BACKGROUND We describe for the first time the epidemiology of homicide-suicide incidents for England and Wales. Previous descriptions have been of incidents in London (1946-62) and Yorkshire and Humberside (1975-1992). METHODS Death certificates were obtained for all who died in homicide-suicide incidents in England and Wales (1988-1992) that were reported by the police to the Home Office. Incidents were included in the analysis if the interval between death or fatal injury of victim and suspect was 3 or fewer days. RESULTS Three hundred and twenty-seven people died in 144 incidents (180 victims and 147 suspects). Eighty per cent of incidents had one victim and one suspect. Three incidents were also suicide pacts between two suspects killing their children. Eighty-eight per cent of incidents exclusively involved members of the same family, 9 % acquaintances or strangers, and 3 % both family and acquaintances or strangers. Seventy-five per cent of victims were female, 85% of suspects male. The victims of male suspects were predominantly their womenfolk, past and present, and their children, and of female suspects their young children. Car exhaust and firearms accounted for 40% of victim and 50% of suspect deaths. Of all homicides during 1988-1992, 3 % of male, 11% of female and 19% of child deaths occurred in homicide-suicide incidents. Similarly, of all suicides, 0.8% of male and 0.4% of female deaths occurred in homicide-suicide incidents. CONCLUSIONS Homicide-suicide in England and Wales is mostly 'a family matter', men of predominantly lower social class killing their kin, and pre-menopausal mothers their young children, before they kill themselves. A few men kill strangers during a crime and then themselves.