Dataset Information

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

ABSTRACT: 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 (N=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.

SUBMITTER: Strauss MJ

PROVIDER: S-EPMC5383816 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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

Strauss Markus J MJ Klimek Peter P Sonneck Gernot G Niederkrotenthaler Thomas T

Royal Society open science 20170308 3

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 ...[more]

PMID: 28405359

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Project description:BackgroundDischarged psychiatric patients are at higher risk of suicide due to various risk factors in their lives compared to the general population. However, specific problems and needs of these patients after discharge remain unclear. This research constitutes a segment of a broader implementation study designed to formulate an interventional strategy targeting post-discharge suicide among Chinese psychiatric patients. The present study seeks to qualitatively investigate the problems and needs from the perspectives of patients, their lay healthcare supporters (LHSs), and mental health professionals (MPs), aiming to enhance the efficacy of the interventional strategy.MethodsThis study is part of a larger implementation study based on Shenzhen Kangning Hospital (SKH) in Shenzhen, Guangdong, China. Under the community-based participatory research framework, we recruited discharged psychiatric patients, their LHSs, and MPs as a collaborative community team, and we conducted individual in-depth interviews for patients and LSHs and focus group interviews with MPs. We utilized a thematic analysis approach to identify sub-themes and themes from interviews through systematically coding and analyzing the data.ResultsA total of 45 participants were recruited for interviews, comprising 17 patients, 8 LHSs, and 20 MPs. We conducted 25 individual in-depth interviews and 3 focus group interviews. Through the interviews, we identified three themes of post-discharge problems: problems related to self, family-related problems, societal and community-related problems. We also identified four themes related to reducing post-discharge suicide: proactive self-management, multifunctional relatives, multifunctional MP group, and a warm society. The tangible support from LHSs and emotional support from MPs are strongly emphasized. Follow-up interventions were identified as the most significant way to addressing these unmet needs. Instrumental support from the community and a caring and non-discriminatory environment for individuals with mental disorders are essential for reducing suicide risk.ConclusionsEstablishing an integrated mental health care service network that connects psychiatric patients, LHSs, and MPs cross community and societal sectors, with patient-centered follow-up care at its core, is a practical approach to better address patients' needs and reduce post-discharge suicide.Trial registrationRegistration number: NCT04907669. Date of registration: May 26th,2021.

Project description:ObjectivesThe objective was to assess the importance of different types of predictors for patient-reported outcome, both background factors at the patient level and healthcare predictors related to structure and processes of healthcare.DesignCross-sectional patient experience survey.SettingAll 280 secondary care institutions in Norway providing inpatient care for adult psychiatric patients.Participants1683 inpatients responded to the questionnaire on-site (73.4%).Primary outcome measuresThe outcome scale of the Psychiatric Inpatient Patient Experience Questionnaire-On-Site was the primary dependent variable. The scale consists of five items relating to overall patient satisfaction, benefit of treatment and patient enablement. Regressions were used to assess predictors, for all patients and for five different patient groups reported by the patients including anxiety/depression, drug-related problems and eating disorders.ResultsMultilevel linear regression for all patients showed that background factors related to overall current state, self-perceived mental health before admission and admission type were the most important predictors for patient-assessed outcome. Poor current state was associated with poor assessment of outcome (estimate: 8.64, p<0.001), poor health before admission was associated with better outcome (estimate: -6.89, p<0.001) and patients with urgent admission had poorer scores on the outcome scale (estimate: 4.40, p<0.001). A range of structure and healthcare variables were related to patient-assessed outcome, the most important being clinicians/personnel understanding your situation, treatment adjusted to your situation and adequate information about mental health condition.ConclusionsSelf-perceived mental health before admission, current overall state and type of admission were the most important background factors for patient-assessed outcome. The most important structure and process variables were related to patient-centred interaction. The background factors should be considered in case-mix adjustments of quality indicators, while the process variables could be used as focus areas in work aiming to improve patients' assessment of outcome.

Dataset Information

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

Publications

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

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