title: Individual and community factors for railway suicide: a matched case-control study in Victoria, Australia.
abstract: OBJECTIVE
  This study aims to simultaneously examine individual- and community-level factors associated with railway suicide.
  
  
  METHODS
  We performed a case-control study in Victoria, Australia between 2001 and 2012. Data on cases of railway suicide were obtained from the National Coronial Information System (a database of coronial investigations). Controls were living individuals randomly selected from the Household, Income and Labour Dynamics in Australia study, matching to cases on age groups, sex and year of exposures. A conditional logistic regression model was used to assess the individual-level and community-level influences on individual odds of railway suicide, controlling for socioeconomic status.
  
  
  RESULTS
  Individual-level diagnosed mental illness increased railway suicide odds by six times [95 % confidence interval (CI) 4.5, 9.2]. Community-level factors such as living in an area with a presence of railway tracks [odds ratio (OR) 1.8, 95 % CI 1.2, 2.8], within a city (OR 3.2, 95 % CI 1.9, 5.4), and with a higher overall suicide rate (OR 1.02, 95 % CI 1.01, 1.04) were independently associated with greater individual odds of railway suicide compared to living in an area without a presence of railway tracks, outside a city, and with a relatively lower overall suicide rate.
  
  
  CONCLUSIONS
  The effects of mental illness and high incidence of overall suicides are prominent, but not specific on railway suicide. The effects of presence of railway tracks and city residence suggest the importance of accessibility to the railways for individual risk of railway suicide. Prevention efforts should focus on vulnerable people live in areas with easy access to the railways.
authors.affiliation: Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia. tiffany.too@unimelb.edu.au.
authors.forename: Lay San
authors.initials: LS
authors.lastname: Too
authors.affiliation: Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Spittal
authors.affiliation: Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC, 3006, Australia.
authors.forename: Lyndal
authors.initials: L
authors.lastname: Bugeja
authors.affiliation: Harvard Injury Control Research Center, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Roderick
authors.initials: R
authors.lastname: McClure
authors.affiliation: Deakin Population Health SRC, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.|Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Milner
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D011890:Railroads / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D013405:Suicide / Q000706:statistics & numerical data*; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: Environment; Mental health; Railroads; Suicide