Title:

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

Authors:Mark Sinyor, resident physician

, Anthony J Levitt, psychiatrist-in-chief

1. Department of Psychiatry, University of Toronto. 250 College Street, Toronto, Canada, M5T1R8.2. Department of Psychiatry, Sunnybrook Health Sciences Centre and Women’s CollegeHospital. 2075 Bayview Avenue, Toronto, Canada, M4N 3M5.Correspondence to M Sinyor 2075 Bayview Avenue, Toronto, Canada, M4N 3M5, Tel.:416-480-4089; Fax:416-480-6878; E-mail:mark.sinyor@utoronto.caThe Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in BMJ editions and any other BMJPGL productsand sublicences such use and exploit all subsidiary rights, as set out in our licence.

We thank Dr. James Edwards, Regional Supervising Coroner for Toronto East, and the entirestaff at the Office of the Chief Coroner of Ontario, including Dorothy Zwolakowski, JuneLindsell, 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 Healthcourse 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 atSunnybrook 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 SciencesCentre and Dr. David Streiner, Senior Scientist at the Kunin-Lunenfeld Applied Research Unit atBaycrest 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 thedesign 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 atwww.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) anddeclare that: MS reports no competing interests. AJL has acted as a consultant for JanssenOrtho, Biovail Corp, and Eli Lilly Canada.

Ethical Approval:

This study was approved by the Research Ethics Board at the University of Toronto, Toronto Canada.

Data sharing:

No additional data available.

All authors had full access to all of the data (including statistical reports and tables) in the studyand can take responsibility for the integrity of the data and the accuracy of the data analysis.

ABSTRACTObjective

To determine whether suicide rates in Toronto changed after a suicide barrier waserected 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 theCanadian Province of Ontario.

Main outcome measures

Changes in yearly rates of suicide by jumping at the Bloor StreetViaduct, other bridges, buildings and by other means.

Results

Yearly rates of suicide by jumping in Toronto were unchanged between the pre-barrier and post-barrier periods (56.4/year vs. 56.6/year, p=0.95). There were 9.3 suicides/year at theBloor Street Viaduct pre-barrier and none post-barrier (p<0.01). Rates of suicide by jumpingfrom other bridges and buildings were higher in the post-barrier period though only former resultwas statistically significant (other bridges: 8.7/year vs. 14.2/year, p=0.01; buildings: 38.5/year vs. 42.7/year, p=0.32).