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Mays VM, Gareeb M, Zhang X, Nguyen V, Rosenberg J, Lin Y, Arseniev-Koehler A, Eliav A, Foster JG, Baumgardner M, Cochran SD. Identifying Witnessed Suicides in National Violent Death Reporting System Narratives. Healthcare (Basel) 2024; 12:209. [PMID: 38255097 PMCID: PMC10815175 DOI: 10.3390/healthcare12020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
There is increasing attention to suicides that occur in view of others, as these deaths can cause significant psychological impact on witnesses. This study illuminates characteristics of witnessed suicides and compares characteristics of these deaths to non-witnessed suicides. We develop a codable definition of what constitutes witnessed (vs. non-witnessed) suicide. Our data include a sample of 1200 suicide descriptions from the 2003-2017 National Violent Death Reporting System (NVDRS). We first developed criteria to identify probable cases of witnessed suicide. The coding scheme achieved 94.5% agreement and identified approximately 10% (n = 125) of suicides as witnessed. Next, we examined differences between witnessed and non-witnessed suicides in demographics, manner of death, and social/environmental factors using bivariate Chi-squared tests, multivariate logistic regression, and ANOVA. Witnessed suicide decedents were significantly more likely than non-witnessed suicide decedents to be male, younger, and members of a sexual minority, and to have died in living spaces by means of a firearm. Two thirds of witnesses were strangers to the decedents, while 23.2% were romantic partners or ex-partners of the decedents. Our coding method offers a reliable approach to identify witnessed suicides. While witnessed suicides are relatively infrequent, these deaths have profound impact on witnesses. Articulating the features of witnessed suicides may contribute to identifying potential risk mitigation strategies.
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Affiliation(s)
- Vickie M. Mays
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA;
- UCLA BRITE Center for Science, Research and Policy, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (M.G.); (V.N.); (Y.L.); (A.A.-K.); (A.E.); (J.G.F.); (S.D.C.)
| | - Mikaela Gareeb
- UCLA BRITE Center for Science, Research and Policy, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (M.G.); (V.N.); (Y.L.); (A.A.-K.); (A.E.); (J.G.F.); (S.D.C.)
| | - Xingruo Zhang
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA;
| | - Vivian Nguyen
- UCLA BRITE Center for Science, Research and Policy, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (M.G.); (V.N.); (Y.L.); (A.A.-K.); (A.E.); (J.G.F.); (S.D.C.)
| | - Joelle Rosenberg
- Department of Sociology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Yuri Lin
- UCLA BRITE Center for Science, Research and Policy, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (M.G.); (V.N.); (Y.L.); (A.A.-K.); (A.E.); (J.G.F.); (S.D.C.)
| | - Alina Arseniev-Koehler
- UCLA BRITE Center for Science, Research and Policy, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (M.G.); (V.N.); (Y.L.); (A.A.-K.); (A.E.); (J.G.F.); (S.D.C.)
- Department of Sociology, Purdue University, West Lafayette, IN 47907, USA
- Department of Biomedical Informatics, University of California, San Diego (UCSD), San Diego, CA 92093, USA
| | - Adam Eliav
- UCLA BRITE Center for Science, Research and Policy, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (M.G.); (V.N.); (Y.L.); (A.A.-K.); (A.E.); (J.G.F.); (S.D.C.)
| | - Jacob Gates Foster
- UCLA BRITE Center for Science, Research and Policy, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (M.G.); (V.N.); (Y.L.); (A.A.-K.); (A.E.); (J.G.F.); (S.D.C.)
- Department of Sociology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Mika Baumgardner
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA;
- UCLA BRITE Center for Science, Research and Policy, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (M.G.); (V.N.); (Y.L.); (A.A.-K.); (A.E.); (J.G.F.); (S.D.C.)
| | - Susan D. Cochran
- UCLA BRITE Center for Science, Research and Policy, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (M.G.); (V.N.); (Y.L.); (A.A.-K.); (A.E.); (J.G.F.); (S.D.C.)
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
- Department of Statistics, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
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Silla A. Identifying measures with the highest potential to reduce suicides on Finnish railways. APPLIED ERGONOMICS 2022; 102:103748. [PMID: 35349938 DOI: 10.1016/j.apergo.2022.103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Anne Silla
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, 02044, VTT, Finland.
