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Dwyer J, Spittal MJ, Scurrah K, Pirkis J, Bugeja L, Clapperton A. Structural intervention at one bridge decreases the overall jumping suicide rate in Victoria, Australia. Epidemiol Psychiatr Sci 2023; 32:e58. [PMID: 37721170 PMCID: PMC10539743 DOI: 10.1017/s2045796023000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
AIMS There is clear evidence that installing safety barriers is effective in preventing jumping suicides from high-risk bridges with only moderate displacement to other nearby bridges. However, the impact of barriers on jumping suicides across broader geographical areas is not well understood. We examined patterns in jumping suicides across the state of Victoria, Australia, after a safety barrier was installed at the West Gate Bridge which, before the installation of the barrier, was the site of approximately 40% of Victoria's jumping suicides. METHODS We used negative binomial regression analyses on Victorian data from 2000 to 2019 to compare rates of jumping suicides at the West Gate Bridge, other bridges and non-bridge jumping locations before, during and after the West Gate Bridge barrier installation. We conducted linear regression analyses to examine whether the distance travelled from the deceased's usual residence to the location of their jumping suicide changed between the before, during and after barrier installation periods. RESULTS After installation of the barrier, there were no jumping suicides at the West Gate Bridge (rate ratio [RR] = 0.00, 95% credible intervals [95% Cr] = 0.00-0.0001) and there was strong evidence that the rate of jumping suicides at all locations declined by 65% (RR = 0.35, 95% Cr = 0.22-0.54). At other bridges, there was also evidence of a reduction (RR = 0.31, 95% Cr = 0.11-0.70), but there was no evidence of a change at non-bridge locations (RR = 0.74, 95% Cr = 0.39-1.30). CONCLUSION After installation of the safety barrier at the West Gate Bridge, jumping suicide in Victoria decreased overall and at other bridges, and did not appear to change at non-bridge locations. Our findings show that when barriers are installed at a site responsible for a disproportionately high number of jumping suicides, they are not only highly effective at the site where the barriers are installed but can also have a prevention impact beyond the immediate locale at similar sites.
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Affiliation(s)
- J. Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria, Southbank, VIC, Australia
| | - M. J. Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - K. Scurrah
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - J. Pirkis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - L. Bugeja
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - A. Clapperton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Sale E, Hendricks M, Weil V, Miller C, Perkins S, McCudden S. Counseling on Access to Lethal Means (CALM): An Evaluation of a Suicide Prevention Means Restriction Training Program for Mental Health Providers. Community Ment Health J 2018; 54:293-301. [PMID: 29185154 DOI: 10.1007/s10597-017-0190-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 11/04/2017] [Indexed: 11/28/2022]
Abstract
This paper evaluates the effectiveness of the Counseling on Access to Lethal Means (CALM) suicide prevention program. CALM trains mental health providers how to counsel suicidal individuals and those who support them on mean restriction during times of crisis. Pre/post/3-month follow-up assessments measured knowledge of lethal means, confidence and comfort in discussing means restriction (self-efficacy), and future intentions to counsel clients on means restriction. Change in the number of clients receiving lethal means counseling was also assessed. All constructs increased significantly at posttest. Confidence and counseling intentions were sustained at follow-up and significantly more clients received means counseling in the 3 months following the CALM training. Knowledge and comfort levels decreased at follow-up but not to pre-training levels. CALM is effective at increasing mental health professionals' comfort, knowledge, and frequency of talking about means restriction with clients. an effective means restriction training program. A template to assess clients for suicidality and lethal means access and booster sessions are recommended to further sustain effects.
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Affiliation(s)
- Elizabeth Sale
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA. .,Missouri Institute of Mental Health, 4633 World Parkway Circle, St. Louis, MO, 63134-3115, USA.
