Suicide on railway networks: epidemiology, risk factors and prevention

A multi-level analysis on the causes of train-pedestrian collisions in Southwest China 2011-2020

Collisions between trains and pedestrians are the primary cause of railway casualties. However, there remains a lack of comprehensive understanding regarding the underlying causes of this phenomenon. This study employs a multi-level approach to investigate the factors associated with the occurrence and severity of train-pedestrian collisions. The investigation is based on 2160 independent cases that occurred in southwest China from 2011 to 2020. Multiple contributing factors related to the victim, train, track, and socio-economic status of the surrounding district were examined, utilizing information from various sources. At the county level, several risk factors were identified in predicting the occurrence rate. These factors include higher population density and a greater number of normal-speed stations. However, the presence of high-speed train stations did not exhibit any significant impact. Additionally, the study found that regulations pertaining to protective fences were highly effective in reducing the occurrence rate. Regarding the prediction of collision severity, certain factors were found to increase the death rate. These factors include young men as victims, engaging in lying down or crossing behaviors, higher train speeds, gentle downhill slopes, lower education levels, and a higher proportion of the labor force. These findings emphasize the necessity of adopting a comprehensive perspective when examining the causes of train-pedestrian collisions. Furthermore, it underscores the significance of considering the notable differences between rapidly developing countries such as China and developed countries. Based on our findings, we also provide corresponding policy suggestions.

[Suicide attempts with a violent method: Experience of a transdisciplinary psychiatric ward combining psychiatric and somatic care]

INTRODUCTION

Suicide is the second leading cause of death in young adults. Suicide attempts by violent methods predict later completed suicide and premature mortality. Suicide prevention is a major public health issue in this specific population. The French Student Health Foundation (FSEF) developed a psychiatric ward that includes psychiatric and somatic approaches. This transdisciplinary unit provides mixed psychiatric and rehabilitation treatments for those persons who have attempted suicide and have severe somatic injuries.

METHODS

We conducted a retrospective study including all subjects admitted into the transdisciplinary unit from 1st January 2011 to 31 December 2017, after a suicide attempt by jumping from a height, in front of a moving object, or by crashing of a motor vehicle. Data was obtained from the medical and administrative records of the clinic.

RESULTS

In total, 215 persons were admitted into the transdisciplinary unit after a suicide attempt by a violent mean. Among them, 91.6% had jumped from a height, 7.4% had jumped in front of a train or a metro and 0.9% had crashed a motor vehicle. They were on average 25.5years old and 50.2% were men. 45.1% had a diagnosis of schizophrenic disorders and 34.4% of mood disorders. A total of 35.6% presented at least one previous suicide attempt, and among them 40.3% had previously attempted suicide with a violent mean. Substance abuse, mostly alcohol and/or cannabis, featured in 40.8% of subject history. The subjects hospitalised in the transdisciplinary unit had multiple, severe injuries: 78.1% had spine fractures, 69.8% had lower limb fractures, 47.9% had pelvic fractures and 43.3% had upper limb fractures. Moreover, 25.5% of them had sacral root damages. The length of stay averaged 184days and varied in a large range (less than a month to more than two years). The Activities of Daily Living scores were higher than 3 (out of a maximum score of 4) reflecting an important need of assistance. These scores decreased significantly during the hospitalisation for dressing, feeding, continence and locomotion but remained high for comportment and communication. At discharge, the physical sequelae were still important: 61% of people hospitalised had pain that required step 2 or 3 analgesics, 44% had analgesics for neuropathic pain, 80% had lower limb impairments, most often with walking limitation, and 26% had continence disorders. The psychotropic treatments at discharge were related to the psychiatric disorders observed and included 42% antidepressants, 63% neuroleptics and 16% mood stabilizers.

CONCLUSION

This study highlights the severity of the somatic and psychiatric disorders affecting people who are admitted into this transdisciplinary unit. These subjects who have attempted suicide require particular care with multidisciplinary management in order to promote their rehabilitation, reintegration and prevent a suicide reattempt.

