Suicides and other fatalities from train-person collisions on Swedish railroads: a descriptive epidemiologic analysis as a basis for systems-oriented prevention

Characteristics and circumstances of rail suicides in England 2019-2021: A cluster analysis and autopsy study

BACKGROUND

Around 4 % of all suicide deaths in Great Britain occur on the railways. This exploratory study was designed to increase understanding of the individuals that take their lives in this way, and the circumstances of their death.

METHOD

Data were obtained from fatality investigation files compiled by the British Transport Police (BTP) relating to suspected suicides on the mainline railway in England from April 2019 to March 2021. Cluster analysis was carried out to identify grouped associations of characteristics and circumstances relating to rail suicide.

RESULTS

A total of 436 files were analysed, representing 93 % of all suspected railway suicides during this period. Cluster analysis identified four groups of almost equal size, distinguished principally by age, living arrangements, employment status and location of death. The study is novel in the way it integrates individual characteristics and circumstances of death. The identified clusters may provide a multidimensional way of conceptualising suicide risk that could inform more targeted interventions at rail locations.

LIMITATIONS

A high proportion of missing data means that the findings need to be interpreted with caution. It also restricted the multivariate analysis to those categories of information for which sufficient information was available.

CONCLUSION

The characteristics and circumstances of suicide deaths on the railways are complex and multifaceted. The typology identified in this study may help to target preventative strategies prior to the incident as well as at different location types.

The "mystery" of the train station: The importance of a forensic approach to a rare case of survival after a train-pedestrian collision

In the early morning a 28-year-old man was found lying on the tracks of a railway station with head injuries and fractures of the cervical spine resulting in permanent quadriplegia. He was in a club about 1 km away until about 2 h earlier and did not have any recollection of what could have happened. Was he the victim of an assault, did he fall down or was he hit by a passing train? The solution to this "mystery" came from a forensic evaluation that included the forensic branches of pathology, chemistry, merceology and genetics as well as the scene evaluation. Through these different steps, the role of a railway collision in determining the injuries was ascertained and a possible dynamic was postulated. The presented case is an expression of the importance of the different forensic disciplines and the difficulties the forensic pathologist encounters when analysing such peculiar and rare cases.

Identifying measures with the highest potential to reduce suicides on Finnish railways

The purpose of this study was to work systematically through all known measures for preventing railway suicides and to consider their suitability for the Finnish railway environment. The research method included a selection and grouping of measures, definition of assessment criteria, a literature review and compilation of assessment forms, and a workshop for experts in the field. We assessed 21 measures based on 12 specified criteria. Specifically, the aim of these criteria was to support the identification and structuring of the available information on each measure to be in easily exploitable format for railway stakeholders. The measures were listed in order of priority in three categories based on final assessments from the workshop. The measures categorised as top priority with the highest potential to reduce suicides on Finnish railways included training of railway personnel to identify suicidal people (also called Gatekeeper training), camera surveillance, detection systems (radar, movement sensors, etc.), collaboration between organisations, learning from international experience, cooperation between railway organisations, police and fire and rescue services, and training of mental health providers. This prioritisation, together with the information included in the assessment forms and expert's views related to each measure, support the Finnish railway stakeholders in selecting measures and defining implementation strategies to prevent railway suicides on Finnish railways. The insights of Finnish experts on the effectiveness and potential implementation of these different measures are valuable information also for railway stakeholders in other countries when selecting appropriate measures to prevent railway suicides. The results of this study support the safe and effective functioning of the railway system by adding knowledge that will help effectively prevent railway suicides and loss of life, delays to train traffic, and work-related stress and trauma to railway staff, rescue personnel and eyewitnesses.

Characteristics of Train-Pedestrian Collisions in Southwest China, 2011-2020

Although train-pedestrian collisions are the primary source of railway casualties, the characteristics of this phenomenon have not been fully investigated in China. This study examined such collisions in the Greater Sichuan-Chongqing area of China by conducting a thorough descriptive analysis of 2090 incident records from 2011 to 2020. The results showed that such collisions have declined gradually over the past decade, but the fatality rate remains high. We found that such collisions were more likely to happen to men, senior citizens and people crossing the tracks and that they occurred more frequently in the morning. While collision rates dropped in February, collisions were more likely to occur in December. In contrast to the situation in Western countries, weekends were not related to increased occurrence. The absence of a protective fence led to a higher collision rate, but level crossings are no longer a concern since most such structures in China have been rebuilt as overpasses. Mild slopes and extreme curvatures were also found to increase the occurrence of such collisions. Freight trains were most likely to be involved in train-pedestrian collisions, and collisions caused by high-speed trains were rare both absolutely and relatively. However, when collisions did occur, higher train speeds were linked with higher fatality rates. The findings suggest that patterns of train-pedestrian collisions in China differ from those in the Western world. This difference might be caused by differences in culture, geography, weather and railway development policies. Future research directions and possible preventive measures are also discussed.

