title: Interventions to reduce suicides at suicide hotspots: a systematic review.
abstract: BACKGROUND
  'Suicide hotspots' include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention.
  
  
  METHODS
  We searched Medline for studies that could inform the following question: 'What interventions are available to reduce suicides at hotspots, and are they effective?'
  
  
  RESULTS
  There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise.
  
  
  CONCLUSIONS
  More well-designed intervention studies are needed to strengthen this evidence base.
authors.affiliation: Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
authors.forename: Georgina R
authors.initials: GR
authors.lastname: Cox
authors.forename: Christabel
authors.initials: C
authors.lastname: Owens
authors.forename: Jo
authors.initials: J
authors.lastname: Robinson
authors.forename: Angela
authors.initials: A
authors.lastname: Nicholas
authors.forename: Anne
authors.initials: A
authors.lastname: Lockley
authors.forename: Michelle
authors.initials: M
authors.lastname: Williamson
authors.forename: Yee Tak Derek
authors.initials: YT
authors.lastname: Cheung
authors.forename: Jane
authors.initials: J
authors.lastname: Pirkis
mesh_terms: D004779:Environment Design; D006801:Humans; D015397:Program Evaluation; D000092864:Suicide Prevention