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Effectiveness of restricting access to a suicide jump site: a test of the method substitution hypothesis
  1. Alan Lee Berman1,
  2. Alisonj Athey2,
  3. Paul Nestadt1
  1. 1 Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA
  2. 2 Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Alan Lee Berman, Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA; drlannyberman{at}


Reducing access to lethal means can prevent suicides. However, substitution of a suicide method remains a concern. Until 1986, the Ellington Bridge was the site of one-half of all Washington, DC bridge suicides. An antisuicide fence was installed in 1986, creating a naturalistic case–control design for testing the substitution hypothesis with the adjacent and equally as lethal jump site, the Taft Bridge. We found that suicide deaths from the Ellington Bridge were reduced by 90% (p=0.001) following barrier construction, without changes in rates of jumps from either the Taft Bridge or any other bridge in the city. Suicides by all methods decreased significantly across the study period. While the decline in suicides from the Ellington Bridge may reflect a broader decline in suicide, the decline in bridge suicide without persistent shifts in deaths to other bridges provides evidence that restricting access to one highly lethal method is effective.

  • environmental modification
  • public health
  • fall
  • case-control study
  • mortality
  • community

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  • Contributors ALB conceived of the study, acquired the data for analysis, was responsible for the literature search and wrote the initial draft of the manuscript. AA conducted the statistical analysis, prepared the data tables and figure, and made substantial contributions to the interpretation of the data. PN contributed substantially to the interpretation of the data and to making editorial revisions of the manuscript. All authors approved the submission of the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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