Learning How to Learn from Disasters through a Comparative Dichotomy Analysis: Grenfell Tower and Hurricane Katrina Case Studies

We describe two well-established, practice-based Master’s programmes as examples of existing competence development opportunities for practitioners and how such links between theory and practice can be developed and taught within the Higher Education (HE) context. We hypothesise that learning from major failures is essential in linking theory with practice in both engineering and management education. We investigate how to train emergency response teams on coping with, and learning from, rare events; a major challenge to other practitioners in the fields of safety and risk management. Comparison is undertaken between two disasters—Hurricane Katrina in the USA and the relatively recent Grenfell Tower in the UK—using a balanced dual approach of paradoxes, a dichotomy. In this paper, we demonstrate the enhancement of both engineering and management education. This was achieved through using the two case studies to emphasize the relevance of incorporating advanced mental modelling approaches for root cause analysis in training and by comparing the two cases with respect to the black swan and black elephant concepts. It is recommended that future training has a balanced approach that encompasses the outlined features of dichotomies.

Patterns of pre-crash behaviour in railway suicides and the effect of corridor fencing: a natural experiment in New South Wales

Suicides on railway systems remain a significant concern world-wide. Understanding patterns of pre-crash behaviour, whether jumping, lying or wandering on tracks, is important for the design of preventative measures, yet prior studies have reported divergent patterns of behaviour. This study tested the hypothesis that higher standards of corridor fencing reduce the proportion of train suicides in the non-jumping category. Data was analyzed as a natural experiment for 171 cases of apparent railway suicides in New South Wales (NSW) for the period 2011-2018. Results were congruent with the hypothesis. A higher level of corridor fencing in metropolitan Sydney was associated with a lower proportion in the non-jumping category (33%) compared with regional areas (74%). The article contributes by showing that: (i) fencing appears to lead to a reduction in some types of rail suicides and thus; (ii) contributes to a lower overall rate of suicide by train; and (iii) even with fencing, the non-jumping incidents warrant attention for appropriate countermeasures.

Developing a framework of behaviours before suicides at railway locations

Better knowledge of behaviours of people at railway property could help with identifying those at risk of suicide. Literature has been reviewed from a range of disciplines on what is known about studying behaviour in this type of public location. Secondary analysis has been carried out on descriptions of behaviour from structured exercises with experts and other pre-existing sources. A framework has been produced with five main classes (display of emotion, appearance, posture/movements, activities and interactions) and associated sub-classes. Commentary has been provided on factors that influence identification of suspicious behaviours, how to distinguish these from normal behaviours and the circumstances that inhibit timely reactions to the behaviour amidst the complexity of the operational railway. Opportunities to develop and use the framework are discussed, including using this to prompt collection of additional behavioural data from wider resources, enhancing staff training and developing requirements for effective use of surveillance technologies. Practitioner Summary: Many railway suicides could be prevented with better understanding of behaviours before events. Pre-existing data sources have been analysed, producing a framework highlighting five aspects of behaviour. This can prompt the collection of better evidence on pre-suicidal behaviours, with future applications in developing surveillance technologies, training staff and public awareness.

Behaviours preceding suicides at railway and underground locations: a multimethodological qualitative approach

OBJECTIVES

Suicides by train have devastating consequences for families, the rail industry, staff dealing with the aftermath of such incidents and potential witnesses. To reduce suicides and suicide attempts by rail, it is important to learn how safe interventions can be made. However, very little is known about how to identify someone who may be about to make a suicide attempt at a railway location (including underground/subways). The current research employed a novel way of understanding what behaviours might immediately precede a suicide or suicide attempt at these locations.

DESIGN AND METHODS

A qualitative thematic approach was used for three parallel studies. Data were gathered from several sources, including interviews with individuals who survived a rail suicide attempt (n=9), CCTV footage of individuals who died by rail suicide (n=16) and qualitative survey data providing views from rail staff (n=79).

RESULTS

Our research suggests that there are several behaviours that people may carry out before a suicide or suicide attempt at a rail location, including station hopping and platform switching, limiting contact with others, positioning themselves at the end of the track where the train/tube approaches, allowing trains to pass by and carrying out repetitive behaviours.

CONCLUSIONS

There are several behaviours that may be identifiable in the moments leading up to a suicide or suicide attempt on the railways which may present opportunities for intervention. These findings have implications for several stakeholders, including rail providers, transport police and other organisations focused on suicide prevention.

Springtime Peaks and Christmas Troughs: A National Longitudinal Population-Based Study into Suicide Incidence Time Trends in the Netherlands

BACKGROUND

Time trends are one of the most studied phenomena in suicide research; however, evidence for time trends in the Dutch population remains understudied. Insight into time trends can contribute to the development of effective suicide prevention strategies.

METHODS

Time trends in national daily and monthly data of 33,224 suicide events that occurred in the Netherlands from 1995 to 2015 were examined, as well as the influence of age, gender, and province, in a longitudinal population-based design with Poisson regression analyses and Bayesian change point analyses.

