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Strategies to prevent suicide

BMJ 2010; 341 doi: (Published 06 July 2010) Cite this as: BMJ 2010;341:c3054
  1. D Gunnell, professor of epidemiology1,
  2. M Miller, associate professor of health policy and injury prevention2
  1. 1Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. 2Harvard School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, USA
  1. d.j.gunnell{at}

    Should target methods that are commonly used, highly lethal, and readily accessible

    Suicide is a leading cause of premature mortality in low and high income countries. Despite this, information to guide prevention strategies is limited. One of the few approaches with a strong evidence base is preventing access to methods that are highly lethal and commonly used in suicidal acts.1 The rationale for this approach is based in four observations: suicide attempts are often impulsive, crises are often fleeting, prognosis is good after non-fatal attempts (<10% of people go on to die by suicide), and acts are more likely to be fatal when highly lethal methods are used.

    Placing barriers on bridges and other sites from which suicide by jumping is common therefore seems sensible. Jumping is highly lethal and deaths are often very public,2 leading to media reporting and possible contagion.3 Reviews and national guidelines have called for safety measures at “suicide hotspots.”4 5 6

    In the linked study (doi:10.1136/bmj.c2884), Sinyor and colleagues describe the apparent failure of the Bloor Street Viaduct barrier in Toronto to reduce suicide by jumping.7 They assessed the yearly rates of suicide by jumping at the Bloor Street …

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