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Suicide et Lieux publics

Octobre 2013

Le 12 septembre dernier – quelques jours après la journée mondiale de prévention du suicide - une situation critique a attiré l’attention des médias montréalais. Un jeune homme s’était hissé en haut de la barrière anti-suicide sur le pont Jacques-Cartier. L’intervention policière rapide, ainsi que celle d’une célébrité québécoise qui se trouvait sur les lieux au même moment, a permis un dénouement moins dramatique. http://fr.canoe.ca/infos/societe/archives/2013/09/20130912-092850.html
Cet événement a rappelé que des mesures prises pour réduire l’accès à certains moyens peuvent être efficaces pour prévenir le suicide. Une étude réalisée par Stephanie Burrows, membre-chercheur du CRISE, et ses collègues, porte sur l’efficacité de cette même barrière, installée depuis 2005. Le nombre de suicides sur ce lieu emblématique à la ville de Montréal a significativement diminué depuis son installation. Leurs résultats démontrent également que peu ou pas de déplacement (le fait d’employer un autre moyen que celui envisagé au départ pour se suicider) n’avait pas été constaté pour les autres ponts sur ce côté du fleuve St-Laurent. De même, les auteurs recommandent l’installation de telles barrières pour toutes nouvelles constructions où un risque pourrait être inhérent. Deux chercheurs du CRISE, Brian Mishara et Cécile Bardon, en collaboration avec Transports Canada et plusieurs compagnies ferroviaires du pays, s’intéressent à la question de la prévention du suicide sur les chemins de fer au Canada. Ils ont récemment présenté les résultats de leur recherche lors du congrès international de l’Association internationale de prévention du suicide ainsi que lors d’une conférence sur la sécurité sur les chemins de fer (visitez le site web où vous y trouverez plusieurs informations ainsi qu’une revue de la littérature sur le sujet: http://railwaysuicideprevention.com/).
Les icônes de certaines villes (Golden Gate Bridge, le métro de Londres, Clifton Suspension Bridge, etc.) ont été identifiées comme des « hotspots » pour le suicide. Installation de barrières, de caméras de surveillance, de patrouilles, de téléphones d’urgence et de panneaux de sensibilisation, plusieurs options existent pour augmenter la sécurité et la prévention du suicide, et plusieurs ont été mises en place un peu partout à travers le monde. Ce mois-ci, nous vous proposons des documents sur le suicide et sa prévention sur les lieux publics, autant les voies, sites et édifices.



NOUVELLES du CRISE:
1-
PARTICIPEZ À L’AMÉLIORATION ET AU DÉVELOPPEMENT DE NOTRE SITE “APPLICATION DES CONNAISSANCES SCIENTIFIQUES EN PRÉVENTION DU SUICIDE”
Le CRISE conduit présentement une évaluation de son site Application des connaissances scientifiques en prévention du suicide. Ce site est largement utilisé par les différents acteurs en prévention et par le public en général. Nous voulons évaluer l’utilisation de son contenu actuel, dresser un profil de ses visiteurs et déterminer les nouveaux thèmes à développer. Nous vous invitons à le visiter et à compléter le sondage d’évaluation en-ligne http://fr.surveymonkey.com/s/crise-application .

2-NOUVEAU LIVRE «SUICIDE PREVENTION AND NEW TECHNOLOGIES » PAR BRIAN MISHARA.
Notre Institut d’été 2012 portait sur la prévention du suicide et les nouvelles technologies où des experts de partout à travers le monde ont présenté les initiatives qu’ils ont développés avec celles-ci. Suite à cet événement, Brian Mishara et Ed Kerkhof viennent de publier un livre sur le sujet. Un ouvrage important pour ceux et celles qui s’intéressent aux nouvelles formes de prévention du suicide. Disponible dans les librairies en-ligne et au centre de documentation du CRISE.

3- DANS NOS ARCHIVES
Notre liste de nouveautés est constituée d’articles et de documents récemment publiés (dans les 5 dernières années approximativement) sur un thème en particulier. Plusieurs de nos membres-chercheurs et partenaires se sont intéressés par le passé à ces thèmes. C’est pourquoi vous trouverez à la fin de cette liste des articles plus anciens d’auteurs du CRISE en lien avec le thème abordé.

