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Preventing suicide by jumping: The effect of a bridge safety fence

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Abstract

To evaluate the effect of a bridge safety fence in preventing suicide. We examined suicides from jumping off the Memorial Bridge in Augusta, Maine, from 1 April 1960 to 31 July 2005. The safety fence was installed during 1983, the mid-point of the study period. 14 suicides from the bridge were identified; all occurred before installation of the safety fence. The number of suicides by jumping from other structures remained unchanged after installation of the fence. The safety fence was effective in preventing suicides from the bridge. There was no evidence that suicidal individuals sought alternative sites for jumping.

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... Nineteen papers describing 14 studies at 13 locations worldwide met our inclusion criteria15161718192021222324252627282930313233, and are summarised inTable 2. There were several instances where the same group of authors used the same core data in more than one paper, augmenting it with data from other sources or with follow-up data15161718192026,32]. In these cases, we took the conservative approach of regarding the different papers as relating to the same study to avoid double-counting of any observed impacts, thereby circumventing the possibility of multiple publication bias. ...
... Nine studies have examined the effectiveness of restricting access to lethal means by installing physical barriers at sites that are used for jumping from a height or jumping in front of a train. All of these studies suggest that suicides reduce once means restriction measures are put in place151617182223242728293031, or rise when they are removed [15,16]. Pelletier [28], Reisch and Michel [29] and Sinyor and Levitt [30] observed no further suicides after barriers were installed on the Memorial Bridge in Augusta, Maine (United States), Muenster Terrace in Bern (Switzerland) and the Bloor Street Viaduct in Toronto (Canada), respectively . ...
... All of these studies suggest that suicides reduce once means restriction measures are put in place151617182223242728293031, or rise when they are removed [15,16]. Pelletier [28], Reisch and Michel [29] and Sinyor and Levitt [30] observed no further suicides after barriers were installed on the Memorial Bridge in Augusta, Maine (United States), Muenster Terrace in Bern (Switzerland) and the Bloor Street Viaduct in Toronto (Canada), respectively . Isaac and Bennett [22] and Skegg and Herbison [31] reported the same 'reduction to zero' finding when access was blocked to Beachy Head in Sussex (United Kingdom) and Lawyers Head Cliff in Dunedin (New Zealand). ...
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Background ‘Suicide hotspots’ include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention. Methods We searched Medline for studies that could inform the following question: ‘What interventions are available to reduce suicides at hotspots, and are they effective?’ Results There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise. Conclusions More well-designed intervention studies are needed to strengthen this evidence base.
... However, the majority of the studies focus on barriers that hinder persons from climbing over. Examples include the Memorial Bridge in Augusta, Maine, U.S.A. [12]; the Bloor Street Viaduct in Toronto, Canada [13]; Clifton Suspension Bridge in Bristol, England [14]; the Jacques-Cartier Bridge in Montréal, Canada [15]; and the Grafton Bridge in Auckland, New Zealand [16,17]. The barriers have reduced the number of suicides at these sites. ...
... However, these studies each focus on one specific jump site, which does not allow direct comparison of the different intervention measures. For example, Pelletier [12] and Sinyor and Levitt [13] showed that barriers with a height of 3.3 meters successfully hinder suicides. Yet, the height of a barrier is not the only criterion that contributes to the effectiveness of a structure. ...
... The results of the current study provide empirical evidence that structural interventions such as barriers or safety nets show a preventive effect. They are consistent with previously published studies [16,17,14,25,12,15,26,8,13]. It has been unclear though if earlier meta-analyses and individual case studies exhibit a publication bias. ...
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The goal of the study was to compare the effectiveness of different suicide prevention measures implemented on bridges and other high structures in Switzerland. A national survey identified all jumping hotspots that have been secured in Switzerland; of the 15 that could be included in this study, 11 were secured by vertical barriers and 4 were secured by low-hanging horizontal safety nets. The study made an overall and individual pre-post analysis by using Mantel-Haenszel Tests, regression methods and calculating rate ratios. Barriers and safety nets were both effective, with mean suicide reduction of 68.7% (barriers) and 77.1% (safety nets), respectively. Measures that do not secure the whole hotspot and still allow jumps of 15 meters or more were less effective. Further, the analyses revealed that barriers of at least 2.3 m in height and safety-nets fixed significantly below pedestrian level deterred suicidal jumps. Secured bridgeheads and inbound angle barriers seemed to enhance the effectiveness of the measure. Findings can help to plan and improve the effectiveness of future suicide prevention measures on high structures.
... Table 1 summarizes key characteristics of these nine studies. Six studies examined the effect of barriers installed on five separate bridges or viaducts-the Grafton Bridge (Auckland, New Zealand), 16,17 the Clifton Suspension Bridge (Bristol, UK), 22,23 the Ellington Bridge (Washington, DC), 24,25 the Memorial Bridge (Augusta, ME) 26 and the Bloor Street Viaduct (Toronto, Canada). 27 Two studies considered the effectiveness of fencing off road access to cliffs-Lawyers Head Cliff (Dunedin, New Zealand) 28 and Beachy Head (Sussex, UK). ...
... The next question that many would ask is whether the reduction in jumping suicides achieved by restricting access to one suicide jump site has a tangible impact on the overall suicide rate in a given location, or whether there is substitution to other suicide methods. Although only two of the studies in our meta-analysis looked at general suicide trends following the installation of barriers on the bridge in question, both identified small decreases in the overall suicide rate in the given cities. [24][25][26] In fact, the question of the impact of the specific intervention on the overall suicide rate may not be the right one to ask in the context of jumping suicides. In the countries in which the studies included in our meta-analysis took place, jumping from heights accounts for between 2% and 9% of male suicides and 3% and 15% of female suicides; other methods like hanging are far more common. ...
Article
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Background: Certain sites have gained notoriety as 'hotspots' for suicide by jumping. Structural interventions (e.g. barriers and safety nets) have been installed at some of these sites. Individual studies examining the effectiveness of these interventions have been underpowered. Method: We conducted a meta-analysis, pooling data from nine studies. Results: Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question (95% CI 79% to 91%). There was a 44% increase in jumping suicides per year at nearby sites (95% CI 15% to 81%), but the net gain was a 28% reduction in all jumping suicides per year in the study cities (95% CI 13% to 40%). Conclusions: Structural interventions at 'hotspots' avert suicide at these sites. Some increases in suicide are evident at neighbouring sites, but there is an overall gain in terms of a reduction in all suicides by jumping.
... Two studies found no shift to other jumping sites after installation of barriers, but they did not examine the effect on overall suicide rates. 9,10 By contrast, other studies have shown evidence of displacement, with overall suicide rates remaining unchanged. 11---13 In 1 of these latter studies, jumping suicides from other bridges and buildings in Toronto increased after the construction of a suicide barrier at Bloor Street Viaduct. ...
... In addition, we found little evidence of displacement to other bridges on Montréal Island and Montérégie. This result resembles those of studies concerning other iconic suicide sites such as the Memorial Bridge between Maine and New Hampshire, 9 Duke Ellington Bridge in Washington, DC, 19 and the Minster Terrace in Bern, Switzerland, 10 but is unlike those of a study regarding a less symbolic site, the Bloor Street Viaduct in Toronto, Ontario, which had several comparable bridges nearby. 13 Jacques-Cartier Bridge, with a bicycle path and pedestrian walkway, is more accessible than other bridges connecting Montréal Island and Montérégie. ...