Efforts to Prevent Railway Suicides in Denmark

Background: Reviews of camera surveillance systems have demonstrated ambivalent behaviors among people who die by railway suicide. Yet, only few preventive measures have been evaluated. Aims: We aimed to review incidents of suicidal behavior at a Danish railway station, install preventive measures, and monitor subsequent calls to a telephone helpline and reports of suicidal incidences. Method: Suicide incidents at Valby Station during 2012-2018 were reviewed to identify options for preventive measures. Based on these findings, signs encouraging help-seeking and other measures were implemented. Calls to the Danish helpline for suicide prevention and suicidal events at the station were subsequently monitored. Results: The review revealed locations where measures were meaningful and signs, physical barriers, and motion-sensitive lights were installed. Over the following 14 months, no suicide deaths occurred, and the signs were mentioned in 14 calls to the helpline, some of which were made by callers who were evaluated to be at high risk of suicide. Limitations: No direct link between implemented measures and observed outcomes could be established. Conclusion: Installing measures, including signs, at appropriate locations at railway platforms may encourage people in crisis to seek support.

Five-year mortality after hospitalisation for suicide attempt with a violent method

OBJECTIVE

This study aimed to estimate the 5-year mortality among people admitted into a transdisciplinary unit providing combined psychiatric and somatic rehabilitation treatment.

METHODS

In this retrospective study, we analyzed the clinical records of all individuals admitted into the transdisciplinary unit from 01/01/2011 to 12/31/2017 after a suicide attempt using violent means. Vital status was ascertained for these 215 people, a standardized mortality ratio (SMR) was calculated and Log-rank tests were used to identify factors associated with mortality.

RESULTS

The crude mortality rate was 5.12% (11 deaths) and the SMR was 15.45 (95% CI = [7.71-27.65]; p < 0.001) 5.40 years after admission into the transdisciplinary unit. Factors associated with mortality were: older age (29.91 years versus 25.30 years, p < 0.001), a longer stay in acute care (p = 0.002) and a shorter stay in the transdisciplinary unit (p < 0.001).

CONCLUSION

Long-term mortality among people who have attempted suicide using violent means is 15 times higher than in the corresponding general young adult population. This study supports the hypothesis that the severity of a suicide attempt is associated with subsequent excess mortality. Therefore, there is a need to consolidate outpatient facilities that provide appropriate support for this specific population after discharge. These programmes need to ensure the continuity of coordinated psychiatric and somatic care and psychosocial rehabilitation in order to prevent the risk of suicide.

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.

Preventing railway suicides through level crossing removal: a multiple-arm pre-post study design in Victoria, Australia

PURPOSE

Rail level crossing removals to improve transport performance across metropolitan Melbourne (state of Victoria) resulted in new rail fencing and grade-separation of tracks from the surrounding environment at several sites. These design changes restricted pedestrian access to the rail tracks, which is a countermeasure known to prevent railway suicide in other settings. We examined whether any such suicide prevention effect followed the removals.

METHODS

We used a multiple-arm pre-post design to test whether a decrease in monthly frequency of railway suicides occurred at level crossing removal sites (intervention sites), compared to randomly matched sites where level crossings had not yet been removed (control sites). We used data available in the Victorian Suicide Register covering the period 1st January 2008 to 30th June 2021.

RESULTS

The mean monthly number of railway suicides decreased by 68% within a 500 m radius of intervention sites (RR: 0.32; CI 95% 0.11-0.74) and by 61% within a 1000 m radius of intervention sites (RR: 0.39; CI 95% 0.21-0.68). There was no evidence that the mean monthly number of railway suicides changed at the control sites, either within a 500 m radius (RR: 0.88; CI 95% 0.47-1.56) or a 1000 m radius (RR: 0.82; CI 95% 0.52-1.26).

