Suicidal behaviour on railways in the FRG

Mind the gap: 11 years of train-related injuries at the Royal London Hospital Major Trauma Centre

Introduction This study presents an extensive retrospective database of patients with polytrauma following train-related injuries and highlights the key lessons learnt in this rare clinical presentation. Materials and methods We retrospectively collected data from 127 patients who presented to Royal London Hospital after sustaining train related trauma. We analysed demographics, accident report data, aetiologies and clinical management interventions. All data were screened and injuries were mapped to various anatomical regions. The revised trauma score, injury severity score and new injury severity scores were used to quantify injury extent. Results Mean patient age was 41 years (range 16-81 years) with a 73% to 27% male to female ratio. Deliberate injuries occurred in 71% of patients, with accidental injury accounting for 29%. The mean new injury severity score was 26.48 (range 1-75), with the most common injuries sustained to the chest and the extremities. Pneumothorax, haemothorax or tension pneumothorax occurred in 44% of patients, with 11% suffering a flail chest injury. Traumatic amputations occurred in 33% of patients and 56% of patients required admission to intensive care. Total mortality rates were 19%, with 12% of patients dying at day 0 and 18% at day 7, respectively. Conclusions This study demonstrated the significant impact of train-related polytrauma and provided a comprehensive injury patterns. It was observed that deliberate polytrauma is related to psychiatric deliberate harm but there is no significant difference in the patterns of injuries between accidental and deliberately caused injuries. Overall injuries to the thorax and extremities were the most severe, demonstrating the highest mean injury scores.

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

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

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

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

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

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

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.

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.

The timing of deliberate self harm behaviour

Objectives: To critically review the scientific literature relating to the timing of deliberate self harm behaviour and completed suicide.

Method: A literature search of the Medline and CINAHL databases from 1970-2002 was performed, using deliberate self harm, overdose, self poisoning, suicide, parasuicide, and time, timing, day, week, month and season as key words. Relevant secondary references were retrieved and hand searching of important journals was done.

Results: The time of day of non-fatal self harm shows a marked diurnal variation, with an evening peak that is related to non-violent episodes, concomitant alcohol use, and a younger age. It is not conclusively linked to the degree of suicidal intent or particular psychiatric diagnoses. Completed suicides more commonly occur earlier in the day, at the beginning of the week and during springtime, but show no overall increase during many national events and holidays.

Conclusions: Circadian biological mechanisms involving the serotonin-melatonin axis, Cortisol secretion and sleep abnormalities appear to be implicated. Psychosocial explanations for these epidemiological findings include alcohol use, a sense of personal isolation and the ‘broken promise’ effect.

Factors associated with suicide method among psychiatric patients in a general hospital in Korea

This study aims to highlight the factors associated with suicide method among psychiatric patients in a general hospital in Korea. In a sample of 467 suicides by patients who had received mental health care in a general hospital in Korea, the relationship between suicide method and time of death as well as clinical characteristics, including psychiatric adiagnosis, was examined using multinomial logistic regression analysis. Compared with the general population, psychiatric patients, regardless of disorder, committed suicide by jumping from heights more often than by hanging (OR=2.35-8.64). In particular, patients with psychotic disorders and female patients were more likely to use jumping from a height than hanging to kill themselves (OR=2.98 and 1.83, respectively). Patients were more likely to use suicide methods other than hanging (e.g., OR=6.7 for jumping, 5.3 for drowning, and 2.7 for self-poisoning) between midnight and dawn. Possible suicide-prevention strategies suggested by this study include limiting access to or fencing off tall structures in close proximity to psychiatric institutions and residential care homes. At night, limiting access to or instituting heightened supervision of tall structures is specifically indicated.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Does the installation of blue lights on train platforms prevent suicide? A before-and-after observational study from Japan

BACKGROUND

Railway and metro suicides constitute a major problem in many parts of the world. Japan has experienced an increase in the number of suicides by persons diving in front of an oncoming train in the last several years. Some major railway operators in Japan have begun installing blue light-emitting-diode (LED) lamps on railway platforms and at railway crossings as a method of deterring suicides, which is less costly than installing platform screen doors. However, the effectiveness of the blue lights in this regard has not yet been proven.

