Factors prompting and deterring suicides on the roads

Abstract

Background
In addition to the devastating impact on the individual and their families, suicides on the roads can cause distress and harm to other people who might be involved in a collision or witness an attempt. Despite an increased focus on the characteristics and circumstances of road-related suicides, little is known about why people choose to end their lives in this way.

Aims
The aim of the current study was to investigate the factors prompting and deterring the decision to attempt suicide on the roads.

Method
We conducted a secondary analysis of survey data, as well as seven in-depth qualitative interviews. Participants had lived experience of suicidal ideation or behaviour at a bridge or road location. We also carried out an online ethnography to explore interactions in different online communities relating to this method of suicide.

Results
Participants perceived a road-related suicide to be quick, lethal, easy and accessible and to have the potential to appear accidental. The proportion of participants who described their thoughts and attempts as impulsive appeared to be higher than had been observed with other method choices. The potential impact on other people was a strongly dissuasive factor.

Conclusions
Measures designed to prevent access to potentially lethal sites may be particularly important, given that many participants described their thoughts and behaviour as impulsive. In addition, fostering a culture of care and consideration for other road users may help to dissuade people from taking action on the roads.

Full text

Factors prompting and deterring suicides on
the roads
Hilary Norman, Lisa Marzano, Rachel Winter, Ioana Crivatu, Jay-Marie Mackenzie and Ian Marsh
Background
In addition to the devastating impact on the individual and their
families, suicides on the roads can cause distress and harm to
other people who might be involved in a collision or witness an
attempt. Despite an increased focus on the characteristics and
circumstances of road-related suicides, little is known about why
people choose to end their lives in this way.
Aims
The aim of the current study was to investigate the factors
prompting and deterring the decision to attempt suicide on the
roads.
Method
We conducted a secondary analysis of survey data, as well as
seven in-depth qualitative interviews. Participants had lived
experience of suicidal ideation or behaviour at a bridge or road
location. We also carried out an online ethnography to explore
interactions in different online communities relating to this
method of suicide.
Results
Participants perceived a road-related suicide to be quick, lethal,
easy and accessible and to have the potential to appear
accidental. The proportion of participants who described their
thoughts and attempts as impulsive appeared to be higher than
had been observed with other method choices. The potential
impact on other people was a strongly dissuasive factor.
Conclusions
Measures designed to prevent access to potentially lethal sites
may be particularly important, given that many participants
described their thoughts and behaviour as impulsive. In addition,
fostering a culture of care and consideration for other road users
may help to dissuade people from taking action on the roads.
Keywords
Suicide; roads; self-harm; impulsive; suicide method.
Copyright and usage
© The Author(s), 2023. Published by Cambridge University Press
on behalf of the Royal College of Psychiatrists. This is an Open
Access article, distributed under the terms of the Creative
Commons Attribution licence (http://creativecommons.org/
licenses/by/4.0/), which permits unrestricted re-use, distribution
and reproduction, provided the original article is properly cited.
Road-related suicide methods include jumping off or on to road
infrastructure, stepping into the path of a moving vehicle, or
driving off or into road infrastructure or into another vehicle.
1
It
has been estimated that at least 50 people take their lives on UK
roads each year.
1
However, the exact number of suicides on the
roads is difficult to establish with certainty, as road-related incidents
may be misclassified as traffic accidents in official records and
national statistics.
2
In Sweden, a re-examination of all road traffic
fatalities to take into account psychosocial information about the
individual, as well as the circumstances of the death, resulted in a
significant increase in the proportion classified as suicides.
3
Suicidal behaviour on the roads has a lasting impact, not only for
the individual concerned and their family and friends, but also for
other road users who might be injured or involved in a collision, or
who might witness the incident.
4
Indeed, one study in Switzerland
found that significantly more people were killed as a consequence
of road-related suicide than with other suicide methods.
5
There is
also a wider impact on the road network as a whole, with fatal and
non-fatal incidents leading to costly road closures and delays.
1
Previous studies have investigated the characteristics of people
who go to the roads to end their lives. The majority of individuals
are male,
5–7
in common with suicide deaths in the general popula-
tion. A study into non-fatal self-harm on the roads found that the
most common road-related method among men was crashing a
vehicle, whereas the most common method among women was
jumping from a bridge or walking out in front of a vehicle.
6
People who use a road-related method of suicide tend to be
younger compared with all suicide deaths.
6
