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Koon W, Stewart O, Brander R, Quan L, Peden AE. Burden of fatal drowning in California, 2005-2019. Inj Prev 2023; 29:371-377. [PMID: 37208006 PMCID: PMC10579480 DOI: 10.1136/ip-2023-044862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/07/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To characterise risk factors for fatal drowning in California, USA to inform priorities for prevention, policy and research. METHODS This retrospective population-based epidemiological review of death certificate data evaluated fatal drowning events in California from 2005 to 2019. Unintentional, intentional, and undetermined drowning deaths and rates were described by person (age, sex, race) and context-based variables (region and body of water). RESULTS California's fatal drowning rate was 1.48 per 100 000 population (n=9237). Highest total fatal drowning rates occurred in the lower population density northern regions, among older adults (75-84 years: 2.54 per 100 000 population; 85+: 3.47 per 100 000 population) and non-Hispanic American Indian or Alaska Native persons (2.84 per 100 000 population). Male drowning deaths occurred at 2.7 times the rate of females; drowning deaths occurred mainly in swimming pools (27%), rivers/canals (22.4%) and coastal waters (20.2%). The intentional fatal drowning rate increased 89% during the study period. CONCLUSIONS California's overall fatal drowning rate was similar to the rest of the USA but differed among subpopulations. These divergences from national data, along with regional differences in drowning population and context-related characteristics, underscore the need for state and regional level analyses to inform drowning prevention policy, programmes and research.
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Affiliation(s)
- William Koon
- School of Biological, Earth, and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
- California Water Safety Coalition, Huntington Beach, California, USA
| | - Orion Stewart
- Center for Healthy Communities, Injury and Violence Prevention Branch, California Department of Public Health, Sacramento, California, USA
| | - Robert Brander
- School of Biological, Earth, and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Linda Quan
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Amy E Peden
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Yip P, Xiao Y, Xu Y, Chan E, Cheung F, Chan CS, Pirkis J. Social Media Sentiments on Suicides at the New York City Landmark, Vessel: A Twitter Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11694. [PMID: 36141964 PMCID: PMC9517673 DOI: 10.3390/ijerph191811694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Vessel is a landmark created by Heatherwick Studio where visitors can enjoy views of New York City from different heights and perspectives. However, between February 2020 and July 2021, four individuals jumped to their deaths from the landmark. Effective preventive solutions have yet to be identified, and the site is currently closed. In this study, we examined the trajectory of public sentiment on the suicide-related activity at Vessel on Twitter by investigating the engagement patterns and identifying themes about the four suicides from February 2020 to August 2021 (n = 3058 tweets). The results show increased levels of discussion about each successive suicide case in the first 14 days following each incident (from 6 daily tweets for the first case to 104 for the fourth case). It also took longer for relevant discussions to dissipate (4 days for the first and 14 days for the fourth case, KS statistic = 0.71, p < 0.001). Thematic analysis shows a shift from expressions of emotion to urging suicide prevention actions in the third and fourth cases; additionally, we detected growing support for restricting means. We suggest that, prior to the reopening of Vessel, collective efforts should be made to install safety protections and reduce further suicide risks.