METHODS

This study evaluates the effect of blue lights on the number of suicides at 71 train stations by using panel data between 2000 and 2010 from a railway company in a metropolitan area of Japan. We use a regression model and compare the number of suicides before and after and with and without the intervention by the blue light. We used the number of suicides at 11 stations with the intervention as the treatment group and at the other 60 stations without the intervention as the control group.

RESULTS

Our regression analysis shows that the introduction of blue lights resulted in a 84% decrease in the number of suicides (CI: 14-97%).

LIMITATION

The analysis relies on data from a single railroad company and it does not examine the underlying suicide-mitigation mechanism of blue lights.

CONCLUSION

As blue lights are easier and less expensive to install than platform screen doors, they can be a cost-effective method for suicide prevention.

Course and predictors of posttraumatic stress among male train drivers after the experience of 'person under the train' incidents

OBJECTIVE

The present prospective study aimed to identify the frequency and course of posttraumatic stress symptoms, anxiety, depression, and quality of life in train drivers after the experience of 'person under the train' incidents. Furthermore, associations between predictors of posttraumatic stress stratified by pre-, peri- and posttraumatic factors, psychological distress, quality of life (QoL), sense of coherence, lack of meaning in life, and post-trauma thoughts are analyzed.

METHODS

Patients (100% male, mean age 48 years) were assessed at the beginning (n=73), at the end (n=71) and six months (n=49) after a four-week rehabilitation program and completed validated self-report questionnaires (e.g. Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Short-Form Health Survey).

RESULTS

Train drivers experienced averagely 1.8 'person under the train' incidents (range 1-8); the majority (81%) was involved in a railway suicide. At the beginning of the rehabilitation, 44% of the patients were classified as having moderate to severe PTSD, and 14% as having severe PTSD. Posttraumatic stress decreased significantly over time (p=.003, η²=.17). We found no significant differences in the course of posttraumatic stress, anxiety, depression, distress and QoL between patients who experienced one or more than one railway related accident or suicide. Anxiety, sense of guilt and sense of alienation emerged as the most important factors in predicting posttraumatic stress six months after rehabilitation (R²=0.55).

CONCLUSION

Findings emphasize the importance of rehabilitation programs for train drivers after railway-related incidents. However, research is needed to develop effective rehabilitation interventions particularly tailored to this patient group.

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

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

Main characteristics of train-pedestrian fatalities on Finnish railroads

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

Suicide and seasonality

OBJECTIVE

  Seasonal variation of deaths by suicide offers an important pathway in the study of possible suicide determinants of suicide and consequently suicide prevention.

METHOD

  We conducted a review of the literature on suicide seasonality, assessing articles published between 1979 and 2009.

RESULTS

  The majority of the studies confirm a peak in spring, mainly for men, older individuals, and violent methods of suicide. A secondary peak during autumn is observed. There is no common seasonality pattern for suicide methods. However, there are also certain studies that did not confirm seasonal variation. Inconsistent results with reduced, unchanged, and even increased suicide seasonality have been reported. Aspects on the association between seasonality and suicides are discussed. Except sex, age, and method of suicide, other parameters were taken into account to find more specific characteristics of seasonality in suicides as well. The influence of clinical, bioclimatic, sociodemographic as well as biological factors seems to affect the seasonal variation.

CONCLUSION

  Studies from both the Northern and the Southern hemisphere report a seasonal pattern for suicides. These studies are not only an important source of epidemiological data for suicides but also represent a global effort to uncover hidden parameters of this self-destructive behaviour.

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 railway suicide death of a famous German football player: impact on the subsequent frequency of railway suicide acts in Germany

BACKGROUND

The railway suicide of Robert Enke, an internationally respected German football goal keeper, sent shockwaves throughout the world of football. We analyzed its impact on the frequency of subsequent railway suicide acts (RS).