Article
Objectives: We investigated whether the installation of a suicide prevention barrier on Jacques-Cartier Bridge led to displacement of suicides to other jumping sites on Montréal Island and Montérégie, Québec, the 2 regions it connects. Methods: Suicides on Montréal Island and Montérégie were extracted from chief coroners' records. We used Poisson regression to assess changes in annual suicide rates by jumping from Jacques-Cartier Bridge and from other bridges and other sites and by other methods before (1990-June 2004) and after (2005-2009) installation of the barrier. Results: Suicide rates by jumping from Jacques-Cartier Bridge decreased after installation of the barrier (incidence rate ratio [IRR] = 0.24; 95% confidence interval [CI] = 0.13, 0.43), which persisted when all bridges (IRR = 0.39; 95% CI = 0.27, 0.55) and all jumping sites (IRR = 0.66; 95% CI = 0.54, 0.80) in the regions were considered. Conclusions: Little or no displacement to other jumping sites may occur after installation of a barrier at an iconic site such as Jacques-Cartier Bridge. A barrier's design is important to its effectiveness and should be considered for new bridges with the potential to become symbolic suicide sites.
... Physical barriers are effective in reducing suicides at particular jumping sites, although evidence regarding displacement of suicides to other sites remains inconclusive. [41][42][43][44] Preventing access to the means of suicide does not, however, address individual psychological distress. Other interventions, such as depression screening and treatment, are likely to be important for reducing high suicide rates in urban and rural areas. ...
Article
We examined the leading causes of unintentional injury and suicide mortality in adults across the urban-rural continuum. Injury mortality data were drawn from a representative cohort of 2,735,152 Canadians aged ≥25 years at baseline, who were followed for mortality from 1991 to 2001. We estimated hazard ratios and 95% confidence intervals for urban-rural continuum and cause-specific unintentional injury (i.e., motor vehicle, falls, poisoning, drowning, suffocation, and fire/burn) and suicide (i.e., hanging, poisoning, firearm, and jumping) mortality, adjusting for socioeconomic and demographic characteristics. Rates of unintentional injury mortality were elevated in less urbanized areas for both males and females. We found an urban-rural gradient for motor vehicle, drowning, and fire/burn deaths, but not for fall, poisoning, or suffocation deaths. Urban-rural differences in suicide risk were observed for males but not females. Declining urbanization was associated with higher risks of firearm suicides and lower risks of jumping suicides, but there was no apparent trend in hanging and poisoning suicides. Urban-rural gradients in adults were more pronounced for unintentional motor vehicle, drowning, and fire/burn deaths, as well as for firearm and jumping suicide deaths than for other causes of injury mortality. These results suggest that the degree of urbanization may be an important consideration in guiding prevention efforts for many causes of injury fatality.
... Studies of individuals who were prevented from jumping on the GGB found that 5% went on to commit suicide over a 26-year interval (Beautrais, 2003;Seiden, 1978). While some studies suggest that suicide survivors show smaller increases in subsequent suicide rate compared to the general population (Beautrais, 2007;Gunnell, Nowers, & Bennewith, 2005;Hawton, 2007;Pelletier, 2007), Suominen et al. (2004) found that 13% of 98 attempted suicides in Finland eventually become suicide victims over a 37-year period. ...
Article
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Background: The Golden Gate Bridge (GGB) is a well-known "suicide magnet" and the site of approximately 30 suicides per year. Recently, a suicide barrier was approved to prevent further suicides. Aims: To estimate the cost-effectiveness of the proposed suicide barrier, we compared the proposed costs of the barrier over a 20-year period ($51.6 million) to estimated reductions in mortality. Method: We reviewed San Francisco and Golden Gate Bridge suicides over a 70-year period (1936–2006). We assumed that all suicides prevented by the barrier would attempt suicide with alternative methods and estimated the mortality reduction based on the difference in lethality between GGB jumps and other suicide methods. Cost/benefit analyses utilized estimates of value of statistical life (VSL) used in highway projects. Results: GGB suicides occur at a rate of approximately 30 per year, with a lethality of 98%. Jumping from other structures has an average lethality of 47%. Assuming that unsuccessful suicides eventually committed suicide at previously reported (12–13%) rates, approximately 286 lives would be saved over a 20-year period at an average cost/life of approximately $180,419 i.e., roughly 6% of US Department of Transportation minimal VSL estimate ($3.2 million). Conclusions: Cost-benefit analysis suggests that a suicide barrier on the GGB would result in a highly cost-effective reduction in suicide mortality in the San Francisco Bay Area.
... Ähnlich fanden Bennewith et al. (2007), dass das Anbringen einer Barriere an der Clifton Suspension Bridge in Bristol (UK) zu einer Halbierung der Suizide an diesem Ort, aber zu keinem Anstieg von Sprüngen an anderen Orten führten. Pelletier (2007) berichtete ein Sistieren von Suiziden an der Memorial Bridge in Augusta (Maine, USA) nach dem Anbringen eines Sicherheitsnetzes, ebenfalls ohne Anstieg von Suiziden durch Sprung an anderen Orten. Auch Perron et al. (2013) berichteten einen signifikanten Rückgang ohne nennenswerte Verlagerung an der Jacques-Cartier Bridge in Montreal (Kanada). ...
... Jumps from these sites (bridges, viaducts and cliffs) generally have high fatality rates, can cause significant distress or injury to bystanders and often receive prominent media coverage, increasing the risk of copycat acts [30]. A number of studies have investigated the effectiveness of structural interventions -such as barriers, fences or safety nets -on reducing suicide by jumping at these sites [31][32][33][34][35][36][37][38][39]. Individual studies are typically before-and-after designs, with the preintervention period considered the "control" group and the post-intervention the "intervention" group. ...
Article
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When summary results from studies of counts of events in time contain zeros, the study-specific incidence rate ratio (IRR) and its standard error cannot be calculated because the log of zero is undefined. This poses problems for the widely used inverse-variance method that weights the study-specific IRRs to generate a pooled estimate. We conducted a simulation study to compare the inverse-variance method of conducting a meta-analysis (with and without the continuity correction) with alternative methods based on either Poisson regression with fixed interventions effects or Poisson regression with random intervention effects. We manipulated the percentage of zeros in the intervention group (from no zeros to approximately 80 percent zeros), the levels of baseline variability and heterogeneity in the intervention effect, and the number of studies that comprise each meta-analysis. We applied these methods to an example from our own work in suicide prevention and to a recent meta-analysis of the effectiveness of condoms in preventing HIV transmission. As the percentage of zeros in the data increased, the inverse-variance method of pooling data shows increased bias and reduced coverage. Estimates from Poisson regression with fixed interventions effects also display evidence of bias and poor coverage, due to their inability to account for heterogeneity. Pooled IRRs from Poisson regression with random intervention effects were unaffected by the percentage of zeros in the data or the amount of heterogeneity. Inverse-variance methods perform poorly when the data contains zeros in either the control or intervention arms. Methods based on Poisson regression with random effect terms for the variance components are very flexible offer substantial improvement.
... We included the remaining 23 articles in the metaanalysis. [4][5][6][7][8][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] We treated articles about the same intervention at the same site as being about the same study (even when the authors were not the same) because Incidence rate ratio (log) ...