RESULTS

Suicide incidence among Dutch residents increased from 2007 until 2015 by 38%. Suicide rates peak in spring, up to 8% higher than in summer (p < 0.001). Suicide incidence was 42% lower at Christmas, compared to the December-average (IRR = 0.580, p < 0.001). After Christmas, a substantial increase occurred on January 1, which remained high during the first weeks of the new year. Suicide occurred more than twice as often in men than in women. For both genders, the results indicated a spring time peak in suicide incidence and a trough at Christmas. Suicide rates were highest in the elderly (age group, 80+), and no evidence was found of a differential effect by season in the age groups with regard to suicide incidence. No interaction effect was found with regard to province of residence for both season and Christmas, indicating that no evidence was found that these time trends had differential effects in the Dutch provinces in terms of suicide incidence.

CONCLUSION

Evidence was found for time trends in suicide incidence in the Netherlands. It is recommended to plan (mental) health care services to be available especially at high-risk moments, at spring time, and in the beginning of January. Further research is needed to explore the protective effect of Christmas in suicide incidence.

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.

Can CCTV identify people in public transit stations who are at risk of attempting suicide? An analysis of CCTV video recordings of attempters and a comparative investigation

Background

Suicides incur in all public transit systems which do not completely impede access to tracks. We conducted two studies to determine if we can reliably identify in stations people at risk of suicide in order to intervene in a timely manner. The first study analysed all CCTV recordings of suicide attempters in Montreal underground stations over 2 years to identify behaviours indicating suicide risk. The second study verified the potential of using those behaviours to discriminate attempters from other passengers in real time.

Methods

First study: Trained observers watched CCTV video recordings of 60 attempters, with 2–3 independent observers coding seven easily observable behaviours and five behaviours requiring interpretation (e.g. “strange behaviours,” “anxious behaviour”). Second study: We randomly mixed 63 five-minute CCTV recordings before an attempt with 56 recordings from the same cameras at the same time of day, and day of week, but when no suicide attempt was to occur. Thirty-three undergraduate students after only 10 min of instructions watched the recordings and indicated if they observed each of 13 behaviours identified in the First Study.

Results

First study: Fifty (83%) of attempters had easily observable behaviours potentially indicative of an impending attempt, and 37 (61%) had two or more of these behaviours. Forty-five (75%) had at least one behaviours requiring interpretation. Twenty-two witnesses attempted to intervene to stop the attempt, and 75% of attempters had behaviours indicating possible ambivalence (e.g. waiting for several trains to pass; trying to get out of the path of the train). Second study: Two behaviours, leaving an object on the platform and pacing back and forth from the yellow line (just before the edge of the platform), could identify 24% of attempters with no false positives. The other target behaviours were also present in non-attempters. However, having two or more of these behaviours indicated a likelihood of being at risk of attempting suicide.

Conclusions

We conclude that real time observations of CCTV monitors, automated computer monitoring of CCTV signals, and/or training of drivers and transit personnel on behavioural indications of suicide risk, may identify attempters with few false positives, and potentially save lives.

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.

Geographic distribution of suicide and railway suicide in Belgium, 2008-2013: a principal component analysis

This study investigated the geographic distribution of suicide and railway suicide in Belgium over 2008--2013 on local (i.e., district or arrondissement) level. There were differences in the regional distribution of suicide and railway suicides in Belgium over the study period. Principal component analysis identified three groups of correlations among population variables and socio-economic indicators, such as population density, unemployment, and age group distribution, on two components that helped explaining the variance of railway suicide at a local (arrondissement) level. This information is of particular importance to prevent suicides in high-risk areas on the Belgian railway network.

Systematic review of research on railway and urban transit system suicides

INTRODUCTION

We critically review research on railway suicides to inform suicide prevention initiatives and future studies, including who is at risk and why, and behaviours at track locations.

METHOD

Literature was identified from Scopus, Web of Science, Google Scholar and our documentation centre, and contacting 71 railway companies, resulting in 716 articles and eight unpublished reports, with 94 having empirical data on 55 unique studies. Research quality was critically assessed.

RESULTS

The quality of studies varies greatly with frequent shortcomings: no justification of sample size, lacking information on the reliability and validity of measures, no explanation nor theoretical understanding of findings. Railway suicides resemble closely people who use other methods, although they tend to be younger. As with other suicide methods, mental health problems are likely to be present. Railway suicide attempters usually die, but most urban transportation systems attempters survive. Railway suicides are rarely impulsive; people usually go to the railway for the purpose of killing themselves. Hotspots have been the focus of some prevention measures. We know little about why people choose railway suicide, but studies of survivors suggest they often thought they would have an immediate, certain and painless death. Media reports on railway suicides can increase their incidence.

CONCLUSIONS

Most research focuses on the incidence and characteristics of events and attempters. Research has not shown that railway suicides are different from suicides by other means. Better quality research is needed, particularly studies that investigate why people use railways to kill themselves and how railway suicides can be effectively prevented, as well as more evaluations of prevention programmes. Because of significant variations by country and region in characteristics of railway suicides, prevention programmes should conduct a local assessment of the characteristics of attempters and incidents.

PRACTICAL IMPLICATIONS

We need more research on indicators of suicide risk in attempters on railway property, and studies of how suicidal people on railway property are prevented from suicide. Changing beliefs and attitudes about railway suicides, reducing media reports, offering help onsite, controlling access at hotspots and better staff training in mental health facilities near tracks are promising prevention strategies. However, local specificities must be considered in planning prevention strategies.

