Suicide Hotspots Research Articles

Association between mental health workforce supply and clusters of high and low rates of youth suicide: An Australian study using suicide mortality data from 2016 to 2020.

To examine the association between mental health workforce supply and spatial clusters of high versus low incidence of youth suicide. A cross-sectional analysis of spatial suicide clusters in young Australians (aged 10-25) from 2016 to 2020 was conducted using the scan statistic and suicide data from the National Coronial Information System. Mental health workforce was extracted from the 2020 National Health Workforce Dataset by local government areas. The Geographic Index of Relative Supply was used to estimate low and moderate-to-high mental health workforce supply for clusters characterised by a high and low incidence of suicide (termed suicide hotspots and coldspots, respectively). Univariate and multivariate logistic regression was used to determine the association between suicide clusters and a range of sociodemographic characteristics including mental health workforce supply. Eight suicide hotspots and two suicide coldspots were identified. The multivariate analysis showed low mental health workforce supply was associated with increased odds of being involved in a suicide hotspot (adjusted odds ratio = 8.29; 95% confidence interval = 5.20-13.60), followed by residential remoteness (adjusted odds ratio = 2.85; 95% confidence interval = 1.68-4.89), and illicit drug consumption (adjusted odds ratio = 1.97; 1.24-3.11). Both coldspot clusters occurred in areas with moderate-to-high mental health workforce supply. Findings highlight the potential risk and protective roles that mental health workforce supply may play in the spatial distributions of youth suicide clusters. These findings have important implications for the provision of postvention and the prevention of suicide clusters.

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

Towards Building a Visual Behaviour Analysis Pipeline for Suicide Detection and Prevention.

Understanding human behaviours through video analysis has seen significant research progress in recent years with the advancement of deep learning. This topic is of great importance to the next generation of intelligent visual surveillance systems which are capable of real-time detection and analysis of human behaviours. One important application is to automatically monitor and detect individuals who are in crisis at suicide hotspots to facilitate early intervention and prevention. However, there is still a significant gap between research in human action recognition and visual video processing in general, and their application to monitor hotspots for suicide prevention. While complex backgrounds, non-rigid movements of pedestrians and limitations of surveillance cameras and multi-task requirements for a surveillance system all pose challenges to the development of such systems, a further challenge is the detection of crisis behaviours before a suicide attempt is made, and there is a paucity of datasets in this area due to privacy and confidentiality issues. Most relevant research only applies to detecting suicides such as hangings or jumps from bridges, providing no potential for early prevention. In this research, these problems are addressed by proposing a new modular design for an intelligent visual processing pipeline that is capable of pedestrian detection, tracking, pose estimation and recognition of both normal actions and high risk behavioural cues that are important indicators of a suicide attempt. Specifically, based on the key finding that human body gestures can be used for the detection of social signals that potentially precede a suicide attempt, a new 2D skeleton-based action recognition algorithm is proposed. By using a two-branch network that takes advantage of three types of skeleton-based features extracted from a sequence of frames and a stacked LSTM structure, the model predicts the action label at each time step. It achieved good performance on both the public dataset JHMDB and a smaller private CCTV footage collection on action recognition. Moreover, a logical layer, which uses knowledge from a human coding study to recognise pre-suicide behaviour indicators, has been built on top of the action recognition module to compensate for the small dataset size. It enables complex behaviour patterns to be recognised even from smaller datasets. The whole pipeline has been tested in a real-world application of suicide prevention using simulated footage from a surveillance system installed at a suicide hotspot, and preliminary results confirm its effectiveness at capturing crisis behaviour indicators for early detection and prevention of suicide.

Home as the first site for suicide prevention: a Hong Kong experience

IntroductionThere has been little research into at-home suicide cases globally, and particularly in Asian regions. This study aimed to investigate the differences in characteristics between suicide cases in Hong Kong...

Spatial Errors in Automated Geocoding of Incident Locations in Australian Suicide Mortality Data.