METHODS

Two analytic approaches were performed applying German Railway Event database Safety (EDS) data: first, an inter-year approach comparing the incidence of RS during a predefined "index period" with identical time windows in 2006 to 2008; second, an intra-year approach comparing the number of RS 28 days before and after the incidence. To analyze a possible "compensatory deficit", the number of RS in the subsequent first quarter of 2010 was compared with the identical time windows in the preceding three years. Incidence ratios with 95% confidence intervals were estimated by Poisson regression. Findings were controlled for temperature.

FINDINGS

Compared to the preceding three years, the incidence ratio (IR) of the number of RS in the index period increased by 1.81 (1.48-2.21; p<0.001), leading to an overall percentage change of 81% (48-121%; p<0.001). Comparing the number of suicides 28 days before and after the incidence revealed an even more pronounced increase of IR (2.2; 1.6-3.0). No modifications of these associations were observed by daytime, by location of the suicide and fatality. No compensatory deficit occurred in the post-acute period.

INTERPRETATION

The substantial increase of RS in the aftermath of the footballer's suicide death brought about copycat behavior in an unforeseen amount, even though the media reporting was largely sensitive and preventive measures were taken.

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.

Evaluating the effectiveness of barrier installation for preventing railway suicides in Hong Kong

BACKGROUND

Railway suicide is a serious mortality issue. Most attempters are unmarried psychotic young men under psychiatric care having a high level of lethal intent. Installation of platform screen doors (PSDs) to limit access to the track has been suggested as an effective way for prevention. This study aims to examine the effectiveness of installing PSDs for preventing railway suicides; any sign of substitution of suicide location; and changes in psychiatric profile of suicide deceased after the PSD installation in the subway system of Hong Kong.

METHODS

Cases of railway suicide and related information from 1997 to 2007 were provided by the railway operators and the Coroner's Court. The effectiveness of installing PSDs was assessed through a quasi-experimental setting. Poisson regression and chi-squared test were used.

RESULTS

Over the 11-year study period, a total of 76 railway suicide cases (0.71% of all suicides) were reported. A significant reduction of 59.9% (p=0.0003) in railway suicides was found after the PSD installation. Analyses confirmed that there was no significant sign of substitution by displacing potential attempters to unsealed platforms (p=0.9051). Those having psychosis would be better protected as no suicide cases with such psychiatric background were reported after the installation of PSDs.

LIMITATIONS

It has not considered the potential economic benefits of PSD. It is difficult if not possible to examine whether the potential attempters would substitute to an alternative method of suicide.

CONCLUSIONS

This study shows that PSDs can effectively prevent suicides with no substitution by "delethalizing" the image and altering people's perception about the desirability of railway suicide. Railway operators should extend the coverage of PSD to all railway stations in Hong Kong without any delay.

The impact of holidays on suicide in Hungary

The suicide rate on religious and public holidays was examined for 133,699 suicides for Hungary for the period 1970-2002. For both men and women, more suicides were committed on Monday, while fewer were committed on the weekends. More suicides occurred on New Year's Day than expected. On Christmas Day and on Easter Sunday and Monday, suicides were less frequent only for men, a result consistent with Durkheim's theory. There was less evidence for Gabennesch's broken promise effect on the days after the holidays. National holidays had no impact on the frequency of suicide.