CONCLUSION

The reduction in railway suicides at locations where level crossings were removed, demonstrates the suicide prevention benefits that can be derived from a major infrastructure project even if not initially intended. Planning for major infrastructure projects should include consideration of these benefits, with designs incorporating features to maximise suicide prevention impact.

[Suicides Among Adolescents in a Major German City]

Suicides Among Adolescents in a Major German City Abstract. Objective: Adolescent suicide is a major contributor to the overall mortality in this age group. This study examined sex and age differences in suicide methods. Method: The investigation is based on death certificates from the years 1996 to 2019 of the city of Leipzig and includes all suicides in the age group under 25 years. The impact of sex and age on the method and location of suicide was examined using chi square statistics. Moreover, we verified the association between suicides and death by drug overdose through statistical regression. Results: 140 suicides were included in the study. The suicide methods differed between the age groups (χ^² = 17,878; p = .022). Individuals under 21 years of age committed suicide almost exclusively by strangulation, jumping from heights, railway suicide, or deliberate intoxication. With the onset of early adulthood, the spectrum of methods expanded. Suicide methods were also different between the sexes (χ^² = 35,166; p < .001): Male adolescents preferred highly lethal methods such as strangulation, whereas in female adolescents intoxication was the leading method of suicide, with a predominance of antidepressants. The annual rates of suicide and death by drug overdose were found to correlate (Pearson correlation = 0,571, p = .004). Minors (χ² = 3.125, p = .077) tended to avoid their own residential environment as a place of suicides compared to adults. Conclusion: When assessing the individual suicide risk and weighing safeguarding measures in clinical practice, the differences shown in the choice of methods should be taken into account.

Why Choose the Railway?

Background: The impact of railway suicide in the United Kingdom is extensive, yet reasons for why people choose this method are not clearly understood and research into the examination of suicide notes in this area is limited. Aims: Our study aimed to utilize the unique access to suicide notes written by those who died by suicide on the railway so as to gain a greater understanding of why people chose this method. Method: Descriptive and thematic analysis was conducted on 75 suicide notes for those who had died by suicide on the UK railway between 2010 and 2016. Results: Demographic findings from the sample were largely consistent with railway UK data trends. Five main themes were identified as being significant: "certain and instant," "impersonal and non-human," "ability to be planned," "a good death," and "bereavement suicide." Limitations: Findings are based on suicide note authors who died by suicide on the railway in the UK, as such generalizability may be limited. Conclusion: Findings suggest that people select the railway for their suicide for the following motives: perception of being instant and certain and viewed as a good death, ability to be planned, belief it causes less of a burden on loved ones (via the perception of the railway as impersonal), and a prior experience of it being fatal (via bereavement suicide). Key implications in relation to prevention strategies and future research are discussed.

Annual Research Review: A meta-analytic review of worldwide suicide rates in adolescents

Suicide is a leading cause of death among youth worldwide. The purpose of the current review was to examine recent cross-national trends in suicide mortality rates among 10- to 19-year-olds. This study extracted suicide mortality data from the World Health Organization's (WHO) Mortality Database for the most recent year (since 2010) from any country with available high-quality data (as defined by the WHO's guidelines). Data on access to lethal means (firearms, railways) and measures of economic quality (World Bank Income Group) and inequality (Gini coefficients) were obtained from publicly available data sources. Cross-national suicide mortality rates in youth were heterogeneous. The pooled estimate across all ages, sexes, and countries was 3.77/100,000 people. The highest suicide rates were found in Estonia, New Zealand, and Uzbekistan. Suicide rates were higher among older compared with younger adolescents and higher among males than females. The most common suicide methods were hanging/suffocation and jumping/lying in front of a moving object or jumping from a height. Firearm and railway access were related to suicide deaths by firearms and jumping/lying, respectively. Economic quality and inequality were not related to overall suicide mortality rates. However, economic inequality was correlated with a higher ratio of male:female suicides. This study provides a recent update of cross-national suicide trends in adolescents. Findings replicate prior patterns related to age, sex, geographic region, and common suicide methods. New to this review are findings relating suicide method accessibility to suicide mortality rates and the significant association between income inequality and the ratio of male:female suicide. Future research directions include expanding the worldwide coverage to more low- and middle-income countries, examining demographic groupings beyond binary sex and to race/ethnicity within countries, and clarifying factors that account for cross-national differences in suicide trends.