4- PROCHAIN CONGRÈS MONDIAL DE L’ASSOCIATION INTERNATIONALE DE PRÉVENTION DU SUICIDE – MONTRÉAL 2015
Lors du congrès de l’Association internationale de prévention du suicide à Oslo (Norvège), Lars Melhum, président du congrès, a remis le drapeau de l’association à Brian Mishara. http://www.flickr.com/photos/104143564@N07/10075544356/lightbox/. Geste symbolique en soit, le professeur Mishara est le président du prochain congrès mondial de l’association qui aura lieu à Montréal en juin 2015. Surveillez nos envois à venir et notre site web pour plus d’information.

Pour vous abonner à notre liste de nouveautés, visitez notre site web


1. Perron, S., Burrows, S., Fournier, M., Perron, P.-A., & Quellet, F. (2013). Installation of a bridge barrier as a suicide prevention strategy in Montréal, Québec, Canada American Journal of Public Health, 103 (7), 1235-1239.
Résumé:Objectives. We investigated whether the installation of a suicide prevention barrier on Jacques-Cartier Bridge led to displacement of suicides to other jumping sites on Montréal Island and Montérégie, Québec, the 2 regions it connects. Methods. Suicides on Montréal Island and Montérégie were extracted from chief coroners' records. We used Poisson regression to assess changes in annual suicide rates by jumping from Jacques-Cartier Bridge and from other bridges and other sites and by other methods before (1990-June 2004) and after (2005-2009) installation of the barrier. Results. Suicide rates by jumping from Jacques-Cartier Bridge decreased after installation of the barrier, which persisted when all bridges and all jumping sites  in the regions were considered. Conclusions. Little or no displacement to other jumping sites may occur after installation of a barrier at an iconic site such as Jacques-Cartier Bridge. A barrier's design is important to its effectiveness and should be considered for new bridges with the potential to become symbolic suicide sites.
http://www.crise.ca/fr/pub_details.asp?no_pub=665&docu=publication&auteurp=Burrows%20Stephanie&section=publications

2. Chen, Y.-Y., Wu, K. C.-C., & Yip, P. S. F. (2011). Suicide prevention through restricting access to suicide means and hotspots . In R. C. O'Connor, S. Platt & J. Gordon (Eds.), International Handbook of Suicide Prevention: Research, Policy and Practice (pp. 545-560). Chichester, UK: John Wiley & Sons, Ltd.
Résumé : Restricting access to suicide means and locations is a component in prevention strategies of almost all prevention centres worldwide.  In this review, we describe the rationale underpinning such approaches in general, as well as for specific methods of suicide.  We review the age, sex, and country distribution of several common methods of suicide, including medication overdose, pesticide poisoning, gas poisoning, jumping, firearms, and hanging.  Current evidence supporting policies to restrict access to suicide means and hotspots is summarized.  In the case of suicides involving self-poisoning and firearms, direct restrictions on selling/purchasing of these lethal or highly toxic means (e.g. guns, pesticides, pills) through regulatory controls is generally effective in reducing suicide.  For suicide by self-poisoning, prevention approaches can also involve reducing the toxicity of subtances used.  Current evidence indicates the effectiveness of erecting barriers at jumping hotspots in reducing suicidal leaps.  As ligature points and ligatures are universally available, restricting access to these suicide means is not a reasonable prevention strategy except in certain controlled envrionments such as psychiatric hospitals and prisons.  Despite the limited opportunities in relation to hanging, restricting access to suicide means and hotspots are effective and feasible strategies in preventing suicide.

3. Cox, G. R., Owens, C., Robinson, J., Nicholas, A., Lockley, A., Williamson, M., et al. (2013). Interventions to reduce suicides at suicide hotspots: a systematic review . BMC Public Health, 13, 214.
Résumé : BACKGROUND: 'Suicide hotspots' include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention. METHODS: We searched Medline for studies that could inform the following question: 'What interventions are available to reduce suicides at hotspots, and are they effective?' RESULTS: There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise. CONCLUSIONS: More well-designed intervention studies are needed to strengthen this evidence base.
http://dx.doi.org/10.1186/1471-2458-13-214

4. Pirkis, J., Spittal, M. J., Cox, G., Robinson, J., Cheung, Y. T., & Studdert, D. (2013). The effectiveness of structural interventions at suicide hotspots: a meta-analysis . International Journal of Epidemiology, 42(2), 541-548.
Résumé : BACKGROUND: Certain sites have gained notoriety as 'hotspots' for suicide by jumping. Structural interventions (e.g. barriers and safety nets) have been installed at some of these sites. Individual studies examining the effectiveness of these interventions have been underpowered.  METHOD: We conducted a meta-analysis, pooling data from nine studies. RESULTS: Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question. There was a 44% increase in jumping suicides per year at nearby sites, but the net gain was a 28% reduction in all jumping suicides per year in the study cities. CONCLUSIONS: Structural interventions at 'hotspots' avert suicide at these sites. Some increases in suicide are evident at neighbouring sites, but there is an overall gain in terms of a reduction in all suicides by jumping.
http://dx.doi.org/10.1093/ije/dyt021