Article
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Background: Various interventions have been introduced to try to prevent suicides at suicide hotspots, but evidence of their effectiveness needs to be strengthened. Methods: We did a systematic search of Medline, PsycINFO, and Scopus for studies of interventions, delivered in combination with others or in isolation, to prevent suicide at suicide hotspots. We did a meta-analysis to assess the effect of interventions that restrict access to means, encourage help-seeking, or increase the likelihood of intervention by a third party. Findings: We identified 23 articles representing 18 unique studies. After we removed one outlier, interventions that restricted access to means were associated with a reduction in the number of suicides per year (incidence rate ratio 0·09, 95% CI 0·03-0·27; p<0·0001), as were interventions that encourage help-seeking (0·49, 95% CI 0·29-0·83; p=0·0086), and interventions that increase the likelihood of intervention by a third party (0·53, 95% CI 0·31-0·89; p=0·0155). When we included only those studies that assessed a particular intervention in isolation, restricting access to means was associated with a reduction in the risk of suicide (0·07, 95% CI 0·02-0·19; p<0·0001), as was encouraging help-seeking (0·39, 95% CI 0·19-0·80; p=0·0101); no studies assessed increasing the likelihood of intervention by a third party as a lone intervention. Interpretation: The key approaches that are currently used as interventions at suicide hotspots seem to be effective. Priority should be given to ongoing implementation and assessment of initiatives at suicide hotspots, not only to prevent so-called copycat events, but also because of the effect that suicides at these sites have on people who work at them, live near them, or frequent them for other reasons. Funding: National Health and Medical Research Council, Commonwealth Department of Health.
... Installing an 11-foot high fencing on either side of a bridge in Maine in the US, and a five-metre high wire mesh barrier on a viaduct in Toronto, Canada, both had the effect of reducing suicides to zero. 15,16 A similar effect was achieved at a bridge in Auckland, New Zealand. Here, safety barriers that had been in place for 60 years were dismantled, following complaints that they were unsightly. ...
... We recently reported that the barriers resulted in a halving of suicides from the bridge (from eight to four per year); 2 this study added to the growing literature on the effects of placing barriers on bridges commonly used for suicide. [3][4][5][6] Less is known about the differences in the characteristics of people who choose different sites from which to jump (e.g. bridges, multi-storey car parks, their place of residence). ...
Article
Little is known about the characteristics of people who die by jumping from different locations (e.g. bridges, buildings) and the factors that might influence the effectiveness of suicide prevention measures at such sites. We collected data on suicides by jumping (n = 134) between 1994 and 2003 in Bristol, UK, an area that includes the Clifton Suspension Bridge, a site renowned for suicide. We also carried out interviews with Bridge staff and obtained records of fatal and non-fatal incidents on the bridge (1996-2005) before and after preventive barriers were installed in 1998. The main sites from which people jumped were bridges (n = 71); car parks (n = 12); cliffs (n = 20) and places of residence (n = 20). People jumping from the latter tended to be older than those jumping from other sites; people jumping from different sites did not differ in their levels of past self-harm or current psychiatric care. As previously reported, suicides from the bridge halved after the barriers were erected; people jumping from the Clifton Suspension Bridge following their construction were more likely to have previously self-harmed and to have received specialist psychiatric care. The number of incidents on the bridge did not decrease after barriers were installed but Bridge staff reported that the barriers 'bought time', making intervention possible. There is little difference in the characteristics of people jumping from different locations. Barriers may prevent suicides among people at lower risk of repeat self-harm. Staff at suicide hotspots can make an important contribution to the effectiveness of installations to prevent suicide by jumping.
... Suicide by jumping is committed by jumping from balconies, bridge, or jumping into water, train, or a vehicle. Fencing in the places such as high buildings and bridges may prevent suicides by jumping [43][44][45][46]. Installing fences along railroad tracks and roads where suicides mostly occur may reduce and restrict access and prevent suicides by jumping [47]. ...
Article
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Objective: The purpose of the study to investigate whether there is gender difference in suicide methods and whether there is any variation in suicide methods by gender over time. Method: Secondary data about suicide from 2007 to 2015 were obtained from Turkish Statistical Institute. Gender specific suicide rate was calculated. Then, a paired-samples t-test was conducted, the ratio of male to female and average of each suicide method rate were calculated, and trends about suicide methods by gender between 2007 and 2015 were graphed. Results: Except for intoxication, all other suicide methods including hanging, firearm, jumping, and cutting/burning differ statistically significant between females and males. From 2007 to 2015, males are inclined to use firearms, jumping, intoxication, and cutting/burning more frequently whereas females have tendency to use jumping more frequently. Conclusions: Suicide methods differ between females and males. Males use more brutal suicide methods compared to females. Keywords: Suicide method; Gender; Hanging; Jumping; Firearm; Cutting/burning; Intoxication
... It took over 1500 deaths before San Francisco decided to address the issue of suicide by jumping off of the Golden Gate Bridge [6]. Studies have shown that suicide barriers effectively reduce the rate of suicides by jumping with no associated increase in suicide by other means [7][8][9]. The Coronado Bridge is the site of over 400 suicides; do we really need to wait for 1100 more people to end their lives before we take definitive action? ...
... Suicide rates may be reduced by removing the opportunities to commit suicide (Clarke & Lester, 2013). Installing fences on high buildings and bridges (Bennewith, Nowers, & Gunnell, 2007;Pelletier, 2007;Reisch & Michel, 2005) and along railroad tracks and roads where suicides most often occur (Kerkhof, 2003) may help reduce suicides by jumping. ...
Article
Introduction: This study investigates the trends in suicide methods by age group in Turkey. Method: Secondary data on suicide from 2007 to 2015 were obtained from the Turkish Statistical Institute. The direct standardization method was used to calculate suicide rates. Correlation test was used to show the trends in suicide methods by age. Results: Statistically significant changes in suicide methods were seen for persons aged 15 to 24 years and 25 to 44 years, where jumping increased; among persons aged 15 to 24 years, cutting/burning decreased. Discussion: The most popular suicide method is jumping. KEYWORDS: age, suicide, suicide method
... Fences can have important psychological as well as physical effects (Cohen 2006;Edmonds 1979;Lagerquist 2004;Litz 2000;Schnell and Mishal 2008). Control of access for people or animals can be considered in their best interests when the barrier is designed for safety (Bateman and others 2007;Dodd and others 2004;Pelletier 2007) or against their interests when the barrier unnecessarily restricts their freedom or access to resources that affect their livelihood (Moseby and Read 2006;Olsson and others 2008). ...
Article
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Sand-trapping fences modify the character of the coastal landscape and change its spatial structure, image, and meaning. This paper examines the relationship between these changes and fence usage at the municipal level, where most decisions about fence deployment are made. Use of fences in 29 municipalities on the developed coast of New Jersey is examined over a 6-year period. Interviews with municipal officers indicate that wooden slat sand-trapping fences are used primarily to build dunes to provide protection against wave uprush and flooding, but they are also used to control pedestrian traffic and demarcate territory. These uses result in changes in landforms and habitats. An aerial video inventory of fences taken in 2002 indicates that 82% of the shoreline had fences and 72% had dunes. Single and double straight fence rows are the most commonly used. Fences are often built to accomplish a specific primary purpose, but they can cause many different and often unanticipated changes to the landscape. The effects of a sand fence change through time as the initial structure traps sand, creates a dune that is colonized by vegetation, and becomes integrated into the environment by increasing topographic variability and aesthetic and habitat value. Sand fences can be made more compatible with natural processes by not placing them in locations where sources of wind blown sand are restricted or in unnatural shore perpendicular orientations. Symbolic fences are less expensive, are easy to replace when damaged, are less visually intrusive, and can be used for controlling pedestrian access.
... The Ohio State University installed fencing on the roofs of campus parking garages after several deaths. Efforts to prevent jumping deaths in the general population by the erection of barriers and nets have had positive results, as found in several studies, and these actions have not been followed by method substitution (122)(123)(124). Reductions in deaths were noted with the detoxification of domestic gas and the introduction of automobile catalytic converters (84,89) and in the United Kingdom with changes to the packaging of analgesics and the withdrawal of particularly toxic analgesics (89,115). ...
