***IN CRISIS? CALL 1-800-273-TALK (8255)***
Since its construction, 55 people have died at Cold Spring Arch Bridge. Eight people died in 2009 alone. These deaths could have been prevented by the installation of a safety barrier.
Cold Spring Arch Bridge has the highest concentration of highway fatalities in Santa Barbara County, according to data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System.
On October 16, 2008, the Board of Directors of the Santa Barbara County Association of Governments voted unanimously in support of a proposed Caltrans project to install a safety barrier along the Cold Spring Bridge. This project has the support of the Glendon Association, the Santa Barbara County Sheriff's Department, the California Highway Patrol, Santa Barbara County Supervisor Brooks Firestone, Assemblymember Pedro Nava, and the Family Service Agency, as well as the leading national organizations dedicated to suicide prevention.
Details of this project,
including the final environmental impact report, may be found at the Caltrans website:
NEWS AND UPDATES
- DO YOU NEED HELP? If you are in crisis and contemplating suicide by any means, please call 1-800-273-TALK (8255). The National Suicide Prevention Lifeline is there to help. Your loved ones want you to live. Make the call.
- CONSTRUCTION TO RESUME! Santa Barbara Superior Court judge Thomas Anderle discharged the mandate suspending construction of the barrier following Caltrans' circulation of a supplemental environmental impact report. Construction of the barrier is expected to resume this summer. Sincere thanks to Caltrans and to all who wrote in support of the SEIR for bringing us one step closer to completing this life-saving project. Please continue to support the construction of a safety barrier to prevent suicides by jumping. Sign the online petition and write letters of support to Caltrans and local government representatives.
- Another death A 34-year-old man died at the bridge on February 19. Our hearts go out to his family and friends.
- A mother's words in support of the barrier Sally Hughes's recent article in the Santa Barbara Independent ('Safe Passage Over the Canyon: The Cold Spring Bridge Suicide Barrier Will Save Lives') is a powerful and eloquent argument in favor of the barrier by a mother who lost her son to suicide. Many thanks to Ms. Hughes for her courageous and invaluable contribution to the barrier debate.
- Another death in 2010 A 52-year-old man died at the bridge just days after the ruling to suspend construction of the safety barrier. Our thoughts are with his family and friends.
- Barrier construction contract awarded! The contract to build the proposed safety barrier at Cold Spring Bridge has been awarded to Bugler Construction in Pleasanton, CA. Construction is expected to begin in early May. We extend our sincerest thanks to Caltrans and SBCAG for moving this project forward, and we applaud the efforts of all those who continue to support the barrier.
- Another preventable tragedy A man died at the bridge on March 10. His family and friends are in our thoughts.
- Seven deaths in 2009 A man died at the bridge on October 27. Our thoughts go out to his loved ones during this difficult time. The tragic history of this bridge and its devastating effects on members of the community cannot be allowed to continue.
- Three deaths in two weeks A 26-year-old man died at the bridge on October 13. We extend our sympathy and condolences to his family and friends.
- Fifth death in 2009 A 59-year-old woman died at the bridge on October 8. Her friends and loved ones are in our thoughts.
- Another tragedy at the bridge A 28-year-old man died at the bridge on September 30. Our thoughts are with his family and friends.
- Third death this year A 39-year-old man died at the bridge on June 3. We extend our sincerest sympathy to his family and friends.
- Harvard School of Public Health campaigns for means restriction The Means Matter campaign, established at the Harvard School of Public Health's Injury Research Center, aims to increase the proportion of suicide prevention groups who promote activities that reduce a suicidal person's access to lethal means of suicide. This includes endorsing the construction of suicide prevention barriers on bridges as well as limiting access other highly lethal suicide methods such as firearms. The Means Matter website provides detailed information about the effective implementation of means restriction for families and loved ones of potential suicide victims as well as clinicians and suicide prevention organizations. Please join us in supporting the Means Matter campaign in its efforts to save lives.
- Another lost loved one A 45-year-old woman died at the bridge on April 4. Those who were close to her are in our thoughts. Please help stop the tragic loss of life at Cold Spring Arch Bridge, and the suffering of friends and loved ones.
