Abstract

Suicide deaths are tragic events and those that occur in public places have an impact not only on the deceased person and their family and friends, but also on members of the public. Having up-to-date information about the effectiveness of interventions allows policymakers and organisations managing locations of concern to choose the most appropriate evidence-based suicide prevention strategies for specific locations. This rapid review was conducted to help inform the development of Welsh national guidance.

The review included literature published since 2014. 24 studies were identified, and these were conducted in the UK, Australia, South Korea, Canada, USA, Denmark and Japan. The studies covered railway or underground stations, bridges, cliffs or other natural heights, tall buildings, and other types of locations.

Surveillance technologies as a means of increasing opportunity for third-party intervention showed the most promise, although the evidence of their effectiveness was limited. In one study, having more closed-circuit television (CCTV) units was associated with fewer suicides at railway stations. Another study that tested a set of interventions including CCTV, infrared security fences, and a suicidal behaviour recognition and alert system, provided some promising initial descriptive data that showed an increase in the number of prevented suicides. Three other studies showed that there was no change in outcomes following the installation of interventions including surveillance technologies. Based on the assessment of the overall body of the evidence, there is a low level of confidence in the findings related to surveillance technologies because of the quality and designs of the studies.

Promotion of suicide helplines as an intervention aimed at increasing opportunities for help seeking was examined in seven studies. Two studies reported that the number of suicides increased after the introduction of the intervention. Three studies, of which two examined a set of interventions including helplines, observed no change. In two studies the effect could not be determined. There is a low level of confidence in the evidence for this outcome.

Other interventions evaluated included staff training; deployment of specialist staff; campaigns encouraging bystanders to intervene; a crisis café; blue lights at railway stations; suicide prevention messages, memorials, or notes other than official crisis line signage; spinning rollers at the top of fences that prevent gripping; and others. The effect of these interventions could not be determined with certainty but some of them appeared promising and warrant further research.

More robust evaluations are needed before any of the interventions reviewed here can be recommended for implementation. To create a better evidence base, high-quality evaluations should be supported and encouraged. Future research should examine which interventions work for who and in what circumstances.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Footnotes

Funding statement The authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.

Data Availability

All data produced in the present study are available upon reasonable request to the authors

ABBREVIATIONSAbbreviationFull descriptionAIArtificial intelligenceAPCAnnual percentage changeCCTVClosed-circuit televisionEAPCEstimated annual percentage changeGRADEGrading of Recommendations, Assessment, Development and EvaluationIMVIntegrated motivational volitionalMedMedianN/ANot applicableRRRapid reviewVIDSVideo Incident Detection SystemGLOSSARYAcademic literatureis literature published in peer-reviewed academic journals.Grey literatureis literature published outside of academic journals, for example, reports by government organisations, charities, research institutes etc.Pre-printis a version of an academic article that has been published online that has not yet been published in a journal. Pre-prints are usually not peer-reviewed.Publication biasis the trend for studies that report positive/statistically significant findings or findings that are perceived to be important to be more likely to be published or published quickly. It can be minimised by searching grey literature.Qualitative researchis research that uses non-numeric data such as people’s views, for example, findings from interviews or focus groups.Quantitative researchis research that uses numbers or statistical data.Confounding factoris a factor that interferes in the relationship between the intervention and the outcome.