The socio-environmental determinants of railway suicide: a systematic review

Change in incidents of suicidal acts after intervention on a bridge in South Korea

PURPOSE

To investigate whether two novel interventions on a bridge - a Video Incident Detection System (VIDS) and spinning bar barriers - have an impact on suicidal behaviour on the bridge.

METHODS

A total of 146 suicidal acts were retrieved for analyses; 108 interventions before suicidal acts, 35 suicide deaths and 3 suicide attempts. Incident rate ratios (IRR) were calculated to estimate the change in incident rate associated with implementation of the two interventions: VIDS and the spinning bar 2-metre high barrier.

RESULTS

The results of the Poisson regression showed that the rate of suicide deaths, after installation the VIDS, did not change significantly (IRR: 1.23, 95% Confidence Interval [95% CI]: 0.59-2.56), although the rate of intervened suicidal acts increased (IRR: 2.40, 95% CI: 1.65-3.47). The results showed that subsequent spinning bar installation resulted in a decrease in the incident rate of intervened suicidal acts (IRR: 0.37, 95% CI: 0.25-0.57) as well as suicide deaths (IRR: 0.23, 95% CI: 0.07-0.71). Comparison of the period when both interventions were in place with the period with no interventions indicated a reduction in suicide deaths (IRR: 0.28, 95% CI: 0.10-0.82), but no change in intervened suicidal acts (IRR: 0.90, 95% CI: 0.59-1.38).

CONCLUSION

The rate of suicide death decreased after the installation of the spinning bar barrier but not after the implementation of VIDS alone. Our findings reinforce that restricting access to means is a highly effective way of preventing suicide on bridges and that spinning bars may be a helpful way to design barriers.

Sociodemographic and psychosocial risk factors of railway suicide a mixed-methods study combining data of all suicide decedents in the Netherlands with data from a psychosocial autopsy study

BACKGROUND

Railway suicide has profound implications for the victims and their family, and affects train drivers, railway personnel, emergency services and witnesses. To inform a multilevel prevention strategy, more knowledge is required about psychosocial and precipitating risk factors of railway suicide.

METHODS

Data from Statistics Netherlands of all suicides between 2017 and 2021 (n = 9.241) of whom 986 died by railway suicide and interview data from a psychosocial autopsy of railway suicide decedents (n = 39) were integrated. We performed logistic regression analyses to identify sociodemographic predictors of railway suicide compared to other methods of suicide. The Constant Comparative Method was subsequently employed on interview data from the psychosocial autopsy to identify patterns in psychosocial risk factors for railway suicide.

RESULTS

The strongest predictors of railway suicide compared to other suicide methods were young age (< 30 years old), native Dutch, a high educational level, living in a multi-person household (especially living with parents or in an institution), living in a rural area and a high annual household income of > 150.000 euros. Several subgroups emerged in the psychosocial autopsy interviews, which specifically reflect populations at risk of railway suicide. These subgroups were [1] young adult males with autism spectrum disorder who strived for more autonomy and an independent life, [2] young adult females with persistent suicidal thoughts and behaviours, [3] middle-aged males with a persistent mood disorder who lived with family and who faced stressors proximal to the suicide in personal and professional settings, [4] male out-of-the-blue suicides and [5] persons with psychotic symptoms and a rapid deterioration.

CONCLUSIONS

based on our findings we propose and discuss several recommendations to prevent railway suicide. We must continue to invest in a safe railway environment by training personnel and installing barriers. Additionally, we should adopt prevention strategies that align the needs of subgroups at increased risk, including young females who have attempted other methods of suicide and young males with autism spectrum disorder. Future research should determine the cost-effectiveness and feasibility of low-maintenance, automated interventions near crossings and psychiatric facilities.

Identifying Witnessed Suicides in National Violent Death Reporting System Narratives

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.

Evaluating a Human Detection Model in a Behaviour Analysis Pipeline for Suicide Prevention

Suicides in public places, such as railways, can have a significant impact on bystanders, railway staff, first responders and the surrounding communities. Behaviours prior to a suicide attempt have been identified, that could potentially be detected automatically. As a first step, the algorithm is required to accurately identify individuals exhibiting these behaviours in different settings. Our study analyses a human detection model focussing on pedestrian detection at railway stations as one component of a broader project to detect pre-suicidal behaviours. Closed-circuit television footage from two stations collected for the same 24-hour period were manually analysed to obtain parameters (true positives, false positives, and false negatives) which were then used to compute performance measures (sensitivity, precision, and F1 score). The model performed differently in both stations with a sensitivity of 0.73 and F1 score of 0.84 in Station A and a sensitivity of 0.48 and F1 score of 0.65 in Station B. Root causes of false negatives identified include differing body postures and occlusion. Although the model was adequate, its performance is dependent on the view captured by the cameras in stations. Collectively, these findings can be used to improve the model's performance.Clinical Relevance-Detecting behaviours prior to a suicide attempt offers a critical period for intervention by bystanders or first responders, potentially interrupting the attempt. This offers the potential to directly reduce suicide attempts, as well as reduce third-party exposure to these traumatic events.