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Affiliation(s)
- Paul Yip
- The HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
| | - Yunyu Xiao
- Department of Population Health Sciences, Weill Cornell Medicine, NewYork-Presbyterian, New York, NY 10065, USA
| | - Yucan Xu
- The HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
| | - Evangeline Chan
- The HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
| | - Florence Cheung
- The HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
| | - Christian S. Chan
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, Carlton VIC 3053, Australia
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3
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Ha NT, Huong NT, Anh VN, Anh NQ. Modelling in economic evaluation of mental health prevention: current status and quality of studies. BMC Health Serv Res 2022; 22:906. [PMID: 35831821 PMCID: PMC9281039 DOI: 10.1186/s12913-022-08206-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background The present study aimed to identify and critically appraise the quality of model-based economic evaluation studies in mental health prevention. Methods A systematic search was performed on MEDLINE, EMBASE, EconLit, PsycINFO, and Web of Science. Two reviewers independently screened for eligible records using predefined criteria and extracted data using a pre-piloted data extraction form. The 61-item Philips Checklist was used to critically appraise the studies. Systematic review registration number: CRD42020184519. Results Forty-nine studies were eligible to be included. Thirty studies (61.2%) were published in 2015–2021. Forty-seven studies were conducted for higher-income countries. There were mainly cost-utility analyses (n = 31) with the dominant primary outcome of quality-adjusted life year. The most common model was Markov (n = 26). Most of the studies were conducted from a societal or health care perspective (n = 37). Only ten models used a 50-year time horizon (n = 2) or lifetime horizon (n = 8). A wide range of mental health prevention strategies was evaluated with the dominance of selective/indicate strategy and focusing on common mental health problems (e.g., depression, suicide). The percentage of the Philip checkilst’s criteria fulfilled by included studies was 69.3% on average and ranged from 43.3 to 90%. Among three domains of the Philip checklist, criteria on the model structure were fulfilled the most (72.1% on average, ranging from 50.0% to 91.7%), followed by the data domain (69.5% on average, ranging from 28.9% to 94.0%) and the consistency domain (54.6% on average, ranging from 20.0% to 100%). The practice of identification of ‘relevant’ evidence to inform model structure and inputs was inadequately performed. The model validation practice was rarely reported. Conclusions There is an increasing number of model-based economic evaluations of mental health prevention available to decision-makers, but evidence has been limited to the higher-income countries and the short-term horizon. Despite a high level of heterogeneity in study scope and model structure among included studies, almost all mental health prevention interventions were either cost-saving or cost-effective. Future models should make efforts to conduct in the low-resource context setting, expand the time horizon, improve the evidence identification to inform model structure and inputs, and promote the practice of model validation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08206-9.
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Affiliation(s)
- Nguyen Thu Ha
- Department of Health Policy and Economics, Hanoi University of Public Health, Hanoi, Vietnam
| | - Nguyen Thanh Huong
- Department of Health Education and Promotion, Hanoi University of Public Health, Hanoi, Vietnam.
| | | | - Nguyen Quynh Anh
- Department of Health Policy and Economics, Hanoi University of Public Health, Hanoi, Vietnam
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4
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Bandara P, Pirkis J, Clapperton A, Shin S, Too LS, Reifels L, Onie S, Page A, Andriessen K, Krysinska K, Flego A, Schlichthorst M, Spittal MJ, Mihalopoulos C, Le LKD. Cost-effectiveness of Installing Barriers at Bridge and Cliff Sites for Suicide Prevention in Australia. JAMA Netw Open 2022; 5:e226019. [PMID: 35380642 PMCID: PMC8984771 DOI: 10.1001/jamanetworkopen.2022.6019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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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Affiliation(s)
- Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Clapperton
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sangsoo Shin
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lay San Too
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sandersan Onie
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
- Emotional Health for All Foundation, Jakarta, Indonesia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anna Flego
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Long Khanh-Dao Le
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
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5
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Torok M, Konings P, Passioura J, Chen NA, Hewett M, Phillips M, Burnett A, Shand F, Christensen H. Spatial Errors in Automated Geocoding of Incident Locations in Australian Suicide Mortality Data. Epidemiology 2021; 32:896-903. [PMID: 34310446 DOI: 10.1097/ede.0000000000001403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is increasing interest in the spatial analysis of suicide data to identify high-risk (often public) locations likely to benefit from access restriction measures. The identification of such locations, however, relies on accurately geocoded data. This study aims to examine the extent to which common completeness and positional spatial errors are present in suicide data due to the underlying geocoding process. METHODS Using Australian suicide mortality data from the National Coronial Information System for the period of 2008-2017, we compared the custodian automated geocoding process to an alternate multiphase process. Descriptive and kernel density cluster analyses were conducted to ascertain data completeness (address matching rates) and positional accuracy (distance revised) differences between the two datasets. RESULTS The alternate geocoding process initially improved address matching from 67.8% in the custodian dataset to 78.4%. Additional manual identification of nonaddress features (such as cliffs or bridges) improved overall match rates to 94.6%. Nearly half (49.2%) of nonresidential suicide locations were revised more than 1,000 m from data custodian coordinates. Spatial misattribution rates were greatest at the smallest levels of geography. Kernel density maps showed clear misidentification of hotspots relying solely on autogeocoded data. CONCLUSION Suicide incidents that occur at nonresidential addresses are being erroneously geocoded to centralized fall-back locations in autogeocoding processes, which can lead to misidentification of suicide clusters. Our findings provide insights toward defining the nature of the problem and refining geocoding processes, so that suicide data can be used reliably for the detection of suicide hotspots. See video abstract at, http://links.lww.com/EDE/B862.