| | - Michelle Hendricks
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA
| | - Virginia Weil
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA
| | - Collin Miller
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA
| | - Scott Perkins
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA
| | - Suzanne McCudden
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4833 World Parkway Circle, St. Louis, MO, 63134, USA
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Lam VC, Kinney JB, Bell LS. Geospatial analysis of suicidal bridge jumping in the Metro Vancouver Regional District from 2006 to 2014. J Forensic Leg Med 2017; 47:1-8. [PMID: 28160665 DOI: 10.1016/j.jflm.2017.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/19/2017] [Accepted: 01/22/2017] [Indexed: 11/26/2022]
Abstract
In the past decade, there have been many structural changes implemented to Vancouver's largest bridges as a means of deterring criminogenic and suicidal behaviors. Guided by an environmental criminology theoretical framework, this research examines the patterns and trends of 201 cases of successful suicide jumping in the Metro Vancouver Regional District (MVRD) of British Columbia, Canada from 2006 to 2014. To evaluate these trends and to bolster the existing literature on deterrence measures through environmental design, this research will examine the spatial relationship between preferential bridge jumping locations and the home addresses of the deceased. Network analysis of 145 bridge jumpers suggests that suicidal people are willing to travel greater distances to jump from more iconic bridges than those closest to their home. Beyond mere aesthetic or practical functions, symbolic significance may impact which bridges become suicide hotspots over other convenient locations. Dwelling types, demographic profiles, and regional prevalence in the MVRD have also been aggregated and explored in this study.
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Affiliation(s)
- Vienna C Lam
- School of Criminology, Simon Fraser University, Canada; Centre for Forensic Research, Simon Fraser University, Canada.
| | | | - Lynne S Bell
- School of Criminology, Simon Fraser University, Canada; Centre for Forensic Research, Simon Fraser University, Canada
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Pirkis J, Too LS, Spittal MJ, Krysinska K, Robinson J, Cheung YTD. Interventions to reduce suicides at suicide hotspots: a systematic review and meta-analysis. Lancet Psychiatry 2015; 2:994-1001. [PMID: 26409438 DOI: 10.1016/s2215-0366(15)00266-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/02/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Lay San Too
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Karolina Krysinska
- Centre of Research Excellence in Suicide Prevention, Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jo Robinson
- Orygen: The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
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Caine ED. Cooling suicide hotspots. Lancet Psychiatry 2015; 2:952-3. [PMID: 26409437 DOI: 10.1016/s2215-0366(15)00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/03/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Eric D Caine
- Injury Control Research Center for Suicide Prevention, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
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Abstract
BACKGROUND There has been no systematic work on the short- or long-term impact of the installation of crisis phones on suicides from bridges. The present study addresses this issue. METHOD Data refer to 219 suicides from 1954 through 2013 on the Skyway Bridge in St. Petersburg, Florida. Six crisis phones with signs were installed in July 1999. RESULTS In the first decade after installation, the phones were used by 27 suicidal persons and credited with preventing 26 or 2.6 suicides a year. However, the net suicide count increased from 48 in the 13 years before installation of phones to 106 the following 13 years or by 4.5 additional suicides/year (t =3.512, p < .001). CONCLUSION Although the phones prevented some suicides, there was a net increase after installation. The findings are interpreted with reference to suggestion/contagion effects including the emergence of a controversial bridge suicide blog.
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Affiliation(s)
- Steven Stack
- 1 Department of Psychiatry and Department of Criminology, Wayne State University, Detroit, MI, USA
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Suicides by jumping from a height in Hong Kong: a review of coroner court files. Soc Psychiatry Psychiatr Epidemiol 2014; 49:211-9. [PMID: 23881109 DOI: 10.1007/s00127-013-0743-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 07/08/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE Jumping from a height is the most common method for suicide in Hong Kong and other urban cities, but it remains understudied locally and internationally. We used Coroner records in exploring the ecological factors associated with these deaths and the personal characteristics of persons who jumped to their death (hereafter, "jumping suicides"). We compared suicides by jumping with all other suicides and examined the suicides that occurred at ten different jumping sites. METHODS The Coroner's files of all suicides in Hong Kong from 2002 to 2007 included 6,125 documented deaths. RESULTS 2,964 (48.4%) involved jumping during the study period. Eighty-three percent (83%) of suicide jumps occurred in residential buildings, and of these, 61% occurred from the decedent's own home. Jumping suicides differed from non-jumping suicides in terms of their socio-demographic characteristics (e.g., for male: 60.8 vs. 67.3% of jumping suicide and non-jumping suicides, p < 0.0001) and the presence of physical illness (44.4 vs. 42.7% for jumping and non-jumping suicides, p < 0.0001). While statistically significant, these differences are relatively modest. In contrast, 40.7 documented illnesses vs. 23.1% for jumping and non-jumping suicides (p < 0.0001). CONCLUSIONS Means restriction is a key strategy for suicide prevention. Installation of physical barriers, one of the mean restriction strategies, at common places for suicide has strong evidence to avert suicides without substitution effects. There seems to be challenges to implement physical barriers to prevent residential jumping suicides. Simply applying physical barriers to preclude jumping in Hong Kong appears to be difficult given its ubiquitous "high-rise" residential dwellings. Hence, we also need to develop alternative strategies aimed at preventing people from becoming suicidal.