- APA President advocates bridge barriers In the April 3 issue of Psychiatric News, President of the American Psychiatric Association Nada Stotland, M.D., Ph.D., promotes the construction of barriers on bridges to prevent suicides by jumping. The APA chose not to use images of the Golden Gate Bridge on posters and programs for its annual meeting, to be held in San Francisco in May, because of the status of the bridge as a suicide hotspot. Stotland writes: "Let us use the largest psychiatric meeting in the world – ours – to advocate for suicide 'means restriction' at the Golden Gate Bridge and throughout the world."
- 2009 brings another death A man jumped from Cold Spring Arch Bridge on January 5. Our thoughts are with his family and friends during this difficult time.
- Another tragic death On November 6, a 56-year-old man jumped to his death from Cold Spring Arch Bridge. We extend our deepest sympathy to his family and friends.
- Triumph over tragedy! At the public hearing in Santa Barbara on 16 October, the SBCAG Board of Directors voted unanimously to support the Cold Spring Bridge safety barrier project. The outstanding presentations by the Glendon Association, the Santa Barbara County Sheriff's Department, and 26 members of the public, as well as the many letters of support sent to board members and the signatures and comments on the online petition, helped to make this outcome a reality. Many thanks to all who contributed, and to Chairman Brooks Firestone and the SBCAG board for your support; your actions will make a real difference in the lives of others.
- Petition: A copy of the petition was given to all members of the SBCAG Board of Directors in advance of the public hearing. We have collected over 600 signatures so far, and the petition will remain online until the construction of the barrier has been completed for those who wish to show their support. Many thanks to those who have already signed. Please continue to circulate the details to others who want to help.
- The Glendon Association website has a comprehensive set of research articles on the effectiveness of safety barriers and other means restriction methods in preventing suicides, downloadable in PDF format. Please consult this excellent resource and read the experimental evidence in its original form. Special thanks to Dr. Lisa Firestone and the Glendon Association for all of their efforts in support of the Cold Spring Bridge barrier project.
- An article published in the New York Times Magazine reports interviews with survivors of attempted suicides by jumping, and reviews the evidence in favor of means restriction.
- Triumph over tragedy at the Golden Gate Bridge: Managers vote to erect net to prevent suicides by jumping (New York Times, October 10 2008; Los Angeles Times, October 11 2008)
The following facts support the construction of a physical safety barrier on the Cold Spring Arch Bridge:
√ Construction of a physical barrier is the only proven method for the prevention of suicide by jumping.
• Numerous research studies have demonstrated that the installation of barriers significantly reduces or eliminates deaths by suicide at a particular location (Beautrais, 2007; Bennewith et al., 2007; O’Carroll & Silverman, 1994; Pelletier, 2007).
• No scientific evaluation of the effectiveness of alternative strategies such as human barriers – including the use of call boxes, video monitoring, or on-site patrols – has been carried out.
• The leading mental health organizations dedicated to suicide prevention support the construction of physical barriers on bridges to stop suicidal jumpers.
√ Suicide is not inevitable in individuals with suicidal thoughts.
• Depression is a serious illness that results in irrational, impulsive behavior in the short term (Mann, 2003; Nock et al, 2008); suicide attempts are often immediately precipitated by stressful life events (Brent et al., 1993; Nock et al., 2008; Phillips et al., 2002; Vijayakumar & Rajkumar, 1999).
• The overwhelming majority (about 90%) of individuals who survive suicide attempts or are prevented from completing suicide do not commit suicide subsequently (Seiden, 1978).
• Individuals who are prevented from committing suicide by jumping have a lower rate of subsequent completed suicide than individuals who attempt suicide by other means (Seiden, 1978).
√ Allowing suicides to continue at the bridge has real human costs.
• A local historic landmark has become a monument to tragedy and grief.
• Law enforcement, safety, and search and rescue personnel are unnecessarily diverted from other emergencies and placed in potentially hazardous situations, at the expense of taxpayers, when responding to suicides and suicide attempts at this location.
• Individuals who have died at the bridge are not statistics, but people; the importance of these individuals to their families, friends, and communities, and their contribution to the quality of life in the local area, cannot be overestimated.
o Example: Matt Aydelott, who died at the bridge on September 8, 2008, was a teacher at a local community college who developed educational and career opportunities for young people and initiated a workplace readiness program for underserved, high-risk students. His death represents an incalculable loss to the young people of California, as well as to those who knew and loved him.
• Continuing to allow preventable deaths to occur at this location is unethical and violates the public safety provision of the state constitution.
