Effectiveness of suicide means restriction: an overview of systematic reviews

Article

Steeg, S., Ledden, S., Marzano, L., Dutta, R., Quinlivan, L., Kapur, N., John, A. and Webb, R. 2025. Effectiveness of suicide means restriction: an overview of systematic reviews. BMJ Mental Health. 28 (1). https://doi.org/10.1136/bmjment-2025-302069
TypeArticle
TitleEffectiveness of suicide means restriction: an overview of systematic reviews
AuthorsSteeg, S., Ledden, S., Marzano, L., Dutta, R., Quinlivan, L., Kapur, N., John, A. and Webb, R.
Abstract

Question
Means restriction for suicide prevention at a population level typically involves policy or environmental changes to limit access to suicide methods. Several systematic reviews of suicide means restriction exist. This umbrella review aimed to synthesise their findings, assess evidence quality, quantify primary study overlap and identify evidence gaps.

Study selection and analysis
Searches were conducted across Web of Science, Ovid (PsycINFO, EMBASE), Cochrane and PubMed, supplemented by reference list screening. Study quality was assessed using A MeaSurement Tool to Assess systematic Reviews-2. Study overlap was calculated using the corrected covered area.

Findings
We included 20 systematic reviews, synthesising evidence from 179 unique primary studies. Physical barriers to prevent jumping showed strong effect sizes, although primary study overlap was high. Train platform screen doors were associated with reduced site-specific suicide mortality, with no evidence of displacement to other sites, although the number of studies was small. Paracetamol pack size limitation reduced self-poisoning admissions, with mixed impacts on mortality. Bans on highly hazardous pesticides reduced suicide rates. More recent reviews suggest firearms restrictions may reduce suicides, but with small effect sizes and methodological limitations. Evidence quality ranged from high to critically low (12/20 rated as critically low). With the exception of pesticide restrictions, lower and middle-income settings were not represented.

Conclusions
Several means restriction approaches demonstrate effectiveness, although high study overlap and variable study quality were evident. A focus on differential impacts across sociodemographic groups, more evidence from lower and middle-income countries and evidence for suicide prevention on roads and from residential buildings is needed.

PROSPERO registration number CRD42024620103.

KeywordsPsychosocial Intervention; Mental Health
Sustainable Development Goals3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
PublisherBMJ Publishing Group
JournalBMJ Mental Health
ISSN
Electronic2755-9734
Publication dates
Online09 Dec 2025
PrintDec 2025
Publication process dates
Submitted26 Aug 2025
Accepted16 Nov 2025
Deposited12 Dec 2025
Output statusPublished
Publisher's version
License
File Access Level
Open
Copyright Statement

© Author(s) (or their employer(s)) 2025. Re- use permitted under CC BY. Published by BMJ Group.

