A Suicide Barrier on a Bridge and Its Impact on Suicide Rates in Toronto: A Natural Experiment

8/9/2019 A Suicide Barrier on a Bridge and Its Impact on Suicide Rates in Toronto: A Natural Experiment

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Title:

A suicide barrier on a bridge and its impact on suicide rates in Toronto: a

natural experiment

Authors:

Mark Sinyor, resident physician1

, Anthony J Levitt, psychiatrist-in-chief2

1. Department of Psychiatry, University of Toronto. 250 College Street, Toronto, Canada, M5T

1R8.

2. Department of Psychiatry, Sunnybrook Health Sciences Centre and Womens College

H it l 2075 B i A T t C d M4N 3M5


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H it l 2075 B i A T t C d M4N 3M5

We thank Dr. James Edwards, Regional Supervising Coroner for Toronto East, and the entire

staff at the Office of the Chief Coroner of Ontario, including Dorothy Zwolakowski, June

Lindsell, Tina Baker and Karen Bridgman-Acker, without whom this research would not have

been possible. We further thank Dr. Ian Johnson and the Determinants of Community Health

course at the University of Toronto Medical School for facilitating the genesis of this project.

Finally, we thank Dr. Alex Kiss of the Department of Research Design and Biostatistics at

Sunnybrook Health Sciences Centre for performing some of the statistical analyses as well as Dr.

Donald Redelmeier, Director of the Clinical Epidemiology Unit at Sunnybrook Health Sciences

Centre and Dr. David Streiner, Senior Scientist at the Kunin-Lunenfeld Applied Research Unit at

Baycrest for their advice and counsel.

Contributors: MS developed the idea for this study. MS contributed to the design of the study,

analysed the data, interpreted the results, and drafted the manuscript. AJL contributed to the

design of the study, interpreted the results, and critically revised the manuscript. MS is guarantor.

Funding: This study did not receive funding.

Competing interests: All authors have completed the Unified Competing Interest form at


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All authors had full access to all of the data (including statistical reports and tables) in the study

and can take responsibility for the integrity of the data and the accuracy of the data analysis.

ABSTRACT

Objective To determine whether suicide rates in Toronto changed after a suicide barrier was

erected at the Bloor Street Viaduct, the bridge with the second highest yearly rate of suicide by

jumping in the world next to the Golden Gate Bridge in San Francisco.

Design A natural experiment.

Setting City of Toronto and Province of Ontario, Canada; records at the Office of the Chief

Coroner of Ontario from 1993-2001 (9 years pre-barrier) and from July 2003-June 2007 (4 years

post-barrier)

Participants Individuals who died by suicide in the city of Toronto and in the rest of the

Canadian Province of Ontario.

Main outcome measures Changes in yearly rates of suicide by jumping at the Bloor Street


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Conclusions Although the barrier prevented suicides at the Bloor Street Viaduct, there was no

change in the rate of suicide by jumping in Toronto. This lack of change in the overall rate of

suicide by jumping may have been due to a reciprocal increase in suicides from other bridges and

buildings. This suggests that the Bloor Street Viaduct was not a uniquely attractive location for

suicide and that suicide barriers on bridges like the Bloor Street Viaduct may not alter absolute

suicide rates by jumping when there are other comparable bridges nearby.

INTRODUCTION

It is well recognized that by restricting access to a means of suicide it may be possible to

delay or even prevent suicide among vulnerable individuals.1 This principle has been

demonstrated in the United Kingdom with successful programs to reduce suicides by switching

to carbon monoxide-free sources of gas,2 restricting package sizes of acetaminophen and

3 4 5


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Golden Gate Bridge in San Francisco, the suicide hotspot with the highest annual rate of suicide

by jumping in the world.10

In one study, four of six surviving jumpers said that they would not

have attempted suicide at any location other than the Golden Gate Bridge and all six favoured the

construction of a suicide barrier at the bridge.12 Another study of 515 individuals who had been

prevented from jumping from the Golden Gate Bridge found that only 6% of them had gone on

to suicide at a later time.13 Despite this evidence, a recent U.S. telephone survey found that 74%

of respondents believed that most or all individuals prevented from suicide by a barrier at the

Golden Gate Bridge would find another way to complete suicide.14 Several studies looking at the

introduction of suicide barriers at the Memorial Bridge in Augusta, Maine,15 and the Clifton