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Affiliation(s)
- Michelle Torok
- From the Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Paul Konings
- National Centre for Geographic Resources & Analysis in Primary Health Care, Research School of Population Health, Australian National University, Canberra, Australia
| | - Jason Passioura
- National Centre for Geographic Resources & Analysis in Primary Health Care, Research School of Population Health, Australian National University, Canberra, Australia
| | - Nicole A Chen
- Orygen Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Michael Hewett
- National Centre for Geographic Resources & Analysis in Primary Health Care, Research School of Population Health, Australian National University, Canberra, Australia
| | - Matthew Phillips
- From the Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Alexander Burnett
- From the Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Shand
- From the Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- From the Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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6
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Berman AL, Athey A, Nestadt P. Effectiveness of restricting access to a suicide jump site: a test of the method substitution hypothesis. Inj Prev 2021; 28:90-92. [PMID: 34417196 DOI: 10.1136/injuryprev-2021-044240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/10/2021] [Indexed: 11/04/2022]
Abstract
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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Affiliation(s)
- Alan Lee Berman
- Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Alisonj Athey
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Paul Nestadt
- Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA
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7
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Le LKD, Esturas AC, Mihalopoulos C, Chiotelis O, Bucholc J, Chatterton ML, Engel L. Cost-effectiveness evidence of mental health prevention and promotion interventions: A systematic review of economic evaluations. PLoS Med 2021; 18:e1003606. [PMID: 33974641 PMCID: PMC8148329 DOI: 10.1371/journal.pmed.1003606] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 05/25/2021] [Accepted: 03/31/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The prevention of mental disorders and promotion of mental health and well-being are growing fields. Whether mental health promotion and prevention interventions provide value for money in children, adolescents, adults, and older adults is unclear. The aim of the current study is to update 2 existing reviews of cost-effectiveness studies in this field in order to determine whether such interventions are cost-effective. METHODS AND FINDINGS Electronic databases (including MEDLINE, PsycINFO, CINAHL, and EconLit through EBSCO and Embase) were searched for published cost-effectiveness studies of prevention of mental disorders and promotion of mental health and well-being from 2008 to 2020. The quality of studies was assessed using the Quality of Health Economic Studies Instrument (QHES). The protocol was registered with PROSPERO (# CRD42019127778). The primary outcomes were incremental cost-effectiveness ratio (ICER) or return on investment (ROI) ratio across all studies. A total of 65 studies met the inclusion criteria of a full economic evaluation, of which, 23 targeted children and adolescents, 35 targeted adults, while the remaining targeted older adults. A large number of studies focused on prevention of depression and/or anxiety disorders, followed by promotion of mental health and well-being and other mental disorders. Although there was high heterogeneity in terms of the design among included economic evaluations, most studies consistently found that interventions for mental health prevention and promotion were cost-effective or cost saving. The review found that targeted prevention was likely to be cost-effective compared to universal prevention. Screening plus psychological interventions (e.g., cognitive behavioural therapy [CBT]) at school were the most cost-effective interventions for prevention of mental disorders in children and adolescents, while parenting interventions and workplace interventions had good evidence in mental health promotion. There is inconclusive evidence for preventive interventions for mental disorders or mental health promotion in older adults. While studies were of general high quality, there was limited evidence available from low- and middle-income countries. The review was limited to studies where mental health was the primary outcome and may have missed general health promoting strategies that could also prevent mental disorder or promote mental health. Some ROI studies might not be included given that these studies are commonly published in grey literature rather than in the academic literature. CONCLUSIONS Our review found a significant growth of economic evaluations in prevention of mental disorders or promotion of mental health and well-being over the last 10 years. Although several interventions for mental health prevention and promotion provide good value for money, the varied quality as well as methodologies used in economic evaluations limit the generalisability of conclusions about cost-effectiveness. However, the finding that the majority of studies especially in children, adolescents, and adults demonstrated good value for money is promising. Research on cost-effectiveness in low-middle income settings is required. TRIAL REGISTRATION PROSPERO registration number: CRD42019127778.