Development of a Comprehensive Programme to Prevent and Reduce the Negative Impact of Railway Fatalities, Injuries and Close Calls on Railway Employees

AIM

This article presents a strategy to prevent trauma, support and care for railway personnel who experience critical incidents (CI) on the job, usually fatalities by accident or suicide.

METHOD

We reviewed all publications on CI management, support and care practices in the railway industry, as well as practices in place in Canada (unpublished protocols). Semi structured interviews were conducted with 40 train engineers and conductors involved in CIs and the content was coded and analysed quantitatively.

RESULTS

Employees' satisfaction with the help received after the incident varies according to the behaviour of the local manager, company officers and police, the level of compliance with existing company protocols to help them, the presence of unmet expectations for support and care, their perceived competency of clinicians they consulted and the level of trust toward their employers.

CONCLUSION

On the basis of the interview results, the review of existing railway practices and discussions with railway stakeholders, a model protocol was developed for a comprehensive workplace prevention, support and care protocol to reduce the negative impact of railway critical incidents on employees. This protocol includes preventive actions before traumatic events occur, immediate responses at the site of incident, interventions within the first few days after the incident and longer term support and interventions provided by the company and by outsourced experts.

An investigation of neighborhood-level social, economic and physical factors for railway suicide in Victoria, Australia

BACKGROUND

This study investigates the associations between railway suicide and neighborhood social, economic, and physical determinants using postcode-level data. It also examines whether the associations are influenced by having high concentration of high-risk individuals in a neighborhood area.

METHODS

Railway suicide cases from Victoria, Australia for the period of 2001-2012, their age, sex, year of death, usual residential address and suicide location were obtained from the National Coronial Information System. Univariate negative binomial regression models were used to estimate the association between railway suicide and neighborhood-level social, economic and physical factors. Variables which were significant in these univariate models were then assessed in a multivariate model, controlling for age and sex of the deceased and other known confounders.

RESULTS

Findings from the multivariate analysis indicate that an elevated rate of railway suicide was strongly associated with neighborhood exposure of higher number of railway stations (IRR=1.30 95% CI=1.16-1.46). Other significant neighborhood risk factors included patronage volume (IRR=1.06, 95% CI=1.02-1.11) and train frequency (IRR=1.02, 95% CI=1.01-1.04). An increased number of video surveillance systems at railway stations and carparks was significantly associated with a modest reduction in railway suicide risk (IRR=0.93, 95% CI=0.88-0.98). These associations were independent of concentration of high-risk individuals.

LIMITATIONS

Railway suicide may be under-reported in Australia.

CONCLUSIONS

Interventions to prevent railway suicide should target vulnerable individuals residing in areas characterized by high station density, patronage volume and train frequency.

Temporal and spatial patterns of suicides in Stockholm's subway stations

This paper investigates the potential temporal and spatial variations of suicides in subway stations in Stockholm, Sweden. The study also assesses whether the variation in suicide rates is related to the station environments by controlling for each station's location and a number of contextual factors using regression models and geographical information systems (GIS). Data on accidents are used as references for the analysis of suicides. Findings show that suicides tend to occur during the day and in the spring. They are concentrated in the main transportation hubs but, interestingly, during off-peak hours. However, the highest rates of suicides per passenger are found in Stockholm's subway stations located in the Southern outskirts. More than half of the variation in suicide rates is associated with stations that have walls between the two sides of the platform but still allow some visibility from passers-by. The surrounding environment and socioeconomic context show little effect on suicide rates, but stations embedded in areas with high drug-related crime rates tend to show higher suicide rates.

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.

Pedestrian fatalities resulting from train-person collisions

OBJECTIVE

Train-person collisions have a significant impact in our society, due to their negative economic and psychological effects. This work aims to study fatalities resulting from train-person collisions in Portugal.

METHODS

A retrospective study was conducted based on the analysis of autopsy reports related to train-person fatalities performed in the North Branch of the National Institute of Legal Medicine and Forensic Sciences.

RESULTS

Suicide was responsible for most of the cases, and males were more often involved in train-person collisions than females. Victims, between 40 and 59 years old, were found to be involved in a high percentage (39%) of the cases, and people older than 65 accounted for a significant percentage (40%) of the accidents. No seasonality was observed in suicide cases, but a decrease in accident numbers was registered in summer. Regarding weekday and time of day, afternoon and non-rush hour were the times when most suicides were observed, whereas accidents did not showed a specific weekday or time of day, except for rush hour, during which they were more frequent. Alcohol-positive blood analysis accounting for 25% of the cases.

CONCLUSIONS

Differences from other European studies were found, which may be related to the different cultures of the countries/regions, as well as to the differences in the railway systems. More extensive studies must be performed in order to develop strategies to prevent train-person collisions.