5. Beautrais, A., & Gibb, S. (2009). Protecting bridges and high buildings in suicide prevention . In D. Wasserman & C. Wasserman (Eds.), Oxford Textbook of Suicidology and Suicide Prevention (pp. 563-568). New York, US: Oxford University Press Inc.
Résumé : Suicide by jumping is a relatively uncommon method of suicide in most countries. However, in some places where there is accessible high-rise housing, jumping accounts for a significant proportion of suicides. While, internationally, most suicides by jumping occur from residential housing units, preventive efforts have tended to focus on a relatively small number of sites (often bridges) which have acquired notoriety as sites for suicide. A small number of studies suggest that the installation of safety barriers at these sites is an effective approach to reducing suicides by jumping. The extent to which lessons and principles from these examples may be applied to other jumping sites has yet to be fully explored.

6. Glasgow, G. (2011). Do local landmark bridges increase the suicide rate? An alternative test of the likely effect of means restriction at suicide-jumping sites . Social Science and Medicine, 72(6), 884-889.
Résumé : A number of recent studies have examined the effect of installing physical barriers or otherwise restricting access to public sites that are frequently used for suicides by jumping. While these studies demonstrate that barriers lead to a reduction in the number of suicides by jumping at the site where they are installed, thus far no study has found a statistically significant reduction in the local suicide rate attributable to a barrier. All previous studies are case studies of particular sites, and thus have limited statistical power and ability to control for confounding factors, which may obscure the true relationship between barriers and the suicide rate. This study addresses these concerns by examining the relationship between large, well-known bridges ("local landmark" bridges) of the type that are often used as suicide-jumping sites and the local suicide rate, an approach that yields many more cases for analysis. If barriers at suicide-jumping sites decrease the local suicide rate, then this implies that the presence of an unsecured suicide-jumping site will lead to a higher local suicide rate in comparison to areas without such a site. The relationship between suicides and local landmark bridges is examined across 3116 US counties or county equivalents with negative binomial regression models. I found that while exposure to local landmark bridges was associated with an increased number of suicides by jumping, no positive relationship between these bridges and the overall number of suicides was detected. It may be impossible to conclusively determine if barriers at suicide-jumping sites reduce the local suicide rate with currently available data. However, the method introduced in this paper offers the possibility that better data, or an improved understanding of which potential jumping sites attract suicidal individuals, may eventually allow researchers to determine if means restriction at suicide-jumping sites reduces total suicides.
http://dx.doi.org/10.1016/j.socscimed.2011.01.001

7. Bateson, J. (2012). The Final Leap: Suicide on the Golden Gate Bridge . Los Angeles: University of California Press.
Résumé : The Golden Gate Bridge is one of the most beautiful and most photographed structures in the world. It’s also the most deadly. Since it opened in 1937, more than 1,500 people have died jumping off the bridge, making it the top suicide site on earth. It’s also the only international landmark without a suicide barrier. Weaving drama, tragedy, and politics against the backdrop of a world-famous city, The Final Leap is the first book ever written about Golden Gate Bridge suicides. John Bateson leads us on a journey that uncovers the reasons for the design decision that led to so many deaths, provides insight into the phenomenon of suicide, and examines arguments for and against a suicide barrier. He tells the stories of those who have died, the few who have survived, and those who have been affected—from loving families to the Coast Guard, from the coroner to suicide prevention advocates [résumé tiré du livre].

