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      Comparing Different Suicide Prevention Measures at Bridges and Buildings: Lessons We Have Learned from a National Survey in Switzerland

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      PLoS ONE
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          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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          Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis.

          The effectiveness of restricting access to certain means of committing suicide has been demonstrated, at least as regards toxic domestic gas, firearms, drugs and bridges. At the individual level, studies tend to indicate that many persons have a preference for a given means, which would limit the possibility of substitution or displacement towards another method. Similarly, the fact that suicidal crisis are very often short-lived (and, what is more, influenced by ambivalence or impulsiveness) suggests that an individual with restricted access to a given means would not put off his plans to later or turn to alternative methods. This has been more difficult to demonstrate scientifically in population studies. Nevertheless, it appears that, should such a shift occur towards other means, it would be put into effect only in part and over a longer term.
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            Media guidelines on the reporting of suicide.

            There is strong evidence for the existence of the Werther effect, or the phenomenon of an observer copying suicidal behavior he or she has seen modelled in the media. As a consequence, a number of countries have developed guidelines that promote responsible reporting of suicide. Using nine such guidelines as examples, this paper demonstrates that they tend to have similar content (emphasizing, for example, that suicide should not be glamorized or sensationalized and that explicit descriptions should be avoided, and stressing the importance of providing information about help services), but differ in the way in which they have been developed (e.g., the extent to which media professionals have been involved) and implemented (e.g., whether their "roll-out" has involved a considered dissemination strategy). The paper also reviews the evidence from evaluations of media guidelines, and concludes that it is too limited to determine whether the guidelines have had an impact on the behavior of media professionals or on completed and attempted suicide rates. It makes recommendations for further evaluative work, and suggests that the lessons from well-designed evaluations should be shared.
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              Suicide prevention by limiting access to methods: a review of theory and practice.

              This review discusses the limitation of access to suicide methods as a way to prevent suicide, an approach which forms a major component of many national suicide prevention strategies. An important distinction is made between efforts that attempt to limit physical access to suicide methods and those that attempt to reduce the cognitive availability of suicide. Physical imitations will be reviewed with reference to restricting access to domestic gas, catalytic converters, firearms, pesticides, jumping, paracetamol and methods used in prisons. Impacts of cognitive availability will be discussed mainly with regard to the media in terms of providing access to technical information and sensational or inaccurate portrayals of suicide. Drawing on psychological models of suicidal ideation and behaviour, this review explores how processes leading to suicidal behaviour and issues around method choice may relate to the effectiveness of limiting access to methods. Potential problems surrounding method limitations are explored, in particular the factors contributing to substitution, the risk that alternative methods of suicide may be used if one is restricted. It is concluded that in appropriate contexts, where substitution is less likely to occur, and in conjunction with psychosocial prevention efforts, limitation of both physical and cognitive access to suicide can be an effective suicide prevention strategy. Copyright (c) 2010 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                6 January 2017
                2017
                : 12
                : 1
                : e0169625
                Affiliations
                [1 ]Department of Psychology, Hospital of Psychiatry Muensingen, Bern, Switzerland
                [2 ]Department of Medicine, Hospital of Psychiatry Muensingen, Bern, Switzerland
                [3 ]Department of Medicine, University Hospital of Psychiatry, Bern, Switzerland
                Stellenbosch University, SOUTH AFRICA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: TR.

                • Data curation: TR.

                • Formal analysis: TR AH.

                • Funding acquisition: TR.

                • Investigation: TR.

                • Methodology: TR AH.

                • Project administration: TR.

                • Resources: TR.

                • Supervision: TR.

                • Validation: TR AH.

                • Visualization: AH.

                • Writing – original draft: TR AH PM.

                • Writing – review & editing: PM.

                Article
                PONE-D-16-06175
                10.1371/journal.pone.0169625
                5218568
                28060950
                03a8adbb-0587-41f7-b175-22f8756d8c33
                © 2017 Hemmer et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 12 February 2016
                : 12 December 2016
                Page count
                Figures: 0, Tables: 3, Pages: 13
                Funding
                The study was part of fund of the SWISS FEDERAL ROADS OFFICE. Additional logistic support (workplace, PC, print copies computer hardware etc) was given by the Psychiatric Hospital of Muensingen, Switzerland. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Suicide
                People and Places
                Geographical Locations
                Europe
                Switzerland
                Biology and Life Sciences
                Biomechanics
                Biological Locomotion
                Climbing
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Climbing
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Climbing
                Physical Sciences
                Mathematics
                Statistics (Mathematics)
                Confidence Intervals
                Social Sciences
                Sociology
                Criminology
                Police
                People and Places
                Population Groupings
                Professions
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                Engineering and Technology
                Structural Engineering
                Built Structures
                Research and Analysis Methods
                Mathematical and Statistical Techniques
                Statistical Methods
                Meta-Analysis
                Physical Sciences
                Mathematics
                Statistics (Mathematics)
                Statistical Methods
                Meta-Analysis
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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