Studies of people who
have thought about or survived suicide attempts on the roads
suggest that the intent to die is high
8
and higher than in relation
to other methods.
6
Despite the increasing interest in road-related suicides, little is
known about why people might choose this particular method to
end their life. One study about the factors influencing choice of
suicide method found that among people who attempted suicide
by putting themselves in front of a vehicle, method effectiveness
was cited most frequently.
9
This appears to be the case particularly
in relation to suicides on the railways, where the perceptions of
lethality tend to be overestimated.
10
However, it is not known
whether the same perceptions are held in relation to road-related
methods. Furthermore, it may be that the various types of road
suicide are associated with different persuasive and dissuasive
factors. Studying the method-specific factors that influence suicidal
thoughts can result in important insights for preventive interven-
tions.
10
A recent Cochrane review on interventions to prevent
road-related suicides highlighted the lack of existing evidence and
specifically recommended further research into the reasons people
might come to the road network to end their life.
11
The aim of the current study was to investigate further the
factors prompting and deterring the decision to attempt suicide
on the roads.
Method
The research question was explored using a multi-methodological
approach. First, we carried out a secondary analysis of a data-set
presented in two previously published studies,
9,10
focusing specific-
ally on responses relating to road-related suicidal ideation and
behaviour. Second, we conducted seven in-depth qualitative inter-
views with people who had experience of feeling suicidal at a
bridge or road location. Finally, we carried out an online
BJPsych Open (2023)
9, e81, 1–8. doi: 10.1192/bjo.2023.52
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ethnography to explore interactions in different online communi-
ties relating to this method of suicide.
Ethics
The authors assert that all procedures contributing to this work
comply with the ethical standards of the relevant national and insti-
tutional committees on human experimentation and with the
Helsinki Declaration of 1975, as revised in 2008. All procedures
involving human subjects/patients were approved by the
Psychology Department Research Ethics Committee at Middlesex
University (reference: ST019-2015 and 7045-2021).
Online survey
The anonymous survey was hosted on Qualtrics, and was open to
participants between July 2015 and 2016. It was advertised
through suicide prevention organisations such as Samaritans UK,
online forums, social media and special interest groups. Study
posters and leaflets were also placed on university bulletin boards,
at local branch offices of relevant charities and in the National
Suicide Prevention Alliance newsletter and were mailed out to sup-
porters of the charity Campaign Against Living Miserably (CALM).
No exclusion criteria were applied. Participants did not receive any
remuneration.
Participants gave their informed consent by clicking a box.
Participants were asked whether they had ever experienced suicidal
thoughts. If so, they were asked to describe any particular methods
they had contemplated and the reasons for these, and whether they
had suggestions for suicide prevention at the specific locations they
had considered. In many cases, this prompted participants to
comment on perceived barriers to the use of those methods and/
or locations. Similar questions were asked in relation to suicide
attempts. All questions allowed open-ended, free-text responses
with no word limit or prompts.
Analysis
The data-set for the current study consisted of those survey
responses that concerned suicidal thoughts and actions at or relating
to road or bridge locations. Open-ended survey data were analysed
inductively for content
12
by one researcher (I.C.), according to a
coding book agreed by three members of the research team.
Survey data are presented as frequencies or percentages, as
appropriate. Coded data were used to calculate descriptive statistics,
with denominators varying in relation to individual variables
because of missing information.
Interviews
Participants and recruitment
We recruited an opportunity sample of participants for inter-
view from among those who had taken part in a second online
survey in 2019.
13
Participants were aged 18 years or over and
had stated in the survey that they had felt suicidal at a road or
bridge location. We contacted 41 people meeting these criteria
who had not previously been interviewed for a different
follow-up study. Nine people responded positively and seven
people agreed to be interviewed. Participants were offered £20
renumeration.
Procedure and interviews
All potential participants received briefing information in
advance of the interview, which outlined the purpose of the
study and contained details of relevant support organisations.
Oral (recorded) consent was obtained at the start. Evidence
suggests that participating in research about suicide or self-
harm does not lead to a significant increase in distress or the
urge to self-harm.
14
However, given the sensitivity of the
subject, steps were taken to minimise any possible impact on par-
ticipants. The interviewer and the participant completed a perso-
nalised safety plan together. The interviewer was a trained
Samaritan listening volunteer (H.N.). A visual analogue scale
15
was used at the beginning and end of the interview to assess the