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Pirkis J, Spittal MJ, Cox G, Robinson J, Cheung YTD, Studdert D. The effectiveness of structural interventions at suicide hotspots: a meta-analysis. Int J Epidemiol 2013; 42:541-8. [PMID: 23505253 DOI: 10.1093/ije/dyt021] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Jane Pirkis
- Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia.
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Cox GR, Owens C, Robinson J, Nicholas A, Lockley A, Williamson M, Cheung YTD, Pirkis J. Interventions to reduce suicides at suicide hotspots: a systematic review. BMC Public Health 2013; 13:214. [PMID: 23496989 PMCID: PMC3606606 DOI: 10.1186/1471-2458-13-214] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 02/27/2013] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Georgina R Cox
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Jo Robinson
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Angela Nicholas
- Centre for Health Policy, Programs and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anne Lockley
- Centre for Health Policy, Programs and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Michelle Williamson
- Centre for Health Policy, Programs and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Yee Tak Derek Cheung
- Centre for Health Policy, Programs and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jane Pirkis
- Centre for Health Policy, Programs and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Abstract
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.
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Affiliation(s)
- Paul S F Yip
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
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Sarchiapone M, Mandelli L, Iosue M, Andrisano C, Roy A. Controlling access to suicide means. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:4550-62. [PMID: 22408588 PMCID: PMC3290984 DOI: 10.3390/ijerph8124550] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 11/15/2011] [Accepted: 11/29/2011] [Indexed: 11/25/2022]
Abstract
Background: Restricting access to common means of suicide, such as firearms, toxic gas, pesticides and other, has been shown to be effective in reducing rates of death in suicide. In the present review we aimed to summarize the empirical and clinical literature on controlling the access to means of suicide. Methods: This review made use of both MEDLINE, ISI Web of Science and the Cochrane library databases, identifying all English articles with the keywords “suicide means”, “suicide method”, “suicide prediction” or “suicide prevention” and other relevant keywords. Results: A number of factors may influence an individual’s decision regarding method in a suicide act, but there is substantial support that easy access influences the choice of method. In many countries, restrictions of access to common means of suicide has lead to lower overall suicide rates, particularly regarding suicide by firearms in USA, detoxification of domestic and motor vehicle gas in England and other countries, toxic pesticides in rural areas, barriers at jumping sites and hanging, by introducing “safe rooms” in prisons and hospitals. Moreover, decline in prescription of barbiturates and tricyclic antidepressants (TCAs), as well as limitation of drugs pack size for paracetamol and salicylate has reduced suicides by overdose, while increased prescription of SSRIs seems to have lowered suicidal rates. Conclusions: Restriction to means of suicide may be particularly effective in contexts where the method is popular, highly lethal, widely available, and/or not easily substituted by other similar methods. However, since there is some risk of means substitution, restriction of access should be implemented in conjunction with other suicide prevention strategies.
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Affiliation(s)
- Marco Sarchiapone
- Department of Health Sciences, University of Molise, Via De Sanctis, Campobasso 86100, Italy; (M.S.); (M.I.)
| | - Laura Mandelli
- Department of Health Sciences, University of Molise, Via De Sanctis, Campobasso 86100, Italy; (M.S.); (M.I.)
- Institute of Psychiatry, University of Bologna, 5 V.le C. Pepoli, Bologna 40133, Italy;
- Author to whom correspondence should be addressed;
| | - Miriam Iosue
- Department of Health Sciences, University of Molise, Via De Sanctis, Campobasso 86100, Italy; (M.S.); (M.I.)
| | - Costanza Andrisano
- Institute of Psychiatry, University of Bologna, 5 V.le C. Pepoli, Bologna 40133, Italy;
| | - Alec Roy
- Psychiatry Service, Department of Veterans Affairs, 385 Tremont Ave., East Orange, NJ 07018, USA;
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