There is increasing interest in the spatial analysis of suicide data to identify high-risk (often public) locations likely to benefit from access restriction measures. The identification of such locations, however, relies on accurately geocoded data. This study aims to examine the extent to which common completeness and positional spatial errors are present in suicide data due to the underlying geocoding process. Using Australian suicide mortality data from the National Coronial Information System for the period of 2008-2017, we compared the custodian automated geocoding process to an alternate multiphase process. Descriptive and kernel density cluster analyses were conducted to ascertain data completeness (address matching rates) and positional accuracy (distance revised) differences between the two datasets. The alternate geocoding process initially improved address matching from 67.8% in the custodian dataset to 78.4%. Additional manual identification of nonaddress features (such as cliffs or bridges) improved overall match rates to 94.6%. Nearly half (49.2%) of nonresidential suicide locations were revised more than 1,000 m from data custodian coordinates. Spatial misattribution rates were greatest at the smallest levels of geography. Kernel density maps showed clear misidentification of hotspots relying solely on autogeocoded data. Suicide incidents that occur at nonresidential addresses are being erroneously geocoded to centralized fall-back locations in autogeocoding processes, which can lead to misidentification of suicide clusters. Our findings provide insights toward defining the nature of the problem and refining geocoding processes, so that suicide data can be used reliably for the detection of suicide hotspots. See video abstract at, http://links.lww.com/EDE/B862.

Suicide Hot Spots: Leveraging County-Level Data and Local Agencies to Target Prevention in High-Risk Areas.

Suicide Hot Spots: Leveraging County-Level Data and Local Agencies to Target Prevention in High-Risk Areas.

Characteristics of Train Stations Where Railway Suicides Have Occurred and Locations Within the Stations.

Background: To devise effective railway suicide countermeasures, it is necessary to identify stations where suicide is likely to occur. Aim: We explored the characteristics of stations where railway suicides have occurred and locations within the stations. Method: (Study 1) Using suicide data from between April 2014 and September 2019 provided by a major railway company in Japan, station-specific suicide was modeled as an outcome variable in a multivariate Poisson regression model. (Study 2) With railway company staff, we visited stations where suicide frequently occurs and conducted fieldwork. Results: (Study 1) Our estimation using a Poisson regression model revealed that railway suicides were more frequent when stations were serviced by passing trains, had a large number of passengers, and were located near psychiatric hospitals. (Study 2) Of 50 suicides, 48.0% occurred in front of benches or waiting rooms, 26.0% occurred at the front end of the platform, 24.0% occurred at the entrance to the platform, and 22.0% occurred at a blind spot for the train driver. Limitations: All data were provided by one railway company in Japan, limiting the generalizability of the results. Conclusion: Stations where suicide occurs frequently have distinct characteristics. Focusing on suicide hotspots may aid suicide prevention.

The utility of artificial intelligence in suicide risk prediction and the management of suicidal behaviors.

Suicide is a growing public health concern with a global prevalence of approximately 800,000 deaths per year. The current process of evaluating suicide risk is highly subjective, which can limit the efficacy and accuracy of prediction efforts. Consequently, suicide detection strategies are shifting toward artificial intelligence platforms that can identify patterns within 'big data' to generate risk algorithms that can determine the effects of risk (and protective) factors on suicide outcomes, predict suicide outbreaks and identify at-risk individuals or populations. In this review, we summarize the role of artificial intelligence in optimizing suicide risk prediction and behavior management. This paper provides a general review of the literature. A literature search was conducted in OVID Medline, EMBASE and PsycINFO databases with coverage from January 1990 to June 2019. Results were restricted to peer-reviewed, English-language articles. Conference and dissertation proceedings, case reports, protocol papers and opinion pieces were excluded. Reference lists were also examined for additional articles of relevance. At the individual level, prediction analytics help to identify individuals in crisis to intervene with emotional support, crisis and psychoeducational resources, and alerts for emergency assistance. At the population level, algorithms can identify at-risk groups or suicide hotspots, which help inform resource mobilization, policy reform and advocacy efforts. Artificial intelligence has also been used to support the clinical management of suicide across diagnostics and evaluation, medication management and behavioral therapy delivery. There could be several advantages of incorporating artificial intelligence into suicide care, which includes a time- and resource-effective alternative to clinician-based strategies, adaptability to various settings and demographics, and suitability for use in remote locations with limited access to mental healthcare supports. Based on the observed benefits to date, artificial intelligence has a demonstrated utility within suicide prediction and clinical management efforts and will continue to advance mental healthcare forward.

