Effectiveness of physical barriers to prevent suicide by jumping from high-risk bridges: From an integrative review to a northern Italian province's paradigm.

Background: Although uncommon, suicide by jumping is almost always lethal and can be significantly elevated locally due to the availability of tall structures including bridges and other high-risk locations. Empirical evidence suggests that restricting access to certain suicide methods is highly effective at preventing suicide, prompting the construction of physical barriers in many high-risk jumping locations. However, some have argued that these measures are too costly and only lead to method or location substitution. Objectives: To examine whether physical barriers are effective at preventing suicide by jumping or whether method or location substitution occur. Methods: An integrative review of the most representative literature. Results: Results clearly show that physical barriers are highly effective at preventing suicide by jumping with little to no method or location substitution occurring. Furthermore, their cost is far outweighed by the monetary benefits of averted suicides. Conclusions: Using the Italian pre-alpine/alpine areas as a paradigm, we argue that local topography and socioeconomic particularities led to significantly elevated rates of suicide in general, and of suicide by jumping from bridges in particular, especially among young adults who are more vulnerable to economic crises and show elevated susceptibility to impulsive acts, a known characteristic associated with suicide by jumping, which makes the issue even more topical and clinically relevant. As these finding are easily generalized to other territories with similar topographical and/or economic characteristics, we end with a call to action, urging local authorities to heed the scientific evidence and take the necessary steps to improve suicide prevention.