Homicides followed by the suicide of the perpetrator constitute a serious form of interpersonal violence. Until now no study has directly compared homicide-suicides to other violent deaths from multiple countries, allowing for a better understanding of the nature of these violent acts. Using country-specific data, this study describes and compares the incidence and patterns of homicide-suicide as well as the relationship between homicide-suicide, homicide, suicide and domestic homicide in the Netherlands, Switzerland and the United States. The results indicate that cross-nationally, homicide-suicides are more likely than other types of lethal violence to involve a female victim, multiple victims, take place in a residential setting and to be committed by a firearm. Although homicide-suicides display many similarities across the different countries, differences exist regarding age and the use of firearms in the offence. This study indicates that homicides followed by suicides differ from both homicides and suicides in similar ways internationally. Cross-national differences in the availability of firearms may explain the international variation of homicide-suicide rates and patterns.