National suicide prevention programme and railway suicide.

Suicidal behaviour is a public health problem closely related to other problems such as mental illness, abuse, violence and accidents. This approach is illustrated by the prevention of railway suicides. A theoretical framework is sketched, which allows for the use of principles from injury prevention in the prevention of suicide. ICD-9 encoded death certificates from 1974, 1980, 1986 and 1987 which concerned suicides and undetermined deaths on roads and railways were analysed (N = 294). Additional data were collected from autopsy, police and hospital protocols and from interviews with engine-drivers. Railroad victims dominated the sample (78% of cases). The mean age was 42 yr. Alcohol was detected in 27% of cases, drugs in 36% and severe illness (mostly psychiatric) in 57%. The relationship between types of collision and nature of injury is discussed. Environmental changes, such as changing the locomotive front design, are suggested as strategies for reducing accidents and suicides on railways.