Reconsidering the effects of blue-light installation for prevention of railway suicides

The role of seasonality and photoperiod on the lethality of suicide attempts: A case-control study

BACKGROUND

The risk factors related to suicidal behaviors are complex and not yet fully known. Several studies underline how suicide results from the combination of psycho-social, biological, cultural, and environmental factors. The aim of this study was to investigate the potential role of seasonality and photoperiod on high-lethality suicide attempts (HLSA) compared with low-lethality suicide attempts (LLSA) in a sample of psychiatric inpatients.

METHODS

After attempting suicide, subjects were admitted in the emergency/psychiatric ward of the IRCCS Ospedale Policlinico San Martino from 1st August 2013 to 31st July 2018. Socio-demographic and clinical characteristics were collected.

RESULTS

The sample consisted of four hundred thirty-two individuals admitted for suicide attempt. One hundred thirty-three subjects (30.8%) of the sample committed a HLSA. The HLSA group peaked in the months with a higher sunlight exposure (June and July). Bivariate correlation analyses between seasonality/photoperiod in the whole sample and HLSA were positively associated with summer and highest solar intensity period.

LIMITATIONS

Data were limited to a single hospital, patients' seasonal environment, meteorological variables and psychological factors. In addition, the presence of acute life-events fostering the suicidal crisis has not been investigated.

CONCLUSIONS

The current study provides a novel perspective on the questions surrounding the impact of seasonality and daylight exposure on lethality of suicide attempts. further studies are needed to provide deeper understandings on the delicate molecular network that links suicide behaviors, seasonality and daylight in order to develop more effective prevention and treatment strategies in the future.

Collecting evidence from distributed sources to evaluate railway suicide and trespass prevention measures

It can be difficult to select from available safety preventative measures, especially where there is limited evidence of effectiveness in different contexts. This paper describes application of a method to identify and evaluate wide-ranging preventative measures for rail suicide and trespass fatalities. Evidence from literature and industry sources was collated and reviewed in a two stage process to achieve consensus among experts on the likely effects of the measures and factors influencing their implementation. Multiple evaluation criteria were used to examine the measures from different perspectives. Fencing, awareness campaigns and different types of organisational initiatives were recommended for further testing. This is the first time evidence has been collected internationally across such a range of preventative measures. Commentary is provided on using this type of approach to select safety measures from a pool of prevention options, including how re-framing the scope of the exercise could identify alternative options for prevention. Practitioner summary: The findings give insight to how different measures work in different ways and how industry can consider this in strategic initiatives. The method could be used in future studies with different frames of reference (e.g. different timescales, level of ambition and safety context e.g. railway crossings or highway fatalities). Abbreviation: RESTRAIL: REduction of Suicides and Trespasses on RAILway property.

Suicide patterns on the London Underground railway system, 2000-2010

Aims and Method Suicidal acts on underground railway networks are an area of public health concern. Our aim was to review recent epidemiological patterns of suicidal acts on the London Underground to inform future preventive interventions. Data from 2000 to 2010 were obtained from the British Transport Police via a Freedom of Information request. Results The mean annual rate of suicidal acts from 2000 to 2010 was 5.8 per 100 million passenger journey stages. Of those who died by suicide, 77.3% were of White Northern European ethnicity. A fifth had a history of mental illness. Clinical implications The widening gap between the number of recorded suicide attempts and completed suicides is encouraging. Further research is required regarding the role of drug and alcohol use, psychiatric history and area of residence. Installation of platform screen doors should be considered in future railway network expansion.

Rail-suicide prevention: Systematic literature review of evidence-based activities

BACKGROUND

Rail-related suicide is a relatively rare but extremely lethal method of suicide that can have far-reaching consequences.

OBJECTIVE

The aim of the systematic literature review was to analyze the existing literature on the effectiveness of rail-suicide prevention activities.

DATA SOURCES

Databases used were Scopus, Medline, and ProQuest.

SEARCH TERMS

The search terms used were "suicid*," "prevent*," "rail*," or "train."

ELIGIBILITY CRITERIA

English-language studies published in peer-reviewed journals between 1 January 1990 and 30 April 2015 that presented an overview of rail-related suicide prevention activities and included an analysis of effectiveness were used.

RESULTS

We retrieved 1,229 results in the original search with nine papers presenting empirical evidence. Three studies in the review analyzed the effectiveness of platform screen doors and another three analyzed the installation of blue lights, two papers analyzed the effectiveness of suicide pits, and one included the influence of media reporting guidelines.

CONCLUSION

Platform screen doors, suicide pits, blue lights, and improved media guidelines all have the potential to reduce rail-related suicide events and deaths.

LIMITATIONS

The review was restricted to English-language peer-reviewed papers published within the chosen time period.

