{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T07:09:04Z","timestamp":1793084944344,"version":"4.5.0"},"reference-count":64,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2011,12,7]],"date-time":"2011-12-07T00:00:00Z","timestamp":1323216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Restricting access to common means of suicide, such as firearms, toxic gas, pesticides and other, has been shown to be effective in reducing rates of death in suicide. In the present review we aimed to summarize the empirical and clinical literature on controlling the access to means of suicide. Methods: This review made use of both MEDLINE, ISI Web of Science and the Cochrane library databases, identifying all English articles with the keywords \u201csuicide means\u201d, \u201csuicide method\u201d, \u201csuicide prediction\u201d or \u201csuicide prevention\u201d and other relevant keywords. Results: A number of factors may influence an individual\u2019s decision regarding method in a suicide act, but there is substantial support that easy access influences the choice of method. In many countries, restrictions of access to common means of suicide has lead to lower overall suicide rates, particularly regarding suicide by firearms in USA, detoxification of domestic and motor vehicle gas in England and other countries, toxic pesticides in rural areas, barriers at jumping sites and hanging, by introducing \u201csafe rooms\u201d in prisons and hospitals. Moreover, decline in prescription of barbiturates and tricyclic antidepressants (TCAs), as well as limitation of drugs pack size for paracetamol and salicylate has reduced suicides by overdose, while increased prescription of SSRIs seems to have lowered suicidal rates. Conclusions: Restriction to means of suicide may be particularly effective in contexts where the method is popular, highly lethal, widely available, and\/or not easily substituted by other similar methods. However, since there is some risk of means substitution, restriction of access should be implemented in conjunction with other suicide prevention strategies.<\/jats:p>","DOI":"10.3390\/ijerph8124550","type":"journal-article","created":{"date-parts":[[2011,12,7]],"date-time":"2011-12-07T13:12:32Z","timestamp":1323263552000},"page":"4550-4562","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":153,"title":["Controlling Access to Suicide Means"],"prefix":"10.3390","volume":"8","author":[{"given":"Marco","family":"Sarchiapone","sequence":"first","affiliation":[{"name":"Department of Health Sciences, University of Molise, Via De Sanctis, Campobasso 86100, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Mandelli","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Molise, Via De Sanctis, Campobasso 86100, Italy"},{"name":"Institute of Psychiatry, University of Bologna, 5 V.le C. Pepoli, Bologna 40133, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Iosue","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Molise, Via De Sanctis, Campobasso 86100, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costanza","family":"Andrisano","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, University of Bologna, 5 V.le C. Pepoli, Bologna 40133, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alec","family":"Roy","sequence":"additional","affiliation":[{"name":"Psychiatry Service, Department of Veterans Affairs, 385 Tremont Ave., East Orange, NJ 07018, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2011,12,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1034\/j.1600-0447.2003.00147.x","article-title":"Trends in mortality from suicide, 1965\u201399","volume":"108","author":"Levi","year":"2003","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_2","unstructured":"(2002). World Report on Violence and Health."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Clarke, R.V., and Lester, D. (1989). Suicide: Closing the Exits, Springer.","DOI":"10.1007\/978-1-4613-8902-6"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1080\/10673220600968662","article-title":"Predicting and preventing suicide: Do we know enough to do either?","volume":"14","author":"Paris","year":"2006","journal-title":"Harv. Rev. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Suominen, K., Isometsa, E., Ostamo, A., and Lonnqvist, J. (2004). Level of suicidal intent predicts overall mortality and suicide after attempted suicide: A 12-year follow-up study. BMC Psychiatry, 4.","DOI":"10.1186\/1471-244X-4-11"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Hawton, K., and van Heeringen, K. (2000). The International Handbook of Suicide and Attempted Suicide, Wiley.","DOI":"10.1002\/9780470698976"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"822","DOI":"10.7326\/0003-4819-140-10-200405180-00015","article-title":"Screening for suicide risk in adults: A summary of the evidence for the U.S. Preventive Services Task Force","volume":"140","author":"Gaynes","year":"2004","journal-title":"Ann. