Change in incidents of suicidal acts after intervention on a bridge in South Korea.

PURPOSE: To investigate whether two novel interventions on a bridge - a Video Incident Detection System (VIDS) and spinning bar barriers - have an impact on suicidal behaviour on the bridge. METHODS: A total of 146 suicidal acts were retrieved for analyses; 108 interventions before suicidal acts, 35 suicide deaths and 3 suicide attempts. Incident rate ratios (IRR) were calculated to estimate the change in incident rate associated with implementation of the two interventions: VIDS and the spinning bar 2-metre high barrier. RESULTS: The results of the Poisson regression showed that the rate of suicide deaths, after installation the VIDS, did not change significantly (IRR: 1.23, 95% Confidence Interval [95% CI]: 0.59-2.56), although the rate of intervened suicidal acts increased (IRR: 2.40, 95% CI: 1.65-3.47). The results showed that subsequent spinning bar installation resulted in a decrease in the incident rate of intervened suicidal acts (IRR: 0.37, 95% CI: 0.25-0.57) as well as suicide deaths (IRR: 0.23, 95% CI: 0.07-0.71). Comparison of the period when both interventions were in place with the period with no interventions indicated a reduction in suicide deaths (IRR: 0.28, 95% CI: 0.10-0.82), but no change in intervened suicidal acts (IRR: 0.90, 95% CI: 0.59-1.38). CONCLUSION: The rate of suicide death decreased after the installation of the spinning bar barrier but not after the implementation of VIDS alone. Our findings reinforce that restricting access to means is a highly effective way of preventing suicide on bridges and that spinning bars may be a helpful way to design barriers.

Does adolescent depression modify the association between psychosocial job stressors and mental health in emergent adulthood?

BACKGROUND: Job stressors can be particularly harmful to the mental health of disadvantaged groups through differential exposure, differential sensitivity to the effects of exposure, or both. In this paper, we assess the extent to which emergent adult workers with an adolescent history of high depression symptoms may be differentially sensitive to the effect of job stressors on mental health. METHODS: We conducted a secondary analysis of three waves of the Australian arm of the International Youth Development Study (n = 1262). We used multivariable linear regression to assess whether self-reported measures of high depression symptoms at one or two time points in adolescence (ages 11-16 years) modified the cross-sectional association between four self-reported job stressors (job demands, job control, job strain, and incivility at work) and psychological distress (Kessler-10 scores) in emergent adulthood (ages 23-27 years). RESULTS: For all four job stressors, there was a consistent pattern of approximately a doubling in the magnitude of association for participants with a history of high depression symptoms at two points in adolescence compared with those with no history of depression. However, results of effect modification analysisfor only job demands and job strain excluded chance as a potential explanation. CONCLUSIONS: Findings showed partial support for the hypothesis that a history of high depression symptoms in adolescence predicts stronger associations between job stressor exposures and psychological distress among those employed in emergent adulthood. The limitations of this secondary analysis suggest a need for purpose-designed studies to answer this important research question more definitively.

Changes in Job Security and Mental Health: An Analysis of 14 Annual Waves of an Australian Working-Population Panel Survey.

We examined whether job security improvements were associated with improvements in mental health in a large, nationally representative panel study in Australia. We used both within-person fixed effects (FE) and random effects (RE) regression to analyze data from 14 annual waves covering the calendar period of 2002-2015 (19,169 persons; 106,942 observations). Mental Health Inventory-5 scores were modeled in relation to self-reported job security (categorical, quintiles), adjusting for age, year, education, and job change in the past year. Both FE and RE models showed stepwise improvements in Mental Health Inventory-5 scores with improving job security, with stronger exposure-outcome relationships in the RE models and for men compared with women. The RE coefficients for improvements in job security in men were 2.06 (95% confidence interval (CI): 1.67, 2.46) for 1 quintile, steadily increasing for 2- (3.94 (95% CI: 3.54, 4.34)), 3- (5.82 (95% CI: 5.40, 6.24)), and 4-quintile (7.18 (95% CI: 6.71, 7.64)) improvements. The FE model for men produced slightly smaller coefficients, reaching a maximum of 5.55 (95% CI: 5.06, 6.05). This analysis, with improved causal inference over previous observational research, showed that improving job security is strongly associated with decreasing depression and anxiety symptoms. Policy and practice intervention to improve job security could benefit population mental health.