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Too LS, Ross A, Pirkis J, Reavley N, Reifels L. The Impact of the "Pause. Call. Be Heard" Campaign on Help-Seeking and Suicidal Behaviors Within Rail Environment in Victoria, Australia. Suicide Life Threat Behav 2020; 50:490-501. [PMID: 31750561 DOI: 10.1111/sltb.12604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/30/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact of the "Pause. Call. Be Heard" campaign on help-seeking and suicidal behaviors within rail environment in Victoria, Australia. METHODS An anonymous online survey was conducted to measure noticeability of and engagement with the campaign and help-seeking intentions and behaviors among rail commuters at 10 rail stations. We generated descriptive statistics to report these data and used logistic regression models to examine the association between campaign-related factors and help-seeking. Changes in Lifeline crisis calls and rail suicide behaviors from precampaign to campaign periods were examined using proportion tests. RESULTS About 25% of rail commuters noticed the campaign and rated the materials as "moderately noticeable." Over half of these individuals correctly identified the campaign intentions and 75% engaged with the materials. Approximately 80% indicated that the materials increased their help-seeking intentions and about half indicated that they had engaged with help-seeking and/or self-caring behaviors. Engaging with the campaign was positively associated with help-seeking. A significant increase in crisis calls but not in suicide-related calls, and a nonsignificant decrease in rail suicidal behaviors were found during the campaign period. CONCLUSIONS Continued implementation of the campaign is warranted as it showed some desirable effects on help-seeking among rail commuters.
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Affiliation(s)
- Lay San Too
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Anna Ross
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Jane Pirkis
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Nicola Reavley
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Lennart Reifels
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Parkville, Vic., Australia
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Ryan B. Developing a framework of behaviours before suicides at railway locations. ERGONOMICS 2018; 61:605-626. [PMID: 29137547 DOI: 10.1080/00140139.2017.1401124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
- Brendan Ryan
- a Human Factors Research Group, Faculty of Engineering , University of Nottingham , Nottingham , UK
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Mackenzie JM, Borrill J, Hawkins E, Fields B, Kruger I, Noonan I, Marzano L. Behaviours preceding suicides at railway and underground locations: a multimethodological qualitative approach. BMJ Open 2018; 8:e021076. [PMID: 29643167 PMCID: PMC5898325 DOI: 10.1136/bmjopen-2017-021076] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
| | - Jo Borrill
- Department of Psychology, University of Westminster, London, UK
| | - Emily Hawkins
- Department of Mental Health, King’s College London School of Medical Education, London, UK
| | - Bob Fields
- Department of Computer Science, Middlesex University, London, UK
| | - Ian Kruger
- Department of Psychology, Middlesex University, London, UK
| | - Ian Noonan
- Department of Mental Health, King’s College London School of Medical Education, London, UK
| | - Lisa Marzano
- Department of Psychology, Middlesex University, London, UK
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Barker E, Kolves K, De Leo D. Rail-suicide prevention: Systematic literature review of evidence-based activities. Asia Pac Psychiatry 2017; 9. [PMID: 27412891 DOI: 10.1111/appy.12246] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/11/2016] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Emma Barker
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Nathan, QLD, Australia
| | - Kairi Kolves
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Nathan, QLD, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Nathan, QLD, Australia
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Too LS, Bugeja L, Milner A, McClure R, Spittal MJ. Predictors of using trains as a suicide method: Findings from Victoria, Australia. Psychiatry Res 2017; 253:233-239. [PMID: 28395228 DOI: 10.1016/j.psychres.2017.03.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/08/2017] [Accepted: 03/31/2017] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Lay San Too
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
| | - Lyndal Bugeja
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Allison Milner
- Deakin Population Health SRC, School of Health and Social Development, Deakin University, Victoria, Australia; Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Roderick McClure
- Harvard Injury Control Research Center, Harvard School of Public Health, Massachusetts, United States
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
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Mishara BL, Bardon C, Dupont S. 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. BMC Public Health 2016; 16:1245. [PMID: 27974046 PMCID: PMC5157080 DOI: 10.1186/s12889-016-3888-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 11/29/2016] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Brian L Mishara
- Centre for Research and Intervention on Suicide and Euthanasia (CRISE), Psychology Department, Université du Québec à Montréal, CRISE-UQAM, C.P. 8888, Succ. Centre-ville, Montreal, QC, H3C 3P8, Canada.
