title: Railway suicide in England and Wales 2000-2013: a time-trends analysis.
abstract: BACKGROUND
  In 2010, the "Tackling Suicide on the Railways" programme was launched as a joint initiative among Network Rail, the Samaritans and other key organisations such as the British Transport Police and train operators to achieve a 20% reduction in railway suicides from 2010 to 2015 in Great Britain. We report the most recent age and sex specific trends in railway suicide in England and Wales from 2000 to 2013 and examine whether the initiative's target reduction in railway suicides is likely to be achieved.
  
  
  METHODS
  Population data and suicide mortality data (all methods combined and railway) for England and Wales were obtained from the Office for National Statistics (ONS) and used to calculate age and gender specific rates for deaths registered from 2000 to 2013. Data on railway suicides were also obtained from the Rail Safety and Standards Board (RSSB) and compared with ONS data. We used joinpoint regression to identify changes in suicide trends across the study period.
  
  
  RESULTS
  The railway was used in 4.1% of all suicides in England and Wales (RSSB data were similar to ONS data for most years). Suicides in all persons from all causes decreased from 2000 to 2007, with small increases from 2008 until 2013; this rise was entirely due to an increase in male suicides. Railway suicide rates increased over the entire study period; the proportion of railway suicides in all persons increased from 3.5 to 4.9% during the study period. This trend was also mainly driven by increases in male suicides as female railway suicide rates remained steady over time. The highest age specific railway suicide rates were observed in middle aged men and women. Although there was no conclusive evidence of an increase in ONS railway suicides, RSSB data showed a statistically significant increase in railway suicides in males from 2009 onwards.
  
  
  CONCLUSIONS
  The continued rise in male railway suicide in England and Wales is concerning, particularly due to the high economic costs and psychological trauma associated with these deaths. The initiative's target of a 20% reduction in railway suicide is unlikely to be achieved.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Address-School of Social and Community Medicine, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Taylor
authors.affiliation: School of Social and Community Medicine, University of Bristol, Address-School of Social and Community Medicine, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Duleeka W
authors.initials: DW
authors.lastname: Knipe
authors.affiliation: School of Social and Community Medicine, University of Bristol, Address-School of Social and Community Medicine, 39 Whatley Road, Bristol, BS8 2PS, UK. kyla.thomas@bristol.ac.uk.
authors.forename: Kyla H
authors.initials: KH
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011890:Railroads / Q000706:statistics & numerical data*; D012737:Sex Factors; D013405:Suicide / Q000639:trends*; D014852:Wales / Q000453:epidemiology; D055815:Young Adult; D000092864:Suicide Prevention
keywords: England and Wales; Epidemiology; Railways; Suicide; Train