Citation

Kivisto AJ. J. Am. Acad. Psychiatry Law 2022; 50(2): 170-176.

Copyright

(Copyright © 2022, American Academy of Psychiatry and the Law, Publisher American Academy of Psychiatry and the Law)

DOI

10.29158/JAAPL.210140-21

PMID

35668037

Abstract

Access to lethal means during a suicidal crisis is strongly linked to suicide, although which lethal means represents the highest risk in any particular case depends on specific cultural and contextual factors.1 For example, pesticide ingestion is estimated to account for approximately 30 percent of suicides globally and historically accounted for up to 80 percent of suicides in certain rural areas of southeast Asia.2,3 In other locations where natural and man-made points of elevation are readily accessible, jumping suicides tend to be highly concentrated in particular suicide "hot-spots."4 As passenger car ownership increased, some countries observed corresponding increases in the number of suicides by carbon monoxide poisoning.5

Accordingly, suicide prevention strategies that emphasize restricting access to lethal means need to be responsive to local, contextually driven risk factors. For example, Sri Lanka's ban on several pesticides known to have the highest suicide case fatality rates (paraquat, dimethoate, and fenthion) is estimated to have resulted in a 21 percent decrease in suicide mortality between 2011 and 2015.6 Similarly, the development of secure, centralized pesticide storage facilities in India has shown promise as a means of averting suicide.7 In areas where jumping suicides are more common, meta-analytic results show that interventions focused on establishing barriers and nets are associated with a 28 percent net decrease in annual jumping suicides.4 Consistent with these findings, evidence shows decreased suicide rates following the development of methods to reduce carbon monoxide via the introduction of catalytic converters (8) and conversions from coal to natural gas...

Language: en

Keywords

suicide prevention; ERPO; firearm suicide; lethal means restriction; red flag law