Train suicide in the county of Fyn 1979-82

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

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

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.

Systematic review of research on railway and urban transit system suicides

INTRODUCTION

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

PRACTICAL IMPLICATIONS

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

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

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

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.

Main characteristics of train-pedestrian fatalities on Finnish railroads

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

Railway Suicide in Belgium 1998–2009

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

Unusual methods of suicide: complexities in investigation

Differentiation between suicide and homicide often becomes difficult owing to the unusual methods of suicide used by the victim and the complexities thus posed. Investigating the cases of unusual suicides provides a considerable challenge to the authorities concerned. The issue of homicide should often be ruled out in such cases, which require careful evaluation. This is best done by correlating the morbid anatomical findings at autopsy with the death scene analysis coupled with psychological autopsy. Many forensic practitioners have reported unusual methods of suicide at their respective workplaces. Various types of unusual methods of suicide and the complexities involved in their investigation are presented and discussed.

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.

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.

Mental healthcare status and psychiatric diagnoses of train suicides

BACKGROUND

The objective of this study is to investigate mental healthcare status and psychiatric disorders in train suicides.

METHODS

Data of 4 published train suicide studies were combined with a study of 57 train suicides in The Netherlands.

RESULTS

53% of all train suicides received psychiatric care at the time of suicide, with 49% of them being inpatients. These values are higher than those found in general suicides. When compared to general suicides, functional non-affective psychoses are overrepresented by 25% vs 14%. The percentage of affective disorders approximates that of general suicides namely: 39% vs 42%. "Other diagnoses" are underrepresented by 23% vs 40%.

LIMITATIONS

All psychiatric diagnoses were based on clinical data, which may not accurately reflect the patient's psychiatric condition at the time of suicide.

CONCLUSIONS

Train suicides receive mental healthcare more often than general suicides and are more often characterized by severe psychopathology. The study indicates that patients with affective and psychotic disorders in particular should be targeted in order to prevent train suicide.

Railway and Metro Suicides

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

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.

Psychiatric diagnoses in 3275 suicides: a meta-analysis

BACKGROUND

It is well known that most suicide cases meet criteria for a psychiatric disorder. However, rates of specific disorders vary considerably between studies and little information is known about gender and geographic differences. This study provides overall rates of total and specific psychiatric disorders in suicide completers and presents evidence supporting gender and geographic differences in their relative proportion.

METHODS

We carried out a review of studies in which psychological autopsy studies of suicide completers were performed. Studies were identified by means of MEDLINE database searches and by scanning the reference list of relevant publications. Twenty-three variables were defined, 16 of which evaluating psychiatric disorders. Mantel-Haenszel Weighted Odds Ratios were estimated for these 16 outcome variables.

RESULTS

Twenty-seven studies comprising 3275 suicides were included, of which, 87.3% (SD 10.0%) had been diagnosed with a mental disorder prior to their death. There were major gender differences. Diagnoses of substance-related problems (OR = 3.58; 95% CI: 2.78-4.61), personality disorders (OR = 2.01; 95% CI: 1.38-2.95) and childhood disorders (OR = 4.95; 95% CI: 2.69-9.31) were more common among male suicides, whereas affective disorders (OR = 0.66; 95% CI: 0.53-0.83), including depressive disorders (OR = 0.53; 95% CI: 0.42-0.68) were less common among males. Geographical differences are also likely to be present in the relative proportion of psychiatric diagnoses among suicides.

CONCLUSIONS

Although psychopathology clearly mediates suicide risk, gender and geographical differences seem to exist in the relative proportion of the specific psychiatric disorders found among suicide completers.

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.

Suicide in the Montreal subway system: characteristics of the victims, antecedents, and implications for prevention

OBJECTIVE

To understand the characteristics of persons who commit suicide in the Montreal subway system (the Montreal Metro), their personal and psychiatric histories, and the nature of the event in order to develop better prevention strategies.

