Systematic review of research on railway and urban transit system suicides

doi:10.1016/j.jad.2015.12.042

Journal of Affective Disorders

Volume 193, 15 March 2016, Pages 215-226

https://doi.org/10.1016/j.jad.2015.12.042 Get rights and content

Highlights

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The quality of rail suicide research varies greatly; better research is needed.
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Rail suicides resemble people who use other methods, but are younger.
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Rail suicides are rarely impulsive; people usually go to the rails to kill themselves.
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Media reports on railway suicides can increase their incidence.
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We need more research on why people choose railway suicide.

Abstract

Introduction

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

Method

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Google Scholar and our documentation centre, and contacting 71 railway companies, resulting in 716 articles and eight unpublished reports, with 94 having empirical data on 55 unique studies.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

Results

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

Conclusions

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

Practical implications

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

Introduction

Suicides occur in most railway and metro transportation systems worldwide. They represent from 1.7% of all suicides in Canada (Mishara and Bardon, 2013) to 12.3% of suicides in the Netherlands (van Houwelingen and Baumert et al., 2013). The only railway systems without suicides are the few which have physical barriers that effectively block all passenger access to the tracks. Railway suicide has a major social and economic cost to witnesses, railway companies (traumatised employees, delays in traffic and costs) and first responders. There are several efforts to reduce the incidence of railway suicides. The International Union of Railways (IUC) has produced a series of recommendations for the selection and implementation of railway suicide prevention strategies (http://www.uic.org/). (Havârneau et al., 2015) recently conducted a systematic review of safety measures to prevent railway suicides and trespassing accidents. These measures include technical (access to tracks, design of platforms and trains), behavioural (identification of at risk persons on railway property and in the community) and social interventions (inter-organisation collaboration, public information and education, enforcement). Unfortunately, few of these measures have been evaluated to assess their effectiveness in reducing railway suicides (Havârneanu et al., 2015). This article presents a systematic review of research on railway and urban transit system suicides, including studies on the incidence, temporal and spatial patterns of attempts as well as characteristics of attempters. This review emphasizes commonalities in railway suicides around the world as well as regional and local difference that may have important implications for prevention. We discuss implications of characteristics of railway suicides for stakeholders in developing prevention strategies based on current recommended best practices (Harvâneanu et al., 2015). We also discuss needs for further research to better understand railway suicide and to develop effective prevention programmes.

Section snippets

Methodology

We searched the databases listed in Table 1 sequentially with the key words indicated. The number or articles consists of unique articles identified that were not previously identified in other databases. To identify unpublished reports, we contacted 71 railway companies around the world. Of the 25 replies, 17 had no data on railway suicide and eight sent a report. Four of the reports included data already published elsewhere and 4 provided new data and were included in this review. Inclusion

Definition of railway suicide

Suicides are defined as instances where there are clear behavioural indications that the victim intended to initiate actions that could lead to his death or the victim presented risk factors and warning signs generally associated with suicide, such as suicide threats, leaving a note, having previously attempted suicide or having mental health problems with indications of suicide risk (Mishara and Tousignant, 2004). Railway suicides generally involve intentionally putting oneself in the path of

Methods of classification of railway suicides, their reliability and validity

The determination of deaths as accidents or suicides is not easy. For example, in Canada from 1993 to 1996, Transport Canada (1996) classified 39% of railway “trespassing” fatalities as being “apparent suicide,” 10% as accidents and the remaining 51% as “undetermined”. In the USA, Martino et al. (2013) found it difficult to obtain accurate data on railway suicides. Berman et al. (2013) identified discrepancies in reporting, inducing a risk of underestimation.

Mishara and Bardon (2013) found that

Incidence and prevalence

Table 2 summarises the incidence of railway suicides in different countries where data are available and the proportion of suicides on railway, based upon our calculations, comparing the data reported in the article with national suicide data from the World Health Organization (2014). There are significant variations that may reflect actual differences or may be influenced by differences in the methods of reporting and classifying deaths. The proportion of all suicides that occur on railways