√ As the debate over a barrier goes on, lives are lost.
• Suicide prevention strategies, including the construction of a physical barrier, have been under discussion since at least November 2005. In the intervening period, debate about the barrier has brought additional media attention to the site as a highly lethal means of suicide.
• Since August 2008, as the debate has continued, no action has been taken to prevent suicides at Cold Spring Bridge, and further preventable deaths have occurred.
RESPONSE TO OBJECTIONS
Opponents of the proposed project, including the so-called “Friends of the Bridge” organization, have raised a number of objections to the safety barrier based on false or misleading information. These objections and their implications are addressed below.
x The Cold Spring Bridge barrier project diverts funds from the Highway 101 widening project.
• This is FALSE. There is sufficient funding for both projects. The funds for the two projects come from different sources.
x There is a lack of statistical evidence that suicide barriers save lives; therefore, suicide barriers do not save lives.
• This type of claim is called accepting the null hypothesis, and it reflects flawed statistical reasoning; it is equally legitimate to argue that there is no evidence that suicide barriers don’t save lives.
• Studies evaluating the effectiveness of safety barriers in the prevention of bridge suicides reveal no increase in suicides by jumping at other nearby locations following the installation of barriers (Beautrais, 2007; Bennewith et al., 2007; O’Carroll & Silverman, 1994; Pelletier, 2007),
• In a number of studies that have directly examined the overall suicide rate in a surrounding area following installation of a barrier at a particular location, the data show a decrease in suicides (by any method, including jumping at other locations), although this decrease does not reach statistical significance (e.g., Bennewith et al., 2007).
• As jumping as a method of suicide is relatively uncommon, failure to obtain statistical significance may simply be due to a lack of power, i.e., to the variance in the overall number of suicides over time (the change in number of suicides from one time interval to the next) being greater than the number of suicides by jumping in a given time interval.
x Other suicide methods are available; therefore it is acceptable not to prevent suicides by this method using the only means that has been proven effective.
• This claim implies that all suicide methods are equally lethal; in fact, jumps from the Cold Spring Bridge have a case fatality rate to date of 100% – far greater than other methods (average case fatality rate for all methods of suicide: 12%; Elnour & Harrison, 2008), meaning that lives could be saved, even if method substitution did occur.
• The method substitution argument ignores the selective nature of suicidal ideation in those who jump (many suicidal jumpers focus on a particular location, e.g., individuals who have driven across the Bay Bridge to commit suicide at the Golden Gate Bridge; Friend, 2003), and is not supported by statistical evidence.
• Most importantly, this argument ignores the human cost of suicide, and the ethical responsibility of a society to protect its citizens in the most effective way possible.
x Suicidal individuals do not deserve our protection, as they have made a choice to end their lives.
• “Choice” implies a reasoned decision made by a healthy person in a rational state of mind. Depression is an illness with a biological basis, which impairs rational decision-making and is associated with impulsive behavior.
• Evidence for the impulsivity of suicide by jumping comes from Seiden (1978), who measured subsequent attempts in a 25-year period following averted suicide attempts by jumping or other means. Suicidal jumpers were less likely to commit suicide at a later time than individuals who had attempted suicide by other means.
• As a society we have a responsibility to protect the safety of the individual, including (and perhaps especially) those made vulnerable by illness, using the most effective means at our disposal. The right of every individual to safety and the obligation of local government to offer such protection are clearly identified in the state constitution of California:
o Article 1, Section 1: All people are by nature free and independent and have inalienable rights. Among these are enjoying and defending life and liberty, acquiring, possessing, and protecting property, and pursuing and obtaining safety, happiness, and privacy.
o Article 13, Section 35: The protection of the public safety is the first responsibility of local government and local officials have an obligation to give priority to the provision of adequate public safety services.
x Cold Spring Arch Bridge is “not a suicide hotspot.”
• The definition of a “suicide hotspot” provided by the National Initiative for Mental Health in England is as follows:
o “A specific, usually public, site which is frequently used as a location for suicide and which provides either means or opportunity for suicide (e.g., a particular bridge from which individuals frequently jump to their deaths).”