Article
Despite increased access to mental health care for the previously uninsured and expanding evidence-based treatments for mood, anxiety, psychotic, and substance use disorders, suicide is on the rise in the United States. Since 1999, the age-adjusted suicide rate in the United States has increased 33%, from 10.5 per 100,000 standard population to 14.0. As of yet, there are no clinically available biomarkers, laboratory tests, or imaging to assist in diagnosis or the identification of the suicidal individual. Suicide risk assessment remains a high-stakes component of the psychiatric evaluation and can lead to overly restrictive management in the name of prevention or to inadequate intervention because of poor appreciation of the severity of risk. This article focuses primarily on suicide risk assessment and management as a critical first step to prevention, given the fact that more research is needed to identify precision treatments and effective suicide prevention strategies. Suicide risk assessment provides the clinical psychiatrist with an opportunity for therapeutic engagement with the ultimate goals of relieving suffering and preventing suicide.
Article
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To determine whether rates of suicide changed in Toronto after a barrier was erected at Bloor Street Viaduct, the bridge with the world's second highest annual rate of suicide by jumping after Golden Gate Bridge in San Francisco. Natural experiment. City of Toronto and province of Ontario, Canada; records at the chief coroner's office of Ontario 1993-2001 (nine years before the barrier) and July 2003-June 2007 (four years after the barrier). 14 789 people who completed suicide in the city of Toronto and in Ontario. Changes in yearly rates of suicide by jumping at Bloor Street Viaduct, other bridges, and buildings, and by other means. Yearly rates of suicide by jumping in Toronto remained unchanged between the periods before and after the construction of a barrier at Bloor Street Viaduct (56.4 v 56.6, P=0.95). A mean of 9.3 suicides occurred annually at Bloor Street Viaduct before the barrier and none after the barrier (P<0.01). Yearly rates of suicide by jumping from other bridges and buildings were higher in the period after the barrier although only significant for other bridges (other bridges: 8.7 v 14.2, P=0.01; buildings: 38.5 v 42.7, P=0.32). Although the barrier prevented suicides at Bloor Street Viaduct, the rate of suicide by jumping in Toronto remained unchanged. This lack of change might have been due to a reciprocal increase in suicides from other bridges and buildings. This finding suggests that Bloor Street Viaduct may not have been a uniquely attractive location for suicide and that barriers on bridges may not alter absolute rates of suicide by jumping when comparable bridges are nearby.
Article
Comparisons of psychiatric patients who die by suicide using different methods are scarce. We aimed to establish the methods of suicide used by those who are currently or have recently been in contact with mental health services in England and Wales (N = 6,203), and describe the social and clinical characteristics of suicides by different methods. We found that hanging, self-poisoning, and jumping (from a height or in front of a moving vehicle) were the most common methods of suicide, accounting for 79% of all deaths. The implications of these and other findings are discussed.
Article
In order to achieve the national target of 20% reduction in suicide in the UK, many primary care trusts have developed local suicide prevention action plans. However, there is concern about a lack of a whole-system approach in some localities. Suicide surveys are a necessary component of any suicide reduction strategy. All deaths by suicides and open verdicts of a multi-ethnic, socio-economically diverse London Borough's residents between February 2005 and February 2008 were identified (n = 54). Health records of the identified subjects were analysed by two researchers. The annual rate of suicide in the study period was 6.8 per 100 000 inhabitants. Of the 54 cases of suicide in the study period, 45% had a psychiatric diagnosis and 18% were in current contact with mental health services. Hanging was the most frequent mode of suicide. Twenty-four per cent were not registered with a GP, most of whom were immigrants. Twenty-five per cent had seen their GP within a month of suicide. The rate of suicide in those born in Ireland was 17.7 per 100 000. Suicide survey is a feasible method of monitoring suicide, sharing data between key stakeholders and learning from the trends uncovered.
Article
The Golden Gate Bridge is the number one suicide site in the world. In this clinical case conference, the authors begin by presenting vignettes to capture the diversity of bridge suicide. They then examine the demographic characteristics of those who commit suicide from the bridge as well as the fatal attraction of the Golden Gate Bridge. Interviews with jump survivors and potential jumpers are presented, and the authors examine the evidence for the efficacy of suicide barriers.
Article
A number of recent studies have examined the effect of installing physical barriers or otherwise restricting access to public sites that are frequently used for suicides by jumping. While these studies demonstrate that barriers lead to a reduction in the number of suicides by jumping at the site where they are installed, thus far no study has found a statistically significant reduction in the local suicide rate attributable to a barrier. All previous studies are case studies of particular sites, and thus have limited statistical power and ability to control for confounding factors, which may obscure the true relationship between barriers and the suicide rate. This study addresses these concerns by examining the relationship between large, well-known bridges ("local landmark" bridges) of the type that are often used as suicide-jumping sites and the local suicide rate, an approach that yields many more cases for analysis. If barriers at suicide-jumping sites decrease the local suicide rate, then this implies that the presence of an unsecured suicide-jumping site will lead to a higher local suicide rate in comparison to areas without such a site. The relationship between suicides and local landmark bridges is examined across 3116 US counties or county equivalents with negative binomial regression models. I found that while exposure to local landmark bridges was associated with an increased number of suicides by jumping, no positive relationship between these bridges and the overall number of suicides was detected. It may be impossible to conclusively determine if barriers at suicide-jumping sites reduce the local suicide rate with currently available data. However, the method introduced in this paper offers the possibility that better data, or an improved understanding of which potential jumping sites attract suicidal individuals, may eventually allow researchers to determine if means restriction at suicide-jumping sites reduces total suicides.
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Three bridges in Hong Kong have become iconic sites for suicide since their openings 11 years ago. This retrospective record-based study aimed to examine suicides by jumping from a group of three iconic bridges in Hong Kong, and to explore potential preventive strategies on these bridges to prevent future suicide. We examined the Coroner's files of 12 people who killed themselves by jumping from the bridges between 1997 and 2007. We also examined the Coroner's files of other suicides in 2003, and compared them with the bridge suicides. The majority of the suicides were male, middle-age (40-59 years), married or cohabiting, not living alone, employed or self-employed, and in financial difficulty. None of these cases had a reported psychiatric diagnosis or psychiatric care history, and only one case had a history of suicidal attempt. Compared with other suicides in Hong Kong, the bridge jumpers were more likely to be younger, holding a job, indebted, free from a psychiatric and attempt history, and to leave a suicide note (p < .05). The bridge suicide cases in Hong Kong also appeared to be different from the profiles of bridge jumpers in other countries. Erection of an effective safety barrier has been found to prevent bridge suicides in many countries. Given the different characteristics of bridge jumpers in Hong Kong and the technical difficulties, more innovative ways may be needed to prevent suicides by such means. Potential prevention measures are discussed and, hopefully, will better inform the future design and development of bridges of significance.
Article
Limitation of access to lethal methods used for suicide--so-called means restriction--is an important population strategy for suicide prevention. Many empirical studies have shown that such means restriction is effective. Although some individuals might seek other methods, many do not; when they do, the means chosen are less lethal and are associated with fewer deaths than when more dangerous ones are available. We examine how the spread of information about suicide methods through formal and informal media potentially affects the choices that people make when attempting to kill themselves. We also discuss the challenges associated with implementation of means restriction and whether numbers of deaths by suicide are reduced.
Article
The road to a headland that had become a suicide jumping hotspot was temporarily closed because of construction work. This created an opportunity to assess whether loss of vehicular access would lead to a reduction in suicides and emergency police callouts for threatened suicide at the site. Deaths at the headland were ascertained for a 10 year period before road closure and for 2 years following closure using records from the local police inquest officer, the coroner's pathologist and Marine Search and Rescue. Police provided a list of police callouts for threatened suicide at the site for a 4 year period before closure and for 2 years following closure. Simple rates were compared and incident rate ratios were calculated where possible. There were 13 deaths at the headland involving suicide or open verdicts in the 10 years before access was restricted, and none in the 2 years following road closure. This difference was statistically significant (incident rate difference = 1.3 deaths per year, 95% confidence interval (CI) = 0.6-2.0). No jumping suicides occurred elsewhere in the police district following the road closure. Police callouts for threatened suicide also fell significantly, from 19.3 per year in the 4 years prior to road closure to 9.5 per year for the following 2 years (incident rate ratio = 2.0, 95% CI = 1.2-3.5). Preventing vehicular access to a suicide jumping hotspot was an effective means of suicide prevention at the site. There was no evidence of substitution to other jumping sites.