Cumulative impact of high job demands, low job control and high job insecurity on midlife depression and anxiety: a prospective cohort study of Australian employees.

OBJECTIVE: There is a lack of evidence concerning the prospective effect of cumulative exposure to psychosocial job stressors over time on mental ill-health. This study aimed to assess whether cumulative exposure to poor quality jobs places employees at risk of future common mental disorder. METHODS: Data were from the Personality and Total Health Through Life project (n=1279, age 40-46 at baseline). Data reported on the cumulative exposure to multiple indicators of poor psychosocial job quality over time (ie, a combination of low control, high demands and high insecurity) and future common mental disorder (ie, depressive and/or anxiety symptom scores above a validated threshold) 12 years later. Data were analysed using logistic regression models and controlled for potential confounders across the lifespan. RESULTS: Cumulative exposure to poor-quality work (particularly more secure work) on multiple occasions elevated the risk of subsequent common mental disorder, independent of social, health, verbal intelligence and personality trait confounders (OR=1.30, 95% CI 1.06 to 1.59). CONCLUSIONS: Our findings show that cumulative exposure to poor psychosocial job quality over time independently predicts future common mental disorder-supporting the need for workplace interventions to prevent repeated exposure of poor quality work.

Suicide Clusters Among Top 10 High-Risk Occupations: A Study From 2001 to 2016 in Australia.

A number of studies have demonstrated elevated risk of suicide in certain occupational groups. We seek to understand a possible new risk factor: suicide contagion, as demonstrated through a suicide cluster analysis. National-level coronial data and census population data were used for the study. We calculated suicide rates to identify "risky" occupations. SaTScan v9.4.1 was used to perform Poisson discrete scan statistic. Suicides occurring in arts and media professionals, construction, manufacturing, and skilled animal and horticultural workers seemed to cluster in time and/or space. Those working in construction settings were at risk of being in both time and space clusters.

Suicides in Australia following media reports of the death of Robin Williams.

OBJECTIVE: This study assessed the extent to which local reporting of Robin Williams' suicide (on 11 August 2014) was associated with suicide in Australia. It followed several studies in the United States which showed that there were significant increases in suicide following media reports of Williams' death and that those media reports were less than optimal in terms of adherence to best-practice guidelines. In a previous study, we demonstrated that Australian media reports of Williams' suicide were largely adherent with our Mindframe guidelines on responsible reporting of suicide, so we speculated that there would be no increase in suicide following the reporting of Williams' suicide in Australia. METHOD: We extracted data on Australian suicides from the National Coroners Information System for the period 2001 to 2016. We conducted interrupted time series regression analyses to determine whether there were changes in suicides in the 5-month period immediately following Williams' suicide. RESULTS: Our hypothesis that there would be no increase in suicides in Australia following Williams' highly publicised suicide was not supported. There was an 11% increase in suicides in the 5-month period following Williams' death, largely accounted for by men aged 30-64 and by people who died by hanging (the method Williams used). CONCLUSION: It may be that Australians were exposed to reports that contravened safe reporting recommendations, particularly via overseas media or social media, and/or that some Australian reports may have had unhelpful overarching narratives, despite largely adhering to the Mindframe guidelines. The Mindframe guidelines constitute international best practice but consideration should be given to whether certain recommendations within them should be further reinforced and whether more nuanced information about how stories should be framed could be provided. Future revision and augmentation of the Mindframe guidelines should, as always, involve media professionals.

Depression literacy and help-seeking in Australian police.

