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

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Crisis

Hogrefe Publishing

VSL, lethality, San Francisco, suicide prevention, demographics

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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.

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      Most cited references 33

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      Completed suicide after a suicide attempt: a 37-year follow-up study.

      Attempted suicide is the strongest known predictor of completed suicide. However, suicide risk declines over time after an attempt, and it is unclear how long the risk persists. Risk estimates are almost exclusively based on studies of less than 10 years of follow-up. The authors followed a cohort of 100 consecutive self-poisoned patients in Helsinki in 1963, for whom forensically classified causes of death during the following 37 years were investigated. They found that suicides continued to accumulate almost four decades after the index suicide attempt. A history of a suicide attempt by self-poisoning indicates suicide risk over the entire adult lifetime.
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        Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study.

        The aim of this study was to compare the prevalence and comorbidity patterns of psychiatric disorders in subjects making medically serious suicide attempts and in comparison subjects. The association between mental disorders and the risk of a suicide attempt was examined in 302 consecutive individuals who made serious suicide attempts and 1,028 randomly selected comparison subjects. Each subject completed a semistructured interview, and a significant other underwent a parallel interview; best-estimate DSM-III-R diagnoses were then generated. Of those who made serious suicide attempts, 90.1% had a mental disorder at the time of the attempt. Multiple logistic regression showed that those who made suicide attempts had high rates of mood disorders (odds ratio = 33.4, 95% confidence interval = 21.9-1.2); substance use disorders (odds ratio = 2.6, 95% confidence interval = 1.6-4.3); conduct disorder or antisocial personality disorder (odds ratio = 3.7, 95% confidence interval = 2.1-6.5); and nonaffective psychosis (odds ratio = 16.8, 95% confidence interval = 2.7-105.8). The relationship between psychiatric morbidity and suicide risk varied with age and gender. The incidence of comorbidity was high: 56.6% of those who made serious suicide attempts had two or more disorders. The risk of a suicide attempt increased with increasing psychiatric morbidity: subjects with two or more disorders had odds of serious suicide attempts that were 89.7 times the odds of those with no psychiatric disorder. Individuals who made serious suicide attempts had high rates of mental disorders and of comorbid disorders. Subjects with high levels of psychiatric comorbidity had markedly high risks of serious suicide attempts.
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          Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study

          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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            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
            23261913
            3643780
            10.1027/0227-5910/a000179
            cri_34_2_98
            © 2012 Hogrefe Publishing..

            Distributed under the Hogrefe OpenMind License

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            Research Trends

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