Suspension Bridge in Bristol, England16 as well as the introduction of a safety net at Muenster

Terrace in Bern, Switzerland17 found reductions in suicides at each of these locations (decreases

of 0.6/year, 4.2/year and 2.5/year respectively). Each article examined the change in rates of

suicides by jumping from nearby bridges and/or buildings and concluded that little, if any,

location substitution was occurring. However, these studies lack statistical power due to the

relatively small yearly decreases in suicides at each bridge as well as low rates of suicide in


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the dubious distinction of being the second most popular suicide bridge studied in the world

behind the Golden Gate Bridge.10

A suicide-prevention barrier was constructed at the Bloor

Street Viaduct between April 2002 and June 2003. The barrier is approximately 5 meters in

height and consists of thousands of thin steel rods spaced closely together supported externally

by an angled steel frame.20 It is not known whether the barrier has had any impact on Torontos

overall rate of suicides and on the rate of suicides by jumping. The current study aims to

examine coroners data, both pre-barrier and post-barrier, to determine if there has been any

change in suicide rates and whether or not people have substituted different locations or methods

for the Bloor Street Viaduct.

METHODS

Study design

Records at the Office of the Chief Coroner (OCC) of Ontario covering all suicides in Ontario


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All suicides in Ontario (excluding Toronto), all suicides in Toronto, suicides in Toronto by

jumping (where jumping implies from a height i.e. subway jumpers do not fall into this

category) and suicides in Toronto by means other than jumping. Charts were examined for all

Toronto suicides coded as fall/jump from height to determine whether the suicide was from a

bridge or a building. The name and location of the bridge from which the deceased jumped was

also obtained.

The barrier was under construction from April 2002-June 2003 (as per correspondence

between the OCC and Mike Laidlaw, one of the barriers engineers). Accordingly, the 9 years

from 1993-2001 were classified as pre-barrier and the 4 years from July 1, 2003-June 30, 2007

were classified as post-barrier. Postal codes of home residence for individuals who jumped to

their deaths from bridges were obtained for 1999-2001 and July 1, 2003-June 30, 2007 to

determine if there was any change in the region from which they came.

Census data was also obtained from Statistics Canada for the years 1996, 2001 and 2006 to

determine the population of Ontario and Toronto.21 These data were used to correct suicide rates


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Poisson regression analyses were conducted to examine differences between pre-barrier

and post-barrier suicide rates. Demographic data were analyzed using two-tailed, independent

sample t tests for continuous variables and 2-sided chi-squared tests for categorical variables.

Postal code data were analyzed using a 1-sided chi-squared test with the hypothesis that more

individuals would travel from outside the city limits to die by suicide at the Bloor Street Viaduct

(pre-barrier) than at other bridges in the post-barrier period. Statistical significance was set at

p=.05.

RESULTS

Suicide Rates

Rates of suicide by jumping in Toronto were statistically identical pre- and post-barrier

(56.4/year vs. 56.6/year, p=0.95) (Table 1)(Figure 1). There were 9.3 suicides/year from the


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253.4/year vs. 225.4/year, p=0.05; Toronto suicides by other means: 197.0/year vs. 168.8/year

p=0.04). The decrease in overall rate of suicide in Toronto bordered on statistical significance

while the decrease in the rate of suicides by other means was significant. The overall rate of

suicides in Ontario (excluding Toronto) also decreased significantly in the post-barrier period

(836.4/year vs. 752.5/year p=0.01).

Demographics

People who died by suicide by other means post-barrier in Toronto were older than those

who did so in the pre-barrier period (48.0 vs. 45.8 yrs, p


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To demonstrate that the Bloor Street Viaduct suicide barrier achieved the aims of its

advocates, one has to show that it prevented suicides at that location and that there were no

reciprocal increases in suicides by jumping at other locations or by other means. Based on the

first criterion, the barrier was a resounding success with no suicides there in the post-barrier

period of July 2003- June 2007. Clearly something about the barriers architectural design, its

aesthetic and/or the publicity surrounding its construction was sufficient to dissuade individuals

considering suicide at the Bloor Street Viaduct. This result is in keeping with previous work

showing that barriers help to prevent suicides at the location where they are placed.15-18,22-23 The

overall rate of suicide in Ontario decreased significantly in the post-barrier period. A similar

trend was observed in Toronto with a decrease in the overall suicide rate which bordered on

significance. This decrease in Torontos overall suicide rate of 28 suicides/year was

accompanied by a statistically significant decrease of the same number of suicides/year by means

other than jumping. There was no reduction in the yearly rate of suicide by jumping in Toronto.