8. Whitmer, D. K., & Woods, D. L. (2013). Analysis of the cost effectiveness of a suicide barrier on the Golden Gate Bridge . Crisis, 34(2), 98-106.
Résumé : 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.
http://dx.doi.org/10.1027/0227-5910/a000179

9. Blaustein, M., & Fleming, A. (2009). Suicide from the Golden Gate Bridge . American Journal of Psychiatry, 166(10), 1111-1116.
Résumé : The Golden Gate Bridge is the number one suicide site in the world. In this clinical case conference, the authors begin by presenting vignettes to capture the diversity of bridge suicide. They then examine the demographic characteristics of those who commit suicide from the bridge as well as the fatal attraction of the Golden Gate Bridge. Interviews with jump survivors and potential jumpers are presented, and the authors examine the evidence for the efficacy of suicide barriers.
http://dx.doi.org/10.1176/appi.ajp.2009.09020296

10. Sinyor, M., & Levitt, A. J. (2010). Effect of a barrier at Bloor Street Viaduct on suicide rates in Toronto: natural experiment . BMJ (Clinical Research Ed.), 341 , c2884.
Résumé : OBJECTIVE: To determine whether rates of suicide changed in Toronto after a barrier was erected at Bloor Street Viaduct, the bridge with the world's second highest annual rate of suicide by jumping after Golden Gate Bridge in San Francisco. DESIGN: Natural experiment. SETTING: City of Toronto and province of Ontario, Canada; records at the chief coroner's office of Ontario 1993-2001 (nine years before the barrier) and July 2003-June 2007 (four years after the barrier). PARTICIPANTS: 14 789 people who completed suicide in the city of Toronto and in Ontario. MAIN OUTCOME MEASURE: Changes in yearly rates of suicide by jumping at Bloor Street Viaduct, other bridges, and buildings, and by other means. RESULTS: Yearly rates of suicide by jumping in Toronto remained unchanged between the periods before and after the construction of a barrier at Bloor Street Viaduct (56.4 v 56.6). A mean of 9.3 suicides occurred annually at Bloor Street Viaduct before the barrier and none after the barrier. Yearly rates of suicide by jumping from other bridges and buildings were higher in the period after the barrier although only significant for other bridges (other bridges: 8.7 v 14.2; buildings: 38.5 v 42.7). CONCLUSIONS: Although the barrier prevented suicides at Bloor Street Viaduct, the rate of suicide by jumping in Toronto remained unchanged. This lack of change might have been due to a reciprocal increase in suicides from other bridges and buildings. This finding suggests that Bloor Street Viaduct may not have been a uniquely attractive location for suicide and that barriers on bridges may not alter absolute rates of suicide by jumping when comparable bridges are nearby.
http://dx.doi.org/10.1136/bmj.c2884

11. Mohl, A. A., Stulz, N. N., Martin, A. A., Eigenmann, F. F., Hepp, U. U., Husler, J. J., et al. (2012). The “Suicide Guard Rail”: a minimal structural intervention in hospitals reduces suicide jumps . BMC Research Notes, 5 (1), 408.
Résumé : BACKGROUND: Jumping from heights is a readily available and lethal method of suicide. This study examined the effectiveness of a minimal structural intervention in preventing suicide jumps at a Swiss general teaching hospital. Following a series of suicide jumps out of the hospital's windows, a metal guard rail was installed at each window of the high-rise building. RESULTS: In the 114 months prior to the installation of the metal guard rail, 10 suicides by jumping out of the hospital's windows occurred among 119'269 inpatients. This figure was significantly reduced to 2 fatal incidents among 104'435 inpatients treated during the 78 months immediately following the installation of the rails at the hospital's windows. CONCLUSIONS: Even a minimal structural intervention might prevent suicide jumps in a general hospital. Further work is needed to examine the effectiveness of minimal structural interventions in preventing suicide jumps.
http://dx.doi.org/10.1186/1756-0500-5-408

12. Skegg, K., & Herbison, P. (2009). Effect of restricting access to a suicide jumping site . Australian and New Zealand Journal of Psychiatry, 43(6), 498-502.
Résumé : OBJECTIVE: The road to a headland that had become a suicide jumping hotspot was temporarily closed because of construction work. This created an opportunity to assess whether loss of vehicular access would lead to a reduction in suicides and emergency police callouts for threatened suicide at the site. METHOD: Deaths at the headland were ascertained for a 10 year period before road closure and for 2 years following closure using records from the local police inquest officer, the coroner's pathologist and Marine Search and Rescue. Police provided a list of police callouts for threatened suicide at the site for a 4 year period before closure and for 2 years following closure. Simple rates were compared and incident rate ratios were calculated where possible. RESULTS: There were 13 deaths at the headland involving suicide or open verdicts in the 10 years before access was restricted, and none in the 2 years following road closure. This difference was statistically significant (incident rate difference = 1.3 deaths per year). No jumping suicides occurred elsewhere in the police district following the road closure. Police callouts for threatened suicide also fell significantly, from 19.3 per year in the 4 years prior to road closure to 9.5 per year for the following 2 years. CONCLUSIONS: Preventing vehicular access to a suicide jumping hotspot was an effective means of suicide prevention at the site. There was no evidence of substitution to other jumping sites.

