Bridges and Suicide

Beautrais, A. Suicide by jumping: A review of research and prevention strategies. Crisis: The Journal of Crisis Intervention and Suicide Prevention. 2007: 28(Suppl 1): 58-63.

  The incidence of suicide by jumping varies but tends to be higher in jurisdcitions that have extensive high-rise housing. Most occur from high-rise residential housing units. However, our knowledge about suicide by jumping tends to be limited to a small number of reports from sites, often bridges. Media reports from these sites appear to encourage imitative behavior. Prevention strategies have focused on limiting suicides from iconic sites by surveillance, barriers, muted media reporting, and signage offering help and telephone hotlines. Evidendence from a small number of studies shows that installing barriers at popular jumping sites reduces suicides from those sites. There are few reports of efforts to reduce suicides from high-rise residential buildings.

Beautrais AL. Effectiveness of barriers at suicide jumping sites: a case study. Aust N Z J Psychiatry. 2001;35(5):557-62.

   After having been in place for 60 years suicide safety barriers were removed from a central city bridge in an Australasian metropolitan area in 1996. A known suicide site, the bridge is located adjacent to the region's largest hospital, which includes an acute inpatient psychiatric unit. 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 (compared with the previous 4 years) the number of suicides increased substantially, from three to 15 (chi2 = 8, df = 1, p < 0.01). Young male psychiatric patients, with psychotic illnesses, comprised the majority of those who died by jumping from the bridge. Following the removal of the barriers from the bridge the rate of suicide by jumping in the metropolitan area 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. The number of suicide deaths by jumping increased substantially after the removal of safety barriers from a known suicide site.

Beautrais A,  Gibb S, Fergusson D, Horwood LJ,  Larkin GL. Removing bridge barriers stimulates suicides: an unfortunate natural experiment.  Australian and New Zealand Journal of Psychiatry. 2009; 43(6):495-497.

   Safety barriers to prevent suicide by jumping were removed from Grafton Bridge in Auckland, New Zealand, in 1996 after having been in place for 60 years. The barriers were reinstalled in 2003. This study compared mortality data for suicide deaths for three time periods: 1991-1995 (old barrier in place); 1997-2002 (no barriers in place); 2003-2006 (new barriers in place).  Removal of barriers was followed by a fivefold increase in the number and rate of suicides from the bridge. Since the reinstallation of barriers, there have been no suicides from the bridge. This natural experiment, using a powerful a-b-a (reversal) design, shows that safety barriers are effective in preventing suicide: their removal increases suicides; their reinstatement prevents suicides.

Bennewith O, Nowers M, Gunnell D. Effect of barriers on the Clifton suspension bridge, England, on local patterns of suicide: Implications for prevention. Br J Psychiatry. 2007; 190:266-7.

   The authors assessed the effect of the 1998 installation of barriers on the Clifton suspension bridge, Bristol, England, on local suicides by jumping. Deaths from this bridge halved from 8.2 per year (1994-1998) to 4.0 per year (1999-2003; P=0.008). Although males constituted 90% of the suicides from the bridge, no evidence was found of an increase in male suicide by jumping from other sites in the Bristol area once barriers had been erected. This study provides evidence for the effectiveness of barriers on bridges in preventing site-specific suicides and suicides by jumping overall in the surrounding area.

Cantor CH, Hill MA. Suicide from river bridges. Aust N Z J Psychiatry. 1990 Sep;24(3):377-80.

  The opening of a new high river bridge in Brisbane allowed a naturalistic experimental testing of whether the sample engaging in suicidal behavior from the new bridge was similar to that from the adjoining older bridge. The differences found were substantial 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.

de Moore, GM, Robertson AR. Suicide Attempts by Firearms and by Leaping From Heights: A Comparative Study of Survivors. Am J Psychiatry. 1999;156: 1425-1431.

  This study compared the clinical and demographic profiles of patients who survived deliberate self-harm from shooting or jumping from a great height. The study consisted of an 18-year retrospective case history analysis of survivors  identified from the database of consultation-liaison psychiatry referrals at a hospital in Sydney, Australia. Fifty-one patients who had shot themselves and 31 patients who had jumped were assessed by the consultation-liaison psychiatry team. Those who jumped were more likely to be single, unemployed, and psychotic. Those who used firearms were more likely to be male, abuse alcohol, have a forensic history, and have an antisocial or borderline personality disorder. The authors conclude that the importance of mental state and specific psychiatric diagnosis as determinants of the method used has been neglected in studies of suicide.

Lindqvist P, Jonsson A, Eriksson A, Hedelin A, Björnstig U. Are suicides by jumping off bridges preventable? An analysis of 50 cases from Sweden. Accid Anal Prev. 2004; 36(4):691-4.  