OBJECTIVE: To assess depression literacy, help-seeking and help-offering to others in members of the police force in the state of Victoria, Australia. METHODS: All staff in police stations involved in a cluster randomised controlled trial of an integrated workplace mental health intervention were invited to participate. Survey questions covered sociodemographic and employment information, recognition of depression in a vignette, stigma, treatment beliefs, willingness to assist co-workers with mental health problems, help-giving and help-seeking behaviours, and intentions to seek help. Using the baseline dataset associated with the trial, the paper presents a descriptive analysis of mental health literacy and helping behaviours, comparing police station leaders and lower ranks. RESULTS: Respondents were 806 staff, comprising 618 lower-ranked staff and 188 leaders. Almost 84% of respondents were able to correctly label the problem described in the vignette. Among those who had helped someone with a mental health problem, both lower ranks and leaders most commonly reported 'talking to the person' although leaders were more likely to facilitate professional help. Leaders' willingness to assist the person and confidence in doing so was very high, and over 80% of leaders appropriately rated police psychologists, general practitioners, psychologists, talking to a peer and contacting welfare as helpful. However, among both leaders and lower ranks with mental health problems, the proportion of those unlikely to seek professional help was greater than those who were likely to seek it. CONCLUSION: Knowledge about evidence-based interventions for depression was lower in this police sample than surveys in the general population, pointing to the need for education and training to improve mental health literacy. Such education should also aim to overcome barriers to professional help-seeking. Interventions that aim to improve mental health literacy and help-seeking behaviour appear to be suitable targets for better protecting police member mental health.

Widening socioeconomic inequalities in Australian suicide, despite recent declines in suicide rates.

PURPOSE: This study aims to investigate trends in socioeconomic inequalities of suicide from 1979 to 2013 for Australian males and females aged 15-34 years and 35-64 years. METHODS: Data on suicides and population were obtained from national registries. An area-based measure of socioeconomic status (SES) was used, and categorized into low, middle, and high SES areas. Suicide rates for each SES groups were estimated using a negative binomial regression model, adjusted for confounders. Socioeconomic inequalities in suicide were assessed using absolute and relative risk of low-to-high SES areas. Secular changes in socioeconomic inequalities were assessed using trend tests for relative risk. RESULTS: For young males, there was an increase in socioeconomic inequality driven by a significant decrease in suicide rates in high SES areas. For older males, inequality in suicide increased by 29%, which was related to a marked increase in suicide rates in low SES areas. Inequalities in both young and older female suicides also increased. These increases occurred when corresponding suicide rates in high SES areas decreased. CONCLUSIONS: Recent widening socioeconomic inequalities in Australian suicide have been primarily associated with declines in suicide rates in high SES areas. However, an increasing inequality in older male suicide is linked with low SES. Efforts targeting people from poor areas, especially older males, should be considered when developing suicide prevention strategy.

Railway suicide clusters: how common are they and what predicts them?

BACKGROUND: A growing number of studies have sought to detect clusters of all suicides, but few have sought to identify clusters of method-specific suicides. METHODS: Data on railway suicides occurring in Victoria, Australia, between 2001 and 2012 were obtained from the National Coronial Information System. We used the Poisson discrete scan statistic to identify railway suicides that occurred close together in space and/or time. We then used a case-control design to compare clustered railway suicides with non-clustered railway suicides on a range of individual and neighbourhood factors. RESULTS: We detected four spatial clusters that accounted for 35% of all railway suicides. Railway suicides by individuals who were hospitalised for mental illness had nearly double the odds of being in a cluster compared with those individuals who had never been hospitalised (OR 1.80, 95% CI 1.02 to 3.18). Higher frequency train services were associated with increased odds of being in a cluster (OR 1.11, 95% CI 1.03 to 1.19). No other predictors were associated with being in a cluster. CONCLUSIONS: Railway suicides that occur in clusters warrant particular attention because of the ripple effect they can have for communities and the risk that they may lead to copycat acts. Railway suicide prevention strategies should consider the fact that these suicides can occur in clusters, particularly among individuals who had previous hospitalisations for mental illness or live in areas with high-frequency train services.

A suicide research agenda for people from immigrant and refugee backgrounds.