13. Beautrais, A. L., Gibb, S. J., Fergusson, D. M., Horwood, L. J., & Larkin, G. L. (2009). Removing bridge barriers stimulates suicides: an unfortunate natural experiment . Australian and New Zealand Journal of Psychiatry, 43 (6), 495-497.
Résumé : OBJECTIVES: Safety barriers to prevent suicide by jumping were removed from Grafton Bridge in Auckland, New Zealand, in 1996 after having been in place for 60 years. This study compared the number of suicides due to jumping from the bridge after the reinstallation of safety barriers in 2003. METHODS: National mortality data for suicide deaths were compared for three time periods: 1991-1995 (old barrier in place); 1997-2002 (no barriers in place); 2003-2006 (after barriers were reinstated). RESULTS: Removal of barriers was followed by a fivefold increase in the number and rate of suicides from the bridge. These increases led to a decision to reinstall safety barriers. Since the reinstallation of barriers, of an improved design, in 2003, there have been no suicides from the bridge. CONCLUSIONS: This natural experiment, using a powerful a-b-a (reversal) design, shows that safety barriers are effective in preventing suicide: their removal increases suicides; their reinstatement prevents suicides.

14. Chen, Y.-Y., & Yip, P. (2009). Prevention of suicide by jumping: Experiences from Taipei City (Taiwan), Hong Kong and Singapore In D. Wasserman & C. Wasserman (Eds.), Oxford Textbook of Suicidology and Suicide Prevention (pp. 569-572). New York, US: Oxford University Press Inc.
Résumé : Nearly 80 per cent of the population of Hong Kong and Singapore live in high-rise buildings. High-rise buildings provide an opportunity for committing suicide by jumping, and elevated rates of suicide by this method are observed in the above-mentioned cities. An analysis of the suicides in Singapore, Hong Kong and Taipei can increase understanding and improve possibilities for prevention.

15. Matsubayashi, T., Sawada, Y., & Ueda, M. (2012). Does the installation of blue lights on train platforms prevent suicide? A before-and-after observational study from Japan . Journal of Affective Disorders, 147(1-3) , 385-388.
Résumé : BACKGROUND: Railway and metro suicides constitute a major problem in many parts of the world. Japan has experienced an increase in the number of suicides by persons diving in front of an oncoming train in the last several years. Some major railway operators in Japan have begun installing blue light-emitting-diode (LED) lamps on railway platforms and at railway crossings as a method of deterring suicides, which is less costly than installing platform screen doors. However, the effectiveness of the blue lights in this regard has not yet been proven. METHODS: This study evaluates the effect of blue lights on the number of suicides at 71 train stations by using panel data between 2000 and 2010 from a railway company in a metropolitan area of Japan. We use a regression model and compare the number of suicides before and after and with and without the intervention by the blue light. We used the number of suicides at 11 stations with the intervention as the treatment group and at the other 60 stations without the intervention as the control group. RESULTS: Our regression analysis shows that the introduction of blue lights resulted in a 84% decrease in the number of suicides. LIMITATION: The analysis relies on data from a single railroad company and it does not examine the underlying suicide-mitigation mechanism of blue lights. CONCLUSION: As blue lights are easier and less expensive to install than platform screen doors, they can be a cost-effective method for suicide prevention.
http://dx.doi.org/10.1016/j.jad.2012.08.018

16. Hannon, K., Giles, S., Deacon, L, & Tocque, K. (2009). Suicide in the North West : A review of non-residential and outdoor suicide locations . Liverpool: North West Public Health Observatory.
Résumé: This analysis identified 49 sites for suicide and attempted suicide with two or more events across the North West between 2001 and 2006. This report also identified high risk features that are used for suicide across the North West. These include waterways, railways, motorways and roads, urban centres, parks and open spaces.
http://www.nwph.net/nwpho/publications/SuicideintheNW.pdf

17. Owens, C., Lloyd-Tomlins, S., Emmens, T., & Aitken, P. (2009). Suicides in public places: findings from one English county . European Journal of Public Health.
Résumé : Little is known about where suicides take place. We collected data from coroners' files on all suicides and undetermined deaths in one large English county from 2000 to 2004. The data show that >30% of suicides occurred in public places. A quarter of these involved jumping from a height and nearly a quarter involved car exhaust poisoning. Several sites were associated with multiple methods of suicide. Identifying and managing high-risk locations should be an important part of an overall suicide prevention strategy and is best tackled at local level.
http://dx.doi.org/10.1093/eurpub/ckp052