Why Choose the Railway?

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

Train-related suicidal decapitation

Suicide by decapitation as a primary method of injury is not common. When decapitation does occur in association with suicide, it may be a secondary consequence of the primary method of suicide, for example massive blunt force trauma, or hanging with a significant drop; however, primary suicidal decapitation has been described specifically in the context of railway incidents wherein victims lie across railroad tracks in-front of oncoming trains. Herein we report the case of a 49-year-old male who was decapitated after lying-down with his neck atop a railroad track in a railroad stockyard. He was subsequently run over by a train as it began to move to leave the stockyard. This case of train-assisted suicide occurs less often than the more common modality of suicide by train wherein victims stand or jump in front of a moving train or lay their body across the railroad tracks in order to be struck by an oncoming train.

Indigenous ethnic identity, in-group warmth, and psychological wellbeing: A longitudinal study of Māori

Longitudinal studies into the relationship between affect (positive or negative feelings) towards one’s own ethnic group and wellbeing are rare, particularly for Indigenous peoples. In this paper, we test the longitudinal effects of in-group warmth (a measure of ethnic identity affect) and ethnic identity centrality on three wellbeing measures for New Zealand Māori: life satisfaction (LS), self-esteem (SE), and personal wellbeing (PW). Longitudinal panel data collected from Māori (N = 3803) aged 18 or over throughout seven annual assessments (2009–2015) in the New Zealand Attitudes and Values Study were analyzed using latent trajectory models with structured residuals to examine cross-lagged within-person effects. Higher in-group warmth towards Māori predicted increases in all three wellbeing measures, even more strongly than ethnic identity centrality. Bi-directionally, PW and SE predicted increased in-group warmth, and SE predicted ethnic identification. Further, in sample-level (between-person) trends, LS and PW rose, but ethnic identity centrality interestingly declined over time. This is the first large-scale longitudinal study showing a strong relationship between positive affect towards one’s Indigenous ethnic group and wellbeing. Efforts at cultural recovery and restoration have been a deliberate protective response to colonization, but among Māori, enculturation and access to traditional cultural knowledge varies widely. The data reported here underline the role of ethnic identity affect as an important dimension of wellbeing and call for continued research into the role of this dimension of ethnic identity for Indigenous peoples.

Characteristics of Train Stations Where Railway Suicides Have Occurred and Locations Within the Stations

Background: To devise effective railway suicide countermeasures, it is necessary to identify stations where suicide is likely to occur. Aim: We explored the characteristics of stations where railway suicides have occurred and locations within the stations. Method: (Study 1) Using suicide data from between April 2014 and September 2019 provided by a major railway company in Japan, station-specific suicide was modeled as an outcome variable in a multivariate Poisson regression model. (Study 2) With railway company staff, we visited stations where suicide frequently occurs and conducted fieldwork. Results: (Study 1) Our estimation using a Poisson regression model revealed that railway suicides were more frequent when stations were serviced by passing trains, had a large number of passengers, and were located near psychiatric hospitals. (Study 2) Of 50 suicides, 48.0% occurred in front of benches or waiting rooms, 26.0% occurred at the front end of the platform, 24.0% occurred at the entrance to the platform, and 22.0% occurred at a blind spot for the train driver. Limitations: All data were provided by one railway company in Japan, limiting the generalizability of the results. Conclusion: Stations where suicide occurs frequently have distinct characteristics. Focusing on suicide hotspots may aid suicide prevention.

The Impact of the "Pause. Call. Be Heard" Campaign on Help-Seeking and Suicidal Behaviors Within Rail Environment in Victoria, Australia

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.

Patterns of pre-crash behaviour in railway suicides and the effect of corridor fencing: a natural experiment in New South Wales

Suicides on railway systems remain a significant concern world-wide. Understanding patterns of pre-crash behaviour, whether jumping, lying or wandering on tracks, is important for the design of preventative measures, yet prior studies have reported divergent patterns of behaviour. This study tested the hypothesis that higher standards of corridor fencing reduce the proportion of train suicides in the non-jumping category. Data was analyzed as a natural experiment for 171 cases of apparent railway suicides in New South Wales (NSW) for the period 2011-2018. Results were congruent with the hypothesis. A higher level of corridor fencing in metropolitan Sydney was associated with a lower proportion in the non-jumping category (33%) compared with regional areas (74%). The article contributes by showing that: (i) fencing appears to lead to a reduction in some types of rail suicides and thus; (ii) contributes to a lower overall rate of suicide by train; and (iii) even with fencing, the non-jumping incidents warrant attention for appropriate countermeasures.