The aim of this study was to establish mental health and suicide research priorities for people from immigrant and refugee background in Australia. This article focuses on the data relevant to the development of the suicide research agenda. This study was conducted using Delphi consensus method with two rounds of online questionnaires. A total of 138 and 86 participants, respectively, completed the first and second rounds of survey. Participants were policy makers, service providers, academics, service users, and carer advocates in Australia with expertise in mental health and/or suicide among people from immigrant and refugee backgrounds. Of the total 268 research questions included in the questionnaires, 70 questions about suicide were ranked as essential by over 50% respondents (i.e., the set level of consensus). In particular, research questions regarded as the greatest priority related to access and engagement with suicide prevention services, suicide protective and risk factors compared to populations not from immigrant and refugee backgrounds, and culturally appropriate assessment of suicide risk.

Spatial suicide clusters in Australia between 2010 and 2012: a comparison of cluster and non-cluster among young people and adults.

BACKGROUND: A suicide cluster has been defined as a group of suicides that occur closer together in time and space than would normally be expected. We aimed to examine the extent to which suicide clusters exist among young people and adults in Australia and to determine whether differences exist between cluster and non-cluster suicides. METHODS: Suicide data were obtained from the National Coronial Information System for the period 2010 and 2012. Data on date of death, postcode, age at the time of death, sex, suicide method, ICD-10 code for cause of death, marital status, employment status, and aboriginality were retrieved. We examined the presence of spatial clusters separately for youth suicides and adult suicides using the Scan statistic. Pearson's chi-square was used to compare the characteristics of cluster suicides with non-cluster suicides. RESULTS: We identified 12 spatial clusters between 2010 and 2012. Five occurred among young people (n = 53, representing 5.6% [53/940] of youth suicides) and seven occurred among adults (n = 137, representing 2.3% [137/5939] of adult suicides). Clusters ranged in size from three to 21 for youth and from three to 31 for adults. When compared to adults, suicides by young people were significantly more likely to occur as part of a cluster (difference = 3.3%, 95% confidence interval [CI] = 1.8 to 4.8, p < 0.0001). Suicides by people with an Indigenous background were also significantly more likely to occur in a cluster than suicide by non-Indigenous people and this was the case among both young people and adults. CONCLUSIONS: Suicide clusters have a significant negative impact on the communities in which they occur. As a result it is important to find effective ways of managing and containing suicide clusters. To date there is limited evidence for the effectiveness of those strategies typically employed, in particular in Indigenous settings, and developing this evidence base needs to be a future priority. Future research that examines in more depth the socio-demographic and clinical factors associated with suicide clusters is also warranted in order that appropriate interventions can be developed.

Individual and community factors for railway suicide: a matched case-control study in Victoria, Australia.

PURPOSE: This study aims to simultaneously examine individual- and community-level factors associated with railway suicide. METHODS: We performed a case-control study in Victoria, Australia between 2001 and 2012. Data on cases of railway suicide were obtained from the National Coronial Information System (a database of coronial investigations). Controls were living individuals randomly selected from the Household, Income and Labour Dynamics in Australia study, matching to cases on age groups, sex and year of exposures. A conditional logistic regression model was used to assess the individual-level and community-level influences on individual odds of railway suicide, controlling for socioeconomic status. RESULTS: Individual-level diagnosed mental illness increased railway suicide odds by six times [95 % confidence interval (CI) 4.5, 9.2]. Community-level factors such as living in an area with a presence of railway tracks [odds ratio (OR) 1.8, 95 % CI 1.2, 2.8], within a city (OR 3.2, 95 % CI 1.9, 5.4), and with a higher overall suicide rate (OR 1.02, 95 % CI 1.01, 1.04) were independently associated with greater individual odds of railway suicide compared to living in an area without a presence of railway tracks, outside a city, and with a relatively lower overall suicide rate. CONCLUSIONS: The effects of mental illness and high incidence of overall suicides are prominent, but not specific on railway suicide. The effects of presence of railway tracks and city residence suggest the importance of accessibility to the railways for individual risk of railway suicide. Prevention efforts should focus on vulnerable people live in areas with easy access to the railways.

The socio-environmental determinants of railway suicide: a systematic review.