18. Bennewith, O., Nowers, M., & Gunnell, D. (2011). Suicidal behaviour and suicide from the Clifton Suspension Bridge, Bristol and surrounding area in the UK: 1994-2003 . European Journal of Public Health, 21(2), 204-208.
Résumé : BACKGROUND: Little is known about the characteristics of people who die by jumping from different locations (e.g. bridges, buildings) and the factors that might influence the effectiveness of suicide prevention measures at such sites. METHODS: We collected data on suicides by jumping (n = 134) between 1994 and 2003 in Bristol, UK, an area that includes the Clifton Suspension Bridge, a site renowned for suicide. We also carried out interviews with Bridge staff and obtained records of fatal and non-fatal incidents on the bridge (1996-2005) before and after preventive barriers were installed in 1998. RESULTS: The main sites from which people jumped were bridges (n = 71); car parks (n = 12); cliffs (n = 20) and places of residence (n = 20). People jumping from the latter tended to be older than those jumping from other sites; people jumping from different sites did not differ in their levels of past self-harm or current psychiatric care. As previously reported, suicides from the bridge halved after the barriers were erected; people jumping from the Clifton Suspension Bridge following their construction were more likely to have previously self-harmed and to have received specialist psychiatric care. The number of incidents on the bridge did not decrease after barriers were installed but Bridge staff reported that the barriers 'bought time', making intervention possible. CONCLUSION: There is little difference in the characteristics of people jumping from different locations. Barriers may prevent suicides among people at lower risk of repeat self-harm. Staff at suicide hotspots can make an important contribution to the effectiveness of installations to prevent suicide by jumping.
http://dx.doi.org/10.1093/eurpub/ckq092

19. Wong, P. W., Chan, W. S., Lau, T. K., Morgan, P. R., & Yip, P. S. (2009). Suicides by jumping from iconic bridges in Hong Kong . Crisis, 30(2), 79-84.
Résumé : BACKGROUND: Three bridges in Hong Kong have become iconic sites for suicide since their openings 11 years ago. AIMS: This retrospective record-based study aimed to examine suicides by jumping from a group of three iconic bridges in Hong Kong, and to explore potential preventive strategies on these bridges to prevent future suicide. METHODS: We examined the Coroner's files of 12 people who killed themselves by jumping from the bridges between 1997 and 2007. We also examined the Coroner's files of other suicides in 2003, and compared them with the bridge suicides. RESULTS: The majority of the suicides were male, middle-age (40-59 years), married or cohabiting, not living alone, employed or self-employed, and in financial difficulty. None of these cases had a reported psychiatric diagnosis or psychiatric care history, and only one case had a history of suicidal attempt. Compared with other suicides in Hong Kong, the bridge jumpers were more likely to be younger, holding a job, indebted, free from a psychiatric and attempt history, and to leave a suicide note. The bridge suicide cases in Hong Kong also appeared to be different from the profiles of bridge jumpers in other countries. CONCLUSIONS: Erection of an effective safety barrier has been found to prevent bridge suicides in many countries. Given the different characteristics of bridge jumpers in Hong Kong and the technical difficulties, more innovative ways may be needed to prevent suicides by such means. Potential prevention measures are discussed and, hopefully, will better inform the future design and development of bridges of significance.
http://dx.doi.org/10.1027/0227-5910.30.2.79

20. Chia, B. H., Chia, A., Ng, W. Y., & Tai, B. C. (2011). Suicide methods in Singapore (2000-2004): Types and associations . Suicide and Life-Threatening Behavior, 41(5), 574-583.
Résumé : The choice of suicide methods varies between countries. Common methods used in Singapore between 2000 and 2004 were jumping (72.4%), hanging (16.6%), and poisoning (5.9%). Those who jumped were more likely to be young, single, female, and to have had a major mental illness. By comparison, those who hung themselves were more likely to be older, Indian, and to leave a suicide note. Those who used poison were more likely to be married, to be on antidepressants, to have previously attempted suicide, and to leave a letter. The choice was determined by accessibility, acceptability, generational, gender, and racial factors.
http://dx.doi.org/10.1111/j.1943-278X.2011.00055.x

