Depression

If You Build it, Will They Stop Coming?

The construction of bridge safety barriers for suicide prevention.

Posted June 17, 2009

I live in a city of bridges. The striking Zakim Bridge, named for civil rights activist Lenny Zakim, connects towns north of Boston and the city. Boston is connected to its neighboring Cambridge by a number of quite ancient pedestrian and public transport bridges.

Despite being surrounded by them, it's only recently that I've really started noticing bridges. On a trip to Cincinnati, I walked across a pedestrian bridge that was encased in wire fencing, creating a cage-like structure that wrapped around the bridge.

If I didn't work on suicide prevention, I might not have thought anything of this particular bridge. I paid attention to this bridge, to its intentionality and its ugliness. Bridges wrapped in cages of fencing are not pretty. But, they are protective.

This month, a group of researchers in New Zealand published a short follow-up article on what they termed an "unfortunate natural experiment."* In 2001, one of these researchers had published an article on the effects of removing safety barriers from a bridge in a metropolitan area.** The removal of the safety barriers was followed by an increase in suicide by jumping. During the four years prior to the removal of the safety barriers, there were three suicides by jumping, with a rate of 0.29 per 100,000 of the population at risk. During the four years following the removal of the safety barriers, there were 15 suicides, with a rate of 1.29 per 100,000.

I think there are many possible psychological underpinnings to suicide by jumping uncovered by this study:

What is going through the minds of individuals who choose to try to end their lives by jumping from a bridge? A fascinating but graphic article published several years ago in the New Yorker explores related questions.

Is there something particular that we should be aware of about the psychological make-up of individuals who choose to jump from bridges? Most of the individuals who jumped from the bridge in the study were being treated for psychiatric illnesses.

What about proximity? We know that proximity is a key factor affecting other decision-making. The majority of those who jumped from this bridge site were in treatment in a psychiatric unit at a nearby hospital.

Why is beauty a more important value than safety? One of the reasons cited by those who wanted the safety barriers removed was that the barriers were "visually unattractive and detracted from the heritage status of the bridge."

It's important to note that the construction of safety barriers is a means-restriction activity, one for public health rather than individual intervention. Ultimately, though, we may be able to look to individuals - and the psychology of individuals - for answers to some of the harder questions about this particular area of suicide prevention.

*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.

**Beautrais, A.L. (2001) Effectiveness of barriers at suicide jumping sties: A case study. Australian and New Zealand Journal of Psychiatry, 35, 557-562.