Effectiveness of barriers at suicide jumping sites: a case study

OBJECTIVES: Suicide safety barriers were removed from a central city bridge in an Australasian metropolitan area in 1996 after having been in place for 60 years. The bridge is a known suicide site and is located adjacent to the region's largest hospital, which includes an acute inpatient psychiatric unit. This paper examines the impact of the removal of these barriers on suicide rates. METHOD: Data for suicide deaths by jumping from the bridge in question, from 1992 to 2000, were obtained from the regional City Police Inquest Office. Data for suicide deaths by jumping from other sites in the metropolitan area in question, from 1992 to 1998, were obtained from the national health statistics database. Case history data about each suicide death by jumping in the metropolitan area in question, from 1994 to 1998, were abstracted from coronial files held by a national database. RESULTS: Removal of safety barriers led to an immediate and substantial increase in both the numbers and rate of suicide by jumping from the bridge in question. In the 4 years following the removal of the barriers (compared with the previous 4 years) the number of suicides increased substantially, from three to 15 (chi2 = 8, df = 1, p < 0.01); the rate of such deaths increased also (chi2 = 6.6, df = 1, p < 0.01). The majority of those who died by jumping from the bridge following the removal of the safety barriers were young male psychiatric patients, with psychotic illnesses. Following the removal of the barriers from the bridge the rate of suicide by jumping in the metropolitan area in question did not change but the pattern of suicides by jumping in the city changed significantly with more suicides from the bridge in question and fewer at other sites. CONCLUSIONS: Removal of safety barriers from a known suicide site led to a substantial increase in the numbers of suicide deaths by jumping from that site. These findings appear to strengthen the case for installation of safety barriers at suicide sites in efforts to prevent suicide deaths, and also suggest the need for extreme caution about the removal of barriers from known jumping sites.     

Suicides by jumping from a height in Hong Kong: a review of coroner court files

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.     

Suicide by jumping from bridges and other heights: social and diagnostic factors

The goal of the study was to determine social and diagnostic characteristics of persons who end their lives by jumping from heights and to compare the characteristics of those who jump from bridges with those jumping from other sites. Data on suicide in Switzerland between 1990 and 2003 were collected from the Swiss Federal Statistical Office and from local authorities. Persons who jumped from heights in general 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. Compared with those who jumped from other sites, subjects were on average 14.3 years younger and more often male. Individuals who jumped from bridges close to psychiatric hospitals were more likely to suffer from psychiatric illness. Individuals who jump from bridges differ in certain characteristics from those who jump from other sites. 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.     

Suicide and media reporting: a longitudinal and spatial analysis

Purpose

The impact of media reporting on copycat suicides has been well established in various cases of celebrity suicide. However, knowledge is limited about the spatial and temporal relationship between suicide death and media reporting over a long period of time. This study investigated the association of suicide deaths with suicide news in longitudinal and spatial dimensions.

Methods

All suicides during 2003–2010 (n = 31,364) were included. Suicide news in the study period was retrieved from Google News, and included all available news media in Taiwan. Empirical mode decomposition was used to identify the main intrinsic oscillation, reflecting both major and minor suicide events, and time-dependent intrinsic correlation was used to quantify the temporal correlation between suicide deaths and suicide news.

Results

The media reporting of suicide was synchronized with increased suicide deaths during major suicide events such as celebrity death, and slightly lagged behind the suicide deaths for 1 month in other periods without notable celebrity deaths. The means of suicide reported in the media diversely affected the suicide models. Reports of charcoal burning suicide exhibited an exclusive copycat effect on actual charcoal burning deaths, whereas media reports of jumping had a wide association with various suicide models. Media reports of suicide had a higher association with suicide deaths in urban than in rural areas.

Conclusions

This report suggested that a delayed effect of copycat suicide may exist in media reports of minor suicide events. The competitive reporting of minor suicide events must be avoided and addressed by media professionals.     

