Surgical health policy advocacy and suicide prevention: the San Diego-Coronado bridge case

Abstract Introduction The 1969 San Diego–Coronado Bridge (SDC bridge) has been the site of more than 473 suicides by jumping. In 2019, a “bird spike” barrier was installed along road edge walls as a suicide deterrent. We hypothesize that current anti-suicide measures have been ineffective in reducing the annual suicide-by-jumping rate at the SDC bridge. Methods The medical examiner and UCSD trauma registries were reviewed for suicide and attempted suicide following jumping from the SDC bridge from January 1997 to August 2024. The data collected included demographics, the injury severity score (ISS), toxicology, and the home area deprivation index (ADI). The suicide rates for the SDC bridge compared with those for the entire county from 1997 to 2018 and 2019 to 2024, before and after the installation of the “bird spike” barrier, were analyzed via Poisson rate tests and difference-in-differences regression. Potential years of life lost (PYLL) and incremental cost-effectiveness ratios (ICERs) were also calculated. Results There were 10,411 suicide deaths in San Diego County and 298 people who jumped from the SDC bridge from January 1997 through August 2024. Among these bridge jumps, 272 (91.2%) resulted in death after jumping from the SDC bridge (8 at the hospital; 264 at the scene), whereas 26 survivors (8.7%) were recorded. The ISS of survivors was significantly lower than that of those who died (18 ± 10 vs. 42 ± 7, p < 0.001). The rate of bridge suicide attempts remained unchanged before and after the deterrent bird spike was installed (pre: 227 over 22 years, post: 71 over 6 years, p = 0.32). DiD analysis revealed no difference between SDC bridge suicides and county jump-from-height suicides (DiD Coeff. <0.0001, p = 0.973). Conclusion A costly project to install a bird spike suicide barrier on the SDC bridge did not decrease the number of bridge suicides. A fence-style physical barrier supported by surgeon-led advocacy could be highly cost-effective. Ongoing advocacy efforts by trauma surgeons and their allies with policymakers are making progress toward implementing effective preventative measures to reduce SDC bridge suicides. Level of Evidence III Prognostic and Epidemiological, Case Control Study without Negative Criteria.