Article
To identify locations to target for suicide preventive measures to reduce suicide by jumping in Taipei city, Taiwan. A descriptive study of suicide by jumping from a height was conducted in Taipei, 2002-2005. Information on sites from which suicide jumps occurred was obtained from death certificates as well as ambulance, medical and newspaper records. Of the 210 jumping suicide deaths with sufficient information on the site of the jump, private residential buildings comprised the highest proportion (67%) of all jumping sites, followed by business office buildings (13%), hospitals (8%) and shopping malls (5%). However, the number of jumping suicides per 1000 sites was highest for hospitals (307 per 1000 hospitals) and shopping malls (275 per 1000 shopping malls) compared with 2 per 1000 for residential buildings. Women and older people who died by jumping were more likely to have jumped from buildings where they lived, compared with men and other age groups. Although two-thirds of suicides occurred from residential buildings, the sites with the greatest number of jumps per location were hospitals and shopping malls, making them the most cost-effective focus for preventive efforts.
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Importance: Installation of barriers has been shown to reduce suicides. To our knowledge, no studies have evaluated the cost-effectiveness of installing barriers at multiple bridge and cliff sites where suicides are known to occur. Objective: To examine the cost-effectiveness of installing barriers at bridge and cliff sites throughout Australia. Design, setting, and participants: This economic evaluation used an economic model to examine the costs, costs saved, and reductions in suicides if barriers were installed across identified bridge and cliff sites over 5 and 10 years. Specific and accessible bridge and cliff sites across Australia that reported 2 or more suicides over a 5-year period were identified for analysis. A partial societal perspective (including intervention costs and monetary value associated with preventing suicide deaths) was adopted in the development of the model. Interventions: Barriers installed at bridge and cliff sites. Main outcomes and measures: Primary outcome was return on investment (ROI) comparing cost savings with intervention costs. Secondary outcomes included incremental cost-effectiveness ratio (ICER), comprising the difference in costs between installation of barriers and no installation of barriers divided by the difference in reduction of suicide cases. Uncertainty and sensitivity analyses were undertaken to examine the association of changes in suicide rates with barrier installation, adjustments to the value of statistical life, and changes in maintenance costs of barriers. Results: A total of 7 bridges and 19 cliff sites were included in the model. If barriers were installed at bridge sites, an estimated US $145 million (95% uncertainty interval [UI], $90 to $160 million) could be saved in prevented suicides over 5 years, and US $270 million (95% UI, $176 to $298 million) over 10 years. The estimated ROI ratio for building barriers over 10 years at bridges was 2.4 (95% UI, 1.5 to 2.7); the results for cliff sites were not significant (ROI, 2.0; 95% UI, -1.1 to 3.8). The ICER indicated monetary savings due to averted suicides over the intervention cost for bridges, although evidence for similar savings was not significant for cliffs. Results were robust in all sensitivity analyses except when the value of statistical life-year over 5 or 10 years only was used. Conclusions and relevance: In an economic analysis, barriers were a cost-effective suicide prevention intervention at bridge sites. Further research is required for cliff sites.
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Suicidul este un fenomen devastator cu efecte tragice pentru indivizi, familii și comunități. Acest comportament disfuncțional este poate forma extremă de manifestare a problemelor de sănătate psihică din viața de zi cu zi și forma cea mai violentă a comportamentului auto-distructiv. Dezechilibrele emoționale și de comportament care influențează predispoziția spre suicid sunt însă preventibile. Scopul acestui capitol este de a furniza informații care să stimuleze implicarea specialiștilor în dezvoltarea unor direcții preventive. După o analiză succintă a amplorii fenomenului și a principalilor factori de risc, capitolul prezintă cele mai importante intervenții care au astăzi suficient suport empiric pentru a putea fi considerate eficiente. Abordarea de față nu se limitează însă la tratamentele psihoterapeutice sau medicamentoase. Capitolul discută mai multe categorii de măsuri preventive și subliniază necesitatea integrării intervențiilor psihologice (consiliere, psihoterapie, suport social) în programe comunitare, locale sau naționale. Capitolul oferă o sinteză de repere teoretice, recomandări și exemple de bune practici utile specialiștilor preocupați de prevenția sinuciderii. Aceste intervenții complementare sunt exemple elocvente de situații în care psihologia clinică și cea socială se îmbină pentru a contribui la ameliorarea unui fenomen îngrijorător din viața cotidiană.
Article
The Gap Park Self-Harm Minimisation Masterplan project is a collaborative attempt to address jumping suicides at Sydney's Gap Park through means restriction, encouraging help-seeking, and increasing the likelihood of third-party intervention. We used various data sources to describe the Masterplan project's processes, impacts, and outcomes. There have been reductions in reported jumps and confirmed suicides, although the trends are not statistically significant. There has been a significant increase in police call-outs to intervene with suicidal people who have not yet reached the cliff's edge. The collaborative nature of the Masterplan project and its multifaceted approach appear to be reaping benefits.
Article
Background: Restricting access to lethal means is a well-established strategy for suicide prevention. However, the hypothesis of subsequent method substitution remains difficult to verify. In the case of jumping from high places ('hotspots'), most studies have been unable to control for a potential shift in suicide locations. This investigation aims to evaluate the short- and long-term effect of safety barriers on Brisbane's Gateway Bridge and to examine whether there was substitution of suicide location. Methods: Data on suicide by jumping - between 1990 and 2012, in Brisbane, Australia - were obtained from the Queensland Suicide Register. The effects of barrier installation at the Gateway Bridge were assessed through a natural experiment setting. Descriptive and Poisson regression analyses were used. Results: Of the 277 suicides by jumping in Brisbane that were identified, almost half (n=126) occurred from the Gateway or Story Bridges. After the installation of barriers on the Gateway Bridge, in 1993, the number of suicides from this site dropped 53.0% in the period 1994-1997 (p=0.041) and a further reduction was found in subsequent years. Analyses confirmed that there was no evidence of displacement to a neighbouring suicide hotspot (Story Bridge) or other locations. Conclusions: The safety barriers were effective in preventing suicide from the Gateway Bridge, and no evidence of substitution of location was found.
Article
Placing safety fences on bridges has turned out to be effective in prevention of suicides by jumping. We report the experience of a patient which wanted to attempt suicide by jumping from a motorway bridge after a safety fence had been established there. The safety fence had been experienced by the patient as effective obstacle to jumping from the bridge. The patient found no possibility to overcome the safety fence and returned to the motorway car park wherefrom she was brought back to the hospital by the police. In view of the increasing proportion of suicides by jumping from a height, the placing of safety fences on bridges or other "hot spots" is recommended as part of a comprehensive suicide prevention.
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This chapter explores the concept of cognitive availability, namely, the awareness of certain methods of suicide, particularly technical information about novel suicide means that may be acquired through media reporting. It illustrates the characteristics of individuals adopting different methods of suicide and explores the existing evidence on the effectiveness of prevention practices that restrict access to the means and sites of suicide. Several recent large-scale meta-analyses have demonstrated that method restriction is one of the few effective suicide prevention strategies. On the basis of a review of psychological models of suicide, Florentine and Crane indicated that “cognitive availability”, namely, how accessible something is in one's mind, could be an important factor influencing the choice of suicide method. The easy access to, and the high toxicity of, pesticides are thought to contribute to the high suicide rates in rural areas of several Asian countries with dominant agricultural economies.
