High-Risk Locations for Suicide in Saxony

A high-risk location for suicide is one where suicides tend to occur more often than elsewhere; more precisely, Reisch et al. (1) defined a high-risk location as one where five or more suicides have occurred in 10 years. These sites are generally chosen because they are well known, e.g., through inappropriate media coverage. Studies have shown that properly securing high-risk locations can markedly lower the number of suicides and suicide attempts there (2) and that only a few people (5–15 %) will seek out alternative sites. Suicide locations in Germany are documented by emergency responders, but the data have not been systematically compiled and analyzed to date. An evidence base is, therefore, lacking for the identification and securing of high-risk locations. In the German federal government’s implementation strategy for suicide prevention (3), restricting potential methods of suicide, which includes the securing of high-risk locations, is stated to be among the most effective means of prevention. Structural safety measures are known to be effective, yet there is currently no systematic compilation of suicide locations in Germany to identify clusters in high-risk locations. In this study, we examine suicide clusters in Saxony to identify potential high-risk locations.

Methods and results

Methods – High-risk locations for suicide in the German federal state of Saxony from 2006 to 2024 were recorded in a registry. The data were collected in a multi-institutional collaboration with the particpation of public health departments and the Criminal Investigation Department of Saxony. Because of official archiving deadlines, a systematic, comprehensive survey of case numbers could be performed only for the years 2019–2023, even though complete figures were available outside this period as well. The survey included all suicide cases documented by the police in Saxony. To ensure data integrity, duplicates were identified by cross-referencing the age and sex of the individual and the location of the incident and were consolidated into single events. Ethical approval for the study was obtained (EK-BR-104/23–1, Nov. 21, 2023). The revised data were imported into a GIS system (Q-GIS) for geographical mapping and clustering of the cases. A high-risk location was defined as an area with a radius of 200 m in which five or more suicides took place in ten years.

Results – 5210 cases were documented from 2006 to 2024. 1097 cases (21.1%) were reported by more than one source. The method of suicide was documented in 2477 cases (47.5%) (Table 1), and the category of the suicide location was documented in 1774 (34.0%). Of these, 872 (49.2%) occurred in public spaces (322 in buildings, 550 outdoors). Among outdoor public locations, railway facilities accounted for the largest share, with 275 cases (50.0%). The remaining 904 suicides (50.8%) occurred in private spaces. During the observation period, 296 suicides (5.7 %) were clustered in Q-GIS into 35 high-risk locations. Of these, 20 were located in or near a hospital (general and psychiatric), 10 in residential areas, and 2 in or near train stations; one location each was in a correctional facility, in a nursing home, and at a scenic overlook.

Table 1

Frequency of suicide methods

Table 2

Frequency of suicide locations

Discussion

Systematic data collection provides the basis for targeted prevention measures and for the prospective assessment of their efficacy. Geographic analyses help public health authorities launch local safety projects. The extent to which the identified locations can be effectively secured can now only be roughly estimated. Suicides on railroad facilities and falls from great heights are thought to be amenable to location-specific safety measures (4). This category included 54 suicides in the clusters of high-risk locations in our study. Systematic reviews and meta-analyses have shown that restricting access to high-risk locations can lower the rate of suicide there by up to 95% (5). In public areas, this can be accomplished mainly by structural interventions; in the present dataset, public areas account for 49.2% of cases with a documented suicide location (n = 1774). The potential effect of such interventions on suicide rates cannot be quantified at present, because the final analysis of high-risk locations is still pending, but the available evidence suggests that they may well be associated with a lower suicide risk not only at the location itself, but also in nearby areas (1). In private spaces, structural and organizational safety measures are less feasible but could include restricting access to rooftops to deter jumping from high-rise buildings and planting vegetation below potential jump sites, which might alter the perception of the location as reliably lethal. If identified high-risk locations are consistently secured and additional preventive measures are taken as well, the synergistic effect might well lower suicide rates measurably. The geographic maps and cluster analysis are made available to the relevant personnel at regional public health departments to support the implementation of safety measures and further preventive measures where appropriate. Even if individual high-risk locations are already unofficially known locally, systematic and continuous data collection enables more comprehensive identification and provides a basis for targeted safety measures and efficacy assessment. For the future, a nationwide standardized data collection system with centralized analysis of the relevant data seems reasonable, for which we propose the present project as a model. In the next phase of our project, the identified high-risk locations will be analyzed for structural and non-structural securing opportunities, and concrete securing proposals will be made where appropriate. A limiting factor is the heterogeneity of data from primary sources, because of which some details on locations and methods are lacking. Moreover, as the period covered by the comprehensive survey was short (5 years), it was difficult to identify rarer clusters according to the 10-year definition.

Katharina König, Thomas Reisch,
Maria Meinhardt, Arina Vorobyeva, Nadine Glasow,
and Ute Lewitzka

Study support

2023/24 Saxon State Ministry of Social Affairs, Health, and
Social Cohesion (project no. 100645157).

Conflict of interest statement

KK is a member of the advisory board of the Center for Suicide Prevention in Berlin, a member of the board of directors of the Werner-Felber-Institut, and co-director of the Working Group on Restrictive Measures of the National Suicide Prevention Program in Germany (NaSPro).

ND received royalties for publications from the Medizinisch-wissenschaftliche Verlagsgesellschaft and from Logos Verlag Berlin. The Werner-Felber-Institut collects licensing fees for certifications in architectural suicide prevention that are offered by ND through her company, universalraum GmbH. Through this company, ND regularly advises psychiatric facilities on architectural measures for suicide prevention and regularly gives expert lectures and conducts continuing education events on architectural suicide prevention. She is the deputy chair of the board of the Werner-Felber-Institut.

UL has received advisor’s fees, lecture honoraria, and/or event support from Janssen Cilag, Johnson & Johnson, Otsuka Pharma, Aristo Pharma, and ROVI. She is chair of the Werner-Felber Institute and of the DGS, and head of the suicide studies section of the DGPPN.

The remaining authors declare that they have no conflict of interest.

Manuscript received on 10 December 2025, revised version accepted
on 23 March 2026.

Translated from the original German by Ethan Taub, M.D.

Cite this as: König K, Reisch T, Meinhardt M, Vorobyeva A,
Glasow N, Lewitzka U:
High-risk locations for suicide in Saxony.
Dtsch Arztebl Int 2026; 123: 420–1.
DOI: 10.3238/arztebl.m2026.0052

References

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