BACKGROUND: Railway suicide has significant adverse impacts for the victims, their family and friends, witnesses to the incident, general public and train network. There is no previous review on the socio-environmental factors and railway suicide. The research question asked in this review was: 'What socio-environmental risk and protective predictors are significantly associated with railway suicide?' METHODS: The review searched Medline, PsycINFO, Web of Science and Scopus for English-language studies that assessed the associations between socio-environmental (i.e. geographical, physical, economic and social) factors and railway suicide from their inception to June 2013. It was reported based on the PRISMA Statement. RESULTS: Eleven studies met the inclusion criteria. They were categorised into railway environments (availability of railways and trains, accessibility to railways and familiarity with trains), population characteristics and impact of media reporting. Findings from ecological studies using population level railway suicide data suggested weak and inconsistent evidence for the first two categories. The evidence on the impact of media reporting was moderately strong, with irresponsible media reporting being associated with an increased risk of railway suicide. CONCLUSIONS: There is a need for further research activity to strengthen evidence about socio-environmental risk factors for railway suicide. The focus of this research should be on the factors that determine individuals' decisions of using the railway as a method of suicide, with the consideration of a range of geographical, physical, social, and economic factors.

Effectiveness of partial restriction of access to means in jumping suicide: lessons from four bridges in three countries.

AIMS: Restricting access to means by installing physical barriers has been shown to be the most effective intervention in preventing jumping suicides on bridges. However, little is known about the effectiveness of partial restriction with interventions that still allow jumping from the bridge. METHODS: This study used a quasi-experimental design. Public sites that met our inclusion criteria were identified using Google search and data on jumping suicides on Bridge A (South Korea), Bridges B and C (the United States) and Bridge D (Canada) were obtained from the relevant datasets. Incidence rate ratios (IRRs) were estimated using Poisson regressions comparing suicide numbers before and after the installation of physical structures at each site. RESULTS: Fences with sensor wires and spinning handrails installed above existing railings on the Bridge A, and fences at each side of the entrances and the midpoint of main suspension cables on the Bridge D were associated with significant reductions in suicides (IRR 0.37, 95% Confidence Interval (CI) 0.26 - 0.54; 0.26, 95% CI 0.09 - 0.76). Installation of bird spike on the parapet on the Bridge B, and fences at the front of seating alcoves on the Bridge C were not associated with changes in suicides (1.21, 95% CI 0.88 - 1.68; 1.49, 95% CI 0.56 - 3.98). CONCLUSIONS: Partial means restriction (such as fences with sensor wires and spinning bars at the top, and partial fencing at selected points) on bridges appears to be helpful in preventing suicide. Although these interventions are unlikely to be as effective as interventions that fully secure the bridge and completely prevent jumping, they might best be thought of as temporary solutions before more complete or permanent structures are implemented.

Road vehicle collision suicide in Australia: Trends, collision types, and individual characteristics.

BACKGROUND: Suicide by road vehicle collision in Australia is under-explored with mixed findings. We aimed to address this research gap by examining time trends, different types of vehicle collision, and individual characteristics related to vehicle-collision suicide. METHOD: We retrospectively analyzed deaths by suicide between 1st January 2001 and 31st December 2017 in Australia, using coronial records from the National Coronial Information System. The travel mode used and collision counterpart were retrieved from records of death by vehicle-collision suicide using all available information. We conducted negative binomial regression analysis to examine annual changes in suicide rate by vehicle collision on a public road (N = 640) and other methods of suicide (N = 41,890), and logistic regression analysis to examine individual characteristics associated with the likelihood of dying by suicide via road vehicle collision. RESULTS: Overall, the national suicide rate involving road vehicle collision significantly increased, while the rate by other methods significantly decreased. Drivers accounted for 61% of suicide events by vehicle collision, of which 72% were single-vehicle collisions (commonly involving a tree). For multiple-vehicle collision suicide events, 82% involved collision with a truck. Pedestrians accounted for more than one-third of suicide events, of which 58% involved collision with a truck and 23% involved collision with a car/van. Individuals who were male (odds ratio 1.15; 95% CI 0.88-1.50), aged <25 years old (odds ratio 5.27; 95% CI 3.05-9.10), non-Indigenous (odds ratio 3.36; 95% CI 1.71-6.62), and born overseas (odds ratio 1.40; 95% CI 1.10-1.79) were more likely to die by vehicle-collision suicide than by other methods of suicide. CONCLUSIONS: This study provides a better understanding of road vehicle collision suicide in Australia and informs future research directions on topic. Our findings can be used to inform suicide prevention initiatives to reduce vehicle-collision suicide deaths.