21. Reisch, T., Schuster, U., & Michel, K. (2008). Suicide by jumping from bridges and other heights: social and diagnostic factors . Psychiatry Research, 161(1), 97-104.
Résumé : The goal of the study was to determine social and diagnostic characteristics of persons who end their lives by jumping from heights and to compare the characteristics of those who jump from bridges with those jumping from other sites. Data on suicide in Switzerland between 1990 and 2003 were collected from the Swiss Federal Statistical Office and from local authorities. Persons who jumped from heights in general were more likely to suffer from schizophrenia than those who used other methods. Persons who jumped from bridges were younger than those committing suicide by other methods. Compared with those who jumped from other sites, subjects were on average 14.3 years younger and more often male. Individuals who jumped from bridges close to psychiatric hospitals were more likely to suffer from psychiatric illness. Individuals who jump from bridges differ in certain characteristics from those who jump from other sites. For future classification it may be helpful to distinguish suicides from bridges from suicides from other heights. For prevention of suicide from bridges, attention should be paid to characteristics of young persons at risk.
http://dx.doi.org/10.1016/j.psychres.2007.06.028

22. Nielssen, O., Glozier, N., Babidge, N., Reutens, S., Andrews, D., Gerard, A., et al. (2010). Suicide attempts by jumping and psychotic illness . Australian and New Zealand Journal of Psychiatry, 44(6), 568-573.
Résumé : BACKGROUND: Several recent studies have reported that serious violence towards self and others is more common in the first episode of psychosis than after treatment. AIM: To estimate the proportion of survivors of suicide attempts during psychotic illness by jumping from a height who had not previously received treatment with antipsychotic medication. METHODS: An audit of the medical records of patients admitted to nine designated trauma centres in New South Wales, Australia, after surviving a jump of more than 3 m. Jumping was defined using routine hospital ascribed International Classification of Diseases (ICD) codes. The height of the jump and all clinical data were extracted from case notes. RESULTS: The files of 160 survivors of jumps of more than 3 m were examined, which included 70 who were diagnosed with a psychotic illness (44%). Thirty-one of the 70 diagnosed with a psychotic illness (44%) had never received treatment for psychosis and hence were in the first episode of psychosis. One in five (19.4%) of all survivors of a suicide attempt by jumping had an undiagnosed and untreated psychosis that was often characterized by frightening delusional beliefs. CONCLUSION: A large proportion of the survivors of suicide attempts by jumping were diagnosed with a psychotic illness, which confirms an association between psychosis and suicide by jumping. Some suicides might not have been linked to psychosis had the patient not survived the suicide attempt, suggesting that the contribution of schizophrenia to suicide mortality might have been underestimated in psychological autopsy studies. The finding that nearly half of the survivors diagnosed to have a psychotic illness had never received treatment with antipsychotic medication indicates a greatly increased risk of suicide by jumping in the first episode of psychosis when compared to the annual risk after treatment.
http://informahealthcare.com/doi/abs/10.3109/00048671003606086

DANS NOS ARCHIVES

23. Daigle, M. S. (2005). Suicide prevention through means restriction: Assessing the risk of substitution: A critical review and synthesis . Accident Analysis and Prevention, 37(4), 625-632.
Résumé : 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.
http://www.crise.ca/fr/mb_pub_details.asp?section=membres&no_pub=387&usager=daiglem&conf_pub=publication

24. Daigle, M. (2003). Analyse du comportement suicidaire sur le pont Jacques-Cartier [Rapport d'expertise remis à la Société des Ponts Jacques-Cartier et Champlain Inc.] . Montréal.
Résumé: Le contrôle des moyens disponibles pour se suicider, dont l’installation de barrières anti-saut sur les ponts, n’est qu’une des facettes de la prévention du suicide. L’efficacité d’un contrôle exercé au niveau d’un moyen particulier n’en est pas moins démontrée, du moins pour ce qu’il en est des gaz toxiques, des armes à feu, des médicaments et des ponts. De plus, au niveau des individus, les études semblent démontrer qu’il existe chez plusieurs une préférence pour une méthode particulière de se suicider, ce qui limiterait la possibilité d’un déplacement (report vers une autre méthode pour se suicider). De la même façon, le fait que la crise suicidaire soit très souvent passagère (et même influencée par l’ambivalence ou l’impulsivité) laisse croire qu’un individu donné, limité dans l’accès à un moyen, ne reporterait pas son projet à plus tard ou sur un autre moyen. Au niveau de l’étude des populations, les démonstrations scientifiques sont parfois plus difficiles à établir. Néanmoins, il semble que, si un déplacement apparaissait vers d’autres méthodes, il ne s’exercerait que partiellement et à plus long terme. Au moins deux exemples importants illustrent ce constat au niveau des populations: celui de la détoxication des gaz domestiques et celui des lois contrôlant l’accès aux armes à feu. Pour ce qu’il en est plus spécifiquement des contrôles exercés sur des ponts, les évaluations statistiques sont limitées par le nombre relativement faible de suicides qui y surviennent. Néanmoins, les quelques rares études répertoriées sur le sujet concluent à une spécificité propre non seulement aux suicides réalisés à partir des ponts mais aussi aux suicides réalisés à partir d’un certain pont. D’où le peu de chance que des déplacements vers d’autres moyens soient observés, à court ou moyen terme, suite à l’installation de barrières anti-saut.
http://www.crise.ca/fr/mb_pub_details.asp?section=membres&no_pub=145&usager=daiglem&conf_pub=publication