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.

Evaluating the effectiveness of platform screen doors for preventing metro suicides in China

BACKGROUND

Metro suicide can cause tremendous effects on the general public. Platform screen doors (PSDs) have been identified as one of the most effective methods of suicide prevention at metro stations. However, there are few studies focusing on their effectiveness in preventing suicides. In particular, the effect of types of PSDs, including full-height and half-height PSDs, has rarely been assessed and compared.

METHODS

Based on the suicide data provided by the Shanghai metro operator, the effectiveness of installing different types of PSDs for preventing metro suicides was investigated using a Poisson regression model. Ten-year monthly panel data for 94 metro stations from 2008 to 2017 were used in this study.

RESULTS

The number of metro suicides declined by 90.9% after the PSDs were installed at metro stations. In addition, different types of PSDs had different effects on decreasing the number of suicides, and a higher half-height PSD was more effective in preventing suicides. Specifically, full-height PSDs could eliminate metro suicides by completely preventing passengers from entering the track area, while half-height PSDs that were 1.5 m and 1.2 m high could decrease the number of suicides by 79.2% and 60.2%, respectively. Moreover, there was no significant indication that the installation of PSDs at metro stations displaced suicides to railway stations without PSDs (p = 0.706).

LIMITATION

The potential economic benefits of different types of PSDs were not considered in our study. In addition, we did not examine whether suicide attempters would try to take their own lives by using other methods of suicide.

CONCLUSION

The installation of PSDs, especially full-height PSDs, could be very effective in preventing suicides at metro stations. Although half-height PSDs are less effective than full-height PSDs, increasing the height of half-height PSDs could be an effective way of enhancing their effectiveness in reducing the number of suicides.

Differences in the epidemiology of out-of-hospital and in-hospital trauma deaths

Background

Trauma is a leading cause of mortality. Holistic views of trauma systems consider injury as a public health problem that requires efforts in primary, secondary and tertiary prevention. However, the performance of trauma systems is commonly judged on the in-hospital mortality rate. Such a focus misses opportunities to consider all deaths within a population, to understand differences in in-hospital and out-of-hospital trauma deaths and to inform population-level injury prevention efforts. The aim of this study was to provide an epidemiological overview of out-of-hospital and in-hospital trauma deaths in a geographically-defined area over a 10-year period.

Methods

We performed a population-based review of out-of-hospital and in-hospital trauma deaths over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System and the Victorian State Trauma Registry. Temporal trends in population-based incidence rates were evaluated.

Results

Over the study period, there were 11,246 trauma deaths, of which 71% were out-of-hospital deaths. Out-of-hospital trauma deaths commonly resulted from intentional self-harm events (50%) and transport events (35%), while in-hospital trauma deaths commonly resulted from low falls (≤1 metre) (50%). The incidence of overall trauma deaths did not change over the study period (incidence rate ratio 0.998; 95%CI: 0.991, 1.004; P = 0.56).

Conclusions

Out-of-hospital deaths accounted for most trauma deaths. Given the notable differences between out-of-hospital and in-hospital trauma deaths, monitoring of all trauma deaths is necessary to inform injury prevention activities and to reduce trauma mortality. The absence of a change in the incidence of both out-of-hospital and in-hospital trauma deaths demonstrates the need for enhanced activities across all aspects of injury prevention.

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.