Suicide hotspots, interventions, and future areas of work at a Californian university

We identified suicide hotspots and effective interventions at a Californian university. We collected timeline and location data of suicides and interventions occurring 2000–2016. We interviewed administrative staff concerning mental health support and suicide prevention systems. We identified three hotspots. Suicides occurred most often on Thursday, in January, during hours of darkness, in a particular plaza and parking structure. Following interventions, suicides declined dramatically. Many interventions followed international guidelines. Low-cost solutions (e.g. ground deterrents) may have contributed to the suicide decrease. To monitor intervention effectiveness, we suggest a GIS-mediated approach.

Geospatial analysis of suicidal bridge jumping in the Metro Vancouver Regional District from 2006 to 2014

In the past decade, there have been many structural changes implemented to Vancouver's largest bridges as a means of deterring criminogenic and suicidal behaviors. Guided by an environmental criminology theoretical framework, this research examines the patterns and trends of 201 cases of successful suicide jumping in the Metro Vancouver Regional District (MVRD) of British Columbia, Canada from 2006 to 2014. To evaluate these trends and to bolster the existing literature on deterrence measures through environmental design, this research will examine the spatial relationship between preferential bridge jumping locations and the home addresses of the deceased. Network analysis of 145 bridge jumpers suggests that suicidal people are willing to travel greater distances to jump from more iconic bridges than those closest to their home. Beyond mere aesthetic or practical functions, symbolic significance may impact which bridges become suicide hotspots over other convenient locations. Dwelling types, demographic profiles, and regional prevalence in the MVRD have also been aggregated and explored in this study.

Global trends in suicide epidemiology.

Suicide is a major cause of mortality accounting for nearly 1 million deaths globally per year. Suicide occurs throughout the lifespan; therefore, large epidemiological samples are needed to identify patterns in suicide death. This review examines emerging evidence relating to risk and protective factors as well as preventive measures for suicide. The global financial crisis, natural disasters, air pollution and second-hand smoke have all been associated with increased suicide rates. At an individual level, past self-harm, parental loss or separation and younger age relative to classmates all confer risk. There is mixed evidence for religious affiliation and lithium levels in drinking water as protective factors. Means restriction strategies including barriers at suicide hotspots, firearms restrictions and limiting access to both pesticides and charcoal have all prevented suicide. Other interventions with recent evidence include improvements in mental health systems, selective serotonin reuptake inhibitor (SSRI) and lithium treatment in youth and mental health awareness in schools. The evidence for risk/protective factors for suicide continues to grow and, more importantly, numerous prevention efforts continue to demonstrate positive outcomes. Public policy experts should attend to the environmental and social determinants of health when devising suicide prevention programs, and the evidence-based prevention strategies identified here should be implemented more broadly.