METHOD

Systematic analysis of coroner's office investigations of the 129 suicides in the Montreal Metro from 1986 to 1996.

RESULTS

Of the 129 people who committed suicide, 81% had expressed a prior suicidal intention, 66% had previously attempted suicide, and 9% had attempted suicide in the metro. One hundred and five of the victims had serious mental health problems, most frequently depression; 73% had had inpatient psychiatric treatment, and at the time of death, 27% resided in a mental health treatment institution. Recent adverse life events included failed relationships, work problems, and family difficulties.

CONCLUSIONS

Suicide victims intentionally go to the metro to kill themselves, often tell others beforehand, and are generally in treatment for serious psychiatric problems. Possible prevention strategies include modification of the environment and procedures in the metro, changing public conceptions of metro suicides, and modifying practice in psychiatric facilities.

Psychiatric and preventative aspects of rail fatalities

A previous survey of national rail fatalities and a sample of fatalities in southern England revealed many probable suicides and a small proportion of accidents. Epidemiological and clinical characteristics of this survey are reviewed in the light of general safety on British railways.

The epidemiology of suicide on the London Underground

A database containing details of every incident of suicidal behaviour on the London Underground railway system between 1940 and 1990 was assembled from the records of London Underground Ltd and the British Transport Police. The total number of cases was 3240. The mean annual number of suicidal acts on the London Underground system increased from 36.1 (1940-1949) to 94.1 (1980-1989). There were significantly fewer incidents on Sundays than on the other days of the week and the daily rate was highest in the spring. 64% of incidents involved males and the peak age group for both sexes was 25-34 yr. Suicide verdicts were returned for a greater proportion of women than men. Overall case fatality was 55%. However, case fatality rates differed between stations, environmental factors appearing to influence survival. Possible strategies to prevent railway suicides and reduce the lethality of this method are discussed.

Suicidal behaviour on railways in the FRG

Between 1976-84 there were 6090 suicides and 391 attempted suicides on railways in the Federal Republic of Germany. This suicide method was compared to other methods with respect to seasonal and daily distributions and fluctuations by time of day for age and sex. The ratio of males to females was 2.54:1 and the relative incidence of this type of suicide as compared to the total number of suicides was high among the younger age groups. Investigation of seasonal variation revealed a peak for males in the autumn. There was a markedly higher incidence of railway suicides committed by males on Mondays and Tuesdays. This peak was less pronounced for females. Most incidents occurred in the evening hours (especially after sunset). An investigation of the relationship between the severity of injuries and the location of the suicide attempt revealed that those who attempted suicide on railway tracks in the countryside were more seriously injured than those whose attempt took place in or near main stations.

The geographical pattern of methods of suicide in Belgium: implications for prevention

The geographical variation of reported suicide among the 43 Belgian districts was analysed for each method of suicide in both sexes and in two time periods: 1968-72 and 1978-81. Different descriptive methods were used to assess the patterns and changes in method-specific indirectly standardized death rates. It appeared that the overall suicide pattern was not always a good reflection of the method-specific patterns. Moreover, these seemed consistent in time and between sexes. Two important methods, which could be partially influenced, showed a remarkable concentration in some southern districts: suicidal poisoning by solid and liquid substances (in both sexes) and the use of firearms (in males). Drowning was much more concentrated in the West of the country and jumping was especially frequent in Brussels. Possible explanations and the relevance of these findings for prevention are discussed.

Study of 100 patients injured by London underground trains 1981-6

One hundred patients who were injured by London underground trains during 1981-6 were studied; 43 of them died. Deliberate self harm was probable in roughly three quarters. Alcohol intoxication was thought to play an important part in a further tenth of cases. Thirteen were psychiatric inpatients at the time of the incident, and a further two had recently been discharged. Early warning of a potential suicide attempt was given during the 24 hours preceding the incident in 15 of the cases. Some of the deaths in the psychiatric patients may have been preventable.