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Around 4 % of all suicide deaths in Great Britain occur on the railways. This exploratory study was designed to increase understanding of the individuals that take their lives in this way, and the circumstances of their death.
Data were obtained from fatality investigation files compiled by the British Transport Police (BTP) relating to suspected suicides on the mainline railway in England from April 2019 to March 2021. Cluster analysis was carried out to identify grouped associations of characteristics and circumstances relating to rail suicide.
A total of 436 files were analysed, representing 93 % of all suspected railway suicides during this period. Cluster analysis identified four groups of almost equal size, distinguished principally by age, living arrangements, employment status and location of death. The study is novel in the way it integrates individual characteristics and circumstances of death. The identified clusters may provide a multidimensional way of conceptualising suicide risk that could inform more targeted interventions at rail locations.
A high proportion of missing data means that the findings need to be interpreted with caution. It also restricted the multivariate analysis to those categories of information for which sufficient information was available.
The characteristics and circumstances of suicide deaths on the railways are complex and multifaceted. The typology identified in this study may help to target preventative strategies prior to the incident as well as at different location types.
A pilot study evaluating the preventive effects of platform-end lengthwise fencing on trespassing, person struck by train and traffic delays
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Background: Trespassing at train tracks and “person under train” (PUT) incidents are serious health, societal and transportation concerns. There is a need for developing different measures to prevent these events. Here, we hypothesized that platform-end lengthwise fences (PLF) reduce trespassing, the number of PUT incidents (suicides and accidents), and train traffic delays. Method: PLFs were installed as the intervention at one station in Stockholm in 2020. The number of trespassers detected using CCTV-cameras was compared before and after at the intervention station over a total period of 29 months (using incidence rate ratio, IRR). The reduction in the number of PUT (over 20 years) and train traffic delays (over 9 years) was also investigated by IRR, and by using three control groups. Results: After installation of PLF there was a significant ∼90% reduction in trespasses (IRR = 0.10, 95%CI 0.04–0.23; one-sided exact p < 0.0001). No PUT incident occurred at the intervention station after the installation, compared to 1.11 per year before installation (IRR = 0.32, 95%CI 0–1.82; one-sided exact p = 0.1216). There was a significant reduction in delay minutes post installation compared to before the installation (Mann Whitney U = 0, upper one-sided exact p = 0.0357). The effect of the PLF was also observable in comparison to the three control groups, suggesting that the preventive effect was not due to wider societal events affecting all stations. Conclusion: PLF had a large effect on reducing the number of trespasses and the number of delay minutes due to trespasses and PUT incidents. PLF may also have an effect of reducing PUT incidents. Practical Applications: PLF is deemed to be relatively easy and cheap to install and thus scalable (as compared to full barriers, e.g., platform screen doors) and may be considered at platform-ends having an exit, provided there is enough space to install them.
Deliberate fatal crashes involving a motor vehicle and a cyclist or pedestrian
2023, Journal of Transport and Health
Deliberate crashes are caused by road users engaging in insurance fraud, attempting suicide, or “punishing” other road users. In this study, we investigated deliberate crashes that resulted in the deaths of “vulnerable” road users (cyclists and pedestrians).
We used in-depth road crash investigation data from the Finnish Crash Data Institute and court decisions for a selected number of cases in which the deceased had not been the main originator of the crash.
In 1997–2018, 96 pedestrians and five cyclists died in 101 deliberately caused crashes involving a motor vehicle. The majority of these crashes were caused by suicides (94/96 pedestrian and 3/5 cyclist crashes). Most of suicide crashes (79%) involved a heavy vehicle. Eighty percent of the victims were male. Previous suicidal thoughts and attempts, and a history of mental disorders/illness was prevalent around two thirds of the originators of the crashes. Four cases were caused by motor vehicle drivers. According to court rulings, the drivers in two of these cases were convicted of manslaughter.
We provide some possible reasons for this relatively high number of road suicides in Finland and discuss the legal implications of deliberately hitting pedestrians or cyclists with a motor vehicle.
A pilot study evaluating the effectiveness of preventing railway suicides by mid-track fencing, which restrict easy access to high-speed train tracks
2022, Journal of Safety Research
Citation Excerpt :
Some studies also showed an effect regarding trenches located in-between the tracks, or so called “suicide pits” (Barker et al., 2017; Coats & Walter, 1999; O’Donnell & Farmer, 1994). However, there is currently limited evidence concerning other types of prevention measures through means restriction in the railway system (Ryan et al., 2018) and there is a need to develop better evidence for suicide prevention strategies and methods (Fredin-Knutzén et al., 2020; Mishara & Bardon, 2016). In a previous study, Rådbo and Andersson (2012) investigated suicides and other trespass fatalities in the railway system of greater Stockholm and its urban areas.
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.
Identifying measures with the highest potential to reduce suicides on Finnish railways
2022, Applied Ergonomics
Citation Excerpt :
However, caution is recommended when considering the suitability of our study findings for other countries. For example, the locations of railway suicides vary significantly by country (see e.g., Mishara and Bardon, 2016) and each country has their unique railway environment. As mentioned as part of the introduction, the length of the Finnish railway network is almost 6000 km, and unlike in some other countries, railways are not usually isolated from the surrounding areas by fencing.
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.
Self-harm on roads: Register-based study of methods and characteristics of individuals involved
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Citation Excerpt :
The latter have received far more attention in terms of both research and prevention (Mishara and Bardon, 2016; Barker et al, 2017). Those dying by suicide on the rail network appear to be similar to those dying on the road network, such as often being relatively young compared with people dying by suicide in general, and often with problems with substance misuse and a history of previous suicide attempts involving other methods (Mishara and Bardon, 2016). However, there is little information regarding non-fatal acts in on the rail network, probably because of their generally high case fatality, but some on survivors of suicide attempts on the underground, who report that their acts were often impulsive but involved high suicide intent (O'Donnell et al., 1996).
Suicide on roads is receiving increased attention. However, there has been little research on non-fatal road-related self-harm. This study was conducted in order to investigate the characteristics of such acts.
Information on non-fatal road self-harm was extracted from a self-harm monitoring system database of self-harm presentations to a major general hospital in England during 2005-2017. Patients were identified through being referred for psychosocial assessment by a clinical service and through scrutiny of medical records.
During the 13-year study period 110 individuals (67 males, 43 females) presented to the hospital with road-related self-harm: 38 (34.5%) jumped from bridges, 34 (30.9%) jumped or lay in front of vehicles, 27 (24.5%) crashed vehicles and 11 (10.0%) jumped from moving vehicles. Crashing vehicles was more common in males and jumping from vehicles more common in females. In patients who received a psychosocial assessment, their most frequent problems were with a partner, employment and family members. Over half had been in psychiatric care and nearly two-thirds had a history of previous self-harm. Suicide intent was often high, especially in those who crashed a vehicle or jumped from a bridge.
The study was based on presentations to a single hospital. Some data were not available for non-assessed patients.
Road-related self-harm, while not common, more frequently involves males and the acts are often of high suicidal intent. The range of problems preceding this method of self-harm indicates that there needs to be a variety of aftercare interventions, adapted to each individual's situation.

