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Effectiveness of restricting access to a suicide jump site: a test of the method substitution hypothesis
Alan Lee Berman1, Alisonj Athey2, Paul Nestadt3
1Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA drlannyberman@gmail.com.
Abstract:
Reducing access to lethal means can prevent suicides. However, substitution of a suicide method remains a concern. Until 1986, the Ellington Bridge was the site of one-half of all Washington, DC bridge suicides. An antisuicide fence was installed in 1986, creating a naturalistic case-control design for testing the substitution hypothesis with the adjacent and equally as lethal jump site, the Taft Bridge. We found that suicide deaths from the Ellington Bridge were reduced by 90% (p=0.001) following barrier construction, without changes in rates of jumps from either the Taft Bridge or any other bridge in the city. Suicides by all methods decreased significantly across the study period. While the decline in suicides from the Ellington Bridge may reflect a broader decline in suicide, the decline in bridge suicide without persistent shifts in deaths to other bridges provides evidence that restricting access to one highly lethal method is effective.
Insights
Installing an antisuicide fence on the Ellington Bridge significantly reduced suicide deaths by 90%. This study found no evidence of method substitution, indicating that restricting access to lethal means is an effective suicide prevention strategy.
Area of Science:
- Public Health
- Suicidology
- Behavioral Science
Background:
- Reducing access to lethal means is a key suicide prevention strategy.
- Method substitution is a potential concern when restricting access to lethal means.
- The Ellington Bridge was a frequent site for bridge suicides in Washington, DC.
Purpose of the Study:
- To test the method substitution hypothesis after the installation of an antisuicide fence on the Ellington Bridge.
- To evaluate the impact of restricting access to a specific lethal means on suicide rates.
Main Methods:
- A naturalistic case-control design was employed.
- The Ellington Bridge antisuicide fence installation in 1986 served as the intervention.
- Suicide deaths and jump rates were compared before and after the fence installation, using the Taft Bridge as a control site.
Main Results:
- Suicide deaths from the Ellington Bridge decreased by 90% after the fence installation (p=0.001).
- There were no significant changes in suicide deaths from the Taft Bridge or other city bridges.
- Overall suicides by all methods showed a significant decrease during the study period.
Conclusions:
- Restricting access to a highly lethal suicide method (Ellington Bridge jumps) was effective in reducing deaths.
- Evidence suggests that antisuicide barriers can prevent suicides without significant method substitution.
- The findings support the implementation of structural interventions for suicide prevention.