Suicide on railway networks: epidemiology, risk factors and prevention

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

Suicidal behaviour by train collision in Queensland, 1990-2004

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Alcohol as a risk factor for unintentional rail injury fatalities during daylight hours

Railway fatalities account for approximately 10% of transport fatalities in Cape Town. The objective of this study was to examine alcohol intoxication as a risk factor during daylight hours by conducting a case - control study to compare rail passenger and pedestrian fatalities (cases) with motor vehicle passenger and pedestrian fatalities (controls). Rail passenger and rail pedestrian fatalities were defined as cases with motor vehicle passenger and pedestrian fatalities as the respective controls. Data were collected from post-mortem reports at two mortuaries from 1994 to 1996. Blood alcohol concentration was the dependent variable. The independent variables were age, gender, date of death, day of week, time of injury and external cause of death. The late afternoon and early evening period from 1600 hours to 1900 hours had the highest frequency of fatalities for all case and control groups. Of the 56 predominately male (89%) railway passenger cases with an average age of 34.5 (SD 12.5) years, Friday (27%) was the most frequent day of death. Railway pedestrian cases (89% male, average age 36.8 years (SD 13.3)) were more likely to be killed on a Monday (11% of cases). Among the controls, motor vehicle passengers (63% male, average age 39.9 (SD 15.5)) were more likely to die on a Sunday (25%) and pedestrians (82% male, average age 41 (SD 14.7)) on a Saturday (21%). The study showed that alcohol consumption is an important risk factor for rail fatalities during daylight hours, with rail passenger fatalities being 4.71 (1.72 - 12.88) and rail pedestrian fatalities 1.62 (0.98 - 2.69) times more likely to be intoxicated than the respective controls. The results provide more evidence for public health campaigners to tackle endemic alcohol abuse and to develop diverse interventions that do not exclusively target motor vehicle drivers.

Symptoms of PTSD according to individual and work environment characteristics of Korean railroad drivers with experience of person-under-train accidents

OBJECTIVE

The purpose of this study is to collect basic data on the prevalence pattern of posttraumatic stress disorder (PTSD) in Korean railroad drivers exposed to person-under-train accidents according to the individual and working environmental characteristics.

METHODS

Questionnaires were sent to all the railroad drivers accompanying active service now by company post. A total of 639 of the 800 questionnaires sent out were returned, showing a response rate of 79.9%. The Impact of Event Scale was utilized to address psychological status of railroad drivers after exposure to person-under-train accident.

RESULTS

Score of PTSD, intrusion, and avoidance ranged from 9.6 to 13.2, from 4.2 to 6.1, and from 5.4 to 7.2 according to individual characteristics and ranged from 11.44 to 12.70, from 5.03 to 5.67, and from 6.41 to 7.04 according to working environmental characteristics, respectively.

CONCLUSION

This study demonstrated that Korean railroad drivers who experienced person-under-train accident expressed adverse symptoms physically and psychologically more than those who did not experience it. Apart from effect of train driver's age, a wide range of individual and working environmental factors appear to have no association with the level of posttraumatic distress following a person-under-train accident.

Trespassing on the tracks: a review of railway pedestrian safety research

INTRODUCTION

Train-pedestrian collisions have been shown to be the leading cause of fatality in train-related accidents worldwide, yet there is remarkably little research in this area.

METHOD

In this paper, the major types of railway transportation accident research are briefly highlighted to indicate the general context of research concerning train-pedestrian collisions, which are then reviewed. Themes emerging from the diverse research are identified, the various strategies that have been proposed for prevention of railway pedestrian accidents are discussed, and the empirical evidence for their efficacy examined in the light of the much more extensive literature on road pedestrian accidents. Finally, it is proposed that application of current theory in behavioral and cognitive psychology may usefully inform future research in transportation safety.

Ten-year incidence and time trends of railway suicides in Germany from 1991 to 2000

BACKGROUND

Railway suicides strongly impact psychological and socioeconomic aspects of the railway company, its employees and possible eye witnesses. We aimed to assess the incidence of railway suicides compared with the total burden of suicides in Germany and its time trend over a 10-year observation period.

METHODS

From 1991 to 2000, a total of 8,653 fatal railway suicides were recorded by the national central registry of all passenger accidents on the German railway net. To assess time trends, the average annual percentage change (AAPC) of the number of suicides was estimated using Poisson regression. Adjustments were made for two age groups and measures of availability.