Predictors of using trains as a suicide method: Findings from Victoria, Australia

This study aimed to investigate the factors associated with the choice of trains over other means of suicide. We performed a case-control study using data on all suicides in Victoria, Australia between 2009 and 2012. Cases were those who died by rail suicide and controls were those who died by suicide by any other means. A logistic regression model was used to estimate the association between the choice of trains and a range of individual-level and neighbourhood-level factors. Individuals who were never married had double odds of using trains compared to individuals who were married. Those from areas with a higher proportion of people who travel to work by train also had greater odds of dying by railway suicide compared to those from areas with a relatively lower proportion of people who travel to work by train. Prevention efforts should consider limiting access to the railways and other evidence-based suicide prevention activities.

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.

Individual and community factors for railway suicide: a matched case-control study in Victoria, Australia

PURPOSE

This study aims to simultaneously examine individual- and community-level factors associated with railway suicide.

METHODS

We performed a case-control study in Victoria, Australia between 2001 and 2012. Data on cases of railway suicide were obtained from the National Coronial Information System (a database of coronial investigations). Controls were living individuals randomly selected from the Household, Income and Labour Dynamics in Australia study, matching to cases on age groups, sex and year of exposures. A conditional logistic regression model was used to assess the individual-level and community-level influences on individual odds of railway suicide, controlling for socioeconomic status.

RESULTS

Individual-level diagnosed mental illness increased railway suicide odds by six times [95 % confidence interval (CI) 4.5, 9.2]. Community-level factors such as living in an area with a presence of railway tracks [odds ratio (OR) 1.8, 95 % CI 1.2, 2.8], within a city (OR 3.2, 95 % CI 1.9, 5.4), and with a higher overall suicide rate (OR 1.02, 95 % CI 1.01, 1.04) were independently associated with greater individual odds of railway suicide compared to living in an area without a presence of railway tracks, outside a city, and with a relatively lower overall suicide rate.

CONCLUSIONS

The effects of mental illness and high incidence of overall suicides are prominent, but not specific on railway suicide. The effects of presence of railway tracks and city residence suggest the importance of accessibility to the railways for individual risk of railway suicide. Prevention efforts should focus on vulnerable people live in areas with easy access to the railways.

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.

Railway suicide in England and Wales 2000-2013: a time-trends analysis

Background

In 2010, the “Tackling Suicide on the Railways” programme was launched as a joint initiative among Network Rail, the Samaritans and other key organisations such as the British Transport Police and train operators to achieve a 20 % reduction in railway suicides from 2010 to 2015 in Great Britain. We report the most recent age and sex specific trends in railway suicide in England and Wales from 2000 to 2013 and examine whether the initiative’s target reduction in railway suicides is likely to be achieved.

Methods

Population data and suicide mortality data (all methods combined and railway) for England and Wales were obtained from the Office for National Statistics (ONS) and used to calculate age and gender specific rates for deaths registered from 2000 to 2013. Data on railway suicides were also obtained from the Rail Safety and Standards Board (RSSB) and compared with ONS data. We used joinpoint regression to identify changes in suicide trends across the study period.

Results

The railway was used in 4.1 % of all suicides in England and Wales (RSSB data were similar to ONS data for most years). Suicides in all persons from all causes decreased from 2000 to 2007, with small increases from 2008 until 2013; this rise was entirely due to an increase in male suicides. Railway suicide rates increased over the entire study period; the proportion of railway suicides in all persons increased from 3.5 to 4.9 % during the study period. This trend was also mainly driven by increases in male suicides as female railway suicide rates remained steady over time. The highest age specific railway suicide rates were observed in middle aged men and women. Although there was no conclusive evidence of an increase in ONS railway suicides, RSSB data showed a statistically significant increase in railway suicides in males from 2009 onwards.

Conclusion

The continued rise in male railway suicide in England and Wales is concerning, particularly due to the high economic costs and psychological trauma associated with these deaths. The initiative’s target of a 20 % reduction in railway suicide is unlikely to be achieved.

