From thought to attempt: Understanding the suicidal proces

Over 1800 suicide deaths occur in The Netherlands every year, 200 of which are
railway suicides. The prevalence of non-fatal suicide attempts is estimated to
be 25 times greater than that of suicides. Although there is much qualitative
data available about the suicidal process, through which
suicidal thoughts may result in a suicide attempt, there is little detailed
information known about this process. Such knowledge about the steps taken by a
suicidal person throughout this process, and the related barriers and triggers,
can provide much insight about the planning, realization, and execution of
suicide plans. Furthermore, it is valuable to gain insight with regards to the
decision-making that leads to railway suicide plans, specifically. Knowledge
gained may contribute to suicide prevention in general, and railway suicide
prevention specifically.

Gain insight into the process through which suicidal thoughts lead to an
attempt, and into the factors, considerations and preparations that play a role
in this process

This is a mixed methods study which features structured interviews.
Interviewees are people who recently carried out a suicide attempt with the
specific intent of passing away, which they survived or was disrupted by
external factors. The study distinguishes between two groups: A) people
who carried out a railway suicide attempt (N=20) and B) people who carried out
a suicide attempt involving any different method, with the specific intent to
pass away (N=20).

The risk associated with participating in this study is considered moderate,
given the relatively small burden of one interview and one questionnaire.
Various international and national studies have demonstrated that asking
questions about suicidality does not have harmful effects. This is the case for
both those that have suicidal thoughts, and those who do not. Severely suicidal
people may actually become less suicidal after being asked questions about
suicidality. It is probable that this is the result of discussions about
suicidality *airing out* suicidal sentiments, making the experience of having
suicidal thoughts less tense. Research has also demonstrated that a previous
suicide attempt is a predictor for future fatal suicide attempt. Thus, the
research population is a vulnerable group, requiring careful research conduct
for this group to be involved in this study responsibly. This is ensured by
screening participants, specific requirements for interviewers, additional
training for interviewers, and establishing a care protocol post-participation.