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BACKGROUND: There is a suicide on the British railways every 36 hours. However, the reasons why people choose to die by train are not well understood.AimsTo explore factors influencing and discouraging the decision to attempt suicide on the railway networks. METHOD: We conducted an online survey and qualitative interviews with individuals who had contemplated or attempted suicide by train. RESULTS: A total of 353 survey responders had considered and 23 had attempted suicide at rail locations (including railways and metro/underground); a third of these cases were impulsive. The most frequently reported motivations for contemplating or attempting suicide were perceptions of quick and certain lethality (54 and 37%, respectively) and easy access to rail settings (33 and 38%, respectively). The main factor discouraging people from rail suicide was its wider impact, especially on train drivers (19%). In qualitative interviews (N = 34) the desire to avoid intervention from others was also a common motivating factor for attempting suicide on the railway networks. CONCLUSIONS: People attempt suicide by train because railway settings are easy to access and because of an inaccurate perception of certain and quick lethality. Tackling exaggerated perceptions of lethality may help reduce suicides by train.Declaration of interestNone.

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OBJECTIVES: Suicides by train have devastating consequences for families, the rail industry, staff dealing with the aftermath of such incidents and potential witnesses. To reduce suicides and suicide attempts by rail, it is important to learn how safe interventions can be made. However, very little is known about how to identify someone who may be about to make a suicide attempt at a railway location (including underground/subways). The current research employed a novel way of understanding what behaviours might immediately precede a suicide or suicide attempt at these locations. DESIGN AND METHODS: A qualitative thematic approach was used for three parallel studies. Data were gathered from several sources, including interviews with individuals who survived a rail suicide attempt (n=9), CCTV footage of individuals who died by rail suicide (n=16) and qualitative survey data providing views from rail staff (n=79). RESULTS: Our research suggests that there are several behaviours that people may carry out before a suicide or suicide attempt at a rail location, including station hopping and platform switching, limiting contact with others, positioning themselves at the end of the track where the train/tube approaches, allowing trains to pass by and carrying out repetitive behaviours. CONCLUSIONS: There are several behaviours that may be identifiable in the moments leading up to a suicide or suicide attempt on the railways which may present opportunities for intervention. These findings have implications for several stakeholders, including rail providers, transport police and other organisations focused on suicide prevention.

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This paper presents a systematic review of the literature concerning the relationship between alexithymia and self-harm. Fifteen studies were selected following a systematic search of relevant databases. Results indicate significantly higher levels of alexithymia in women who self-harm compared with women who do not self-harm. Studies of men were less conclusive and require further investigation. A subsample of the studies found that childhood abuse and bullying were more likely to be associated with self-harm if alexithymia was present as a mediator. Other studies found that depression mediated between alexithymia and self-harm. The results indicate that the poor emotional cognition and expression associated with alexithymia may increase vulnerability to self-harm, particularly in women.

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BACKGROUND: Chlorpromazine (CPZ) remains one of the most common drugs used for people with schizophrenia worldwide, and a benchmark against which other treatments can be evaluated. Quantitative reviews are rare; this one evaluates the effects of chlorpromazine in the treatment of schizophrenia in comparison with placebo. METHODS: We sought all relevant randomised controlled trials (RCT) comparing chlorpromazine to placebo by electronic and reference searching, and by contacting trial authors and the pharmaceutical industry. Data were extracted from selected trials and, where possible, synthesised and random effects relative risk (RR), the number needed to treat (NNT) and their 95% confidence intervals (CI) calculated. RESULTS: Fifty RCTs from 1955-2000 were included with 5276 people randomised to CPZ or placebo. They constitute 2008 person-years spent in trials. Meta-analysis of these trials showed that chlorpromazine promotes a global improvement (n = 1121, 13 RCTs, RR 0.76 CI 0.7 to 0.9, NNT 7 CI 5 to 10), although a considerable placebo response is also seen. People allocated to chlorpromazine tended not to leave trials early in both the short (n = 945, 16 RCTs, RR 0.74 CI 0.5 to 1.1) and medium term (n = 1861, 25 RCTs, RR 0.79 CI 0.6 to 1.1). There were, however, many adverse effects. Chlorpromazine is sedating (n = 1242, 18 RCTs, RR 2.3 CI 1.7 to 3.1, NNH 6 CI 5 to 8), increases a person's chances of experiencing acute movement disorders, Parkinsonism and causes low blood pressure with dizziness and dry mouth. CONCLUSION: It is understandable why the World Health Organization (WHO) have endorsed and included chlorpromazine in their list of essential drugs for use in schizophrenia. Low- and middle-income countries may have more complete evidence upon which to base their practice compared with richer nations using recent innovations.

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AIM: The aim was to investigate ethnic differences in lifetime self-harm and attempted suicide in women prisoners, and to examine relationships between self-harm, suicide and substance use on dependence. BACKGROUND: Previous studies have suggested that there may be ethnic differences in the proportion of prisoners reporting substance misuse, self-harm and attempted suicide, although relatively few minority ethnic women have been studied in the UK. This study examines drug and alcohol dependence in white and black British women in prison, and explores possible associations with self-harm, suicide attempts, and family violence. METHODS: 301 women (190 white, 111 black or mixed race) were interviewed in ten prisons from different parts of England. Measures included the Alcohol Use Disorders Identification test (AUDIT), the severity of Dependence Scale (SDS), and section C (suicidality) of the MINI International Neuropsychiatric Interview. RESULTS: Half of the women in the sample reported at least one act of self-harm in their life and 46% reported making a suicide attempt at some time. Lifetime self-harm was associated with a history of harmful drinking and with being a victim of violence, including physical assault, sexual assault and violence from family and friends. Lifetime suicide attempts were associated with reported violence from family or friends. Current high suicide risk was most common among women on remand. Drug dependence and reported violence from family or friends were both more common amongst white women than black/mixed race women. Self-harm and attempted suicide were generally more common among white women, but black/mixed race women dependent on drugs had the highest proportion of women reporting self-harm. There was tentative support for a three-way association between ethnicity, dependence and self-harm; this raises the possibility that drug dependence may be a predictor of self-harm in the black female prison population.

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