Suicides on the Austrian railway network: hotspot analysis and effect of proximity to psychiatric institutions.

Railway suicide is a significant public health problem. In addition to the loss of lives, these suicides occur in public space, causing traumatization among train drivers and passengers, and significant public transport delays. Prevention efforts depend upon accurate knowledge of clustering phenomena across the railway network, and spatial risk factors. Factors such as proximity to psychiatric institutions have been discussed to impact on railway suicides, but analytic evaluations are scarce and limited. We identify 15 hotspots on the Austrian railway system while taking case location uncertainties into account. These hotspots represent 0.9% of the total track length (5916 km/3676 miles) that account for up to 17% of all railway suicides (=1130). We model suicide locations on the network using a smoothed inhomogeneous Poisson process and validate it using randomization tests. We find that the density of psychiatric beds is a significant predictor of railway suicide. Further predictors are population density, multitrack structure and-less consistently-spatial socio-economic factors including total suicide rates. We evaluate the model for the identified hotspots and show that the actual influence of these variables differs across individual hotspots. This analysis provides important information for suicide prevention research and practice. We recommend structural separation of railway tracks from nearby psychiatric institutions to prevent railway suicide.