians in comparison to Afro- Trinidadians. 4 Maharajh and Abdool 5 postulated that transgenerational conflict, religious beliefs, mar- ginalization, and sensationalized reporting of sui- cides in the media are factors that increase suicide risk among Indo-Trinidadians. However, empirical sup- port for these hypotheses is limited. Patterns of homicide, both in the Caribbean and internationally, are characterized by men commit- ting most of the violent offenses. In addition, men constitute 82 percent of homicide victims world- wide. The typical scenario is that of a man shooting another man. Violence against women often takes the form of intimate-partner or family-relation vio- lence. Unlike men, women are more often murdered at home than in public. Since 1995, homicide rates in the Caribbean have risen, particularly in Jamaica and Trinidad (Table 2). The United Nations has described this trend as near- ing a crisis point. 6 Factors such as poor economic development, drug trafficking, availability of fire- arms, political violence, and organized crime have contributed to the rise. In contrast, rates in Asia, Europe, and North America have fallen during this period. The link between suicide, homicide, and homi- cide-suicide (H-S) is not well established interna- tionally. In addition to Roma et al., 1 previous stud- ies 7 of perpetrators of H-S have been identified in the extant literature. However, this limited understand- ing does not provide an adequate basis for prediction and prevention. This is further complicated by the extremely low incidence of the phenomenon (less than 0.001 percent). 7 Roma et al. note that “H-S events are rare . . .” and that “studies on H-S are scarce” (Ref. 1, p 462). Dr. Emmanuel is a Lecturer in Psychiatry and Dr. Campbell is a Lecturer in Behavioral Science/Psychology, The University of the West Indies, Cave Hill, Barbados. Address correspondence to: Maisha K. Emmanuel, MB, BS, The University of the West Indies, Cave Hill, Barbados. E-mail: e.maisha@gmail.com. Disclosures of financial or other potential conflicts of interest: None. 469 Volume 40, Number 4, 2012