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1001\/jama.294.16.2064","article-title":"Suicide prevention strategies: A systematic review","volume":"294","author":"Mann","year":"2005","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1521\/suli.2007.37.6.688","article-title":"Restrictions in means for suicide: An effective tool in preventing suicide: The Danish experience","volume":"37","author":"Nordentoft","year":"2007","journal-title":"Suicide Life Threat. Behav."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/MOP.0b013e32833057d0","article-title":"Lethal means reduction: What have we learned?","volume":"21","author":"Johnson","year":"2009","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1136\/jech.2007.065391","article-title":"Suicide methods in Europe: A gender-specific analysis of countries participating in the \u201cEuropean alliance against depression\u201d.","volume":"62","author":"Varnik","year":"2008","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"726","DOI":"10.2471\/BLT.07.043489","article-title":"Methods of suicide: International suicide patterns derived from the WHO mortality database","volume":"86","author":"Weiss","year":"2008","journal-title":"Bull. World Health Organ."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.aap.2005.03.004","article-title":"Suicide prevention through means restriction: Assessing the risk of substitution. A critical review and synthesis","volume":"37","author":"Daigle","year":"2005","journal-title":"Accid. Anal. Prev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1521\/suli.32.1.5.76.24215","article-title":"Studying survivors of nearly lethal suicide attempts: An important strategy in suicide research","volume":"32","author":"Hawton","year":"2001","journal-title":"Suicide Life Threat. Behav."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1001\/archpsyc.1992.01820060031005","article-title":"The effect of access to lethal methods of injury on suicide rates","volume":"49","author":"Marzuk","year":"1992","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1093\/ije\/dyq094","article-title":"Suicide in England and Wales 1861\u20132007: A time-trends analysis","volume":"39","author":"Thomas","year":"2010","journal-title":"Int. J. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/NMD.0b013e3181da47e2","article-title":"Suicide inside: A systematic review of inpatient suicides","volume":"198","author":"Bowers","year":"2010","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_18","first-page":"1622:1","article-title":"A conceptual model of suicide in rural areas","volume":"11","author":"Stark","year":"2011","journal-title":"Rural Remote Health"},{"key":"ref_19","first-page":"1029","article-title":"Household firearm ownership and rates of suicide across the 50 United States","volume":"62","author":"Miller","year":"2007","journal-title":"J. Trauma"},{"key":"ref_20","first-page":"201","article-title":"A prospective study of suicidal behaviour in Sundarban Delta, West Bengal, India","volume":"23","author":"Chowdhury","year":"2010","journal-title":"Natl. Med. J. India"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1111\/j.1556-4029.2009.01054.x","article-title":"Methods of choice in completed suicides: Gender differences and review of literature","volume":"54","author":"Kanchan","year":"2009","journal-title":"J. Forensic Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1027\/0227-5910.28.S1.4","article-title":"Restricting access to methods of suicide: Rationale and evaluation of this approach to suicide prevention","volume":"28","author":"Hawton","year":"2007","journal-title":"Crisis"},{"key":"ref_23","first-page":"86","article-title":"The coal gas story. United Kingdom suicide rates, 1960\u201371","volume":"30","author":"Kreitman","year":"1976","journal-title":"Br. J. Prev. Soc. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1192\/bjp.166.1.35","article-title":"Trends and availability of suicide methods in Finland. Proposals for restrictive measures","volume":"166","author":"Ohberg","year":"1995","journal-title":"Br. J. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/0048-9697(94)90224-0","article-title":"Unanticipated benefits of automotive emission control: Reduction in fatalities by motor vehicle exhaust gas","volume":"146-147","author":"Shelef","year":"1994","journal-title":"Sci. Total Environ."},{"key":"ref_26","first-page":"29","article-title":"Trends in suicide in England and Wales, 1982\u201396","volume":"92","author":"Kelly","year":"1998","journal-title":"Popul. Trends"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1111\/j.1556-4029.2011.01723.x","article-title":"Recent trends in suicides utilizing helium","volume":"56","author":"Austin","year":"2011","journal-title":"J. Forensic Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.2105\/AJPH.2005.075812","article-title":"Changing times: A longitudinal analysis of international firearm suicide data","volume":"96","author":"Killias","year":"2006","journal-title":"Am. J. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1136\/ip.2005.010850","article-title":"The association between changes in household firearm ownership and rates of suicide in the United States, 1981\u20132002","volume":"12","author":"Miller","year":"2006","journal-title":"Inj. Prev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s001270050261","article-title":"Method availability and the prevention of suicide\u2014A re-analysis of secular trends in England and Wales 1950\u20131975","volume":"35","author":"Gunnell","year":"2000","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1192\/bjp.bp.106.032862","article-title":"Firearm legislation reform in the European Union: Impact on firearm availability, firearm suicide and homicide rates in Austria","volume":"191","author":"Kapusta","year":"2007","journal-title":"Br. J. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1111\/j.1943-278X.2011.00034.x","article-title":"Rate, relative risk, and method of suicide by students at 4-year colleges and universities in the United States, 2004\u20132005 through 2008\u20132009","volume":"41","author":"Schwartz","year":"2011","journal-title":"Suicide Life Threat. Behav."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1056\/NEJM199911183412106","article-title":"Mortality among recent purchasers of handguns","volume":"341","author":"Wintemute","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.healthpol.2010.10.005","article-title":"Gun control and suicide: The impact of state firearm regulations in the United States, 1995\u20132004","volume":"101","author":"Hempstead","year":"2011","journal-title":"Health Policy"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.jadohealth.2009.11.206","article-title":"Changes in suicide rates by hanging and\/or suffocation and firearms among young persons aged 10\u201324 years in the United States: 1992\u20132006","volume":"46","author":"Bridge","year":"2010","journal-title":"J. Adolesc. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"357:1","DOI":"10.1186\/1471-2458-7-357","article-title":"The global distribution of fatal pesticide self-poisoning: Systematic review","volume":"7","author":"Gunnell","year":"2007","journal-title":"BMC Public Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"405:1","DOI":"10.1186\/1471-2458-9-405","article-title":"Pattern of pesticide storage before pesticide self-poisoning in rural Sri Lanka","volume":"9","author":"Mohamed","year":"2009","journal-title":"BMC Public Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1177\/0020764008095340","article-title":"Does \u2018no pesticide\u2019 reduce suicides?","volume":"55","author":"Vijayakumar","year":"2009","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"737","DOI":"10.5694\/j.1326-5377.1975.tb111781.x","article-title":"Suicide in Brisbane, 1956 to 1973: The drug-death epidemic","volume":"1","author":"Whitlock","year":"1975","journal-title":"Med. J. Aust."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"495","DOI":"10.3109\/15563657508988095","article-title":"Barbiturates","volume":"8","author":"Matthew","year":"1975","journal-title":"Clin. Toxicol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1136\/bmj.322.7296.1203","article-title":"Effects of legislation restricting pack sizes of paracetamol and salicylate on self poisoning in the United Kingdom: Before and after study","volume":"322","author":"Hawton","year":"2001","journal-title":"BMJ"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e105:1","DOI":"10.1371\/journal.pmed.0040105","article-title":"Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning","volume":"4","author":"Morgan","year":"2007","journal-title":"PLoS Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1080\/15563650903093192","article-title":"Limiting paracetamol pack size: Has it worked in the UK?","volume":"47","author":"Bateman","year":"2009","journal-title":"Clin. Toxicol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"6:1","DOI":"10.1186\/1472-6904-10-6","article-title":"Use of analgesics in intentional drug overdose presentations to hospital before and after the withdrawal of distalgesic from the Irish market","volume":"10","author":"Corcoran","year":"2010","journal-title":"BMC Clin. Pharmacol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1600-0447.1993.tb05371.x","article-title":"The toxicity of drugs used for suicide","volume":"371","author":"Crome","year":"1993","journal-title":"Acta Psychiatr. Scand. Suppl."