• Cold Spring Bridge is a public site that has served as a consistent and predictable location for suicides for 46 years, resulting in a substantial loss of life in the local community. More deaths have occurred at Cold Spring Bridge than at any other single location in the Caltrans District 5 area during this time period (Caltrans DEIR, 2008). An analysis of traffic fatalities from 1994 to 2008 reveals that no single mile of highway in all of Santa Barbara County is associated with a higher annual fatality rate than Cold Spring Bridge (Fatality Analysis Reporting System, National Highway Traffic Safety Administration). The bridge has earned its reputation as a "suicide hotspot."
• Approximately 2.4% of all suicides in Santa Barbara County each year are the result of jumps from Cold Spring Bridge, which is consistent with the overall frequency of jumping as a means of suicide in the wider population (less than 4% of all suicides in the United States; Marzuk et al., 1992).
• Statistics citing a greater absolute number of suicides from other bridges in California are misleading, as they do not take into account the population of the surrounding area (e.g., six suicides per year at Coronado Bridge in San Diego County, population approx. 3.1 million, vs. one suicide per year at Cold Spring Arch Bridge in Santa Barbara County, population approx. 425,000).
• Defining “hotspot” in terms of the Golden Gate Bridge, a world-famous landmark and tourist attraction which is arguably the most popular location for suicide by jumping in the world, is disingenuous and invalid.
x Expert opinion does not explicitly support physical barriers as an effective means of suicide prevention.
• In a joint statement, the American Association for Geriatric Psychiatry, the American Association of Suicidology, the American Foundation for Suicide Prevention, the American Psychiatric Association, Families for Depression Awareness, Mental Health America, Suicide Awareness Voices of Education, and Suicide Prevention Action Network USA, make the following declaration:
o “As leading organizations dedicated to preventing suicide and ending the stigma of mental illness, we support restricting the means of access by which people die by suicide as a vital and effective approach for saving lives. This includes the construction of suicide prevention barriers on bridges such as those being considered for the Golden Gate Bridge. Numerous scientific studies examining the effectiveness of bridge barriers and other means restrictions support this position.”
• The following organizations have explicit policies supporting the construction of barriers on bridges to prevent suicides:
o American Foundation for Suicide Prevention: “According to AFSP-funded research and additional studies worldwide, prevention barriers on bridges have been effective at reducing suicide. Since suicide by jumping tends to be more impulsive in nature than some other methods of suicide, barriers help prevent suicide by providing suicidal individuals the time needed to change their minds, and to seek the treatment that might save their lives. AFSP supports the construction of barriers.”
o National Suicide Prevention Lifeline: “The Lifeline Steering Committee position is that the use of bridge barriers is the most effective means of bridge suicide prevention.”
o American Association of Suicidology
• The National Suicide Prevention Lifeline policy statement on bridge barriers may be found here.
x Human barriers are more effective than physical barriers.
• As noted above, a physical barrier is the only method that has been shown empirically to be effective for preventing suicides by jumping at a particular location.
• Restricting the availability of highly lethal means of suicide is the most effective method for reducing the overall suicide rate on a large scale (Hawton & Heeringen, 2000).
• Physical barriers restrict the availability of jumping as a means of suicide, either by deterring or thwarting suicide attempts by making these attempts physically difficult or impossible, or by increasing the amount of time and effort required to complete an attempt, thereby giving law enforcement and safety personnel greater opportunity to react.
o Example: On at least one recent occasion, an individual was observed on Cold Spring Bridge by a passing motorist who reported the sighting to authorities. In the time it took law enforcement personnel to respond, the individual jumped from the bridge. In this instance, the delay introduced by a physical barrier might have been sufficient to save a life.
• No peer-reviewed study of the effectiveness of human barriers – including the use of call boxes, video monitoring, or on-site patrols – has been carried out.
• Human barriers have failed to reduce the number of suicides at other bridge locations, e.g., Coronado Bridge in San Diego (Caltrans DEIR, 2008).
• Human barriers do not restrict the available means of suicide, and place the entire burden of suicide prevention on law enforcement, safety, and support personnel.
• Exclusive use of human barriers presents an unnecessary increased risk to law enforcement and safety personnel (see below).
• Construction of a physical barrier does not preclude the use of human barrier strategies such as signs and call boxes. The National Suicide Prevention Lifeline policy report recommends the combined use of both approaches: “Rather than contrasting the effectiveness of these approaches, a strong case can be made for their complementary impact on suicide prevention if employed in tandem.”
x Human barriers are more cost-effective than physical barriers.