| | - Cécile Bardon
- Centre for Research and Intervention on Suicide and Euthanasia (CRISE), Psychology Department, Université du Québec à Montréal, CRISE-UQAM, C.P. 8888, Succ. Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Serge Dupont
- Metro Network, Société des Transports de Montréal, Montréal, Canada
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Havârneanu GM, Burkhardt JM, Silla A. Optimizing suicide and trespass prevention on railways: a problem-solving model from the RESTRAIL project. Int J Inj Contr Saf Promot 2016; 24:469-486. [DOI: 10.1080/17457300.2016.1232275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Anne Silla
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
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10
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Sher L. Commentary: Police and Suicide Prevention. Front Public Health 2016; 4:119. [PMID: 27377447 PMCID: PMC4896938 DOI: 10.3389/fpubh.2016.00119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/26/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Leo Sher
- James J. Peters Veterans’ Administration Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- *Correspondence: Leo Sher,
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Mishara BL, Bardon C. Systematic review of research on railway and urban transit system suicides. J Affect Disord 2016; 193:215-26. [PMID: 26773913 DOI: 10.1016/j.jad.2015.12.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/21/2015] [Accepted: 12/26/2015] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Brian L Mishara
- Centre for Research and Intervention on Suicide and Euthanasia, Psychology Department, Université du Québec à Montréal, Canada.
| | - Cécile Bardon
- Centre for Research and Intervention on Suicide and Euthanasia, Psychology Department, Université du Québec à Montréal, Canada
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Too LS, Spittal MJ, Bugeja L, Milner A, Stevenson M, McClure R. An investigation of neighborhood-level social, economic and physical factors for railway suicide in Victoria, Australia. J Affect Disord 2015; 183:142-8. [PMID: 26005775 DOI: 10.1016/j.jad.2015.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Lay San Too
- Monash Injury Research Institute, Monash University, Victoria, Australia.
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Lyndal Bugeja
- Monash Injury Research Institute, Monash University, Victoria, Australia
| | - Allison Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Mark Stevenson
- Melbourne School of Design, The University of Melbourne, Victoria, Australia
| | - Roderick McClure
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, USA
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Havârneanu GM, Burkhardt JM, Paran F. A systematic review of the literature on safety measures to prevent railway suicides and trespassing accidents. ACCIDENT; ANALYSIS AND PREVENTION 2015; 81:30-50. [PMID: 25939134 DOI: 10.1016/j.aap.2015.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 04/09/2015] [Accepted: 04/11/2015] [Indexed: 05/23/2023]
Abstract
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.
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Affiliation(s)
- Grigore M Havârneanu
- International Union of Railways (UIC), Security division, 16 rue Jean Rey, F-75015 Paris, France.
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Lukaschek K, Baumert J, Krawitz M, Erazo N, Förstl H, Ladwig KH. Determinants of completed railway suicides by psychiatric in-patients: case-control study. Br J Psychiatry 2014; 205:398-406. [PMID: 25257065 DOI: 10.1192/bjp.bp.113.139352] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
- Karoline Lukaschek
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jens Baumert
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marion Krawitz
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Natalia Erazo
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans Förstl
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl-Heinz Ladwig
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Lukaschek K, Baumert J, Erazo N, Ladwig KH. Stable time patterns of railway suicides in Germany: comparative analysis of 7,187 cases across two observation periods (1995-1998; 2005-2008). BMC Public Health 2014; 14:124. [PMID: 24498876 PMCID: PMC3933256 DOI: 10.1186/1471-2458-14-124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 02/04/2014] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Karl-Heinz Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr 1, Neuherberg 85764, Germany.
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16
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Too LS, Milner A, Bugeja L, McClure R. The socio-environmental determinants of railway suicide: a systematic review. BMC Public Health 2014; 14:20. [PMID: 24405530 PMCID: PMC3922773 DOI: 10.1186/1471-2458-14-20] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 01/05/2014] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Lay San Too
- Monash Injury Research Institute, Monash University, Melbourne, Victoria 3800, Australia
| | - Allison Milner
- McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Lyndal Bugeja
- Monash Injury Research Institute, Monash University, Melbourne, Victoria 3800, Australia
| | - Roderick McClure
- Monash Injury Research Institute, Monash University, Melbourne, Victoria 3800, Australia
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