Suicide mortality in Southern Italy: 1998-2002

The purpose of the study was to describe the deaths by suicides that occurred in an area of Southern Italy in the period 1998-2002. Data were obtained from death records, and population estimates for each year were provided by the National Institute of Statistics. A total of 367 suicides were retrieved. The number of suicides was stable for the 5 years recorded, with the highest value for 1998, ranging from 1.4% for ages 0 to 14 to 25.1% for ages 25 to 44 years. Age-specific rates of suicide showed that the highest rates were in those 75 to 84 years old. Rates are always higher in males, with a tendency to stability or decrease in all age groups in the years observed, except for males in the 45- to 64-year-old age range, in whom an increase from 5.71 to 7.28 was observed. The suicides increased proportionally with age, in those with the lowest level of education (53.3%) and among retirees (46.5%). Hanging/suffocation (44.1%) and jumping from high places (23.2%) were the most frequently used methods of suicide. Males had higher standardized suicide rates ranging from 5.4 per 100,000 in 1999 to 7.7 in 1998, whereas in females the range was 1.4 per 100,000 in 2001 to 2.4 in 1998. The study shows that suicide rates in Southern Italy are lower compared with national trends.     

Suicide among soldiers and young men in the Nordic countries 1977-1984

A comparison of suicide rates among soldiers and civilians in the Nordic countries during the 8-year period 1977-1984 revealed that suicides among soldiers were more frequent in Norway than in Sweden and Finland. An in-depth study of the suicides of Norwegian soldiers during the same time period points to selection procedures and distance from home to the soldier's duty camp as possible causal factors. The suicides were frequently precipitated by an acute crisis. Preventive measures are discussed.     

Completed suicide among psychiatric in‐patients with depression in an Australian mental hospital

Up to 45% of completed psychiatric in‐patient suicides have a diagnosis of depression. Twenty‐two completed psychiatric in‐patient suicides with depression, over a 21‐year period, in a large psychiatric hospital in Melbourne, Australia, were examined. The characteristics, including demographic and clinical data, for the completed suicides with depression were compared with a comparison group of ‘alive’ in‐patients with depression. Completed suicide among psychiatric in‐patients with depression was associated with male sex, suicidal thoughts during admission, and fluctuating suicidal ideation or continuous absence of suicidal ideation. Over 40% of completed suicides occurred whilst on approved leave and over 20% after absconding from the hospital. Violent methods (including jumping in front of trains, trams and road traffic, jumping of buildings, hanging and drowning) were used in over 65% of completed suicides. Psychiatric units should be developed away from readily available methods of suicide. In‐patients with suicidal thoughts during the admission and unstable suicidal ideation should be carefully observed to avoid absconding and suicide, and should be carefully assessed prior to granting of leave. Copyright © 2000 Whurr Publishers Ltd.     

Suicide in Austrian children and young adolescents aged 14 and younger

Introduction Research on suicide in childhood and early adolescence is sparse. We investigated suicide cases of children and young adolescents in terms of prevalence, gender differences, suicide methods and monthly distribution during a period of 32 years. Methods Registered suicides aged 14 or younger occurring between 1970 and 2001 (n = 275) in Austria were studied. Results The mean suicide rate for 10 to 14-year-olds was 1.4 per 100,000 with a male–female ratio of 3.1:1. The total child and young adolescent suicide rate and boys’ suicide rates decreased over the study period. However, there was no significant fluctuation in girls’ suicide rates. Hanging was the predominant suicide method in both genders. Use of this method decreased steadily over the study period, whereas the percentage of suicides by other methods, i.e., jumping and firearms suicides increased. Greater number of suicides in children and young adolescents was observed during the months of April/May and October/November. Conclusion Suicide rates of children and young adolescents in Austria are on the decrease, in accordance with a reported decrease in the general suicide rate in Austria.     

Suicide in epilepsy: psychopathology,pathogenesis, and prevention

OBJECTIVE: Death by suicide among patients with epilepsy has found scant psychiatric attention, yet it may occur at the rate reported among patients with manic-depressive illness. We aim to clarify the psychopathology and pathogenesis of suicide in epilepsy and to document an effective method of prevention.METHOD: A total of 10,739 patients with epilepsy were seen at the Epi-Care Center in Memphis from 1987 to 1999. The patients with significant psychiatric complications were evaluated systematically and treated with an increasingly effective psychopharmacologic approach.RESULTS: Five suicides were registered during the 12-year period. All occurred in patients with longstanding complex partial seizures and dysphoric disorder a short time after full control of the seizures was achieved. During the last 8years of the 12-year period, more effective pharmacotherapy of the psychiatric complications of epilepsy was used (augmented antidepressant medication), and the two suicides that still occurred had eluded this treatment. Review of earlier series confirms that suicide tends to occur particularly among patients with chronic epilepsy who have obtained good control of their seizures; suicide may occur during interictal dysphoric episodes with or without psychotic features or in a state of postictal depression.CONCLUSIONS: Suppression of seizures in longstanding epilepsy may be associated with suicidal risk. The psychotoxic effect of predominant inhibitory mechanisms appears to be the crucial pathogenetic factor in all suicides. The number of suicides in our series is a fraction of that expected based on previous reports and indicates that prevention by psychopharmacologic treatment is available.     

