ObjectivesSuicides by train have devastating consequences for families, the rail industry, staff dealing with the aftermath of such incidents and potential witnesses. To reduce suicides and suicide attempts by rail, it is important to learn how safe interventions can be made. However, very little is known about how to identify someone who may be about to make a suicide attempt at a railway location (including underground/subways). The current research employed a novel way of understanding what behaviours might immediately precede a suicide or suicide attempt at these locations.Design and methodsA qualitative thematic approach was used for three parallel studies. Data were gathered from several sources, including interviews with individuals who survived a rail suicide attempt (n=9), CCTV footage of individuals who died by rail suicide (n=16) and qualitative survey data providing views from rail staff (n=79).ResultsOur research suggests that there are several behaviours that people may carry out before a suicide or suicide attempt at a rail location, including station hopping and platform switching, limiting contact with others, positioning themselves at the end of the track where the train/tube approaches, allowing trains to pass by and carrying out repetitive behaviours.ConclusionsThere are several behaviours that may be identifiable in the moments leading up to a suicide or suicide attempt on the railways which may present opportunities for intervention. These findings have implications for several stakeholders, including rail providers, transport police and other organisations focused on suicide prevention.

BackgroundThere 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.MethodWe conducted an online survey and qualitative interviews with individuals who had contemplated or attempted suicide by train.ResultsA 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.ConclusionsPeople 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.

Background Choice of suicide method can strongly influence the outcome of suicidal behaviour, and is an important aspect of the process and planning involved in a suicide attempt. Yet, the reasons why individuals consider, choose or discard particular methods are not well understood. Aims This is the first study to explore method choices among people with a history of suicidal behaviour and individuals who have experienced, but not enacted, suicidal thoughts. Method Via an online survey, we gathered open-ended data about choice of methods in relation to suicidal thoughts and behaviours, including reasons for and against specific means of harm. Results A total of 712 respondents had attempted suicide, and a further 686 experienced suicidal thoughts (but not acted on them). Self-poisoning was the most commonly contemplated and used method of suicide, but most respondents had considered multiple methods. Method choices when contemplating suicide included a broader range of means than those used in actual attempts, and more unusual methods, particularly if perceived to be lethal, ‘easy’, quick, accessible and/or painless. Methods used in suicide attempts were, above all, described as having been accessible at the time, and were more commonly said to have been chosen impulsively. Key deterrents against the use of specific methods were the presence of and impact on other people, especially loved ones, and fears of injury and survival. Conclusions Exploration of method choices can offer novel insights into the transition from suicidal ideation to behaviour. Results underscore the need for preventative measures to restrict access to means and delay impulsive behaviour.