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Objective This research aims to determine the long-term impact of the Bloor Street Viaduct suicide barrier on rates of suicide in Toronto and whether media reporting had any impact on suicide rates. Design Natural experiment. Setting City of Toronto, Canada; records at the chief coroner’s office of Ontario 1993–2003 (11 years before the barrier) and 2004–2014 (11 years after the barrier). Participants 5403 people who died by suicide in the city of Toronto. Main outcome measure Changes in yearly rates of suicide by jumping at Bloor Street Viaduct, other bridges including nearest comparison bridge and walking distance bridges, and buildings, and by other means. Results Suicide rates at the Bloor Street Viaduct declined from 9.0 deaths/year before the barrier to 0.1 deaths/year after the barrier (incidence rate ratio (IRR) 0.005, 95% CI 0.0005 to 0.19, p=0.002). Suicide deaths from bridges in Toronto also declined significantly (IRR 0.53, 95% CI 0.40 to 0.71, p<0.0001). Media reports about suicide at the Bloor Street Viaduct were associated with an increase in suicide-by-jumping from bridges the following year. Conclusions The current study demonstrates that, over the long term, suicide-by-jumping declined in Toronto after the barrier with no associated increase in suicide by other means. That is, the barrier appears to have had its intended impact at preventing suicide despite a short-term rise in deaths at other bridges that was at least partially influenced by a media effect. Research examining barriers at other locations should interpret short-term results with caution.
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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To conduct a suite of reviews to assess the effectiveness of restriction of physical means of access as a method of suicide prevention. These reviews will focus on the method of suicide - jumping, colliding with a train, poisoning, hanging, using a firearm, using a sharp object, inhaling motor vehicle exhaust, drowning, and charcoal burning.
Article
Objective: The purpose of the study is to investigate the trend in suicide methods rates by gender among age groups over time and whether suicide methods rates significantly differ in age groups between males and females in Turkey. Method: Secondary data on suicide from 2007 to 2015 were obtained from the Turkish Statistical Institute. The number of suicide cases was 24,936. Numerical (correlation test) and graphical methods (line charts) were used to show the trends in suicide methods rates by gender among age groups. A dependent sample t-test was conducted to determine whether suicide methods rates significantly differed by gender in age groups. Results: Among all age groups, the most common suicide methods were hanging and firearm for males and hanging and jumping for females except for females aged 15-24 years. Similar to males, hanging and firearm also were the most common suicide methods for females aged 15-24 years. Statistically significant changes in suicide methods rates by age group and gender are as follows: Among males aged 15-24 years, hanging, jumping, and firearm increased; among females in that age group, jumping increased, while cutting/burning decreased. Among males aged 25-44 years, cutting/burning increased; among females in that age group, jumping increased, while firearm decreased. The results of the dependent sample t-test showed that except for intoxication among those aged 15-24 years and 25-44 years, a statistically significant difference in suicide methods rates existed between males and females in all age groups. Except for intoxication and jumping among persons aged 15-24 years, males used other suicide methods more than females in all age groups. Conclusions: Gender differences in suicide methods exist in all age groups.
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Objective: There is not adequate research on suicide methods by age in Turkey. The purpose of the present study is to investigate whether there is any change in suicide methods by age over time and whether suicide methods significantly differ by age. Method: Secondary data about suicide from 2007 to 2015 were obtained from the Turkish Statistical Institute. The number of suicide cases was 25,696. Direct standardization method was used to calculate suicide rates. Line charts were plotted to reveal the trends in suicide methods by age. Then, one-way anova (ANOVA) test was conducted to test whether suicide methods significantly differed by age. Results: Among all ages, hanging was the most common suicide method, followed by firearm, jumping, intoxication, and cutting/burning among all age groups. Moreover, all of the other suicide methods increased except for cutting/burning among those aged 15-24 years, except for firearm among those aged 25-44 years, except for hanging among those aged 45-64 years. Among those aged 65 and older, suicide by hanging decreased, however, suicide by other methods overall remained stable. The results also showed that with increasing age, suicide by hanging, jumping, and cutting increased, while suicide by firearm and intoxication decreased. In addition, the results of ANOVA test indicated that except for intoxication, all other suicide methods differed significantly by age groups. Conclusions: Hanging, jumping, and cutting/burning were the most popular methods among older people, while firearm and intoxication were more popular among younger people. Keywords: suicide, suicide method, age, firearm, hanging, cutting/burning, intoxication, jumping
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Background: Jumping from a height is an uncommon but lethal means of suicide. Restricting access to means is an important universal or population-based approach to suicide prevention with clear evidence of its effectiveness. However, the evidence with respect to means restriction for the prevention of suicide by jumping is not well established. Objectives: To evaluate the effectiveness of interventions to restrict the availability of, or access to, means of suicide by jumping. These include the use of physical barriers, fencing or safety nets at frequently-used jumping sites, or restriction of access to these sites, such as by way of road closures. Search methods: We searched the Cochrane Library, Embase, MEDLINE, PsycINFO, and Web of Science to May 2019. We conducted additional searches of the international trial registries including the World Health Organization International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov, to identify relevant unpublished and ongoing studies. We searched the reference lists of all included studies and relevant systematic reviews to identify additional studies and contacted authors and subject experts for information on unpublished or ongoing studies. We applied no restrictions on date, language or publication status to the searches. Two review authors independently assessed all citations from the searches and identified relevant titles and abstracts. Our main outcomes of interest were suicide, attempted suicide or self-harm, and cost-effectiveness of interventions. Selection criteria: Eligible studies were randomised or quasi-randomised controlled trials, controlled intervention studies without randomisation, before-and-after studies, or studies using interrupted time series designs, which evaluated interventions to restrict the availability of, or access to, means of suicide by jumping. Data collection and analysis: Two review authors independently selected studies for inclusion and three review authors extracted study data. We pooled studies that evaluated similar interventions and outcomes using a random-effects meta-analysis, and we synthesised data from other studies in a narrative summary. We summarised the quality of the evidence included in this review using the GRADE approach. Main results: We included 14 studies in this review. Thirteen were before-and-after studies and one was a cost-effectiveness analysis. Three studies each took place in Switzerland and the USA, while two studies each were from the UK, Canada, New Zealand, and Australia respectively. The majority of studies (10/14) assessed jumping means restriction interventions delivered in isolation, half of which were at bridges. Due to the observational nature of included studies, none compared comparator interventions or control conditions. During the pre- and postintervention period among the 13 before-and-after studies, a total of 742.3 suicides (5.5 suicides per year) occurred during the pre-intervention period (134.5 study years), while 70.6 suicides (0.8 suicides per year) occurred during the postintervention period (92.4 study years) - a 91% reduction in suicides. A meta-analysis of all studies assessing jumping means restriction interventions (delivered in isolation or in combination with other interventions) showed a directionality of effect in favour of the interventions, as evidenced by a reduction in the number of suicides at intervention sites (12 studies; incidence rate ratio (IRR) = 0.09, 95% confidence interval (CI) 0.03 to 0.27; P < 0.001; I2 = 88.40%). Similar findings were demonstrated for studies assessing jumping means restriction interventions delivered in isolation (9 studies; IRR = 0.05, 95% CI 0.01 to 0.16; P < 0.001; I2 = 73.67%), studies assessing jumping means restriction interventions delivered in combination with other interventions (3 studies; IRR = 0.54, 95% CI 0.31 to 0.93; P = 0.03; I2 = 40.8%), studies assessing the effectiveness of physical barriers (7 studies; IRR = 0.07, 95% CI 0.02 to 0.24; P < 0.001; I2 = 84.07%), and studies assessing the effectiveness of safety nets (2 studies; IRR = 0.09, 95% CI 0.01 to 1.30; P = 0.07; I2 = 29.3%). Data on suicide attempts were limited and none of the studies used self-harm as an outcome. There was considerable heterogeneity between studies for the primary outcome (suicide) in the majority of the analyses except those relating to jumping means restriction delivered in combination with other interventions, and safety nets. Nevertheless, every study included in the forest plots showed the same directional effects in favour of jumping means restriction. Due to methodological limitations of the included studies, we rated the quality of the evidence from these studies as low. A cost-effectiveness analysis suggested that the construction of a physical barrier on a bridge would be a highly cost-effective project in the long term as a result of overall reduced suicide mortality. Authors' conclusions: The findings from this review suggest that jumping means restriction interventions are capable of reducing the frequency of suicides by jumping. However, due to methodological limitations of included studies, this finding is based on low-quality evidence. Therefore, further well-designed high-quality studies are required to further evaluate the effectiveness of these interventions, as well as other measures at jumping sites. In addition, further research is required to investigate the potential for suicide method substitution and displacement effects in populations exposed to interventions to prevent suicide by jumping.
