Suicidal behaviour on subway systems: a review of the epidemiology.

Suicide on subway systems is a public health challenge that has been reported in urban centers worldwide. Our objective was to analyze studies of suicide on subway systems, develop a profile of characteristics that are suggestive of association with suicides or attempts, and show how this profile can inform prevention. A literature review involving epidemiology studies and studies relating to subway suicide was conducted. Twenty-eight studies were included in this review. Across studies, characteristics were not often assessed for risk factor status, although several characteristics were remarkably similar. Those attempting suicide on the subway appear to be affected by serious mental illness and have contact with mental health services before the suicidal behavior. Several characteristics may be shared among this population, emphasizing the potential for prevention in clinical and public health domains. Well-designed studies that utilize robust data collection and statistical methods are needed to establish the risk status associated with these characteristics.