Bridge Bibliography

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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.

Gunnell D and Miller M. Strategies to prevent suicide. British Medical Journal. 2010; 341: 157-158.

• This editorial discusses the efficacy of restricting access to various lethal means.

Jeon HJ, Lee JY, Lee YM, Hong JP, Won SH, Cho SJ, Kim JY, Chang SM, Lee HW, Cho MJ. Unplanned versus planned suicide attempters, precipitants, methods, and an association with mental disorders in a Korea-based community sample. J Affect Disord. 2010 Dec;127(1-3):274-80. Epub 2010 Jun 29.

• In a nationally representative household survey (n=6,510), among the 208 (3.2%) who reported having ever made a suicide attempt, two-thirds reported having made a suicide plan and one-third reported no plan. Unplanned attempts were more common among male than female attempts (43% of male attempters vs. 31% of female attempters). Precipitants were similar across the two groups with family conflicts topping both lists. Medications were more frequently used in the planned attempts (60% of planned vs. 37% of unplanned); planned attempts were less likely than unplanned to use chemical agents (12% vs. 34%) and jumps (12% vs. 32%).

Lin J & Lu T. Association between the accessibility to lethal methods and method-specific suicide rates: an ecological study in Taiwan. J Clin Psychiatry. 2006;67(7):1074-1079.

• The authors calculated suicide rates for five years and 23 counties/cities in Taiwan. Adjusting for unemployment and depression rates, they found a strong positive correlation (0.77) between rurality and poisoning as well as between suicide by jumping and living on or above the sixth floor (0.73). Hanging rates were not related to the proportion of agricultural households or the proportion of households living on or above the sixth floor. The authors conclude that because localities that had little access to pesticides (the leading poisoning method) and tall buildings were no more likely to have a higher rate of suicide by hanging (a universally available method), restricting pesticide availability and adding barriers to high places may help prevent suicides.

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.

• The number one jump site in DC used to be the Ellington Bridge. In 1986 an 8-foot fence was erected as a barrier. In the five years following, there was no significant increase in suicide by jumping from the nearby Taft Bridge, and there was a 50% reduction in suicide by jumping compared to 1979-1985. The mean number of total suicides per year in DC decreased from 76.5/year in the seven years prior to the barrier to 71/year in the five years since.

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.

• The Golden Gate Bridge is the number one suicide location in the world. Since opening in 1937, there have been 625 officially reported suicide deaths and perhaps more than 200 others. Proposals for the construction of a hardware antisuicide barrier have been challenged with the untested contention that attempters will simply substitute another method. This research tests this contention by evaluating the long-term mortality of the 515 people who attempted suicide from the Golden Gate Bridge but were restrained, from the opening day through 1971, plus a comparison group of 184 persons who made nonbridge suicide attempts during 1956–57 and were treated at an ED and then followed through the close of 1971. The author found that only about 10% of attempters went on to die by suicide.

Skegg K, Herbison P. Effect of restricting access to a suicide jumping site. Australian and New Zealand Journal of Psychiatry, 2009; Volume 43(6):498–502

• The road to a  suicide jumping hotspot was temporarily closed due to construction work. This created an opportunity to assess whether loss of vehicular access would lead to a reduction in suicides and emergency police callouts for threatened suicide at the site. Using records from the local police inquest officer, the coroner’s pathologist, and Marine Search and Rescue, the study compared deaths during a 10 year period before, and 2 year period following, road closure. Police data on number of callouts for threatened suicide at the site were also compared for a 4 year period before, and a 2 year period following, closure.  There were 13 deaths at the headland involving suicide or open verdicts in the 10 years before access was restricted, and none in the 2 years following closure.  No jumping suicides occurred elsewhere in the police district following the road closure. Police callouts for threatened suicide also fell significantly, from 19.3 per year in the 4 years prior  to 9.5 per year for the following 2 years (incident rate ratio = 2.0, 95%CI = 1.2-3.5). Preventing vehicular access to a suicide jumping hotspot was an effective means of suicide prevention at the site. There was no evidence of substitution to other jumping sites.

Sinyor M, Levitt AJ. Effect of a barrier at Bloor Street Viaduct on suicide rates in Toronto: a natural experiment. British Medical Journal. 2010; 340:c2884.

• The authors compared nine years of data on suicide by jumping before a barrier was installed at the Bloor Street Viaduct to four years of data afterwards. While the barrier was successful in preventing suicides from the Viaduct, the rate of suicide by jumping in the region overall did not decline. There was a significant rise in suicide by jumping from nearby bridges. The overall suicide rate in this region declined over the two time periods compared. The authors conclude that installation of a barrier on one bridge may not alter the jump suicide rate if equally suitable jump sites are nearby.