RESULTS

Railway suicides accounted for 7.0% (annual range 5.0-7.9%) of all suicides in Germany. The time trend of the number of suicides by all means declined, with a significant stronger decline for older subjects [AAPC -2.2; 95% confidence intercal (CI) -3.0 to -1.5; and -4.2; 95% CI -5.2 to -3.0]. An AAPC of 1.8% (95% CI 0.1-3.4) indicated an increasing time trend of the number of railway suicides for subjects aged <or=65 years, whereas, in contrast, fatal incidences for subjects aged >65 years exhibited a strong decrease (AAPC -6.2%; 95% CI -10.9 to -1.3).

CONCLUSIONS

The present study demonstrates different time trends for railway suicides compared with all suicides. It underlines the urgent need for amplified research efforts in the particular field of railway suicides. Further examinations are recommended, in particular concerning possible reasons for this suicidal method.

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

PROBLEM

Suicide is a dominating, although hidden, safety problem on Swedish railroads. The aim of this paper is to describe the epidemiology of fatal train-person collisions as a basis for systems-oriented prevention.

METHOD

Data on collision circumstances were collected from narrative reports at the Swedish National Rail Administration.

RESULTS

The events were evenly distributed by months and weekdays, however, most suicides occur during the day while unintentional events usually occur at night. Most train-person collisions happened in densely populated areas, and 75% of the suicide victims were waiting on the track before the collision. Significance test between types of injury event (suicide, accident, or unknown intent) showed small or no differences.

CONCLUSION

Traditional approaches to accident prevention by systems modification seem largely applicable to combat railroad suicide as well.

IMPACT ON INDUSTRY

Our findings show promising preventive potentials.

Seasonal fluctuation of suicide in Hungary between 1970-2000

The authors studied the seasonal fluctuation of suicide events in Hungary in a 31-year period. A summer maximum and a winter minimum were found in both genders. A second autumn peak did not occur among women. The suicide rate of Hungary fell markedly in 1998, parallel with the fundamental political-economical-social changes in the country. After 1988 the ANOVA statistic did show a moderate decrease in the seasonal fluctuation but only among those under 29 years of age. This young generation was the real "winner" of the deep social changes which suggests an indirect connection between the decrease of the seasonal fluctuation of suicide and the socio-political changes.

Sex-specific time patterns of suicidal acts on the German railway system. An analysis of 4003 cases

OBJECTIVE

To examine sex-specific time patterns of suicidal behaviour on railway tracks as basis of suicide preventive strategies.

METHOD

Cases were derived from the National Central Registry of all person accidents on the German railway net (STABAG) between 1997 and 2002 satisfying the operational definition of suicidal behaviour and included sex, age, date, clock time and outcome of the incidence.

RESULTS

Over the 6-year observation period, 4003 fatal and non-fatal suicidal incidences were documented. Male to female ratio was 2.70:1 (p<0.0001). The female subgroup was significantly older than the male subgroup (p<0.0001). The monthly distribution revealed a bimodal pattern (p=0.01), particularly in men younger than 65 years, with an excess risk in April and September. This circannual pattern attenuated in the second half of the observation period as shown by adjusted Poisson regression. Monday and Tuesday proved to be high risk days for both sexes. For males and females, a bimodal diurnal distribution pattern with a morning and an evening peak was observed. While both sexes followed the same pattern in the winter half year, in summer females showed a pronounced excess risk in the morning hours while for men the evening peak was substantially amplified (p<0.0001). Risk assessment revealed a marked broadening by approximately 6 h of the time window in the summer half year compared to the winter half year.

LIMITATIONS

About 30% of cases were excluded because of missing data on sex specification. However, cases with and without sex information did not differ significantly in the variables under investigation.

CONCLUSION

The analysis revealed marked seasonal, weekly and diurnal peaks of railway suicide intensity. Differences between men and women indicate sex-specific processes underlying their suicidal behaviour. The findings may increase alertness of railway and security personal for particular vulnerable time windows of excess risk for railway suicides.