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Affiliation(s)
- Long Khanh-Dao Le
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
- * E-mail:
| | - Adrian Cuevas Esturas
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Cathrine Mihalopoulos
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Oxana Chiotelis
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Jessica Bucholc
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Mary Lou Chatterton
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Lidia Engel
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
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8
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Lee YY, Chisholm D, Eddleston M, Gunnell D, Fleischmann A, Konradsen F, Bertram MY, Mihalopoulos C, Brown R, Santomauro DF, Schess J, van Ommeren M. The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries: an economic modelling study. Lancet Glob Health 2021; 9:e291-e300. [PMID: 33341152 PMCID: PMC7886657 DOI: 10.1016/s2214-109x(20)30493-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Reducing suicides is a key Sustainable Development Goal target for improving global health. Highly hazardous pesticides are among the leading causes of death by suicide in low-income and middle-income countries. National bans of acutely toxic highly hazardous pesticides have led to substantial reductions in pesticide-attributable suicides across several countries. This study evaluated the cost-effectiveness of implementing national bans of highly hazardous pesticides to reduce the burden of pesticide suicides. METHODS A Markov model was developed to examine the costs and health effects of implementing a national ban of highly hazardous pesticides to prevent suicides due to pesticide self-poisoning, compared with a null comparator. We used WHO cost-effectiveness and strategic planning (WHO-CHOICE) methods to estimate pesticide-attributable suicide rates for 100 years from 2017. Country-specific costs were obtained from the WHO-CHOICE database and denominated in 2017 international dollars (I$), discounted at a 3% annual rate, and health effects were measured in healthy life-years gained (HLYGs). We used a demographic projection model beginning with the country population in the baseline year (2017), split by 1-year age group and sex. Country-specific data on overall suicide rates were obtained for 2017 by age and sex from the Global Burden of Disease Study 2017 Data Resources. The analysis involved 14 countries spanning low-income to high-income settings, and cost-effectiveness ratios were analysed at the country-specific level and aggregated according to country income group and the proportion of suicides due to pesticides. FINDINGS Banning highly hazardous pesticides across the 14 countries studied could result in about 28 000 (95% uncertainty interval [UI] 24 000-32 000) fewer suicide deaths each year at an annual cost of I$0·007 per capita (95% UI 0·006-0·008). In the population-standardised results for the base case analysis, national bans produced cost-effectiveness ratios of $94 per HLYG (95% UI 73-123) across low-income and lower-middle-income countries and $237 per HLYG (95% UI 191-303) across upper-middle-income and high-income countries. Bans were more cost-effective in countries where a high proportion of suicides are attributable to pesticide self-poisoning, reaching a cost-effectiveness ratio of $75 per HLYG (95% UI 58-99) in two countries with proportions of more than 30%. INTERPRETATION National bans of highly hazardous pesticides are a potentially cost-effective and affordable intervention for reducing suicide deaths in countries with a high burden of suicides attributable to pesticides. However, our study findings are limited by imperfect data and assumptions that could be improved upon by future studies. FUNDING WHO.