Analysis of fatal train-pedestrian collisions in metropolitan Chicago 2004-2012

The paper analyzes spatial and temporal data on fatal train-pedestrian collisions in the Chicago metropolitan area between 2004 and 2012. In comparing different municipalities within the region, the density of grade crossings and stations is found to increase the frequency of unintentional deaths. However, unintentional deaths do not increase with train volume suggesting that pedestrians may exercise more care around busier lines. The distribution of apparent intentional deaths is less strongly related to the density of crossings and stations suggesting that those intending self-harm will seek out a point of access. Apparent intentional deaths are more prevalent on lines with frequent passenger trains, and in municipalities with higher incomes and lower population densities. While most of the apparent intentional deaths (about 70%) are not associated with any copycat activities, the dataset contains possible clusters of intentional deaths that are proximate in both time and space. There was also a highly publicized suicide that led to a 95% increase in apparent intentional deaths throughout the region in the 18 weeks following the incident.

Celebrity suicide on the railway network: Can one case trigger international effects?

BACKGROUND

After the railway suicide of the German national goalkeeper Robert Enke in 2009, a significant increase of railway suicides was observed nationally. This study analyses whether this incident also triggered copycat effects in other European countries. Additionally, media coverage proxied by Google Trends and long-term changes taking into account general changes in suicide rates and kilometres driven by trains were examined.

METHODS

The numbers of railway suicides before and after Enke´s suicide were analysed for short and long-term periods (2 weeks and 2 years post-event) across five European countries. Incidence ratios and resulting percentage changes were computed.

RESULTS

Similar to Germany, there were significant short and long-term effects for the combined data of the four other countries (increase of 93.9%; p=0.004 and 16.7%; p=0.003). There was no indication that long-term effects are a mere reflection of an overall increase in suicide frequencies or due to increased numbers of kilometres driven by trains. Analyses on country level revealed heterogeneous results.

LIMITATIONS

Due to incomplete data, analyses regarding age and gender were not performed. Media coverage was only proxied by a Google Trends analysis. The study includes a small sample of European countries.

CONCLUSIONS

Enke's suicide in 2009 was followed by increasing train suicide numbers in Europe. Although this incident may have reinforced an existing European trend of growing railway suicides, an international copycat effect and/or an increased overall awareness about this particular suicide method appears to be one likely explanation for the changes.

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.

Methods of committing suicide among 2,347 people in Ohio

The present study explored gender differences in suicidal methods, aiming to identify ways to improve our identification of individuals at risk for suicide. Preferred suicide methods vary by demographics; however, method-specific risk factors have not been consistently identified. All suicidal deaths (N=2,347) in a large urban county were identified over a 15-year period (1994-2008). The majority of men used shooting and hanging. In contrast, women relied on a variety of methods, including self-poisoning, shooting, hanging, and carbon monoxide poisoning. Significant demographic differences are evident among individuals who die by shooting and self-poisoning.

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.

Determinants of completed railway suicides by psychiatric in-patients: case-control study

BACKGROUND

Suicide prediction during psychiatric in-patient treatment remains an unresolved challenge.

AIMS

To identify determinants of railway suicides in individuals receiving in-patient psychiatric treatment.

METHOD

The study population was drawn from patients admitted to six psychiatric hospitals in Germany during a 10-year period (1997-2006). Data from 101 railway suicide cases were compared with a control group of 101 discharged patients matched for age, gender and diagnosis.

RESULTS

Predictors of suicide were change of therapist (OR = 22.86, P = 0.004), suicidal ideation (OR = 7.92, P<0.001), negative or unchanged therapeutic course (OR = 7.73, P<0.001), need of polypharmaceutical treatment (OR = 2.81, P = 0.04) and unemployment (OR = 2.72, P = 0.04). Neither restlessness nor impulsivity predicted in-patient suicide.

CONCLUSIONS

Suicidal ideation, unfavourable clinical course and the use of multiple psychotropic substances (reflecting the severity of illness) were strong determinants of railway suicides. The most salient finding was the vital impact of a change of therapist. These findings deserve integration into the clinical management of patients with serious mental disease.

