Ambivalence and Suicidal Behavior at Railway Stations: A Scoping Review.

Abstract

Objective: Suicide on railways cause immense emotional distress for families, bystanders, and railway staff and carries substantial economic costs. Although behaviors suggesting ambivalence have been identified in individuals dying by suicide at railway stations, relatively little is known about this phenomenon. We conducted a scoping review to examine the prevalence and characteristics of ambivalence among individuals who died by suicide at railway stations and, secondly, to identify factors, which may influence ambivalence in the suicidal process.

Method: Following a 6-stage model, evidence identified in PubMed and Google Scholar was reviewed and discussed with experts. Findings were grouped into central themes.

Results: Only 16 relevant publications were identified, implying that ambivalence has been addressed relatively infrequently in studies of individuals who have died by suicide at railway stations. Nevertheless, signs of ambivalence have been observed in a substantial proportion of such individuals. Behaviors indicative of ambivalence include hesitation, letting trains pass, and climbing back up on the platform after having jumped. At-risk individuals may express suicidal intentions either directly or indirectly, possibly in the hope of intervention. Based on recordings from surveillance cameras and interviews with survivors, some behaviors of at-risk individuals at railway stations may be interpreted as signs of an internal conflict.

Conclusions: Some at-risk individuals at railway stations exhibit signs of ambivalence. This may increase the probability of detection of and intervention. Further, those designing interventions at railway stations, such as encouragement of help-seeking, trained gatekeepers, and means restriction, might consider addressing ambivalence of at-risk individuals.