How can we better prevent railway suicide in the Netherlands? An in-depth study of risk locations, precipitating factors and personal risk factors.

In the Netherlands, on average nearly 200 people die annually by railway
suicide. Suicide has major societal impact. Aside from the victim and the
bereaved, it has considerable consequences for train drivers, railway
personnel, and witnesses or bystanders. Worryingly, there is an
overrepresentation of youths using this violent method of suicide, 9% of
victims of railway suicide in the Netherlands is aged 20 or below. Preventive
measures on risk locations, such as fences, lighting and signs referring to 113
Suicide Prevention have presumably contributed to a 10% decrease of railway
suicides in 2018. This decrease was maintained in 2019. Aside from physical
preventive measures, suicide prevention efforts include training staff of
transport providers, improved collaboration between stakeholders and campaigns
aimed to create awareness in the general public. To organize such forms of
prevention, it is crucial to obtain more insight into the background, risk
locations, precipitating factors and personal risk factors which contribute to
railway suicide.

The aim of the current study is to identify risk locations, precipitating
factors and personal risk factors of railway suicides in order to support
additional preventive measures.

This study adheres to several research questions:
- What are important characteristics of locations near or on the railway in the
Netherlands where people have died by suicide?
- What patterns can be identified in the preparation, behaviours and
suicide-related communication of victims who died by railway suicide in the
Netherlands?
- What are personal risk factors of persons who have died by railway suicide in
the Netherlands? Are there differences between youths and adults, or males and
females?
- What are additional, promising preventive measures to prevent railways
suicide in the Netherlands, based on the findings of the current study?

The current study has an observational design, entailing a mixed methods
psychological autopsy study. People bereaved by a railway suicide of a loved
one are recruited through the bereavement support program of the transport
operator, as well as other organizations providing services for bereaved. A
semi-structured interview of approximately two hours will be conducted with
participants. The interview consists of two sections: (1) a reconstruction of
the last period of the victims' lives, with focus on the location and
circumstances of the incident, and precipitating factors preceding the suicide,
and (2) a section dedicated to identifying personal risk factors, accounting
for the age and gender of the person who died by suicide. Information gathered
by interviews is supplemented by incident reports of the transport operator, to
obtain additional insights into risk locations and circumstances of the
suicide.

People bereaved by suicide are at higher risk to develop suicidal thoughts and
are in the middle of grasping the reality of a loved one's death. Taking part
in the interview may cause psychological distress. As such, the researcher team
has developed a thorough strategy to approach and recruit potential
participants, clear exclusion criteria and developed a careful plan with regard
to potential unmet health needs of participants.

Participants are screened ahead of the interview to examine current suicidal
ideation. The general practitioner of the participant is informed about
participation. The interview has been designed to obtain the desired
information, while aiming to minimize the burden of participation. The
interview lasts approximately two hours, and always includes a short break from
the interview. All participants receive a follow-up telephone contact with the
researcher to observe their wellbeing two-three weeks after the interview.
Participants with unmet healthcare needs are referred to the general
practitioner and actively followed until adequate care has been realized. The
researchers are under supervision of a clinical psychologist from 113 Suicide
Prevention.