Means restriction for the prevention of suicide by jumping (review)

Why is this review important?

Jumping from a height is an uncommon but lethal means of suicide. While there is evidence that restricting access to means of suicide is an effective approach for preventing suicides, the evidence for preventing suicide by jumping is not well established. This review therefore aimed to explore the impact restriction of access would have on suicide by jumping.

Searching for evidence

We searched several databases (the Cochrane Library, Embase, MEDLINE, PsycINFO, and Web of Science) to find studies that assessed the impact of restricting access to means of suicide by jumping. We searched the databases up until May 2019. We included studies that assessed jumping means restriction interventions delivered on their own, such as physical barriers, fencing or safety nets on bridges, or those delivered in combination with other suicide prevention interventions, such as crisis telephones and CCTV cameras. We also searched the reference lists of all included studies and relevant systematic reviews to identify additional studies and contacted authors to obtain missing information. Our main outcomes of interest were suicide, attempted suicide or self-harm and cost-effectiveness of interventions.

Key results

We found 14 relevant studies. Three studies each were from Switzerland and the USA, while two studies each were from the UK, Canada, New Zealand, and Australia respectively. The majority of studies had a before-and-after study design. Due to the observational nature of our included studies, none compared other interventions or control conditions. Jumping means restriction interventions delivered in isolation or in combination with other interventions were found to reduce the number of suicides by jumping. Data on suicide attempts were limited and no study reported self-harm. A cost-effectiveness analysis suggested that the construction of a physical barrier on a bridge would be cost-effective in the long term. The evidence for these assessments was of low quality because of weaknesses in study design and differences in findings between studies, therefore requiring the need for further high-quality studies.