Spatiotemporal study of elderly suicide in Korea by age cohort

ObjectivesThis study analyzed the spatiotemporal pattern and spatial diffusion of elderly suicide by age cohort, in Korea. Study designThe research investigated the elderly suicide rates of the 232 municipal units in South Korea between 2001 and 2011. MethodsThe Gi* score, which is a spatially weighted indicator of area attributes, was used to identify hot spots and the spatiotemporal pattern of elderly suicide in the nation during the last 10 years. The spatial Markov matrix and spatial dynamic panel data model were employed to identify and estimate the diffusion effect. ResultsThe suicide rate among elderly individuals 75 years and older was substantially higher than the rate for those between 65 and 74 years of age; however, the spatial patterns of the suicide clusters were similar between the two groups. From 2001 to 2011, the spatial distribution of elderly suicide hot spots differed each year. For both age cohorts, elderly suicide hot spots developed around the north area of South Korea in 2001 and moved to the mid-east area and the mid-western coastal area over 10 years. The spatial Markov matrix indicates that the change in the suicide rate of one area was affected by the suicide rates of neighbouring areas from the previous year, which suggests that suicide increase in one area inflates a neighbouring area's suicide rate over time. Using a spatial dynamic panel data model, elderly suicide diffusion effects were found to be statistically significant for both age cohorts even after economic and demographic indicators and a time variable are included. For individuals 75 years and older, the diffusion effect appeared to be larger. ConclusionsThis study demonstrates that elderly suicide can spread spatially over time in both age cohorts. Thus, it is necessary to design a place-based and age-differentiated intervention policy that precisely considers the spatial diffusion of elderly suicide.

Suicide crisis among indigenous Australians tests rural services.

A psychiatrist working in one of the world’s worst suicide hotspots has said that identifying people at risk is like “capturing lightning in a jar.” Murray Chapman is clinical director of the Kimberley Mental Health and Drug Service, which is based in Broome in remote northwestern Australia, more than 2000 km from Perth. Indigenous communities in the region are in the grip of a suicide crisis. In March a 10 year old indigenous girl is believed to have hanged herself, in one of more than 20 recent suspected suicide cases being investigated by the Western Australia state coroner. Chapman, who is originally from the United Kingdom and has spent the past 14 years in the Kimberley region, said, “We know we [mental health services] can’t stop it on our own. We have a certain role. We save one or two, but we are standing at the bottom of a cliff. Trying to …

Interventions to reduce suicides at suicide hotspots: a systematic review and meta-analysis

Various interventions have been introduced to try to prevent suicides at suicide hotspots, but evidence of their effectiveness needs to be strengthened. We did a systematic search of Medline, PsycINFO, and Scopus for studies of interventions, delivered in combination with others or in isolation, to prevent suicide at suicide hotspots. We did a meta-analysis to assess the effect of interventions that restrict access to means, encourage help-seeking, or increase the likelihood of intervention by a third party. We identified 23 articles representing 18 unique studies. After we removed one outlier, interventions that restricted access to means were associated with a reduction in the number of suicides per year (incidence rate ratio 0.09, 95% CI 0.03-0.27; p<0.0001), as were interventions that encourage help-seeking (0.49, 95% CI 0.29-0.83; p=0.0086), and interventions that increase the likelihood of intervention by a third party (0.53, 95% CI 0.31-0.89; p=0.0155). When we included only those studies that assessed a particular intervention in isolation, restricting access to means was associated with a reduction in the risk of suicide (0.07, 95% CI 0.02-0.19; p<0.0001), as was encouraging help-seeking (0.39, 95% CI 0.19-0.80; p=0.0101); no studies assessed increasing the likelihood of intervention by a third party as a lone intervention. The key approaches that are currently used as interventions at suicide hotspots seem to be effective. Priority should be given to ongoing implementation and assessment of initiatives at suicide hotspots, not only to prevent so-called copycat events, but also because of the effect that suicides at these sites have on people who work at them, live near them, or frequent them for other reasons. National Health and Medical Research Council, Commonwealth Department of Health.

Does the installation of blue Lights on train platforms shift suicide to another station?: Evidence from Japan

BackgroundInstalling physical barriers at suicide hotspots is known as an effective strategy for suicide prevention. However, the effectiveness of physical barriers may be nullified by the substitution phenomenon, i.e., that restricting access to a particular place induces people at risk to look for a nearby place for suicide. MethodsThis study tests whether the substitution phenomenon exists in the case of railway and metro suicides. We focused on the prevention effort by a Japanese railway company that installed blue light-emitting-diode (LED) lamps on railway platforms to prevent people from diving to a running train. Using panel data of 71 train stations between 2000 and 2013, we compared the number of suicides before and after the installation of the blue lights at 14 stations where the lights were installed and at neighboring five stations on the same railway line, using the number of suicides at all other stations without the intervention as a control group. FindingsOur regression analysis shows that the introduction of blue lights decreased the number suicides by 74% (CI: 48–87%) at stations where the blue lights were installed, while it did not result in a systematic increase in the number of suicides at the neighboring stations. InterpretationThe installation of blue lights generated no systematic substitution phenomenon at nearby stations.