Digital Object Identifier (DOI)https://doi.org/10.1136/bmjment-2025-302069
PubMed ID41365522
PubMed Central IDPMC12699607
Web of Science identifierWOS:001636618100001
National Library of Medicine ID9918521385306676
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Marzano, L., Ciclitira, K. and Adler, J. 2012. The impact of prison staff responses on self-harming behaviours: prisoners’ perspectives. British Journal of Clinical Psychology. 51 (1), pp. 4-18. https://doi.org/10.1111/j.2044-8260.2010.02007.x
Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners
Marzano, L., Hawton, K., Rivlin, A. and Fazel, S. 2011. Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners. Social Science & Medicine. 72 (6), pp. 874-883. https://doi.org/10.1016/j.socscimed.2010.12.028
Near-lethal self-harm in women prisoners: contributing factors and psychological processes
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2011. Near-lethal self-harm in women prisoners: contributing factors and psychological processes. The Journal of Forensic Psychiatry & Psychology. 22 (6), pp. 863-884. https://doi.org/10.1080/14789949.2011.617465
Self-harm in a men's prison: staff's and prisoners' perspectives.
Marzano, L. 2007. Self-harm in a men's prison: staff's and prisoners' perspectives. PhD thesis Middlesex University
Visuo-spatial ability and dyslexia: is there a male global advantage?
Brunswick, N., Martin, G. and Marzano, L. 2008. Visuo-spatial ability and dyslexia: is there a male global advantage? British Dyslexia Association International Conference, 2008 [Dyslexia: making links]. Harrogate, York 27 - 29 Mar 2008
Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol?
Brunswick, N., Martin, G. and Marzano, L. 2007. Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol? 25th European Workshop on Cognitive Neuropsychology. Bressanone, Italy 21 - 26 Jan 2007
To be or not to be … a psychologist: critical and feminist dilemmas.
Ciclitira, K., Capdevila, R., Marzano, L. and Adams, E. 2008. To be or not to be … a psychologist: critical and feminist dilemmas. 2008 BPS Annual Conference.. Dublin 04 Feb 2008
Counsellors’ experiences of working as volunteers at a women’s service.
Costa, A., Ciclitira, K. and Marzano, L. 2008. Counsellors’ experiences of working as volunteers at a women’s service. 2008 Psychology of Women Section 21st Anniversary Conference on 'Rights and Changes'.. Cumberland Lodge, The Great Park, Windsor.
The impact of personal psychotherapy and supervision on volunteer counsellors.
Ciclitira, K., Marzano, L., Starr, F., Brunswick, N., Costa, A. and Berger, S. 2009. The impact of personal psychotherapy and supervision on volunteer counsellors. 2009 BPS Annual Conference. Brighton, UK 01 - 03 Apr 2009
Afghan nationals in the UK: professional capacity and views on return
Sales, R., Blitz, B. and Marzano, L. 2002. Afghan nationals in the UK: professional capacity and views on return. Research commissioned by Refugee Action and the International Organization for Migration, London..
Self-harm in prisons: dominant models and (mis)understandings
Marzano, L. 2010. Self-harm in prisons: dominant models and (mis)understandings. in: Adler, J. and Gray, J. (ed.) Forensic psychology: concepts, debates and practice Willan. pp. 486-507
Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study
Rivlin, A., Hawton, K., Marzano, L. and Fazel, S. 2010. Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study. The British Journal of Psychiatry. 197 (4), pp. 313-319. https://doi.org/10.1192/bjp.bp.110.077883
Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2010. Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study. The British Journal of Psychiatry. 197 (3), pp. 219-226. https://doi.org/10.1192/bjp.bp.109.075424
Visuospatial superiority in developmental dyslexia: myth or reality?
Brunswick, N., Martin, G. and Marzano, L. 2010. Visuospatial superiority in developmental dyslexia: myth or reality? Learning and Individual Differences. 20 (5), pp. 421-426. https://doi.org/10.1016/j.lindif.2010.04.007
Theoretical and ethical issues in conducting research at a women’s centre.
Ciclitira, K. and Marzano, L. 2004. Theoretical and ethical issues in conducting research at a women’s centre. Proceedings of the British Psychological Society. 12 (2).
Being a man: justice and care.
Capdevila, R., Ciclitira, K., Lazard, L. and Marzano, L. 2006. Being a man: justice and care. Psychology of Women Section Annual Conference 2005.. University of Huddersfield. The British Psychological Society.
Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners
Marzano, L., Rivlin, A., Fazel, S. and Hawton, K. 2009. Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners. Journal of Forensic and Legal Medicine. 16 (3), pp. 152-155. https://doi.org/10.1016/j.jflm.2008.08.011
Justice and care: theorising the 'new man' and the 'caring father.'
Marzano, L., Capdevila, R., Ciclitira, K. and Lazard, L. 2009. Justice and care: theorising the 'new man' and the 'caring father.'. Psychology of Women Secton Review. 11 (2), pp. 11-20.
Being young feminists: discussions and (dis)contents
Adams, E., Del Busso, L., Foster, N., Majumdar, A., Marzano, L. and Papadima, M. 2007. Being young feminists: discussions and (dis)contents. Feminism and Psychology. 17 (3), pp. 291-294. https://doi.org/10.1177/0959353507079081
I. Is my work 'feminist' enough? Tensions and dilemmas in researching male prisoners who self-harm
Marzano, L. 2007. I. Is my work 'feminist' enough? Tensions and dilemmas in researching male prisoners who self-harm. Feminism and Psychology. 17 (3), pp. 295-301. https://doi.org/10.1177/0959353507079082
Supporting staff working with prisoners who self-harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales
Marzano, L. and Adler, J. 2007. Supporting staff working with prisoners who self-harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales. International Journal of Prisoner Health. 3 (4), pp. 268-282. https://doi.org/10.1080/17449200701682501
Non voluntary return? The politics of refugee return to Afghanistan
Sales, R., Blitz, B. and Marzano, L. 2005. Non voluntary return? The politics of refugee return to Afghanistan. Political Studies. 53 (1), pp. 182-200. https://doi.org/10.1111/j.1467-9248.2005.00523.x
Theoretical and ethical issues in conducting research at a women’s health centre.
Ciclitira, K., Marzano, L., Brunswick, N., Starr, F. and Berger, S. 2004. Theoretical and ethical issues in conducting research at a women’s health centre. Psychology of Women Section Review. 6 (1), pp. 60-69.