Stable time patterns of railway suicides in Germany: comparative analysis of 7,187 cases across two observation periods (1995-1998; 2005-2008)

BACKGROUND

The majority of fatalities on the European Union (EU) railways are suicides, representing about 60% of all railway fatalities. The aim of this study was to compare time patterns of suicidal behaviour on railway tracks in Germany between two observation periods (1995-1998 and 2005-2008) in order to investigate their stability and value in railway suicide prevention.

METHODS

Cases were derived from the National Central Registry of person accidents on the German railway network (STABAG). The association of daytime, weekday and month with the mean number of suicides was analysed applying linear regression. Potential differences by observation period were assessed by adding observation period and the respective interaction terms into the linear regression. A 95% confidence interval for the mean number of suicides was computed using the t distribution.

RESULTS

A total of 7,187 railway suicides were recorded within both periods: 4,102 (57%) in the first period (1995-1998) and 3,085 (43%) in the second (2005-2008). The number of railway suicides was highest on Mondays and Tuesdays in the first period with an average of 3.2 and 3.5 events and of 2.6 events on both days in the second period. In both periods, railway suicides were more common between 6:00 am and noon, and between 6:00 pm and midnight. Seasonality was only prominent in the period 1995-1998.

CONCLUSIONS

Over the course of two observation periods, the weekday and circadian patterns of railway suicides remained stable. Therefore, these patterns should be an integral part of railway suicide preventive measures, e.g. gatekeeper training courses.

The socio-environmental determinants of railway suicide: a systematic review

BACKGROUND

Railway suicide has significant adverse impacts for the victims, their family and friends, witnesses to the incident, general public and train network. There is no previous review on the socio-environmental factors and railway suicide. The research question asked in this review was: 'What socio-environmental risk and protective predictors are significantly associated with railway suicide?'

METHODS

The review searched Medline, PsycINFO, Web of Science and Scopus for English-language studies that assessed the associations between socio-environmental (i.e. geographical, physical, economic and social) factors and railway suicide from their inception to June 2013. It was reported based on the PRISMA Statement.

RESULTS

Eleven studies met the inclusion criteria. They were categorised into railway environments (availability of railways and trains, accessibility to railways and familiarity with trains), population characteristics and impact of media reporting. Findings from ecological studies using population level railway suicide data suggested weak and inconsistent evidence for the first two categories. The evidence on the impact of media reporting was moderately strong, with irresponsible media reporting being associated with an increased risk of railway suicide.

CONCLUSIONS

There is a need for further research activity to strengthen evidence about socio-environmental risk factors for railway suicide. The focus of this research should be on the factors that determine individuals' decisions of using the railway as a method of suicide, with the consideration of a range of geographical, physical, social, and economic factors.

Railway suicide attempts are associated with amount of sunlight in recent days

BACKGROUND

To assess the relationship between hours of sunlight and railway suicide attempts, 3-7 days before these attempts.

METHODS

All railway suicide attempts causing railway suspensions or delays of 30 min or more between 2002 and 2006. We used a linear probability model to assess this relationship. This study was conducted at Tokyo, Kanagawa, and Osaka prefectures in Japan. Data were collected from the railway delay incident database of the Japanese Railway Technical Research Institute and public weather database of the Japan Meteorological Agency.

RESULTS

About 971 railway suicides attempts occurred between 2002 and 2006 in Tokyo, Kanagawa, and Osaka. Less sunlight in the 7 days leading up to the railway suicide attempts was associated with a higher proportion of attempts (p=0.0243). Sunlight over the 3 days before an attempt had a similar trend (p=0.0888). No difference was found in sunlight hours between the days with (median: 5.6 [IQR: 1.1-8.8]) and without (median: 5.7 [IQR: 1.0-8.9]) railway suicide attempts in the evening. Finally, there was no apparent correlation between the railway suicide attempts and the monthly average sunlight hours of the attempted month or those of a month before.

LIMITATIONS

Railway suicides were not the main suicidal methods in Japan,

CONCLUSIONS

We observed an increased proportion of railway suicide attempts after several days without sunlight. Light exposure (blue light or bright white light) in trains may be useful in reducing railway suicides, especially when consecutive days without sunshine are forecasted.

Epidemiology & preventive aspects of railway suicides and fatalities related to trespassing accidents

PURPOSE

Suicide and trespass are major contributors to risk on the railway, resulting in around 170-180 fatalities per year in Lucknow region, as well as associated major disruption to the rail network. Lucknow is the capital city of the state of Uttar Pradesh in India.

METHODS

The analysis included train-pedestrian fatalities during 2007-2012. The data for 2007-2012 were collected from the autopsy reports of the university, case sheets from the hospital, the general prosecutor's investigations report and the inquest reports from police.

RESULTS

The results show that the majority of victims were males. Half of the suicide victims were 20-39 years old. Accidents happened most frequently in situations when a person was walking on the tracks/in front of train (22.7%) or were crossing the tracks illegally (20.9%). Among all train-pedestrian fatalities, about half of the victims (42.8%) were intoxicated by alcohol. Female suicide victims suffered from mental health problems more frequently (55.8%) than male suicide victims.

