Posttraumatic stress reactions of underground drivers after suicides by jumping to arriving trains; feasibility of an early stepped care outpatient intervention

Behavioral and location-related antecedents of train suicides

BACKGROUND

In the European Union, over 2000 suicides on railway premises were reported in 2020. Identifying individuals' behavioral and location patterns just before they die or attempt to die by train suicide (ITS) is critical for effective prevention of suicides by train. We conducted a naturalistic study using a newly developed instrument for the assessment of fatalities in rail traffic that used information from on-site video cameras.

METHODS

A total of 56 case files and surveillance recordings of ITS prior to their suicide or suicide attempt were compared to 46 surveillance recordings of matched regular train passengers (RTP) before they boarded their trains. Groups were compared on individuals' behavior as well as location and contextual parameters.

RESULTS

ITS performed unusual movement patterns more frequently, carried luggage less often, stayed on the platform longer, and let more trains pass relative to RTP.

CONCLUSIONS

If this study is replicated with a larger sample, artificial intelligence could be used to detect suspicious/unusual (movement) patterns in order to prevent train suicide. Social awareness campaigns that foster the identification of people in distress at train stations in combination with lower thresholds for the use of emergency devices on platforms may help to detect potential train suicides and reduce their incidence.

A pilot study evaluating the effectiveness of preventing railway suicides by mid-track fencing, which restrict easy access to high-speed train tracks

BACKGROUND

Suicides in the railway system is a serious health, societal, and transportation concern. Restriction of the access to suicide methods in the form of different physical barriers is a promising approach for suicide prevention.

METHOD

Mid-track fencing, which is fencing placed in-between the high-speed and commuter train tracks, was installed at one out of seven stations along a train line outside of Stockholm in the years 2013/2014. The number of suicides at the intervention station was compared to six other stations used as controls, over a total period of 20 years (2002-2021).

RESULTS

Suicides at high-speed tracks occurring at stations was the major cause of death on the investigated railway line. Prior to the year 2014, the intervention and control stations displayed similar time trends in the number of suicides. After installation of the mid-track fencing in 2014, there was a 62.5% reduction in the rate of suicides occurring at the intervention station. Compared to the six other control stations, the intervention station displayed a significant reduction in the number of suicides during the years 2014-2021 (OR = 0.14, 95%CI 0.013-0.95). Suicides at the railway lines in-between stations were not increased post-intervention. However, nearby control stations showed a 162% increase in suicides after the intervention, suggesting the induction of transfer effects.

CONCLUSION

Mid-track fences restricting access to high-speed train tracks may have a large effect on reducing the number of railway suicides at intervention stations, but may also induce an increase in suicides at nearby stations without mid-track fences.

PRACTICAL APPLICATIONS

Partial physical barriers such as mid-track fencing is deemed to be relatively easy and cheap to install (as compared to full barriers; e.g., full height platform screen doors) and should be considered at all stations on railway lines that have high-speed trains passing by.

The experience of south Korean railroad drivers exposed to "person under train" incidents: A qualitative study

A "person under train" (PUT) incident is a suicidal action involving a person throwing themselves at a moving train. This may cause trauma, including post-traumatic stress disorder (PTSD), to railroad drivers. This study investigated the experiences of railroad drivers of a PUT incident. Data were obtained from two drivers through in-depth interviews and personal narratives regarding their PUT experience and personal lives after the incident. Expressing thoughts through writing was an effective intervention that provided insights into their experience. Thus, an educational program combining mental health management and PTSD treatment is recommended for workers who experience such trauma.

Impact of Railway Critical Incidents on Train Drivers and Effectiveness of Critical Incident Management and Support Protocols: A Recovery Trajectory Analysis

OBJECTIVE

Train drivers are regularly involved in railway critical incidents (CI) and critical incident management and support protocols (CIMSPs) have been developed to support them. This study describes the impact of CIs and evaluates the effectiveness of CIMSPs.

METHODS

We interviewed 74 train drivers 1 week, 1, 3, and 6 months after a CI. We performed Linear growth model analyses to describe recovery paths and the effect of CIMSPs, considering the effect of CI complexity, proximity to victims, social support, self-assessment of health, use of resources, and attribution of responsibility.

RESULTS

CIs have a significant negative impact on train drivers. Recovery paths can be explained by the level of implementation of CIMSPs, and other contributing factors.

CONCLUSIONS

CIMSPs are effective in reducing the negative impact of CIs and should be implemented rigorously by employers.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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