Article
Background The purpose of this study was to evaluate the characteristics and temporal trends of the incidence and survival outcomes of suicide-related out-of-hospital cardiac arrest (OHCA) according to the suicide attempt method during the past decade. Methods A population-based observational study between 2009 and 2018 was conducted. EMS-treated suicide-related OHCAs were classified according to the suicide method into hanging, jumping, poisoning, asphyxia and drowning, and other trauma. The study outcomes were survival to discharge and good neurological outcome. The temporal trends of crude and age- and sex-standardized incidence per 100,000 person-years and standardized rates for outcomes were calculated using direct standardization methods. Predictors of survival to discharge were investigated using multivariable logistic regression. Results From 2009 to 2018, the age- and sex-standardized incidence rate of suicide-related OHCA increased from 3.5 to 4.0 cases per 100,000 person-years. Of 21,720 eligible OHCAs, hanging (59.2%) was the most common suicide method, followed by jumping (21.3%), poisoning (14.9%), and asphyxia and drowning (3.5%). Although the standardized rates of survival to hospital discharge improved from 2.9% to 5.1% during the study period, good neurological outcome was not improved (from 0.7% to 1.0%). By suicide method, survival to discharge for the hanging group was increased, and good neurological outcome for the poisoning group showed improvement (both p-for-trend <0.05). Compared with hanging, other suicide methods were negatively associated with survival outcome. Conclusion The incidence of suicide-related OHCA has increased over the past decade in Korea, and survival outcomes are still very low. New interventions are needed to decrease the incidence and burden of suicide-related OHCAs.
Article
Background: In most countries, more females than males attempt suicide, yet suicide mortality is typically higher for males. The aim of this study was to investigate how suicide method choice contributed to gender disparity in suicide mortality. Methods: This study used population-based data collected in Hong Kong (HK) and the United States of America (USA) (2007-2014), comprising suicide deaths and medically treated suicide attempts. We calculated suicide rates, suicide act rates, and case fatality rates (CFRs), by gender and suicide method in HK and the USA respectively. Decomposition analysis was used to quantify the contribution of gender differences in method choice and method-specific CFRs to the excess male suicide rates in each region. Results: Gender disparity in suicide mortality was mostly driven by gender differences in method used in suicide acts. In HK, gender difference in choosing jumping as the method in suicide acts explained 44.5% of the gender imbalance in suicide rates, whilst in the USA, 62.4% of male excess in suicide rates was explained by gender difference in using firearms in suicide acts. Limitations: Cases of suicide attempts in this study were restricted to those severe enough to require medical attention. Conclusion: Gender-specific suicide method choice largely determined gender patterns in suicide. Our findings highlighted the importance of developing locally tailored suicide prevention strategies targeting commonly used and highly lethal suicide methods. Future research is needed to explore underlying reasons for gender differences in method choice.
Article
Reducing access to lethal means can prevent suicides. However, substitution of a suicide method remains a concern. Until 1986, the Ellington Bridge was the site of one-half of all Washington, DC bridge suicides. An antisuicide fence was installed in 1986, creating a naturalistic case–control design for testing the substitution hypothesis with the adjacent and equally as lethal jump site, the Taft Bridge. We found that suicide deaths from the Ellington Bridge were reduced by 90% (p=0.001) following barrier construction, without changes in rates of jumps from either the Taft Bridge or any other bridge in the city. Suicides by all methods decreased significantly across the study period. While the decline in suicides from the Ellington Bridge may reflect a broader decline in suicide, the decline in bridge suicide without persistent shifts in deaths to other bridges provides evidence that restricting access to one highly lethal method is effective.
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Suicidality remains an incredible mortality threat to adolescents in the United States. While self-harm continues to serve as a concerning risk factor for suicide, reassuring evidence suggests that the majority of individuals that survive their first suicide attempt will ultimately never complete suicide. Therefore, the lethality of suicide method makes a significant impact on the likelihood of ultimate survival for these adolescents. As such, several historical public health initiatives have successfully implemented lethal means reduction strategies to prevent suicide mortality. As firearms remain the most common suicide method among American teenagers with the highest fatality rate, physician counseling, legislative efforts, and health campaigns focused on reducing the accessibility of firearms serve as a promising path towards reducing adolescent mortality.
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Suicide safety barriers were removed from a central city bridge in an Australasian metropolitan area in 1996 after having been in place for 60 years. The bridge is a known suicide site and is located adjacent to the region's largest hospital, which includes an acute inpatient psychiatric unit. This paper examines the impact of the removal of these barriers on suicide rates. Data for suicide deaths by jumping from the bridge in question, from 1992 to 2000, were obtained from the regional City Police Inquest Office. Data for suicide deaths by jumping from other sites in the metropolitan area in question, from 1992 to 1998, were obtained from the national health statistics database. Case history data about each suicide death by jumping in the metropolitan area in question, from 1994 to 1998, were abstracted from coronial files held by a national database. Removal of safety barriers led to an immediate and substantial increase in both the numbers and rate of suicide by jumping from the bridge in question. In the 4 years following the removal of the barriers (compared with the previous 4 years) the number of suicides increased substantially, from three to 15 (chi2 = 8, df = 1, p < 0.01); the rate of such deaths increased also (chi2 = 6.6, df = 1, p < 0.01). The majority of those who died by jumping from the bridge following the removal of the safety barriers were young male psychiatric patients, with psychotic illnesses. Following the removal of the barriers from the bridge the rate of suicide by jumping in the metropolitan area in question did not change but the pattern of suicides by jumping in the city changed significantly with more suicides from the bridge in question and fewer at other sites. Removal of safety barriers from a known suicide site led to a substantial increase in the numbers of suicide deaths by jumping from that site. These findings appear to strengthen the case for installation of safety barriers at suicide sites in efforts to prevent suicide deaths, and also suggest the need for extreme caution about the removal of barriers from known jumping sites.
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In 2002, an estimated 877,000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated. To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research. Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide. Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented. Education of physicians and restricting access to lethal means were found to prevent suicide. Other methods including public education, screening programs, and media education need more testing. Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy. Ascertaining which components of suicide prevention programs are effective in reducing rates of suicide and suicide attempt is essential in order to optimize use of limited resources.