Work-related posttraumatic stress disorder (PTSD) and other emotional diseases as consequence of traumatic events in public transportation: a systematic review

BACKGROUND

Drivers in public transportation are at risk of experiencing potential traumatic events such as accidents involving persons, collisions, or suicides. In this context, the question arises to what extent psychological traumatization and posttraumatic diseases occur.

PURPOSE

The aim of this systematic review was to describe the frequency and nature of work-related posttraumatic disorders, to analyze risk and prognostic factors after potentially traumatic events (accidents resulting in damage to property and/or in injury or death), and address sick leave after such events in the realm of public transportation, based on the available literature.

METHODS

Systematic review based on four databases (PubMed, PSYNDEX/MEDLINE, ScienceDirect, PILOTS) between 1980 and June 2013.

RESULTS

We identified seven studies (four longitudinal, three cross-sectional) that examine employees after person under train (PUT) events. PTSD prevalences varied broadly between 0.7 and 17 %. The same applies to dysthymia/neurotic depression (1-26 %). However, similarly low prevalences of major depression (1.3-2.8 %) and panic disorder (0.5-1.3 %) have been observed. Risk factors of PTSD comprised individual, work-related, event-related, and prognostic aspects. Following the traumatic event, a total of 69-81 % of the drivers were absent, and if sick leave occurs, this was on average 3-19 days.

CONCLUSIONS

It became evident that drivers in public transportation run a high risk of sick leave. It was also striking that despite the immense impact of PUT and high number of suicides, only an infinitesimal number of studies exists. Due to various differences (period of follow-up, instrument of measurement and study period), it turned out that the comparability of the results of the studies is limited. For various reasons, further research is urgently needed, as from an occupational health point of view the issue of posttraumatic diseases and implications for fitness for service should be addressed.

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.

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.

Suicide mortality and risk factors in the 12 months after discharge from psychiatric inpatient care in Korea: 1989-2006

This study aimed to determine the suicide mortality within 1 year after discharge from psychiatric inpatient care and identify the risk factors for suicide completion during this period. A total of 8403 patients were admitted to general hospitals in Seoul, Korea, for psychiatric disorders from January 1989 to December 2006. The suicide mortality risk of these patients within 1 year of discharge was compared with that of gender- and age-matched subjects from the general population of Korea. The standardized mortality ratios (SMR) for suicide in the year following discharge were 49.7 for males and 45.5 for females. Patients aged 15-24 years had the highest risk for suicide. Among the different diagnostic groups, patients with personality disorders, schizophrenia, or affective disorders had the highest risk for suicide completion. Suicidal ideation at admission and inpatient stay more than 1 month were also associated with increased risk of suicide. In Korean psychiatric patients, the SMR is much higher in young female patients, a high percentage of patients commit suicide by jumping, and there is a stronger association of long duration of hospitalization and suicide. These factors should be considered in the development and implementation of suicide prevention strategies for Korean psychiatric patients.

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.

Proximal risk factors and suicide methods among suicide completers from national suicide mortality data 2004-2006 in Korea

This study was conducted to examine differences in proximal risk factors and suicide methods by sex and age in the national suicide mortality data in Korea. Data were collected from the National Police Agency and the National Statistical Office of Korea on suicide completers from 2004 to 2006. The 31,711 suicide case records were used to analyze suicide rates, methods, and proximal risk factors by sex and age. Suicide rate increased with age, especially in men. The most common proximal risk factor for suicide was medical illness in both sexes. The most common proximal risk factor for subjects younger than 30 years was found to be a conflict in relationships with family members, partner, or friends. Medical illness was found to increase in prevalence as a risk factor with age. Hanging/Suffocation was the most common suicide method used by both sexes. The use of drug/pesticide poisoning to suicide increased with age. A fall from height or hanging/suffocation was more popular in the younger age groups. Because proximal risk factors and suicide methods varied with sex and age, different suicide prevention measures are required after consideration of both of these parameters.

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.