Seasonality of self-destructive behaviour: Seasonal variations in demographic and suicidal characteristics in Van,Turkey

Abstract

Objective. Seasonality is one of the most interesting but still elusive issue in suicide research. Linkages of seasonality in suicides to possible contributors such as gender, type of method used, and climatic factors have received attention in different cultures. We aimed at evaluating seasonal trends in suicidal behaviour according to demographic characteristics, reasons for self-destructive behaviour and means preferred in suicide. Methods. Our aim was to assess the seasonal variation in self-destructive behaviour in terms of completed and attempted suicides in a 3-year time period from 2008 to 2010 in Van, Turkey. A total of 1448 cases were registered over a 3-year time period in the city. Seasonal deviations in demographic characteristics, reasons for suicide, and methods of suicide were evaluated. Results. Seasonal distribution of both completed and attempted suicides by gender did not significantly deviate. On the other hand, we found a significant decline in self-destructive behaviours among those who were single and student in the spring. We found a peak in self-destructive behaviours in the autumn among Individuals who suffer from psychological problems. Conclusions. Subjects with psychological difficulties were more prone to commit suicide in autumn. Seasonal differences in methods of suicide used by suicidal subjects were not significant.     

Suicide trends in Norway during the first year of the COVID-19 pandemic: A register-based cohort study

BackgroundThere is a concern that the COVID-19 pandemic will lead to an increase in suicides. Several reports from the first months of the pandemic showed no increase in suicide rates while studies with longer observation times report contrasting results. In this study, we explore the suicide rates in Norway during the first year of the pandemic for the total population as well as for relevant subgroups such as sex, age, geographical areas, and pandemic phases.MethodsThis is a cohort study covering the entire Norwegian population between 2010 and 2020. The main outcome was age-standardized suicide rates (per 100,000 inhabitants) in 2020 according to the Norwegian Cause of Death Registry. This was compared with 95% prediction intervals (95% PI) based on the suicide rates between 2010 and 2019.ResultsIn 2020, there were 639 suicides in Norway corresponding to a rate of 12.1 per 100,000 (95% PI 10.2–14.4). There were no significant deviations from the predicted values for suicides in 2020 when analyzing age, sex, pandemic phase, or geographical area separately. We observed a trend toward a lower than predicted suicide rate among females (6.5, 95% PI 6.0–9.2), and during the two COVID-19 outbreak phases in 2020 (2.8, 95% PI 2.3–4.3 and 2.8, 95% CI 2.3–4.3).ConclusionThere is no indication that the COVID-19 pandemic led to an increase in suicide rates in Norway in 2020.     

An epidemiologic study of adolescent suicide

This study investigated suicides by persons aged ten to nineteen during the years 1978 to 1982 in the City of Montreal. Records of death in the Office of the Coroner, City of Montreal, were examined and suicides designated according to standard criteria. Age, sex, method of suicide, and month of death were noted. Mean incidence of suicide for the entire sample was 5.92 per 100,000 population. The mean figure for males was 9.52 and for females 2.32, with the incidence greater among males in each of the five years. Incidence of suicide in the fifteen to nineteen year old group was approximately ten times that in the ten to fourteen year old group, a difference which was constant across sex and across the five year period. Among boys, hanging was the most frequent method of suicide, with firearms second, and jumping from a height or in front of a vehicle third. Among girls, drug intoxication was most common, with firearms and jumping ranking second and third respectively. No monthly periodicity was found. The epidemiology of adolescent suicide in Montreal appears to be similar to that reported in other locations.     