Effectiveness of Physical Barriers Installation for Prevention of Incidents in Mexico City’s Subway System

Nowadays, suicides inside the installations of subway platforms are considered a public health problem in Mexico City. One solution to prevent them is the installation of physical barriers, but their high cost is unattractive for governmental authorities. Traditional approaches of research on the effectiveness of physical barriers for preventing suicides have been limited to analyzing statistically the effects of installing platform screen doors and blue lights on subway platforms. Although considerable progress has been made in this field, many important issues remain unexplored. This study investigates the effectiveness of physical barriers installation for prevention of incidents in Mexico City subway system by means of an agent-based simulation model. Firstly, the design of physical barriers for prevention of incidents in Mexico City subway system is described. Secondly, a conceptual model of the Zócalo station subway platform is presented. Thirdly, an agent-based simulation model of Zócalo station subway platform is implemented using AnyLogic™ software considering normal operations of the subway station. This study shows that physical barriers installation on the Zócalo subway platform can effectively prevent 76% of passenger’s suicides.

Suicides in commuting railway systems: The case of Stockholm county, Sweden

The objective of this study is to understand the spatial and temporal dynamics of suicides in commuting railway environments. Data on suicides in Stockholm commuting railway from 2006 to 2013 was analysed. The study sets out to identify significant clusters in suicides then evaluate whether commuting railway environments affect variations in suicide rates. Fieldwork inspection, spatial cluster techniques (NNHC and Getis-Ord statistics) and regression models underlie the methodology of study. Findings show no seasonality was observed in suicide cases, but winter months concentrate a larger share of events. Suicides do not occur evenly throughout the day but tend to take place more often in weekdays. Modelling findings shows that suicide rates increase with speed trains and decrease where barriers along tracks are installed. Although high speed trains are still a motive of concern for suicide prevention, findings call for a whole railway-approach to safety - one that extends maintenance beyond the platforms and stations' vicinities.

A systematic review of the literature on safety measures to prevent railway suicides and trespassing accidents

This review covers a central aspect in railway safety which is the prevention of suicides and trespassing accidents. The paper attempts to answer the following research question: 'What measures are available to reduce railway suicide and trespass, and what is the evidence for their effectiveness?' The review is based on 139 relevant publications, ranging from 1978 to 2014. The analysis aimed to identify the past and current trend in the prevention practice by looking both quantitatively and qualitatively at the recommended measures. According to the results, there has been a constant focus on suicide prevention, and only relatively recent interest in trespass countermeasures. The content analysis revealed 19 main preventative categories which include more than 100 specific measures. We identified 16 common categories against railway suicide and trespass, and 3 categories of specific measures to prevent suicide. There are only 22 studies which provide empirical support for the effectiveness of measures. Actual combinations of measures are barely evaluated, but several challenges emerge from the literature. The discussion focuses on the need for a unified approach to suicide and trespass prevention, and on the importance to consider the effect mechanism of the measures in order to design better interventions.

Does the installation of blue Lights on train platforms shift suicide to another station?: Evidence from Japan

BACKGROUND

Installing physical barriers at suicide hotspots is known as an effective strategy for suicide prevention. However, the effectiveness of physical barriers may be nullified by the substitution phenomenon, i.e., that restricting access to a particular place induces people at risk to look for a nearby place for suicide.

METHODS

This study tests whether the substitution phenomenon exists in the case of railway and metro suicides. We focused on the prevention effort by a Japanese railway company that installed blue light-emitting-diode (LED) lamps on railway platforms to prevent people from diving to a running train. Using panel data of 71 train stations between 2000 and 2013, we compared the number of suicides before and after the installation of the blue lights at 14 stations where the lights were installed and at neighboring five stations on the same railway line, using the number of suicides at all other stations without the intervention as a control group.

FINDINGS

Our regression analysis shows that the introduction of blue lights decreased the number suicides by 74% (CI: 48-87%) at stations where the blue lights were installed, while it did not result in a systematic increase in the number of suicides at the neighboring stations.

INTERPRETATION

The installation of blue lights generated no systematic substitution phenomenon at nearby stations.

Suicide on railroad rights-of-way: a psychological autopsy study

Findings from 55 psychological autopsies of decedents who perished on U.S. railroad rights-of-way between October 1, 2007, and September 30, 2010 are reported. Described are distal, proximal, and contextual factors of risk; understandings of why these suicides occurred on railroad rights-of-way; and opportunities for prevention of similar suicides. International comparisons of suicides on railroad rights-of-way are made to highlight distinct findings regarding U.S. cases. Decedents studied exhibited considerable predisposing risk for suicide, with a high prevalence of severe mental disorders and substance abuse. In addition, a number of acute risk factors were commonly observed, notably suicide ideation, hopelessness, anxiety, and anger. In the context of that acute risk, associated situational variables and a relative absence of protective factors are described.