• The actual cost-effectiveness of human barriers in the long term (e.g., the projected salary costs for individuals responsible for telephone and camera monitoring and foot patrols) must be comprehensively reviewed before a fair comparison can be made with the cost of installation and maintenance of a physical barrier.
• The full cost to the taxpayer of suicide attempts and completed suicides at this location, which make quantifiable time demands on law enforcement, safety, and medical personnel, must also be considered.
x A physical barrier must be justified in terms of a monetary cost-benefit analysis.
• This argument assumes the value of a human life can only be measured in taxpayer dollars.
• In fact, as a society we must also consider the ethical consequences of allowing preventable deaths to occur, and weigh our civic responsibility, as outlined in the state constitution, to protect the public safety of all citizens.
x Local public support for the safety barrier is limited.
• To support this claim, the “Friends of the Bridge” organization cites data from a nationwide survey that was in fact intended to assess levels of misinformation and incorrect assumptions about the likelihood of substitution of suicide method and inevitability of suicide (Miller et al., 2006). This article in fact argues in favor of reducing method availability: “In light of the evidence that the most dramatic reductions in suicide rates to date have resulted not from improvements in well-being but rather from reductions in the availability of certain lethal methods of suicide (Hawton & Heeringen, 2000), efforts to inform public debate about suicide prevention efforts should include the promotion of means restriction as one among several approaches.”
• No formal opinion survey has been carried out in the Caltrans District 5 area to determine the extent of local public support for the project. Those who support the barrier must therefore make their views known to the Board of Supervisors.
x Law enforcement and emergency personnel do not face increased safety risks in responding to suicide attempts or deaths at the bridge; any risks incurred “go with the job.”
• Risks to law enforcement, search and rescue, traffic management, and emergency personnel in responding to suicide-related incidents at Cold Spring Bridge include:
o inherent dangers associated with crossing the bridge on foot in the absence of a safety barrier due to the narrow footpath, high speed of passing traffic, and heavy winds
o inherent dangers associated with providing traffic control at the bridge during prevention and recovery operations
o increased risk associated with approaching suicidal individuals whose behavior is unpredictable
o posttraumatic stress associated with failure to prevent suicides
o physical hazards encountered when locating and recovering bodies from the steep and heavily wooded terrain below the bridge, including risk from falling objects
• These risks are preventable by the installation of a physical barrier, and are therefore entirely unnecessary.
• The suggestion by “Friends of the Bridge” that minimizing unnecessary risk to those responsible for protecting the safety of the public is “coddling” is callous and offensive.
• The safety guidelines indicated in the alternative human barrier proposal suggested by “Friends of the Bridge” (e.g., “Do remain at all times in a safe position from which you can attempt to induce the person to move to you so that you can safely accept the person into protective custody. Don't move out of a safe position in an effort to take the person into protective custody, as by grabbing, shoving, or similar means”) would minimize the effectiveness of the human barrier strategy.
x A safety barrier would negatively affect the aesthetics of the bridge, and would obstruct the scenic view for motorists.
• When viewed from the perspective of a motorist, the original bridge railing resembles a standard guard rail used on highway overpasses elsewhere in the state. The arch structure of the bridge is not visible to motorists on the highway.
• The bridge itself is over 400 feet tall; a six foot barrier therefore represents less than 1.5% of the overall height of the structure. The visual impact of the barrier would be minimal relative to the overall impact of the bridge from the perspective of an observer on the ground. (Please see DEIR photo simulations and architectural diagrammatic elevation sketches for illustration.)
• A motorist traveling at the speed limit traverses the full length of the bridge in a matter of seconds. The surrounding scenic view can be observed from other points on the route before and after the bridge.
x The argument for the barrier is based on subjective, emotional considerations, whereas the argument against the barrier is based on facts.
• The only decisive facts available show that barriers are effective in preventing suicides at the location where they are constructed.
• No studies to date support claims of displacement or substitution of suicide method in response to the construction of a physical barrier, nor have any studies investigated the effectiveness of human barriers.
• The argument against the barrier is based on three considerations: (1) cost effectiveness; (2) possible disturbance to the “grace and beauty” of the bridge; and (3) possible obstruction of the scenic view from the bridge. Two of these three considerations are subjective and/or emotional in nature.
• The argument for the barrier favors taking the most effective steps toward protecting this location from continuing to serve as a monument to human tragedy.