CONCLUSION

Overall, there is no reason to believe that train-pedestrian fatalities are unavoidable. By contrast, the effective prevention of railway suicides and accidents should be based on a systems approach involving effective measures introduces by several organisations such as government, railway organisations, various authorities (such as public health, education, enforcement, urban planning) and communities. Same measures can often be used to prevent both trespassing and suicides, even though their effectiveness may depend on the target group. In addition, there are measures specifically targeted to prevent either trespassing or suicides.

Train suicide mortality and availability of trains: a tale of two countries

When compared to German rates, train suicides in The Netherlands have made up a larger proportion of the total number of suicides. This study examines whether this difference is attributable to railway parameters, familiarity with rail transport, or population density. Dutch and German train suicide rates from 2000 to 2007 were compared by means of Poisson regression analyses. Train suicide rate ratios were calculated and related to the railway parameters or population density in a Poisson regression model. The Dutch-German general suicide rate ratio was 0.72. In contrast, the train suicide rate in The Netherlands exceeded the German rate by 1.23. In the Poisson regression analyses, where suicide rate was related to railway density or passenger traffic intensity, the Dutch-German train suicide rate ratios became 1.49 and 1.20 respectively. When related to train traffic intensity or population density, however, rate ratios turned into 0.74 and 0.59 respectively. Train traffic intensity contributes to train suicide frequency. Population density also contributes, whereas railway density and familiarity with rail transport do not. In a cross-national comparison the availability hypothesis regarding the number of trains passing was confirmed, which leads to the recommendation of limiting access to the railway tracks.

Passenger behavior in trains during emergency situations

INTRODUCTION

This research presents a methodology for analyzing the behavior of people (passengers and crew) involved in emergency situations on passenger trains.

METHODS

This methodological tool centers around a qualitative character study coming from Focus Groups (FG) and in-depth interviews to extract the determinant variables on passenger and crew behavior when faced with certain emergency situations on trains.

RESULTS

This research has led to the creation of a classification of possible behaviors associated to each type of incident and dependent on certain variables. The qualitative study was used as the basis for modeling stated preference data using logit type discrete choice models to characterize and quantify the behavior. The most important results show that the determinant variables on passenger behavior correspond to the type of emergency suffered (its degree of seriousness), the type of passenger, the reasons for the journey (demands of time), the information received during the incident, the relationship between crew and passengers, the duration of the incident and the conditions (temperature control, availability of water, occupancy of the train), the distance to the destination station, and finally, the outside weather conditions. This research was carried out using the Spanish railway network as its reference, although it is applicable to any geographical area.

IMPACT ON INDUSTRY

The results show that the information variable should be considered in the development of future research and that the evidences of this research can be used to develop behavioral models for modeling railway passenger evacuations.

Patterns of suicide and other trespassing fatalities on state-owned railways in greater Stockholm; implications for prevention

Each year, approximately 80-100 people are killed on state-owned railways due to train-person collisions in Sweden. Underlying causes are suicide and accidents; suicide constituting a vast majority. Earlier Swedish studies at a national level revealed a relation between population density and incident frequency, however, with places of occurrence often located to the outskirts of cities some distance away from station areas where victims can await approaching trains in seclusion. The aim of this study was to investigate whether this national pattern also applies to larger urban areas such as greater Stockholm, and to discuss preventative implications based on these observations. All registered incidents (N = 41) where people were hit or run-over by trains with a fatal outcome over the four-year period 2005-2008 were investigated. Results deviating from the national pattern include that most incidents occur at station areas, and that most victims enter the tracks from platforms. Passing express trains appear to be overrepresented, compared to commuter trains. Due to a low number of cases, our observations must be interpreted with caution. However, they imply that preventative measures in this type of area should focus on platform safety foremost, especially protection against rapid trains passing by station areas.

Main characteristics of train-pedestrian fatalities on Finnish railroads

The aim of this study was to describe the frequency of fatalities, timing of collisions and characteristics of persons killed in train-pedestrian collisions on Finnish railways during 2005-2009. In addition, the Finnish results were compared with those collected in Sweden. The Finnish data were combined from five different sources. The results showed that 311 pedestrians were killed in train-pedestrian collisions, including 264 suicides, 35 accidents and 12 unclassified events. For each event type, most of the victims were male. Most suicide victims were in the 20-29 year age group and on average younger than people who chose some other form of suicide. About half of all victims were intoxicated by alcohol, medicines and/or drugs. Both suicides and accidents occurred most often at the end of the week but no specific peak for time of year was found. Suicides occurred most frequently from afternoon to night and accidents during the rush hours. Most train-pedestrian fatalities happened in densely populated areas. In conclusion, the effective prevention of railway suicides and accidents calls for a systems approach involving effective measures introduced by authorities responsible for urban planning, railways, education and public health.