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Affiliation(s)
- Y Y Lee
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
| | - D Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - M Eddleston
- Pharmacology, Toxicology and Therapeutics, University and British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | - D Gunnell
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; Population Health Sciences Institute, Bristol Medical School, Bristol, UK; National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, UK
| | - A Fleischmann
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
| | - F Konradsen
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Y Bertram
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - C Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - R Brown
- Department of Environment, Climate Change and Health, WHO, Geneva, Switzerland
| | - D F Santomauro
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - J Schess
- Generation Mental Health Association, New York, NY, USA; Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| | - M van Ommeren
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
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9
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Lebenbaum M, Cheng J, de Oliveira C, Kurdyak P, Zaheer J, Hancock-Howard R, Coyte PC. Evaluating the Cost Effectiveness of a Suicide Prevention Campaign Implemented in Ontario, Canada. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:189-201. [PMID: 31535350 DOI: 10.1007/s40258-019-00511-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although suicide-prevention campaigns have been implemented in numerous countries, Canada has yet to implement a strategy nationally. This is the first study to examine the cost utility of the implementation of a multidimensional suicide-prevention program that combines several interventions over a 50-year time horizon. METHODS We used Markov modeling to capture the dynamic changes to health status and estimate the incremental cost per quality-adjusted life-year gained over a 50-year period for Ontario residents for a suicide-prevention strategy compared to no intervention. The strategy consisted of a package of interventions geared towards preventing suicide including a public health awareness campaign, increased identification of individuals at risk, increased training of primary-care physicians, and increased treatment post-suicide attempt. Four health states were captured by the Markov model: (1) alive and no recent suicide attempt; (2) suicide attempt; (3) death by suicide; (4) death (other than suicide). Analyses were from a societal perspective where all costs, irrespective of payer, were included. We used a probabilistic analysis to test the robustness of the model results to both variation and uncertainty in model parameters. RESULTS Over the 50-year period, the suicide-prevention campaign had an incremental cost-effectiveness ratio (ICER) of $18,853 (values are in Canadian dollars) per QALY gained. In all one-way sensitivity analyses, the ICER remained under $50,000/QALY. In the probabilistic analysis, there was a probability of 94.8% that the campaign was cost effective at a willingness-to-pay of $50,000/QALY (95% confidence interval of ICER probabilistic distribution: 2650-62,375). Among the current population, the intervention was predicted to result in the prevention of 4454 suicides after 50 years (1033 by year 10; 2803 by year 25). A healthcare payer perspective sensitivity analysis showed an ICER of $21,096.14/QALY. INTERPRETATION These findings demonstrate that a suicide-prevention campaign in Ontario is very likely a cost-effective intervention to reduce the incidence of suicide and suggest suicide-prevention campaigns are likely to be cost effective for some other Canadian provinces and potentially other countries.
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Affiliation(s)
- Michael Lebenbaum
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - Joyce Cheng
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
- Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, Canada.
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Paul Kurdyak
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada
- ICES, Toronto, ON, Canada
- Health Outcomes and Performance Evaluation, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rebecca Hancock-Howard
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada
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Okolie C, Wood S, Hawton K, Kandalama U, Glendenning AC, Dennis M, Price SF, Lloyd K, John A. Means restriction for the prevention of suicide by jumping. Cochrane Database Syst Rev 2020; 2:CD013543. [PMID: 32092795 PMCID: PMC7039710 DOI: 10.1002/14651858.cd013543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Chukwudi Okolie
- Swansea University Medical SchoolSwanseaUKSA2 8PP
- Public Health WalesSwanseaUK
| | | | - Keith Hawton
- Warneford HospitalCentre for Suicide Research, University Department of PsychiatryOxfordUKOX3 7JX
| | | | | | | | - Sian F Price
- Public Health WalesPublic Health Wales ObservatoryPO Box 108, Building 1, St David?s ParkCarmarthenWalesUKSA31 3WY
| | - Keith Lloyd
- Swansea University Medical SchoolSwanseaUKSA2 8PP
| | - Ann John
- Swansea University Medical SchoolSwanseaUKSA2 8PP
- Public Health WalesSwanseaUK
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Abstract
Poor mental health has profound economic consequences. Given the burden of poor mental health, the economic case for preventing mental illness and promoting better mental health may be very strong, but too often prevention attracts little attention and few resources. This article describes the potential role that can be played by economic evidence alongside experimental trials and observational studies, or through modeling, to substantiate the need for increased investment in prevention. It illustrates areas of action across the life course where there is already a good economic case. It also suggests some further areas of substantive public health concern, with promising effectiveness evidence, that may benefit from economic analysis. Financial and economic barriers to implementation are then presented, and strategies to address the barriers and increase investment in the prevention of mental illness are suggested.