25. Prévost, C., Julien, M., & Brown, B. P. (1996). Suicides associated with the Jacques Cartier Bridge, Montreal, Quebec 1988-1993: descriptive analysis and intervention proposal.Canadian Journal of Public Health, 87(6), 377-380.
Résumé : Falls from heights represent an uncommon means of suicide. Regional variations are attributable to the presence of particular sites which attract suicidal individuals. The Jacques Cartier Bridge in Montreal is one such site, though less well known than North American sites such as the Golden Gate Bridge or Niagara Falls. According to Coroner's records, 54 suicides were associated with the bridge for the period 1988 to 1993. All but one of the suicides were the result of jumps from the bridge. The median age of victims was 30 years, and 46 of the victims were male. Bridge-specific verbalization of suicidal intent and prior history of medically diagnosed psychiatric disorders are frequently noted. Based on a review of the effectiveness of preventive measures, we propose limiting access to jumping by means of a fence along the bridge railing.
http://www.crise.ca/fr/mb_pub_details.asp?section=membres&no_pub=84&usager=julienm&conf_pub=publication

26. Mishara, B. L. (1999). Suicide in the Montreal subway system: Characteristics of the victims, antecedents, and implications for prevention .Canadian Journal of Psychiatry, 44(7), 690-696.
Résumé : Objective: To understand the characteristics of persons who commit suicide in the Montreal subway system (the Montreal Metro), their personal and psychiatric histories, and the nature of the event in order to develop better prevention strategies. Method: Systematic analysis of coroner's office investigations of the 129 suicides in the Montreal Metro from 1986 to 1996. Results: Of the 129 people who commited suicide, 81% had expressed a prior suicidal intention, 66% had previously attempted suicide, and 9% had attempted suicide in the metro. 105 of the victims had serious mental health problems, most frequently depression; 73% had had inpatient psychiatric treatment, and at the time of death, 27% resided in a mental health treatment institution. Recent adverse life events included failed relationships, work problems, and family difficulties. Conclusions: Suicide victims intentionally go to the metro to kill themselves, often tell others beforehand, and are generally in treatment for serious psychiatric problems. Possible prevention strategies include modifications of the environment and procedures in metro, changing public conceptions of metro suicides, and modifying practice in psychiatric facilities.
http://www.crise.ca/fr/mb_pub_details.asp?section=membres&no_pub=44&usager=misharab&conf_pub=publication

27. Mishara, B. L. (2007). Railway and metro suicides: understanding the problem and prevention portential . Crisis, 28(Suppl.1), 36-43.
Résumé : This article reviews research on railway and metro (underground and subway) suicides around the world. Although the incidence and survival rates vary and standardized methodologies are lacking, it is evident that there is a high incidence among psychiatric patients and at stations, crossings, and track areas near psychiatric institutions. Fictional and news reports of railway and metro suicides are related to increased rates, and false beliefs about a certain, fatal, and painless outcome may contribute to use of this method. Train drivers and rail personnel are often traumatized and in need of personal support after the incident. Most prevention involves surveillance, limiting access to tracks, or prompt intervention during an attempt. Other potential strategies include focusing upon the high-risk populations of previous attempters and patients in psychiatric facilities near stations and tracks and changing attitudes concerning the acceptability of this method to ensure that potentially suicidally active individuals are not under the illusion that this is a certain and painless method of death
http://www.crise.ca/fr/mb_pub_details.asp?section=membres&no_pub=553&usager=misharab&conf_pub=publication

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