Indeed, suicides from other bridges in Toronto showed a statistically significant increase of 5.5

suicides/year post-barrier (a 63% increase from the pre-barrier rate of 8.7 suicides/year).


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substitution. As mentioned, no study of a suicide barrier has been able to demonstrate a

statistically significant drop in overall suicide rates in the vicinity. Of note, a study of the

removalof a suicide barrier on the Grafton Bridge in Auckland, New Zealand found that suicides

there increased significantly. However, suicides by jumping from other locations decreased by

the same number resulting in an unchanged total rate of suicide by jumping. 22 As mentioned, the

suggestion that suicide barriers on bridges would be effective comes from studies conducted in

San Francisco, however these studies examined individuals who had either jumped from the

Golden Gate Bridge and survived12 or those who had contemplated suicide or made a suicidal

gesture there and had thereby come to the attention of the police or an emergency room.13 These

two groups may be qualitatively different from individuals who have been prevented from

jumping at a location due to a physical barrier alone. Though some have argued that bridge

barriers are effective suicide prevention tools,24 the evidence in the literature in favour of such

barriers reducing absolute rates of suicide when there are other available buildings or bridges is

weak, in part due to the scarcity of bridges with pre-barrier suicide rates of sufficient magnitude

to make statistical calculations plausible.


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The evidence presented here demonstrates that the Bloor Street Viaduct, despite being the second

most popular bridge for suicide, was a relatively weak magnet. There are a number of factors

that might make a bridge a stronger magnet. Ease of pedestrian access, perceived lethality of a

jump off the bridge and unique geographical features such as a bridge over water might all be

important factors which might influence an individuals preference for one bridge over another.

The Bloor Street Viaduct is easily accessed, jumps from the bridge are highly lethal and it is over

major highways. However, there are numerous other bridges in Toronto which fit this

description. Another consideration would be the bridges aesthetic and that of the surrounding

environment. While the Bloor Street Viaduct was likely viewed as an impressive structure when

completed in 1918, it is not aesthetically grand by 21st century standards and there are nearby

bridges of similar scale and that afford a similar view. A final consideration is the notoriety of

the bridge. While the Bloor Street Viaduct is a sufficiently notorious suicide location to have

become a minor pop culture reference, notably being featured in a song by the Barenaked

Ladies25 and a book by Michael Ondaatje26, it is not a cultural icon like the Golden Gate Bridge.

Images and news about the Bloor Street Viaduct are not ubiquitous in Toronto in comparison to


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compared to only 38% of individuals who died by jumping from a nearby bridge.27 However,

this pattern was not observed with the Bloor Street Viaduct. Indeed, postal code data show that

significantly more people traveled from outside the city limits to jump from other bridges in the

post-barrier period than to jump from the Bloor Street Viaduct in the pre-barrier period

(p=0.049).

A third explanation is that the Bloor Street Viaduct suicide barrier could have decreased

rates of suicide by jumping under different circumstances. It is important to note that the barrier

was a standalone intervention. It has been argued that optimal suicide prevention programs

involve comprehensive strategies to provide education, combat stigma and improve accessibility

of services to individuals contemplating suicide.28 It is unclear whether a different result would

have been observed if the Bloor Street Viaduct suicide barrier had been part of a more

comprehensive suicide prevention program for suicide by jumping in Toronto. Furthermore, at

least one prominent newspaper article published shortly after the barriers construction

speculated that it did not prevent suicides because individuals were jumping at other locations.29

I S t b 2003 th ti l t d th t i di id l h d t l t d i id t th Bl


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Bloor Street Viaduct during the study (19 suicides) were 1998 and 2002, the year in which the

coroners inquest into suicide at the Bloor Street Viaduct occurred and the year in which the

barrier was constructed respectively. This suggests that, at least in those instances, publicity may

have influenced patterns of suicide by jumping in Toronto.