Factors associated with suicide method among psychiatric patients in a general hospital in Korea

This study aims to highlight the factors associated with suicide method among psychiatric patients in a general hospital in Korea. In a sample of 467 suicides by patients who had received mental health care in a general hospital in Korea, the relationship between suicide method and time of death as well as clinical characteristics, including psychiatric adiagnosis, was examined using multinomial logistic regression analysis. Compared with the general population, psychiatric patients, regardless of disorder, committed suicide by jumping from heights more often than by hanging (OR=2.35–8.64). In particular, patients with psychotic disorders and female patients were more likely to use jumping from a height than hanging to kill themselves (OR=2.98 and 1.83, respectively). Patients were more likely to use suicide methods other than hanging (e.g., OR=6.7 for jumping, 5.3 for drowning, and 2.7 for self-poisoning) between midnight and dawn. Possible suicide-prevention strategies suggested by this study include limiting access to or fencing off tall structures in close proximity to psychiatric institutions and residential care homes. At night, limiting access to or instituting heightened supervision of tall structures is specifically indicated.     

Regionale und örtliche Verteilungsmuster von Bahnsuiziden

BACKGROUND AND METHOD: Suicide research has identified regional and local clusters of increased suicide prevalence. As part of a comprehensive prevention strategy to fight railway suicides, we sought to identify such particular clusters on the German Railway net (total length 37,080 km) during a 6-year observation period (1997-2002). Data stem from the central registry of all person accidents on the German Railway net. RESULTS: During the observation period, a total of 5,731 suicides (in average 18 cases per week) were registered. Against expectation derived from distribution patterns in the general suicide research, we found a preponderance in the southern part compared to the northern part of Germany and a significant downward trend from west to east ( p=0.004). Most suicides occurred on open track (66%) compared to suicides at railway platforms (34%). We identified 16 places of high risk with 6 to 29 suicides per railway km. Of these high risk places, 75% were in the proximity of psychiatric hospitals. CONCLUSION: Increased awareness for regional and local suicide clusters, initiatives to reduce the accessibility and warning infra-red beams are among recommendations for suicide prevention derived from these data.     

Trends in method-specific suicide in Brazil from 2000 to 2017

Purpose

Understanding long-term patterns of suicide methods can inform public health policy and prevention strategies. In Brazil, firearm-related policies may be one salient target for suicide prevention. This study describes trends in method-specific suicide at the national and state-levels in Brazil, with a particular focus on firearm-related suicides.

Methods

Brazilian mortality data for suicide and undetermined intent among people aged 10 years and older between 2000 and 2017 were obtained from the National Mortality Information System. We examined national and state-level trends in age-standardised suicide rates for hanging, self-poisoning, firearms, jumping from a high place, other, and unspecified methods. We also compared total rates of mortality from suicide and undetermined intent over the period. Applying Joinpoint regression, we tested changes in trends of firearm-specific suicide rates.

Results

The total suicide rate increased between 2000 and 2017. Rates of hanging, self-poisoning by drugs or alcohol and jumping from a high place showed the largest increases, while firearm-specific suicide rates decreased over the study period. Trends in methods of suicide varied by sex and state.

Conclusion

It is of public health concern that suicide rates in Brazil have risen this millennium. Restricting access to firearms might be an effective approach for reducing firearm-specific suicides, especially in states where firearm availability remains particularly high. Treatment and management of substance misuse may also be an important target for suicide prevention policies. More work is needed to understand the causes of rising suicide rates in Brazil and to improve the mental health of the population.

     

Comparison of psychiatric inpatient suicides with suicides completed in the surrounding community

We compared main characteristics of 58 (22 male and 36 female) psychiatric inpatients that committed suicide in the psychiatric hospital with all 1261 suicides (956 male and 305 female) that occurred outside hospitals in the same health district of Slovenia, all these in the period between 1985 and 1993. The independent t-test and cross-tabulation were used to compare the two groups on age, sex, marital status and suicide method profile. It appeared that female suicide is much more frequent in the psychiatric inpatients' group than in others. Only male psychiatric inpatients' suicides are younger than other suicide victims. Psychiatric inpatients use methods like jumping from high places and drowning more often than do others, which goes in line with the availability of methods of suicide. Apparently, the studied hospital has some wards on the third floor and majority of acute wards are located by the river. However, psychiatric inpatients do not differ from other suicide victims on marital status. Higher suicide rates in men compared with women in the population, but not in psychiatric inpatients, could be explained by the presence of so-called atypical, clinically unrecognized depression in the male population.     