The Effects of Publicized Suicide Deaths on Subsequent Suicide Counts in Israel

This study investigated associations between indiscriminate media reporting of suicides and later inflated suicide counts among Israel's general population between the years 2008 and 2012. Self-inflicted deaths that received post-suicide media exposure (referred to as "publicized suicides") were selected via Google news search-hit appraisals. Distributions of suicides were inspected and risk ratios (RRs) estimated by comparing population suicide rates 4 weeks before and 4 weeks after each publicized suicide ("reference" vs. "affected" periods, respectively). Poisson time series regression was employed to account also for secular trends and seasonality. A total of 2,119 people died by suicide, 13 of whom received noticeable media attention throughout the study. No meaningful impact following the 13 deaths on subsequent suicide counts during the observation window (affected vs. reference phase) was found. Poisson regression confirmed that suicide counts following publicized suicides were independent of media coverage. Given the pronounced search hits following the publicized suicides developing regulation practices that constrain indiscreet media reporting should officially be included as part of suicide prevention practices. Future research should focus on imitation suicide effects as a function of post-suicide media exposure, while including both risk and protective factors.

Factors deterring and prompting the decision to attempt suicide on the railway networks: findings from 353 online surveys and 34 semi-structured interviews

BACKGROUND

There is a suicide on the British railways every 36 hours. However, the reasons why people choose to die by train are not well understood.AimsTo explore factors influencing and discouraging the decision to attempt suicide on the railway networks.

METHOD

We conducted an online survey and qualitative interviews with individuals who had contemplated or attempted suicide by train.

RESULTS

A total of 353 survey responders had considered and 23 had attempted suicide at rail locations (including railways and metro/underground); a third of these cases were impulsive. The most frequently reported motivations for contemplating or attempting suicide were perceptions of quick and certain lethality (54 and 37%, respectively) and easy access to rail settings (33 and 38%, respectively). The main factor discouraging people from rail suicide was its wider impact, especially on train drivers (19%). In qualitative interviews (N = 34) the desire to avoid intervention from others was also a common motivating factor for attempting suicide on the railway networks.

CONCLUSIONS

People attempt suicide by train because railway settings are easy to access and because of an inaccurate perception of certain and quick lethality. Tackling exaggerated perceptions of lethality may help reduce suicides by train.Declaration of interestNone.

Collecting evidence from distributed sources to evaluate railway suicide and trespass prevention measures

It can be difficult to select from available safety preventative measures, especially where there is limited evidence of effectiveness in different contexts. This paper describes application of a method to identify and evaluate wide-ranging preventative measures for rail suicide and trespass fatalities. Evidence from literature and industry sources was collated and reviewed in a two stage process to achieve consensus among experts on the likely effects of the measures and factors influencing their implementation. Multiple evaluation criteria were used to examine the measures from different perspectives. Fencing, awareness campaigns and different types of organisational initiatives were recommended for further testing. This is the first time evidence has been collected internationally across such a range of preventative measures. Commentary is provided on using this type of approach to select safety measures from a pool of prevention options, including how re-framing the scope of the exercise could identify alternative options for prevention. Practitioner summary: The findings give insight to how different measures work in different ways and how industry can consider this in strategic initiatives. The method could be used in future studies with different frames of reference (e.g. different timescales, level of ambition and safety context e.g. railway crossings or highway fatalities). Abbreviation: RESTRAIL: REduction of Suicides and Trespasses on RAILway property.

Suicide on the Railways in Belgium: A Typology of Locations and Potential for Prevention

Suicide on railway networks comprises a serious public health problem. However, the geographical distribution and the environmental risk factors remain unclear. This study analyzed the geographic distribution of railway suicides in Belgium from 2008–2013 at the level of a railway section (average length of 3.5 km). Principal component analysis (PCA) identified three groups of correlations that helped explain the variance of railway suicide. The three groups are related to characteristics of urban spaces, psychiatric facilities, and railway traffic density. Based on the PCA results, the study found four types of railway sections. The density of railway suicide was average and low in the urban and rural/industrial sections, respectively. However, it was high in the suburban sections and the sections close to psychiatric facilities. As the geographical proximity of a psychiatric facility comprises a specific risk factor for suicide on railways, preventative measures should target these sections and establish collaborations with psychiatric facilities. The typology of locations found in this study constitutes crucial information for national and local suicide prevention on the Belgian railway network.

Rail-suicide prevention: Systematic literature review of evidence-based activities

BACKGROUND

Rail-related suicide is a relatively rare but extremely lethal method of suicide that can have far-reaching consequences.

OBJECTIVE

The aim of the systematic literature review was to analyze the existing literature on the effectiveness of rail-suicide prevention activities.

DATA SOURCES

Databases used were Scopus, Medline, and ProQuest.