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Affiliation(s)
- David McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, United Kingdom; ,
| | - A-La Park
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, United Kingdom; ,
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Abstract
OBJECTIVE A suicide attempt is at least somewhat life-threatening by definition and is, for some, traumatic. Thus, it is possible that some individuals may develop posttraumatic stress disorder (PTSD) from a suicide attempt. METHOD In this article, we consider whether one's suicide attempt could fulfill Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for a PTSD Criterion A event and contribute to the development of attendant PTSD symptoms (e.g., flashbacks, avoidance, shame/guilt, nightmares); discuss theoretical models of PTSD as they relate to suicide attempts; reflect on factors that might influence rates of suicide attempt-related PTSD; highlight methodological limitations that have hampered our understanding of suicide attempt-related PTSD; and posit areas for future scientific and clinical inquiry. RESULTS Strikingly, the degree to which a suicide attempt leads to PTSD is unknown. CONCLUSIONS We conclude with a call for research to systematically assess for suicide attempts alongside other potentially traumatic experiences (e.g., combat exposure, rape) that are included in standardized PTSD assessments.
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Affiliation(s)
- Ian H Stanley
- a Ian H. Stanley, Joseph W. Boffa, and Thomas E. Joiner are affiliated with Florida State University in Tallahassee , Florida
| | - Joseph W Boffa
- a Ian H. Stanley, Joseph W. Boffa, and Thomas E. Joiner are affiliated with Florida State University in Tallahassee , Florida
| | - Thomas E Joiner
- a Ian H. Stanley, Joseph W. Boffa, and Thomas E. Joiner are affiliated with Florida State University in Tallahassee , Florida
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Bustamante Madsen L, Eddleston M, Schultz Hansen K, Konradsen F. Quality Assessment of Economic Evaluations of Suicide and Self-Harm Interventions. CRISIS 2018; 39:82-95. [DOI: 10.1027/0227-5910/a000476] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Abstract. Background: Death following self-harm constitutes a major global public health challenge and there is an urgent need for governments to implement cost-effective, national suicide prevention strategies. Aim: To conduct a systematic review and quality appraisal of the economic evaluations of interventions aimed at preventing suicidal behavior. Method: A systematic literature search was performed in several literature databases to identify relevant articles published from 2003 to 2016. Drummond's 10-item appraisal tool was used to assess the methodological quality of the included studies. Results: In total, 25 documents encompassing 30 economic evaluations were included in the review. Of the identified evaluations, 10 studies were found to be of poor quality, 14 were of average quality, and six studies were considered of good quality. The majority of evaluations found the interventions to be cost-effective. Limitations: Several limitations were identified and discussed in the article. Conclusion: A notable few economic evaluations were identified. The studies were diverse, primarily set in high-income countries, and often based on modeling, emphasizing the need for more primary research into the topic. The discussion of suicide and self-harm prevention should be as nuanced as possible, including health economics along with cultural, social, and political aspects.
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Affiliation(s)
- Lizell Bustamante Madsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kristian Schultz Hansen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Anestis MD, Law KC, Jin H, Houtsma C, Khazem LR, Assavedo BL. Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention. Suicide Life Threat Behav 2017; 47:523-537. [PMID: 27862187 DOI: 10.1111/sltb.12311] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/28/2016] [Indexed: 11/29/2022]
Abstract
Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence-based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population-level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability-centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population-level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence-based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.
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Affiliation(s)
| | - Keyne C Law
- University of Southern Mississippi, Hattiesburg, MS, USA
| | - Hyejin Jin
- University of Southern Mississippi, Hattiesburg, MS, USA
| | - Claire Houtsma
- University of Southern Mississippi, Hattiesburg, MS, USA
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Suicides by Jumping Off Istanbul Bridges Linking Asia and Europe. Am J Forensic Med Pathol 2017; 38:139-144. [PMID: 28230653 DOI: 10.1097/paf.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to determine the injury spectrum and characteristics of people who committed suicide by jumping into water from the July 15th Martyrs Bridge and Fatih Sultan Mehmet Bridges in Istanbul, Turkey. METHODS This study included all of the jumpers from the July 15th Martyrs Bridge and Fatih Sultan Mehmet Bridge who were autopsied by the Council of Forensic Medicine, Istanbul Morgue Department, between 2000 and 2013. All of the data were collected from archived case files. Trauma scores were calculated from the traumatic findings of the autopsy reports using the New Injury Severity Score (NISS). RESULTS A total of 80 jumping suicides were identified. The male-to-female ratio was 9:1, and the mean age was 34.06 ± 9.6 years. Most suicides occurred in 2009. The suicide rates were higher in the winter, particularly in December. The most frequent injuries were skin lesions, rib fractures, and lung lacerations. In 12% of the cases, the trauma was minor (NISS range, 0-14; mean, 7 ± 5.67), and in 88% of the cases, it was major (NISS range, 17-66; mean NISS, 44.5 ± 12.46). CONCLUSION The sociodemographic features of the jumpers who committed suicide were quite similar to those reported in previous studies. Preventative measures (installation of barriers or banning pedestrian access to bridges) reduced the suicide rate but were not completely effective. Establishing early warning systems and rescue strategies could save the lives of jumpers who have minor trauma.