Regionale und �rtliche Verteilungsmuster von Bahnsuiziden

BACKGROUND AND METHOD

Suicide research has identified regional and local clusters of increased suicide prevalence. As part of a comprehensive prevention strategy to fight railway suicides, we sought to identify such particular clusters on the German Railway net (total length 37,080 km) during a 6-year observation period (1997-2002). Data stem from the central registry of all person accidents on the German Railway net.

RESULTS

During the observation period, a total of 5,731 suicides (in average 18 cases per week) were registered. Against expectation derived from distribution patterns in the general suicide research, we found a preponderance in the southern part compared to the northern part of Germany and a significant downward trend from west to east ( p=0.004). Most suicides occurred on open track (66%) compared to suicides at railway platforms (34%). We identified 16 places of high risk with 6 to 29 suicides per railway km. Of these high risk places, 75% were in the proximity of psychiatric hospitals.

CONCLUSION

Increased awareness for regional and local suicide clusters, initiatives to reduce the accessibility and warning infra-red beams are among recommendations for suicide prevention derived from these data.

About morphological findings in fatal railway collisions

The autopsy findings in fatal cases of railway collisions of the Bonn Institute of Legal Medicine in 1992-1999 were investigated and compared to the statements in the investigation files of the public prosecutor with regard to classification as accident or suicide as well as with regard to type and speed of collision. Of the 38 deaths, 10 were hit in an upright position, 11 fatal collisions affected persons lying outside the track and 13 were hit and overrun lying inside the track. According to the investigation classification 21 persons committed suicide (56%), while 10 died in an accident (26%). Our survey confirmed the leading role of being over-rolled in a lying position as an indication for suicides, while in accidents the upright hit was most important. With exception of the persons primarily affected between the rails in upright position and over-rolled consecutively an unequivocal assignment of injury patterns to the hit categories was possible. In cases of persons being primarily over-rolled in a lying position especially the criteria (i) opening of body cavities, (ii) organ injuries and (iii) loss of parts of the body allowed for careful conclusion on hit, respectively, overrunning speed.

Seasonal changes in 24-h patterns of suicide rates: a study on train suicides in The Netherlands

BACKGROUND

Annual patterns in suicide rates, peaking near the summer solstice, are well documented. It has been suggested that day length or total hours of sunshine has an impact on suicide rates. If these environmental factors are involved, we would expect changes in the daily pattern of suicide rates to occur over the year. To test this hypothesis, the 24-h patterns of suicide rate were investigated as a function of time of year.

METHOD

Detailed information about the exact time of suicides in The Netherlands is only available for train suicides. Therefore, information concerning age, sex, time and place of occurrence of all verified train suicides over 15 years in The Netherlands (n=2830) was obtained from The Netherlands Railways archives.

RESULTS

Daily patterns in train suicides show systematic variations of two kinds. First, independently of time of year, suicide rates at night drop to about 10% of their daytime values. Second, there are two daily peaks in the patterns which shift their timing over the year, with one peak occurring shortly after sunset, and the other one consistently occurring 9-10 h earlier. Both peaks shift with the 5.5-h shift in sunset time.

LIMITATIONS

Train suicidal behaviour may not represent fatal suicidal behaviour in general.

CONCLUSIONS

There are pronounced and systematic daily variations in train suicide rates in The Netherlands. One of these is related to clock time, the others are related to the light-dark cycle. The consistency of the patterns suggests a strong environmental influence on train suicidal behaviour. Research on 24-h patterns of suicide rates should control for time of year.

Electrical injury from subway third rails: serious injury associated with intermediate voltage contact

BACKGROUND

Railway and subway-associated electrical trauma is rare and typically involves high voltage (> 20,000) arc injuries. Not all rail systems utilize such high voltage. We report 16 cases of electrical trauma due to 600 V direct contact with subway 'third' rails.