   This is a sequential community-based 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 (median age, 35 years). At least 40 had psychiatric problems. The summer months and weekends saw the highest frequency of suicide. A total of 27 bridges were used. Almost half of all the suicides occurred from three bridges. Since this study demonstrates that few bridges attract suicide candidates, the authors recommend that road system owners need to acknowledge this injury mechanism and include it in safety work.

Miller M, Azrael D, Hemenway D. Belief in the inevitability of suicide: results from a national survey. Suicide Life Threat Behav. 2006;36(1):1-11.

   In order to examine public opinion regarding the effectiveness of means restriction as an approach to preventing suicide the authors asked a national sample of 2,770 respondents a hypothetical question about what effect a suicide barrier might have had ultimately on the fate of the more than 1,000 people who have jumped to their death from the Golden Gate Bridge. Thirty-four percent of respondents believed that every single jumper would have found another way to complete suicide, and an additional 40% believed that "most" would have done so. The strongest predictors of belief in complete substitution were firearm ownership and cigarette smoking. Belief in the inevitability of suicide may be a political impediment to adopting suicide prevention efforts.

Nowers M, Gunnell D. Suicide from the Clifton Suspension Bridge in England. J Epidemiol Community Health. 1996;50(1): 30-2.

  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). Ten percent 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). The presence of the Clifton Suspension Bridge affected patterns of suicide in the Bristol and District Health Authority. 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.

O'Carroll PW, Silverman MM. Community suicide prevention: the effectiveness of bridge barriers. Suicide and Life Threatening Behavior. 1994;24(1):89-91; discussion 91-9.

Pelletier AR. Preventing suicide by jumping: the effect of a bridge safety fence. Injury Prevention. 2007;13(1):57-9.

  The authors evaluated the effect on suicides of installing a bridge safety fence on the Memorial Bridge in Augusta, Maine in 1983.  From 1 April 1960 to 31 July 2005 there were  14 suicides from the bridge, all of which occurred before installation of the safety fence. The number of suicides by jumping from other structures remained unchanged after installation of the fence. The authors concluded that the safety fence was effective in preventing suicides from the bridge. No evidence was found that suicidal individuals sought alternative sites for jumping.

Reisch, T., & Michel, K.  Securing a suicide hot spot: Effects of a safety net at the Bern Muenster Terrace. Suicide and Life-Threatening Behavior. 2005; 35: 460-467.

  In the city of Bern, 29% of suicides are by jumping. The highest number of deaths (mean 2.5 per year) was at the Muenster Terrace in the old city. A safety net was built in 1998 after a series of suicides to prevent people from leaping from the terrace and to avoid further traumatization of people living nearby. The authors analyzed suicides by jumping before and after the installation of the net and assessed the number of media reports referring to this suicide method. No suicides occurred from the terrace after the installation of the net. Compared with the pre-installation period, the number of people jumping from all high places in Bern was significantly lower, indicating that no immediate shift to other nearby jumping sites took place. There was a moderate correlation between the number of media reports and the number of residents from outside Bern committing suicide by jumping from high places in the city.

Reisch T, Schuster U, Michel K. Suicide by Jumping and Accessibility of Bridges: Results from a National Survey in Switzerland. Suicide and Life-Threatening Behavior. 2007; 37(6): 681-87.

  This study compared suicide data from regions with and without suicide bridges to estimate the effects on method and site substitution if bridges were to be secured. Suicide data for the years 1990 to 2003 were collected in a national survey. The analysis revealed that in regions with high rates of bridge suicides compared with regions with low rates, about one third of the individuals would be expected to jump from buildings or other structures if no bridge was available. The results suggest no substitution of method for women. For men, a trend of a substituting jumping by overdosing in regions without suicide bridges was found. The authors conclude that restricted access to suicide bridges will not automatically lead suicidal individuals to choose another jumping site or suicide method.

Reisch T, Schuster U, Michel K. Suicide by jumping from bridges and other heights: Social and diagnostic factors. Psychiatry Research. 2008; 161(1): 97-104

   This study documented the social and diagnostic characteristics of persons who end their lives by jumping from heights and compared those who jump from bridges with those jumping from other sites. Persons who jumped from heights were more likely to suffer from schizophrenia than those who used other methods. Persons who jumped from bridges were younger than those committing suicide by other methods. Subjects were on average 14.3 years younger and more often male compared with those who jumped from other sites., Individuals who jumped from bridges close to psychiatric hospitals were more likely to suffer from psychiatric illness. For future classification it may be helpful to distinguish suicides from bridges from suicides from other heights. For prevention of suicide from bridges, attention should be paid to characteristics of young persons at risk.

Seiden R. Where are they now? A follow-up study of suicide attempters from the Golden Gate Bridge. Suicide and Life Threatening Behavior, 1978; 8:203-16.