HOW TO HELP
- Sign the online petition at thepetitionsite.com
- Post comments in support of the barrier on news media blog sites
- Contact Caltrans representatives and declare your support for the proposed barrier:
Sara von Schwind
Caltrans Project Manager
50 Higuera Street
San Luis Obispo, CA 93041
Public Affairs Manager
Caltrans District 5
50 Higuera Street
San Luis Obispo, CA 93041
- Contact local government representatives and declare your support for the proposed safety barrier (see sample letters):
COUNTY OF SANTA BARBARA
1st District: Salud Carbajal
Supervisor Salud Carbajal
SBCAG Chair and First District Supervisor
105 E. Anapamu St., 4th Floor
Santa Barbara, CA 93101
Phone: (805) 568-2186
Fax: (805) 568-2534
2nd District: Janet Wolf
Supervisor Janet Wolf
Second District Supervisor
105 E. Anapamu St., 4th Floor
Santa Barbara, CA 93101
Phone: (805) 568-2191
Fax: (805) 568-2283
3rd District: Doreen Farr
Supervisor Doreen Farr
105 East Anapamu St., 4th Floor
Santa Barbara, CA 93101
4th District: Joni Gray
Supervisor Joni Gray
SBCAG Vice-Chair and Fourth District Supervisor
100 E. Locust Avenue, Suite 101
Lompoc, CA 93436
Lompoc: (805) 737-7700
Santa Maria: (805) 346-8407
5th District: Steve Lavagnino
Supervisor Steve Lavagnino
Fifth District Supervisor
511 E. Lakeside Parkway, Suite 141
Santa Maria, CA 93455-1341
Santa Maria: (805) 346-8400
Fax: (805) 346-8404
E-mail: firstname.lastname@example.org, email@example.com
CITY OF SANTA BARBARA
Mayor Helen Schneider
CITY OF GOLETA
Mayor Margaret Connell
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Bennewith, O, Nowers, M. & Gunnell, D. (2007) Effects of barriers on the Clifton Suspension Bridge, England, on local patterns of suicide: implications for prevention. British Journal of Psychiatry, 190, 266-267.
Brent, D. A., Perper, J. A., Goldstein, C.E., Kolko, D.J., Allan, M.J., Allman, C.J., & Zelenak, J.P. (1993) Risk factors for adolescent suicide. A comparison of adolescent suicide victims with suicidal inpatients. Archives of General Psychiatry, 45(6), 581-588.
Elnour, A.A. & Harrison, J. (2008) Lethality of suicide methods. Injury Prevention, 14, 39-45.
Friend, Tad (2003) Jumpers. The New Yorker, October 13.
Hawton, K. & Heeringen, K. van (2000) The International Handbook of Suicide and Attempted Suicide. Chichester UK: Wiley.
Mann, J.J. (2003) Neurobiology of suicidal behaviour. Nature Reviews: Neuroscience, 4, 819-828.
Marzuk, P.M., Leon, A.C., Tardiff, K., Morgan, E.B., Statjic, M., & Mann, J.J. (1992) The effect of access to lethal methods of injury on suicide rates. Archives of General Psychiatry, 49. 451-458.
Miller, M., Azrael, D., & Hemenway, D. (2006) Belief in the inevitability of suicide: results from a national survey. Suicide and Life Threatening Behavior, 36(1), 1-11.
Nock, M.K., Borges, G., Bromet, E.J., Cha, C.B., Kessler, R.C., & Lee, S. (2008) Suicide and suicidal behavior. Epidemiologic Reviews Advance Access published July 24, 2008.
O’Carroll, P.W. & Silverman, M.M. (1994) Community suicide prevention: The effectiveness of bridge barriers. Suicide and Life-Threatening Behavior, 24, 89-99.
Pelletier, A.R. (2007) Preventing suicide by jumping: The effect of a bridge safety fence. Injury Prevention, 13, 57-59.
Phillips, M.R., Yang, G., Zhang, Y., Wang, L., Ji, H., & Zhou, M. (2002) Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet, 360(9347),1728-36.
Seiden, R.H. (1978) Where are they now? A follow-up study of suicide attempters from the Golden Gate Bridge. Suicide and Life-Threatening Behavior, 8(4), 203-216.
Vijayakumar, L. & Rajkumar, S. (1999) Are risk factors for suicide universal? A case-control study in India. Acta Psychiatrica Scandinavica, 99, 407-411.