Railway Suicide in Belgium 1998–2009

Background: Belgium is a country with a high suicide rate (19.1/100,000 in 2004), and railway suicide poses a substantial safety and public health problem. This problem was addressed by the Suicide Prevention Unit of Infrabel (Manager of the Belgian Railway Infrastructure), which collects relevant data and implements a prevention program. Aims: To present data on fatal and nonfatal suicidal behavior on the Belgian railway network, including monthly and regional distribution and identification of hotspots; and to present the Infrabel suicide prevention program. Methods: Analysis of Infrabel data on railway suicide (1998–2009) and comparison with data on suicide in Belgium. Results: A total of 1,092 railway suicides (1998–2009) and 557 suicide attempts (2003–2009) in Belgium (fatality rate of 54%) were studied. Monthly fluctuations were observed, with the majority of suicides occurring in Flanders, followed by Wallonia and Brussels. We identified 34 hotspots accounting for 35% of cases, mostly in Flanders. Conclusions: In 2004 railway suicide accounted for 5.3% of all suicides in Belgium (railway suicide rate of 1.03/100,000). Such a major human and economic loss warrants implementation of prevention measures. Infrabel has initiated a comprehensive suicide prevention program which focuses mainly on safeguarding the suicide hotspots.

The reliability of suicide rates: an analysis of railway suicides from two sources in fifteen European countries

BACKGROUND

National suicide data are an underestimation of the actual number of suicides but are often assumed to be reliable and useful for scientific research. The aim of this study is to contribute to the discussion of the reliability of suicide mortality data by comparing railway suicides from two data sources.

METHODS

Data for the railway suicides and the concurrent causes of death of fifteen European countries were collected from the European Detailed Mortality Database and the European Railway Agency (ERA). Suicide rates, odds ratios and confidence intervals were calculated.

RESULTS

The suicide data from the ERA were significantly higher than the national data for six out of fifteen countries. In three countries, the ERA registered significantly more railway suicides compared to the sum of the national suicides and undetermined deaths. In Italy and France, the ERA statistics recorded significantly more railway related fatalities than the national statistical offices. In total the ERA statistics registered 34% more suicides and 9% more railway fatalities compared with the national statistics.

LIMITATIONS

The findings of this study concern railway suicides and they cannot be extrapolated to all types of suicides. Further, the national suicide statistics and the ERA data are not perfectly comparable, due to the different categorisations of the causes of death.

CONCLUSIONS

Based on the data for railway suicides, it seems that the underestimation of suicide rates is significant for some countries, and that the degree of underestimation differs substantially among countries. Caution is needed when comparing national suicide rates. There is a need for standardisation of national death registration procedures at the European level.

Jumping, lying, wandering: analysis of suicidal behaviour patterns in 1,004 suicidal acts on the German railway net

Current knowledge on behavioural patterns and personal characteristics of subjects who choose the railway as means of suicide is sparse. The aim of this study was to determine the frequency of three distinct behaviour patterns (jumping, lying, wandering) in railway suicides and to explore associated variables. Cases were derived from the National Central Registry of person accidents on the German railway net covering the period from 2002 to 2006. A retrospective analysis of registry protocols of all 4127 suicidal acts allowed classification of behaviour patterns in 1004 cases. Types of suicidal behaviour occurred with nearly equal frequencies; jumping in 32.2%, lying in 32.6% and wandering in 34.2% of cases. Age and sex were not associated with type of suicidal behaviour. The proportion of jumping was highest during 9:01 am to 6:00 pm while at night, lying was used most frequently. Jumping predominated in the station area, while lying and wandering on the open track. Fatality was highest in liers and lowest in jumpers. The frequency of jumping decreased during the study period by 12.6% (p < .05). These findings may help to elucidate differential risk features of this highly lethal suicide method.

Train suicides in The Netherlands

BACKGROUND

Little is known about train suicide and factors influencing its prevalence. This study tests the hypotheses that railway density, railway transportation volume, familiarity with railway transportation and population density contribute to train suicide. It also tests the relationship between train suicide and general population suicide and examines the prevalence and the characteristics of high-risk locations and their contribution to the grand total of train suicides.

METHODS

Trends in train suicides were compared with trends in railway track length, train kilometres, passenger kilometres and national suicide figures over the period 1950-2007. The geographical distribution over the national network over the period 1980-2007 was studied. Data were obtained from The Netherlands Railways, Prorail and Statistics Netherlands.

RESULTS

1. The incidence of train suicides is unrelated to railway parameters. 2. Being familiar with railway transportation as a passenger is not a contributory factor. 3. Train suicide rates are unrelated to regional population density. 4. The incidence of train suicides parallels that of general population suicides. 5. Half of the train suicides took place at a limited number of locations, the most important of which were situated within a village or town and were close to a psychiatric hospital.

LIMITATIONS

Most conclusions are based on correlational relationships between variables.

CONCLUSIONS

1. Train suicide trends reflect trends in general population suicides. 2. Increased train transportation does not lead to more train suicides. 3. The prevention of train suicide at high-risk locations (HRLs) in built-up areas and near psychiatric hospitals deserves first priority.