SEARCH TERMS

The search terms used were "suicid*," "prevent*," "rail*," or "train."

ELIGIBILITY CRITERIA

English-language studies published in peer-reviewed journals between 1 January 1990 and 30 April 2015 that presented an overview of rail-related suicide prevention activities and included an analysis of effectiveness were used.

RESULTS

We retrieved 1,229 results in the original search with nine papers presenting empirical evidence. Three studies in the review analyzed the effectiveness of platform screen doors and another three analyzed the installation of blue lights, two papers analyzed the effectiveness of suicide pits, and one included the influence of media reporting guidelines.

CONCLUSION

Platform screen doors, suicide pits, blue lights, and improved media guidelines all have the potential to reduce rail-related suicide events and deaths.

LIMITATIONS

The review was restricted to English-language peer-reviewed papers published within the chosen time period.

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

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Interventions to reduce suicides at suicide hotspots: a systematic review and meta-analysis

BACKGROUND

Various interventions have been introduced to try to prevent suicides at suicide hotspots, but evidence of their effectiveness needs to be strengthened.

METHODS

We did a systematic search of Medline, PsycINFO, and Scopus for studies of interventions, delivered in combination with others or in isolation, to prevent suicide at suicide hotspots. We did a meta-analysis to assess the effect of interventions that restrict access to means, encourage help-seeking, or increase the likelihood of intervention by a third party.

FINDINGS

We identified 23 articles representing 18 unique studies. After we removed one outlier, interventions that restricted access to means were associated with a reduction in the number of suicides per year (incidence rate ratio 0.09, 95% CI 0.03-0.27; p<0.0001), as were interventions that encourage help-seeking (0.49, 95% CI 0.29-0.83; p=0.0086), and interventions that increase the likelihood of intervention by a third party (0.53, 95% CI 0.31-0.89; p=0.0155). When we included only those studies that assessed a particular intervention in isolation, restricting access to means was associated with a reduction in the risk of suicide (0.07, 95% CI 0.02-0.19; p<0.0001), as was encouraging help-seeking (0.39, 95% CI 0.19-0.80; p=0.0101); no studies assessed increasing the likelihood of intervention by a third party as a lone intervention.

INTERPRETATION

The key approaches that are currently used as interventions at suicide hotspots seem to be effective. Priority should be given to ongoing implementation and assessment of initiatives at suicide hotspots, not only to prevent so-called copycat events, but also because of the effect that suicides at these sites have on people who work at them, live near them, or frequent them for other reasons.

FUNDING

National Health and Medical Research Council, Commonwealth Department of Health.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

An investigation of neighborhood-level social, economic and physical factors for railway suicide in Victoria, Australia

BACKGROUND

This study investigates the associations between railway suicide and neighborhood social, economic, and physical determinants using postcode-level data. It also examines whether the associations are influenced by having high concentration of high-risk individuals in a neighborhood area.

METHODS

Railway suicide cases from Victoria, Australia for the period of 2001-2012, their age, sex, year of death, usual residential address and suicide location were obtained from the National Coronial Information System. Univariate negative binomial regression models were used to estimate the association between railway suicide and neighborhood-level social, economic and physical factors. Variables which were significant in these univariate models were then assessed in a multivariate model, controlling for age and sex of the deceased and other known confounders.

RESULTS

Findings from the multivariate analysis indicate that an elevated rate of railway suicide was strongly associated with neighborhood exposure of higher number of railway stations (IRR=1.30 95% CI=1.16-1.46). Other significant neighborhood risk factors included patronage volume (IRR=1.06, 95% CI=1.02-1.11) and train frequency (IRR=1.02, 95% CI=1.01-1.04). An increased number of video surveillance systems at railway stations and carparks was significantly associated with a modest reduction in railway suicide risk (IRR=0.93, 95% CI=0.88-0.98). These associations were independent of concentration of high-risk individuals.

LIMITATIONS

Railway suicide may be under-reported in Australia.

CONCLUSIONS

Interventions to prevent railway suicide should target vulnerable individuals residing in areas characterized by high station density, patronage volume and train frequency.

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.

Suicide on railroad rights-of-way: a psychological autopsy study

Findings from 55 psychological autopsies of decedents who perished on U.S. railroad rights-of-way between October 1, 2007, and September 30, 2010 are reported. Described are distal, proximal, and contextual factors of risk; understandings of why these suicides occurred on railroad rights-of-way; and opportunities for prevention of similar suicides. International comparisons of suicides on railroad rights-of-way are made to highlight distinct findings regarding U.S. cases. Decedents studied exhibited considerable predisposing risk for suicide, with a high prevalence of severe mental disorders and substance abuse. In addition, a number of acute risk factors were commonly observed, notably suicide ideation, hopelessness, anxiety, and anger. In the context of that acute risk, associated situational variables and a relative absence of protective factors are described.