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Hemmer A, Meier P, Reisch T. Comparing Different Suicide Prevention Measures at Bridges and Buildings: Lessons We Have Learned from a National Survey in Switzerland. PLoS One 2017; 12:e0169625. [PMID: 28060950 PMCID: PMC5218568 DOI: 10.1371/journal.pone.0169625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Alexander Hemmer
- Department of Psychology, Hospital of Psychiatry Muensingen, Bern, Switzerland
| | - Philipp Meier
- Department of Psychology, Hospital of Psychiatry Muensingen, Bern, Switzerland
| | - Thomas Reisch
- Department of Medicine, Hospital of Psychiatry Muensingen, Bern, Switzerland
- Department of Medicine, University Hospital of Psychiatry, Bern, Switzerland
- * E-mail:
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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: 86] [Impact Index Per Article: 9.6] [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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18
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Dua A, Wei S, Safarik J, Furlough C, Desai SS. National mandatory motorcycle helmet laws may save $2.2 billion annually: An inpatient and value of statistical life analysis. J Trauma Acute Care Surg 2015; 78:1182-6. [PMID: 26151521 DOI: 10.1097/ta.0000000000000601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND While statistics exist regarding the overall rate of fatalities in motorcyclists with and without helmets, a combined inpatient and value of statistical life (VSL) analysis has not previously been reported. METHODS Statistical data of motorcycle collisions were obtained from the Centers for Disease Control, National Highway Transportation Safety Board, and Governors Highway Safety Association. The VSL estimate was obtained from the 2002 Department of Transportation calculation. Statistics on helmeted versus nonhelmeted motorcyclists, death at the scene, and inpatient death were obtained using the 2010 National Trauma Data Bank. Inpatient costs were obtained from the 2010 National Inpatient Sample. Population estimates were generated using weighted samples, and all costs are reported using 2010 US dollars using the Consumer Price Index. RESULTS A total of 3,951 fatal motorcycle collisions were reported in 2010, of which 77% of patients died at the scene, 10% in the emergency department, and 13% as inpatients. Thirty-seven percent of all riders did not wear a helmet but accounted for 69% of all deaths. Of those motorcyclists who survived to the hospital, the odds ratio of surviving with a helmet was 1.51 compared with those without a helmet (p < 0.001). Total costs for nonhelmeted motorcyclists were 66% greater at $5.5 billion, compared with $3.3 billion for helmeted motorcyclists (p < 0.001). Direct inpatient costs were 16% greater for helmeted riders ($203,248 vs. $175,006) but led to more than 50% greater VSL generated (absolute benefit, $602,519 per helmeted survivor). CONCLUSION A cost analysis of inpatient care and indirect costs of motorcycle riders who do not wear helmets leads to nearly $2.2 billion in losses per year, with almost 1.9 times as many deaths compared with helmeted motorcyclists. The per capita cost per fatality is more than $800,000. Institution of a mandatory helmet law could lead to an annual cost savings of almost $2.2 billion. LEVEL OF EVIDENCE Economic analysis, level III.
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Affiliation(s)
- Anahita Dua
- From the Department of Surgery (A.D., S.W.), Medical College of Wisconsin, Milwaukee, Wisconsin; University of Virginia (J.S.), Charlottesville, Virginia; Department of Surgery (C.F.), University of Texas at Houston, Houston, Texas; and Department of Vascular Surgery (S.S.D.), Southern Illinois University, Springfield, Illinois
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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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