View all citing articles on Scopus

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Review articleSystematic review of research on railway and urban transit system suicides

Highlights

Abstract

Introduction

Method

Results

Conclusions

Practical implications

Introduction

Section snippets

Methodology

Definition of railway suicide

Methods of classification of railway suicides, their reliability and validity

Incidence and prevalence

J. Psychiatr. Res.

J. Affect. Disord.

J. Affect. Disord.

Soc. Sci. Med.

J. Saf. Res.

Accid. Anal. Prev.

Eur. Psychiatry

J. Affect. Disord.

J. Affect. Disord.

Soc. Sci. Med.

J. Saf. Res.

Accid. Anal. Prev.

Soc. Sci. Med.

Psychiatry Res.

J. Affect. Disord.

J. Affect. Disord.

J. Affect. Disord.

J. Affect. Disord.

Railway Suicide: An Investigation of Individual and Organisational Consequences: A Report of the SOVRN (Suicides and Open Verdicts on the Railway Network) Project

Railway suicide in Belgium 1998–2009: incidence and prevention

Crisis

Psychiatric diagnoses in 3275 suicides: a meta-analysis

BMC Psychiatry

Prévention du Suicide Dans le Métro de Montréal, Phase 2- Analyse de Contenu des Dossiers du Coroner 2000–2008

Prévention du suicide dans le métro de Montréal, Phase 1 - Description des gestes suicidaires dans le métro de Montréal à partir des dossiers d'incident

Train-related suicides in Milan, Italy: analysis of cases 1993-2008

Med. Sci. Law

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

Eur. J. Public Health

Defining Characteristics of Intentional Fatalities on Railway Rights-of-way in the United States, 2007–2010

Suicides on Commuter Rail in California: Possible Patterns – A case study

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

Br. Med. J.

Suicidal behaviour by train collision in Queensland, 1990–2004

Aust. N. Z. J. Psychiatry

Characteristics of suicide hotspots on the Belgian railway network

Int. J. Inj. Control. Saf. Promot.

Railroad suicides and attempted suicides in Austria 1990–1994. Extending the hypothesis mass media transmission of suicidal behavior

Nervenarzt

Train suicides in Brisbane, Australia, 1980–1986

Crisis

Preventing suicide by influencing mass-media reporting. The Viennese experience 1980–1996

Arch. Suicide Res.

Suicide in the London underground system

Int. J. Epidemiol.

Review article
Systematic review of research on railway and urban transit system suicides