Article
Objectives: Suicide safety barriers were removed from a central city bridge in an Australasian metropolitan area in 1996 after having been in place for 60 years. The bridge is a known suicide site and is located adjacent to the region's largest hospital, which includes an acute inpatient psychiatric unit. This paper examines the impact of the removal of these barriers on suicide rates. Method: Data for suicide deaths by jumping from the bridge in question, from 1992 to 2000, were obtained from the regional City Police Inquest Office. Data for suicide deaths by jumping from other sites in the metropolitan area in question, from 1992 to 1998, were obtained from the national health statistics database. Case history data about each suicide death by jumping in the metropolitan area in question, from 1994 to 1998, were abstracted from coronial files held by a national database. Results: Removal of safety barriers led to an immediate and substantial increase in both the numbers and rate of suicide by jumping from the bridge in question. In the 4 years following the removal of the barriers (compared with the previous 4 years) the number of suicides increased substantially, from three to 15 (chi(2) = 8, df = 1, p < 0.01); the rate of such deaths increased also (χ(2) = 6.6, df = 1, p < 0.01). The majority of those who died by jumping from the bridge following the removal of the safety barriers were young male psychiatric patients, with psychotic illnesses. Following the removal of the barriers from the bridge the rate of suicide by jumping in the metropolitan area in question did not change but the pattern of suicides by jumping in the city changed significantly with more suicides from the bridge in question and fewer at other sites. Conclusions: Removal of safety barriers from a known suicide site led to a substantial increase in the numbers of suicide deaths by jumping from that site. These findings appear to strengthen the case for installation of safety barriers at suicide sites in efforts to prevent suicide deaths, and also suggest the need for extreme caution about the removal of barriers from known jumping sites.
Article
In an effort to reduce the number of suicides from the Mid-Hutson Bridge in Poughkeepsie, New York, the Dutchess County Department of Mental Hygiene and the New York State Bridge Authority jointly established a suicide prevention phone on the bridge, which is directly connected to a 24-hour psychiatric emergency service. This program is the first known one in which a dedicated suicide prevention helpline has been installed at a site of known suicides and linked with a mental health service. After 2 years of operation, the phone has been used 30 times; the data suggest that most would-be jumpers are ambivalent enough about dying that they will reach out for help/contact if the opportunity exists, and, as a consequence, can be saved.
Article
The Golden Gate Bridge is currently the number one suicide location in the world. From the opening day, May 18, 1937 to April 1, 1978, there have been 625 officially reported suicide deaths and perhaps more than 200 others which have gone unseen and unreported. Proposals for the construction of a hardware antisuicide barrier have been challenged with the untested contention that “they'll just go someplace else.” This research tests the contention by describing and evaluating the long-term mortality experience of the 515 persons who had attempted suicide from the Golden Gate Bridge but were restrained, from the opening day through the year 1971 plus a comparison group of 184 persons who made nonbridge suicide attempts during 1956–57 and were treated at the emergency room of a large metropolitan hospital and were also followed through the close of 1971. Results of the followup study are directed toward answering the important question: “Will a person who is prevented from suicide in one location inexorably tend to attempt and commit suicide elsewhere?”
Article
The opening of a new high river bridge in Brisbane allowed a naturalistic experimental testing of whether the sample engaging in suicidal behaviour from the new bridge was similar to that from the adjoining older bridge. Substantial differences were found for the two samples. This suggests that persons prevented from jumping from one bridge, for example by a barrier, will not automatically jump from the alternative bridge although a minority may do so. © 1990 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.
Article
To examine the epidemiology of suicide by jumping from the Clifton Suspension Bridge and its impact on local patterns of suicide. Case-control study of falls from the bridge (1974-93) matched by age and sex with those using other methods of suicide. Routine OPCS mortality statistics for Bristol and District Health Authority. The County of Avon and the Bristol and District Health Authority. 1. Individuals given coroners' verdicts of suicide, "open", or misadventure after falls from the suspension bridge and 127 matched control suicides using other methods. 2. All deaths from suicide within the Bristol and District Health Authority 1982-91. Past psychiatric history, demographic characteristics of suicides, and proximity of place of residence to the bridge. There were 127 falls from the Clifton Suspension Bridge between 1974 and 1993. The mean age was 35.4 years for males (n = 93) and 35.5 for females (n = 34). Those who committed suicide by jumping were no more likely to have psychiatric histories than controls (95% CI of difference--1.17%, 23.2%) and were no more likely to have been psychiatric inpatients in the past (95% CI of difference--10.2%, 13.3%). Mean distance of residence from the bridge differed little between jumping suicides and controls (difference 1.7 km 95% CI 0.5, 3.9 km). Altogether 10.2% of jumpers had a past history of schizophrenia. Suicide by jumping is significantly more common in the Bristol and District Health Authority (9.3% of all suicides; 95% CI 7.6%, 11.3%) than in England and Wales (4.9% of suicides). Patterns of suicide in the Bristol and District Health Authority are affected by the presence of the Clifton Suspension Bridge. Those who commit suicide by jumping from the bridge do not differ significantly from those using other methods of suicide. Provision of safety measures on the bridge may lead to the prevention of some suicides.
Article
This review summarizes the published literature on suicide by jumping, in particular focusing on the social and psychological characteristics of people who have chosen this method of suicide, and the opportunities for prevention. Suicide by jumping accounts for 5% of suicides in England and Wales, and there are marked variations in the use of this method world-wide. A number of locations have gained notoriety as popular places from which to jump. Such sites include The Golden Gate Bridge and Niagara Falls in the USA, and Beachy Head and the Clifton Suspension Bridge in the UK. There is no consistent evidence that those who commit suicide by jumping differ sociodemographically or in their psychopathology from those who use other methods of suicide, although this method is more often used for in-patient suicides, possibly due to lack of access to other means. Survivors of suicidal jumps experience higher subsequent rates of suicide and mental ill health, but the majority do not go on to kill themselves, suggesting that preventive efforts may be worthwhile. This view is supported by other evidence that restricting access to the means of suicide may prevent some would-be suicides. Such measures may also reduce the emotional trauma suffered by those who witness these acts. Health authorities and coroners should consider reviewing local patterns of suicide by jumping, and if necessary institute preventive measures.
Article
To describe characteristics of people who jumped from the Westgate Bridge (identifying risk factors for attempted suicide) and to determine why people may survive such a jump. A retrospective case review (coroners' reports and hospital records) of all people known to have jumped from the Westgate Bridge between 1991 and 1998. We identified 62 people who jumped from the Westgate Bridge over the study period. Seven survived. Forty-one (74%) of those who jumped were male. The average age was 33.8 years (range, 15-58 years). Forty-four (71%) had known mental illness (23 schizophrenia, 21 depression). Thirty-nine (63%) landed in water, falling from a height of 58.5 m. Nineteen (31%) fell onto land and in four cases (6%) the landing site was not determined. All survivors landed in water. Six people died from drowning after the fall, and in eight more deaths drowning was a major or contributing factor. All jumps resulted from suicidal intent, and 12 people (19%) had positive toxicology screens for alcohol or other non-prescription drugs at postmortem. Each year the Westgate Bridge is the scene of about eight suicide attempts by jumping (particularly by men with active psychiatric illness). Some deaths by drowning could be prevented by early detection and rapid emergency service response. The erection of an effective safety barrier would probably prevent more deaths.
Article
This is a community-based sequential case series of 50 individuals who committed suicide by jumping from bridges in two regions of Sweden. Of the 50 subjects, 32 were men and 18 women, with a median age of 35 years. At least 40 had psychiatric problems. The frequency of suicide was highest during the summer months and during the weekends. A total of 27 bridges were used, with a total length of just under 9 km. Three bridges accounted for almost half of all suicides. Limiting the availability of one method of committing suicide is reported to reduce the overall suicide rate; why suicide and injury suicide preventive measures might be considered. Since this study demonstrates that few bridges attract suicide candidates, this injury mechanism needs to be acknowledged by the road system owners and included in the safety work.