Whether the Bloor Street Viaduct suicide barrier has had an impact on factors other

than rates of completed suicide is outside the scope of this research. Nonetheless, it is important

to note that there may be other reasons why one might want to prevent suicides at a particular

location. Several of the charts reviewed for this study noted vehicular trauma to the bodies of the

deceased. This underscores the fact that there may be social consequences to people jumping

onto busy highways including psychological or physical morbidity as well as mortality risk to

bystanders as a result of motor vehicle collisions, damage to property, disruption to travel

networks and impact on the economy. By eliminating all suicides at the Bloor Street Viaduct in

the post-barrier period, the suicide barrier prevented such negative social consequences from

occurring at that location. However, it may be that there was an increase in similar negative

outcomes at other bridges and buildings where suicides increased.


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the Bloor Street Viaduct (median age 36, 79% male) were similar to data recently reported for

Golden Gate Bridge jumpers (median age 40, 74% male).21

However, as in any natural

experiment, this research comes with many uncontrolled variables. First, despite the relatively

high rate of suicides by jumping at this site, the absolute numbers may have been too low to

achieve adequate power in a study of this kind. Second, despite the relative comprehensiveness

of the OCC records, it is possible that suicide rates by all causes were over-estimated and/or

under-estimated in the pre-barrier and/or post-barrier period due to incompleteness or inaccuracy

of records kept by the OCC. Third, there is the possibility of bias in the OCC records because

deceased individuals found beneath certain bridges or indeed after falling from any bridge or

building may be more likely to have been ruled as having died by suicide than by other causes

such as misadventure, homicide or accidental death. Finally, it is also possible that an ecological

fallacy is operating. Suicide in itself is a rare event and suicides by jumping are uncommon to an

even greater extent. Despite the remarkably stable number of suicides by jumping in Toronto

pre-barrier, one cannot discount the possibility that rates of suicide at other bridges increased

post-barrier for reasons other than location substitution. These might include chance fluctuations


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statistically significant rise in suicides by jumping from other bridges and a non-significant rise

in suicides by jumping from buildings. This suggests that the availability of the Bloor Street

Viaduct was not an essential element for suicide among individuals contemplating suicide by

jumping in Toronto. The authors speculate that a different result may be observed if a bridge

holds a more powerful influence on suicidal individuals. This may be the case for the Golden

Gate Bridge in San Francisco for example, though further evidence is needed. A safety net

might be installed at the Golden Gate Bridge in the near future,24 so it may be possible to

undertake research similar to the present study in San Francisco. However, there may be greater

logistical challenges since the major bridges in San Francisco are over water making it more

difficult to obtain accurate suicide counts. This research demonstrates that constructing a suicide

barrier on a bridge with a high pre-barrier rate of suicide by jumping is likely to dramatically

reduce or eliminate suicides at that bridge but that it may not alter absolute suicide rates by

jumping when there are other comparable bridges nearby.


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WHAT THIS STUDY ADDS

There were no suicides at the Bloor Street Viaduct in Toronto, previously the bridge with the

second highest yearly rate of suicide next to the Golden Gate Bridge, after a barrier was

erected.

Suicide rates were unchanged due to a corresponding increase in jumps from other bridges

and buildings in the area.

This suggests that barriers may not decrease suicide rates when other, similar jumping

locations are available though we speculate that the Golden Gate Bridge might be an

exception given evidence that it holds a special meaning for some individuals contemplating

suicide.

REFERENCES


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14.Miller M, Azrael D, Hemenway D. Belief in the inevitability of suicide: results from a

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16.Bennewith O, Nowers M, Gunnell D. Effect of barriers on the Clifton suspension bridge,

England, on local patterns of suicide: Implications for prevention.British Journal of

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17.Reisch T, Michel K. Securing a Suicide Hot Spot: Effects of a Safely Net at the Bern

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18.Glenn WM. The Magnet and the Veil. MD Canada 2003; May/June:36-42.

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20.The Luminous Veil Prince Edward Viaduct Safety Barriers. University of Waterloo

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http://www.architecture.uwaterloo.ca/faculty_projects/terri/steel/veil.html)
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24. Blaustein M, Fleming A. Suicide from the Golden Gate Bridge. American Journal of

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25. Barenaked Ladies. War on drugs. In: Everything to Everyone. Reprise Records, 2003.