Preventing Suicide at Suicide Hotspots: A Case Study from Australia

The Gap Park Self-Harm Minimisation Masterplan project is a collaborative attempt to address jumping suicides at Sydney’s Gap Park through means restriction, encouraging help-seeking, and increasing the likelihood of third-party intervention. We used various data sources to describe the Masterplan project’s processes, impacts, and outcomes. There have been reductions in reported jumps and confirmed suicides, although the trends are not statistically significant. There has been a significant increase in police call-outs to intervene with suicidal people who have not yet reached the cliff’s edge. The collaborative nature of the Masterplan project and its multifaceted approach appear to be reaping benefits.

Characteristics of suicide hotspots on the Belgian railway network

In 2004, railway suicide accounted for 5.3% of all suicides in Belgium. In 2008, Infrabel (Manager of the Belgian Railway Infrastructure) introduced a railway suicide prevention programme, including identification of suicide hotspots, i.e., areas of the railway network with an elevated incidence of suicide. The study presents an analysis of 43 suicide hotspots based on Infrabel data collected during field visits and semi-structured interviews conducted in mental health facilities in the vicinity of the hotspots. Three major characteristics of the hotspots were accessibility, anonymity, and vicinity of a mental health institution. The interviews identified several risk and protective factors for railway suicide, including the training of staff, introduction of a suicide prevention policy, and the role of the media. In conclusion, a comprehensive railway suicide prevention programme should continuously safeguard and monitor hotspots, and should be embedded in a comprehensive suicide prevention programme in the community.

The effectiveness of structural interventions at suicide hotspots: a meta-analysis

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. We conducted a meta-analysis, pooling data from nine studies. Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question (95% CI 79% to 91%). There was a 44% increase in jumping suicides per year at nearby sites (95% CI 15% to 81%), but the net gain was a 28% reduction in all jumping suicides per year in the study cities (95% CI 13% to 40%). 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.

Interventions to reduce suicides at suicide hotspots: a systematic review.

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.MethodsWe searched Medline for studies that could inform the following question: ‘What interventions are available to reduce suicides at hotspots, and are they effective?’ResultsThere 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.ConclusionsMore well-designed intervention studies are needed to strengthen this evidence base.

Railway Suicide in Belgium 1998–2009

Belgium is a country with a high suicide rate (19.1/100,000 in 2004), and railway suicide poses a substantial safety and public health problem. This problem was addressed by the Suicide Prevention Unit of Infrabel (Manager of the Belgian Railway Infrastructure), which collects relevant data and implements a prevention program. To present data on fatal and nonfatal suicidal behavior on the Belgian railway network, including monthly and regional distribution and identification of hotspots; and to present the Infrabel suicide prevention program. Analysis of Infrabel data on railway suicide (1998-2009) and comparison with data on suicide in Belgium. A total of 1,092 railway suicides (1998-2009) and 557 suicide attempts (2003-2009) in Belgium (fatality rate of 54%) were studied. Monthly fluctuations were observed, with the majority of suicides occurring in Flanders, followed by Wallonia and Brussels. We identified 34 hotspots accounting for 35% of cases, mostly in Flanders. In 2004 railway suicide accounted for 5.3% of all suicides in Belgium (railway suicide rate of 1.03/100,000). Such a major human and economic loss warrants implementation of prevention measures. Infrabel has initiated a comprehensive suicide prevention program which focuses mainly on safeguarding the suicide hotspots.