High-Risk Suicide Locations in Australia.

Importance: Although several interventions have been shown to be effective in preventing suicide at high-risk locations, the potential for these interventions to be deployed is limited by a lack of knowledge about where high-risk locations are and the factors associated with choosing these locations. Objective: To identify high-risk suicide locations in Australia and the factors associated with choosing these locations. Design, Setting, and Participants: This case-control study included data on individuals who died by suicide in Australia between January 2001 and December 2017, obtained from the National Coronial Information System. Data analysis was conducted from February to December 2021. Exposures: Sociodemographic, residential, incident time, and incident location variables. Main Outcomes and Measures: The scan statistic was used to detect spatial clusters of suicides in public locations. Suicide locations within significant clusters with at least 0.5 suicides per year were defined as high-risk locations. Multivariable logistic regression analyses were performed to examine the factors associated with choosing a high-risk location. Results: Over the study period, 10 701 suicides took place in public places. The individuals who died of suicide in public places included 8602 (80.4%) male individuals, and most were aged 25 to 49 years (5825 [54.5%]). A total of 17 high-risk suicide locations in Australia were detected. These involved 495 suicides, which accounted for 4.6% of suicides in public locations. For suicides at high-risk locations, 82.2% (407 of 495) occurred at cliffs and bridges. Being female (adjusted odds ratio [aOR], 1.73; 95% CI, 1.41-2.13), employed (aOR, 1.57; 95% CI, 1.20-2.04), never married (aOR, 1.64; 95% CI, 1.26-2.13), and from a major city (aOR, 3.94; 95% CI, 2.94-5.28) were associated with the choice of a high- over low-risk suicide location. High-risk locations tended to be in major cities. Conclusions and Relevance: This case-control study found 17 high-risk suicide locations in Australia and the factors associated with the choice of these locations. Actions should be taken to prevent suicide at these locations where possible.

Poor psychosocial job conditions increase sickness absence: evidence from the PATH Through Life Mid-Aged Cohort.

OBJECTIVES: Evidence is mounting that poor psychosocial job conditions increase sickness absence, but there is a need for further rigorous prospective research to isolate the influence of psychosocial job quality from other measured and unmeasured confounders. This study used four waves of prospective longitudinal data (spanning 12 years) to investigate the extent to which increases in poor psychosocial job quality are associated with greater relative risk of day of sickness absence. DESIGN: Prospective cohort study. SETTING: Data were from the Australian PATH Through Life cohort study. The analyses adopted hybrid-regression estimations that isolated the effect of within-person change in psychosocial job quality on sickness absence over time. PARTICIPANTS: Participants were from a midlife cohort aged 40-44 at baseline (7644 observations from 2221 participants). PRIMARY OUTCOME MEASURE: Days sickness absence in the past 4 weeks. RESULTS: The results show that after adjusting for a wide range of factors as well as unmeasured between-person differences in job quality, each additional psychosocial job adversity was associated with a 12% increase in the number of days of sickness absence (relative risk ratio: 1.12, 95% CI 1.03 to 1.21). Increases in psychosocial job adversity were also related to greater functional impairment (relative risk ratio: 1.17 (1.05 to 1.30)). CONCLUSION: The results of this study strengthen existing research highlighting the importance of addressing poor psychosocial job quality as a risk factor for sickness absence.

Understanding the Context of Suicides by Older Men Compared With Younger Old Men and Women.