Railway associated injuries in Pakistan

Pakistan is ranked 12th worldwide for passenger kilometres (km) travelled by railway network. The objective of this study was to assess the railway network related morbidity and mortality in Pakistan. Reported deaths and injuries due to this network were extracted from two secondary datasets: (1) an international disaster database and (2) ambulance log registers for the city of Karachi. Over the period from 1997 to 2006, a total of 11 railway disasters resulted in 449 deaths and 840 injuries. An estimated 2.05 passengers died and another 3.84 passengers were injured per billion km travelled in Pakistan, a rate six times higher than Western European countries. The ambulance log showed that one person died every two weeks in Karachi over a period from September 2007 to Jun 2008 (N = 26). The male-to-female ratio of all injury victims (N = 50) was 9:1 with a mean age of 35.6 years. Surveillance of these injuries is essential to implement prevention and control measures in Pakistan.

Epidemiology of subway-related fatalities in New York City, 1990-2003

PROBLEM

Subway transit is a relatively safe mode of transportation, yet compared to all other forms of mass transit in the United States (U.S.), subways have the highest fatality rate. The aim of this paper is to characterize subway-related fatalities in order to identify opportunities for risk reduction.

METHOD

Medical examiner records for all New York City (NYC) subway-related deaths (1990-2003) were reviewed. Data were abstracted on decedents' demographics and autopsy findings, including laboratory findings.

RESULTS

There were 668 subway-related fatalities, of these, 10 (1.5%) were homicides, 343 (51.3%) were determined to be suicides, and 315 (47.2%) were accidental. Although decedent characteristics varied between fatality categories, they were not particularly informative with regard to prevention.

CONCLUSION

Prevention strategies that focus on structural controls are likely to be most efficacious in improving the overall safety of the NYC subway systems.

IMPACT ON INDUSTRY

These findings suggest that structural rather than individual-level interventions would be most successful in preventing subway fatalities.

Suicide on railway networks: epidemiology, risk factors and prevention

The aim of the present study was to review international literature on the incidence of suicide on railway networks, describe risk factors associated with it, and examine existing prevention practices. Searches on Medline and PsycINFO for the period 1966-2007 were performed. Thirty original studies published in English on epidemiology of rail suicide were included in the review along with peer-reviewed articles on risk factors and prevention of rail suicide. Internationally, suicide by collision with a train accounted for 1-12% of all suicides, with up to 94% of all attempts resulting in death. Suicide by train seriously affects not only survivors, but also train drivers and bystanders. Correlations between density of rail network, number of passengers and number of suicides by train have been found. Conflicting data exist on gender ratio of this type of suicide, but studies are homogenous in identifying young adults (20-40 year of age) as those most exposed to train suicide. Documented psychiatric diagnoses were found in up to 83% of cases. Mid-seasonal peaks were also identified, with events occurring mostly during late morning and early afternoon. Limited evidence exists for effective suicide prevention practices. Successful examples are represented by pits and sliding door systems (Singapore Mass Rapid Transit System) and responsible media reporting (Viennese Subway). Suicide by train involves emotional and financial costs to individuals and society as a whole. A combination of different strategies might significantly reduce its effect.

Suicidal behaviour by train collision in Queensland, 1990-2004

OBJECTIVE

A study on the incidence of suicide in the train system and a description of main characteristics of victims and attempters was commissioned by Queensland Rail in response to an apparent increase of suicide phenomena and their consequences.

METHODS

Two sources of data were used for the analyses: the Queensland Suicide Register (QSR) and the Queensland Rail Incident Surveillance Information System (ISIS). Data on suicide were cross-checked on the two systems for the years 1990-2004. ISIS provided information on cases of attempted suicide for the period 1993-2206.

RESULTS

One hundred and sixty-one train suicide victims were identified. Globally, they represented 2% of all cases of suicide in Queensland. During the examined period no significant changes in trends of suicide through that method were found. Of all suicide cases, 59 (36.6%) included victims aged 15-24 years. The ratio of male :female was 4:1, equal to the sex distribution of suicide with all methods in Queensland. Positive blood alcohol content was found in nearly 50% of young people and in 29.8% of the total sample. A psychiatric diagnosis was documented in 40.4% of all train suicide victims. Only 18 suicide attempters were identified through the ISIS database; of them, 15 were male and three were female, with a gender ratio similar to that of suicide victims.

CONCLUSIONS

This study involved the largest dataset ever published in Australia on this topic. In Queensland, train suicides presented a stable trend during 1990-2004. Subjects of very young age (15-24) seem to be particularly exposed to this method; in this age group one in two individuals had positive blood alcohol content.

Railway and Metro Suicides

Abstract. This article reviews research on railway and metro (underground and subway) suicides around the world. Although the incidence and survival rates vary and standardized methodologies are lacking, it is evident that there is a high incidence among psychiatric patients and at stations, crossings, and track areas near psychiatric institutions. Fictional and news reports of railway and metro suicides are related to increased rates, and false beliefs about a certain, fatal, and painless outcome may contribute to use of this method. Train drivers and rail personnel are often traumatized and in need of personal support after the incident. Most prevention involves surveillance, limiting access to tracks, or prompt intervention during an attempt. Other potential strategies include focusing upon the high-risk populations of previous attempters and patients in psychiatric facilities near stations and tracks and changing attitudes concerning the acceptability of this method to ensure that potentially suicidally active individuals are not under the illusion that this is a certain and painless method of death.