The Balkan Piedmont: male suicide rates pre-war, wartime, and post-war in Serbia and Montenegro.

The epidemiology of suicide in Serbia and Montenegro from 1989 to 2003, a period of civil war, is presented. Following the break-up of former Yugoslavia, Serbia and Montenegro underwent a period of war from 1991-1994 and another in 1999. During the war years, the number of suicides increased, reaching its peak in 1993. Male suicides outnumbered female suicides by a ratio of 2:1. Male suicides decreased slightly after the war of 1991-1994 only to rise in 1997 and continue at this higher level throughout the nineties. In Serbia alone, male suicide reached its peak in 2002 (nearly 29/100,000). The methods of suicide changed significantly, with the use of firearms doubling during and after the war years. Speculations are offered about the findings, many consistent with Durkheim's classical hypothesis concerning suicide and unpopular wars.     

The Balkan Piedmont: Male Suicide Rates Pre-war,Wartime, and Post-war in Serbia and Montenegro

The epidemiology of suicide in Serbia and Montenegro from 1989 to 2003, a period of civil war, is presented. Following the break-up of former Yugoslavia, Serbia and Montenegro underwent a period of war from 1991–1994 and another in 1999. During the war years, the number of suicides increased, reaching its peak in 1993. Male suicides outnumbered female suicides by a ratio of 2:1. Male suicides decreased slightly after the war of 1991–1994 only to rise in 1997 and continue at this higher level throughout the nineties. In Serbia alone, male suicide reached its peak in 2002 (nearly 29/100,000). The methods of suicide changed significantly, with the use of firearms doubling during and after the war years. Speculations are offered about the findings, many consistent with Durkheim's classical hypothesis concerning suicide and unpopular wars.     

Study of Deaths by Suicide in the Soviet Special Camp Number 7 (Sachsenhausen), 1945–1950

After World War II, Sachsenhausen Nazi concentration camp (Oranienburg) was administered until the spring of 1950 by Soviet occupation forces (Special Camp Number 7) and used mainly for political prisoners. Our study analyzes suicides in this camp during the Soviet period. Data was collected from the archives of Sachsenhausen Memorial, Special Camp Collection. Original documents containing certificates or autopsy reports of prisoners who committing suicide were reviewed. In this period, authorities registered 17 suicides. The age of suicides was between 19 and 64 years. The most frequent cause of imprisonment was Blockleiter (Kapo in Nazi period, n = 4), Mitarbeiter Gestapo (member of the Gestapo, n = 3) and Wehrmacht (military, n = 3). Hanging was the most frequent method of suicide. The average time spent in the camp until suicide was 715 days. The number of recorded suicides under Soviet control is considerably lower (calculated rate 2.8/10,000 per year) than under Nazi control (calculated rate 11/10,000 per year). This could be due to comparably more favorable conditions for prisoners and the abolishment of the death penalty during this period. Possible motives for suicides include feelings of guilt for crimes committed, fear of punishment and a misguided understanding of honor on the eve of criminal trials.     

Comparison of psychiatric inpatient suicides with suicides completed in the surrounding community

We compared main characteristics of 58 (22 male and 36 female) psychiatric inpatients that committed suicide in the psychiatric hospital with all 1261 suicides (956 male and 305 female) that occurred outside hospitals in the same health district of Slovenia, all these in the period between 1985 and 1993. The independent t -test and cross-tabulation were used to compare the two groups on age, sex, marital status and suicide method profile. It appeared that female suicide is much more frequent in the psychiatric inpatients' group than in others. Only male psychiatric inpatients' suicides are younger than other suicide victims. Psychiatric inpatients use methods like jumping from high places and drowning more often than do others, which goes in line with the availability of methods of suicide. Apparently, the studied hospital has some wards on the third floor and majority of acute wards are located by the river. However, psychiatric inpatients do not differ from other suicide victims on marital status. Higher suicide rates in men compared with women in the population, but not in psychiatric inpatients, could be explained by the presence of so-called atypical, clinically unrecognized depression in the male population.