26. Ondaatje M. In the skin of a lion. Vintage Canada, 1996.

27. Cantor CH, Hill MA. Suicide from river bridges. Aust N Z J Psychiatry 1990;24(3):377-

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28. Cole-King A, Lepping P. Suicide mitigation: time for a more realistic approach. BJGP.

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29. Harding K. The new suicide bridge. The Globe and Mail. September 6, 2003:M1.
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Table 1. Poisson Regression Analysis of Yearly Suicide Rates by Jumping and by Other Means in Ontario and Toronto Pre-Barrier

(1993-2001) and Post-Barrier (July 2003-June 2007).

Subgroup Suicides Pre-barrier

Mean Number Per Year

Suicides Post-barrier

Mean Number Per Year

Regression

Coefficient

Standard

Error

p IRR (95% Cl)

Observed Corrected* Observed Corrected*

Ontario (excluding Toronto) 880.1 836.4 887.5 752.5 -0.11 0.04 0.01 0.90 (0.83 to 0.98)

Toronto (total) 261.2 253.4 241.8 225.4 -0.12 0.06 0.05 0.89 (0.79 to 1.00)

Jumping 58.2 56.4 60.8 56.6 0.00 0.08 0.95 1.00 (0.87 to 1.17)

Building 39.7 38.5 45.8 42.7 0.10 0.10 0.32 1.11 (0.90 to 1.36)

Bridge 18.6 17.9 15.3 14.2 -0.23 0.19 0.22 0.79 (0.55 to 1.15)

Bloor Street Viaduct 9.6 9.3 0 0 -2.92 0.89


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22


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Table 2. Demographic Characteristics of Individuals Who Died by Suicide by Jumping and by Other Means in Toronto Pre-Barrier

(1993-2001) and Post-Barrier (July 2003-June 2007)

Suicides by Jumping

Building

A

Suicide by Jumping

Bloor Street Viaduct

B

Suicide by

Jumping Other

Bridges

C

Suicide by Other

Means (Non-

Jumping)

D

Statistical

Comparison

Across Rows*

Pre-barrier Mean Age in Years (SD) 43.5 (18) 38.1 (12.5) 38.6 (15.6) 45.8 (17.4) D>A>B=C

Post-barrier Mean Age in Years (SD) 45.8 (17.8) - 38.5 (13.6) 48.0 (17.2) D=A>C

Pre-barrier vs. Post-barrier comparison* Non significant Non significant Significant

Pre-barrier Number of Males (%) 357 (59.4) 86 (79.3) 81 (78.5) 1827 (70.7) B=C>D>A

Post-barrier Number of Males (%) 183 (64.5) - 61 (72.1) 723 (70.1) C=D=A

Pre-barrier vs. Post-barrier comparison* Non significant - Non significant Non significant

*Significant if p


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Location of Residence Pre-barrier

N=57

Post-barrier

N=61

Suicide by jumping from

other bridges

N (% post-barrier)


Bloor Street Viaduct

N (% pre-barrier)


other bridges

N (% pre-barrier)

Toronto 17 (29.8%) 23 (40.4%) 41 (67.2%)

Suburbs or Beyond 2 (3.5%) 0 (0%) 9 (14.8%)

No Fixed Address/Unknown 4 (7.0%) 11 (19.3%) 11 (18.0%)

*Postal codes were only available for this analysis from 1999 onwards

More individuals travelled from outside the city limits in the post-barrier period, chi-squared=3.8, df=1, p=0.049

24


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Figure 1: Toronto Suicides by Jumping and by Other Means Pre-

Barrier (1993-2001) and Post-Barrier (July 2003 - June 2007)*

0

50

100

150

200

250

19921994 1996 1998 2000 20022004 2006 2008

Year

#ofsuicid

es

Other means

Jumping

25


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*Corrected per capita to suicides per 1993 population; not age-standardized

26


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Figure 2: Toronto Suicides by Jumping from the Bloor Street

Viaduct and Other Bridges Pre-Barrier (1993-2001) and Post-

Barrier (July 2003 - June 2007)*

0

5

10

15

20

25

1992 199419961998 2000 2002 2004 2006 2008

Year

#o

fsuicides

Bloor StreetViaduct

Other Bridges

*Corrected per capita to suicides per 1993 population; not age-standardized

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A Suicide Barrier on a Bridge and Its Impact on Suicide Rates in Toronto: A Natural Experiment