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1001\/archpsyc.62.2.165","article-title":"The relationship between antidepressant medication use and rate of suicide","volume":"62","author":"Gibbons","year":"2005","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1080\/0004867010060501","article-title":"Effectiveness of barriers at suicide jumping sites: A case study","volume":"35","author":"Beautrais","year":"2001","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1093\/eurpub\/ckq092","article-title":"Suicidal behaviour and suicide from the Clifton Suspension Bridge, Bristol and surrounding area in the UK: 1994\u20132003","volume":"21","author":"Bennewith","year":"2011","journal-title":"Eur. J. Public Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/j.1943-278X.1994.tb00666.x","article-title":"Case consultation: Community suicide prevention: The effectiveness of bridge barriers","volume":"24","author":"Berman","year":"1994","journal-title":"Suicide Life Threat. Behav."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.4088\/JCP.v67n0709","article-title":"Association between the accessibility to lethal methods and method-specific suicide rates: An ecological study in Taiwan","volume":"67","author":"Lin","year":"2006","journal-title":"J. Clin. Psychiatry"},{"key":"ref_51","first-page":"289","article-title":"Suicide survivors. A follow-up study of persons who survived jumping from the Golden Gate and sSan Francisco\u2013Oakland Bay Bridges","volume":"122","author":"Rosen","year":"1975","journal-title":"West. J. Med."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Sinyor, M., and Levitt, A.J. (2010). Effect of a barrier at Bloor Street Viaduct on suicide rates in Toronto: Natural experiment. BMJ, 341.","DOI":"10.1136\/bmj.c2884"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/j.socscimed.2011.01.001","article-title":"Do local landmark bridges increase the suicide rate? An alternative test of the likely effect of means restriction at suicide-jumping sites","volume":"72","author":"Glasgow","year":"2011","journal-title":"Soc. Sci. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1080\/15622970701216681","article-title":"The \u2018European Alliance Against Depression (EAAD)\u2019: A multifaceted, community-based action programme against depression and suicidality","volume":"9","author":"Hegerl","year":"2008","journal-title":"World J. Biol. Psychiatry"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/ije\/dyh398","article-title":"The epidemiology and prevention of suicide by hanging: A systematic review","volume":"34","author":"Gunnell","year":"2005","journal-title":"Int. J. Epidemiol."},{"key":"ref_56","unstructured":"Shaw, J., Appleby, L., and Baker, D. (2003). Safer Prisons: A National Study of Prison Studies 1999\u20132000 by the National Confidential Inquiry into Suicides and Homicides by People with Mental Illness, Department of Health."},{"key":"ref_57","unstructured":"(2002). Preventing Suicide. A Resource for Prisoner Officers."},{"key":"ref_58","unstructured":"Appleby, L., Shaw, J., Sherratt, J., Amos, T., Robinson, J., and McDonnell, R. (2001). Safety First: Five-Year Report of the National Confidential Enquiry into Suicide and Homicide by People with Mental Illness, Department of Health."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.jad.2010.12.013","article-title":"Why do people choose charcoal burning as a method of suicide? An interview based study of survivors in Taiwan","volume":"131","author":"Tsai","year":"2011","journal-title":"J. Affect. Disord."},{"key":"ref_60","unstructured":"Littmann, S.K. The Role of the Press in the Control of Suicide Epidemics. Proceedings of the International Association for Suicide Prevention and Crisis Intervention."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/0277-9536(94)90447-2","article-title":"Imitative suicide on the Viennese subway","volume":"38","author":"Sonneck","year":"1994","journal-title":"Soc. Sci. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1016\/j.socscimed.2010.01.029","article-title":"Suicide prevention by limiting access to methods: A review of theory and practice","volume":"70","author":"Florentine","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1017\/S1041610210001377","article-title":"Suicide and deliberate self harm in older Irish adults","volume":"22","author":"Corcoran","year":"2010","journal-title":"Int. Psychogeriatr."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"432","DOI":"10.5694\/j.1326-5377.2010.tb03580.x","article-title":"Suicide in Australia: Meta-analysis of rates and methods of suicide between 1988 and 2007","volume":"192","author":"Large","year":"2010","journal-title":"Med. J. Aust."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/8\/12\/4550\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:58:15Z","timestamp":1760219895000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/8\/12\/4550"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,12,7]]},"references-count":64,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2011,12]]}},"alternative-id":["ijerph8124550"],"URL":"https:\/\/doi.org\/10.3390\/ijerph8124550","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,12,7]]}}}