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## Analysis of the Cost Effectiveness of a Suicide Barrier on the Golden Gate Bridge

Crisis

Hogrefe Publishing

3643780

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### Abstract

Background: The Golden Gate Bridge (GGB) is a well-known “suicide magnet” and the site of approximately 30 suicides per year. Recently, a suicide barrier was approved to prevent further suicides. Aims: To estimate the cost-effectiveness of the proposed suicide barrier, we compared the proposed costs of the barrier over a 20-year period ($51.6 million) to estimated reductions in mortality. Method: We reviewed San Francisco and Golden Gate Bridge suicides over a 70-year period (1936–2006). We assumed that all suicides prevented by the barrier would attempt suicide with alternative methods and estimated the mortality reduction based on the difference in lethality between GGB jumps and other suicide methods. Cost/benefit analyses utilized estimates of value of statistical life (VSL) used in highway projects. Results: GGB suicides occur at a rate of approximately 30 per year, with a lethality of 98%. Jumping from other structures has an average lethality of 47%. Assuming that unsuccessful suicides eventually committed suicide at previously reported (12–13%) rates, approximately 286 lives would be saved over a 20-year period at an average cost/life of approximately$180,419 i.e., roughly 6% of US Department of Transportation minimal VSL estimate (\$3.2 million). Conclusions: Cost-benefit analysis suggests that a suicide barrier on the GGB would result in a highly cost-effective reduction in suicide mortality in the San Francisco Bay Area.

### Most cited references23

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### Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study.

(1996)
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### Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study

(2010)
Objective To study the association between method of attempted suicide and risk of subsequent successful suicide. Design Cohort study with follow-up for 21-31 years. Setting Swedish national register linkage study. Participants 48 649 individuals admitted to hospital in 1973-82 after attempted suicide. Main outcome measure Completed suicide, 1973-2003. Multiple Cox regression modelling was conducted for each method at the index (first) attempt, with poisoning as the reference category. Relative risks were expressed as hazard ratios with 95% confidence intervals. Results 5740 individuals (12%) committed suicide during follow-up. The risk of successful suicide varied substantially according to the method used at the index attempt. Individuals who had attempted suicide by hanging, strangulation, or suffocation had the worst prognosis. In this group, 258 (54%) men and 125 (57%) women later successfully committed suicide (hazard ratio 6.2, 95% confidence interval 5.5 to 6.9, after adjustment for age, sex, education, immigrant status, and co-occurring psychiatric morbidity), and 333 (87%) did so with a year after the index attempt. For other methods (gassing, jumping from a height, using a firearm or explosive, or drowning), risks were significantly lower than for hanging but still raised at 1.8 to 4.0. Cutting, other methods, and late effect of suicide attempt or other self inflicted harm conferred risks at levels similar to that for the reference category of poisoning (used by 84%). Most of those who successfully committed suicide used the same method as they did at the index attempt—for example, >90% for hanging in men and women. Conclusion The method used at an unsuccessful suicide attempt predicts later completed suicide, after adjustment for sociodemographic confounding and psychiatric disorder. Intensified aftercare is warranted after suicide attempts involving hanging, drowning, firearms or explosives, jumping from a height, or gassing.
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### Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis.

(2005)
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.

### Author and article information

###### Affiliations
Human Cognitive Neurophysiology Research Laboratory, VA Northern California Healthcare Outpatient Clinic, Martinez, CA, USA
###### Author notes
Dayna Atkins WhitmerEEG/Sleep Labs – 127VA Northern California Health Care System150 Muir RoadMartinez, CA 94553USA Phone: +1 925 372-2056 Fax: +1 925 372-2111 E-mail: dayna.whitmer@123456va.gov
###### Journal
Crisis
Crisis
Crisis
Hogrefe Publishing
0227-5910
2151-2396
December 24 2012
2013
: 34
: 2
: 98-106