METHODS

A case series of injured patients presenting to Shriners Burns Institute, Boston or Massachusetts General Hospital between 1970 and 1995 was retrospectively analyzed.

RESULTS

A total of 16 cases was identified. Among seven subway workers, the mechanism of rail contact was unintentional by a tool, a hand or by falling; no deaths occurred. Among nine non-occupational victims, injuries involved suicide attempts, unintentional falls, or risk-taking behavior. This group suffered greater burn severity, operative procedures, and complications; three deaths occurred.

CONCLUSIONS

This is the largest report series of direct electrical trauma from a subway third rail. The high morbidity and mortality from this 600 V contact suggests that the traditional classification of low voltage (< 1000 V) exposure can be subdivided to reflect the serious and lethal potential of intermediate range exposures compared to household range exposures (0-220 V).

Fatal railway injuries in Cape Town, South Africa

To describe the features of railway-related deaths in Cape Town, South Africa, we reviewed demographic, autopsy, and accident report data on all such deaths between 1 April 1992 and 30 September 1994. Of the 379 railway-related deaths, 27 were among pedestrians or commuters who were hit by a train while crossing the track, 38 were among commuters who fell from moving trains, 32 were suicides, 43 were the result of criminal violence on trains or at railway stations, and 38 were due to other causes. Most railway fatalities were among men between the ages of 25 and 44 years. About half of all railway fatalities occurred at peak commuting times, with high levels of violence (often robbery related) recorded during the evening peak. A blood alcohol concentration > 0.1 g/100 ml was found in 35% of the people who died from crossing the track or falling from moving trains. Fatal railway injury is characterized by extensive disruption of more than one body region. The high levels of fatal railway injury make a strong case for a range of injury control interventions, including ticket control, surveillance, law enforcement, and safety engineering.

Meeting the challenge of railway injury in a South African city

BACKGROUND

Efficient and safe transport infrastructure is vital for economic growth in developing countries. The city of Cape Town, South Africa, has an extensive rail network with high levels of injury and violence. We investigated the reporting and frequency of railway injuries and examined their reduction through a range of interventions.

METHODS

We analysed railway injury and death reporting by Cape Town's rail utility, state mortuaries, and a regional trauma survey. The data were obtained over 2.5 years, and the use of more than one data source was necessary to increase the size of the data pool and to determine under-reporting.

FINDINGS

There were 379 railway-related deaths and 505 serious injuries during the study period. Most death (190) were train-pedestrian collisions, and the fatality rate on the metropolitan lines was about 60 per 100 million passenger journeys. There was substantial under-reporting by the rail utility of both fatal (20% under-reported) and non-fatal injuries (at least 24%). Many injuries occurred during peak commuting times and alcohol played an important part, especially in pedestrian fatalities.

INTERPRETATION

Our results demonstrate the importance of a comprehensive, sustainable railway injury surveillance system to promote safety engineering and law enforcement in a metropolitan rail system.

Suicide in the People's Republic of China categorized by age and gender: evidence of the influence of culture on suicide

Throughout the developed world suicide is predominantly associated with psychiatric disorders and substance misuse. The main social factors are age, as suicide increases with each decade, and gender, as suicide is more frequent among men than women, and proportionately more young men die than their female peers. An analysis of suicide in the People's Republic of China found that the profile was the opposite to that reported in the rest of the world, as more female subjects kill themselves than males, particularly younger women. Also, unlike the situation in other countries, suicide occurred more often in rural than in urban areas. It is argued that the Chinese data provide evidence of a greater cultural influence upon suicide rates than had previously been realized.

Suicidality and personality disorders in adolescence

The prevalence of personality disorders is higher among suicidal adolescent inpatients (15.3% out of 163) than among nonsuicidal adolescent inpatients (8.6% out of 374). Among the personality disorders, the borderline syndromes or emotionally unstable personality disorders were more frequent in the suicidal adolescents. Limited emotional control, intolerance of frustration, and impulsiveness are important characteristics of suicidal adolescents.