Background: The rate of suicide among men aged 85 years or older is the highest of any age or gender group in many countries, but little is known about their pathways to suicide. Aims: This study aimed to determine the context of suicide by men aged 85 years or older. Method: Data were extracted from the Victorian Suicide Register regarding suicide deaths between 2009 and 2015. Chi-squared test or Fisher's exact test was used to compare old men (65-84 years old) and older men (85 years or more), and old women and old men (both 65 years or more). Results: The context of suicide by older men differed significantly from that of old men, as did that of old men compared with old women, on variables related to suicidal behavior and intention, mental illness, mental health treatment, and life stressors. Limitations: The study is limited by the small numbers of deaths by suicide in this age group in Victoria. Conclusion: The context of suicide by older and old men is different from that of old men and old women, respectively. More research is needed to understand the pathways to suicide by older men.

Quantitative Methods to Detect Suicide and Self-Harm Clusters: A Systematic Review.

Suicide and self-harm clusters exist in various forms, including point, mass, and echo clusters. The early identification of clusters is important to mitigate contagion and allocate timely interventions. A systematic review was conducted to synthesize existing evidence of quantitative analyses of suicide and self-harm clusters. Electronic databases including Medline, Embase, Web of Science, and Scopus were searched from date of inception to December 2020 for studies that statistically analyzed the presence of suicide or self-harm clusters. Extracted data were narratively synthesized due to heterogeneity among the statistical methods applied. Of 7268 identified studies, 79 were eligible for narrative synthesis. Most studies quantitatively verified the presence of suicide and self-harm clusters based on the scale of the data and type of cluster. A Poisson-based scan statistical model was found to be effective in accurately detecting point and echo clusters. Mass clusters are typically detected by a time-series regression model, although limitations exist. Recently, the statistical analysis of suicide and self-harm clusters has progressed due to advances in quantitative methods and geospatial analytical techniques, most notably spatial scanning software. The application of such techniques to real-time surveillance data could effectively detect emerging clusters and provide timely intervention.

Cost-effectiveness of Installing Barriers at Bridge and Cliff Sites for Suicide Prevention in Australia.

Importance: Installation of barriers has been shown to reduce suicides. To our knowledge, no studies have evaluated the cost-effectiveness of installing barriers at multiple bridge and cliff sites where suicides are known to occur. Objective: To examine the cost-effectiveness of installing barriers at bridge and cliff sites throughout Australia. Design, Setting, and Participants: This economic evaluation used an economic model to examine the costs, costs saved, and reductions in suicides if barriers were installed across identified bridge and cliff sites over 5 and 10 years. Specific and accessible bridge and cliff sites across Australia that reported 2 or more suicides over a 5-year period were identified for analysis. A partial societal perspective (including intervention costs and monetary value associated with preventing suicide deaths) was adopted in the development of the model. Interventions: Barriers installed at bridge and cliff sites. Main Outcomes and Measures: Primary outcome was return on investment (ROI) comparing cost savings with intervention costs. Secondary outcomes included incremental cost-effectiveness ratio (ICER), comprising the difference in costs between installation of barriers and no installation of barriers divided by the difference in reduction of suicide cases. Uncertainty and sensitivity analyses were undertaken to examine the association of changes in suicide rates with barrier installation, adjustments to the value of statistical life, and changes in maintenance costs of barriers. Results: A total of 7 bridges and 19 cliff sites were included in the model. If barriers were installed at bridge sites, an estimated US $145 million (95% uncertainty interval [UI], $90 to $160 million) could be saved in prevented suicides over 5 years, and US $270 million (95% UI, $176 to $298 million) over 10 years. The estimated ROI ratio for building barriers over 10 years at bridges was 2.4 (95% UI, 1.5 to 2.7); the results for cliff sites were not significant (ROI, 2.0; 95% UI, -1.1 to 3.8). The ICER indicated monetary savings due to averted suicides over the intervention cost for bridges, although evidence for similar savings was not significant for cliffs. Results were robust in all sensitivity analyses except when the value of statistical life-year over 5 or 10 years only was used. Conclusions and Relevance: In an economic analysis, barriers were a cost-effective suicide prevention intervention at bridge sites. Further research is required for cliff sites.