impact on mood.
Procedure and materials
Semi-structured interviews were carried out in January and
February 2021 over Zoom video conferencing. Participants were
asked to describe incidents in their lives where they had felt suicidal
at a road or bridge location, or where they had experienced suicidal
thoughts relating to roads or bridges (e.g. ‘Could you tell me, in your
own way, about your [most recent] experience of attempting to end
your life on the roads?’). Prompting questions were used to explore
the background to the experiences, including the degree of prepar-
ation or premeditation, the circumstances and the feelings relating
to the incident itself (or the ideation), reasons for and thoughts
about the choice of method relative to other methods, and partici-
pants’views on prevention. The interviews ranged in duration
from 44 to 73 min (average 63 min). They were audio recorded
and transcribed verbatim.
Analysis
The transcripts were analysed using thematic analysis.
16
One
researcher (H.N.) coded all the transcripts inductively, line by
line, using NVIVO software. Two transcripts were independently
coded by J.-M.M., and emerging themes were discussed among
members of the research team (L.M., J.-M.M. and H.N.).
Online ethnography
Online ethnography was used to gather an in-depth understanding
of how people were engaging with and discussing suicide on the
roads in online spaces.
17
Two researchers (R.W. and I.M.) explored suicide forums,
Reddit and Twitter to provide a range of voices. First, key terms
related to road and suicide were searched for on each site. As the
research progressed, and through continual analysis of the data,
we noted further terms that were being used to talk about suicide
on the road. This cyclical method was an effective way to explore
conversations relating to jumping or walking into traffic and
suicide by car accident. We particularly analysed the ensuing con-
versations that happened in the comments associated with the ori-
ginal posts.
Data were collected from April 2018 to December 2020. In total,
we analysed 2306 original posts and 4169 comments posted on
suicide forums, Reddit and Twitter. Reflecting offline ethnographic
data collection, field notes were kept throughout the data collection
to capture our observations. To respect the online communities we
researched, and in an endeavour to reduce traceability of this popu-
lation, we have not included direct quotes, user names, or the terms/
hashtags that were used to find the data.
Analysis
Analysis was conducted throughout the data collection and once the
final data-set has been compiled. Thematic analysis was then used to
analyse the field notes and posts.
16
Codes and developing findings
were continually discussed within the research team (I.M. and
R.W.) to help increase the validity of the analysis.
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Integrating the analyses
The three strands of the study were conducted separately and ana-
lysed independently. Subsequently, the research team reviewed and
discussed the findings in the light of two main research questions.
(a) Why do people choose a road or bridge location to end their
lives?
(b) Why do they reject a road or bridge location?
Convergent themes were identified. Notable divergent findings
were discussed and are also presented here, where they deepen our
understanding of road suicides.
Results
Of the 1398 people who took part in the online survey, 340 reported
having considered (N= 323/1398, 23.1%) and/or attempted
(N= 50/712, 7.0%) suicide at a road or bridge location (Table 1).
More than half the participants (173/318, 54.4%) were under the
age of 35 years (including 78 participants who were aged between
18 and 25 years), and two-thirds were female (209/320, 65.3% v.
102 males, 31.9%; six participants described themselves as nonbin-
ary and three as transgender males).
Seven interviewees, five women and two men, were aged
between 28 and 58 years (Table 2). All had experienced suicidal
thoughts at a road location; none had taken action on the roads
resulting in injury to themselves or others. Five participants had
attempted to take their own lives using a different method
(usually overdose).
Persuasive factors
Survey participants’self-reported reasons for thinking about and
attempting suicide using a road-related method are illustrated in
Figs. 1 and 2, respectively. Common persuasive factors were identi-
fied across the survey, interview and ethnographic analyses,
although they differed in some cases according to the method con-
sidered (e.g. jumping from a bridge, stepping out in front of a vehicle
or causing a collision) and according to whether people were
describing suicidal thoughts or suicide attempts. The reasons
given for considering a specific road-related method were often
multiple: in the survey, 48.3% of those who commented on their
motivations (N= 143) mentioned at least two factors.
Quick
The survey responses indicated that road suicide was perceived as a
quick method (Fig. 1). Although this was mentioned in relation to
all types of road suicide method, it was particularly the case for step-
ping in front of a vehicle, for which it was the most commonly cited
factor in relation to suicidal thoughts.
‘I knew it would be quick’(Survey participant, SP)
Similarly, online, people commented on posted videos of people
being hit or run over by a vehicle, saying that it looked like a fast
method to die. Four interview participants also thought that
suicide on the roads would be quick, giving little time to reflect or
regret, particularly in contrast to other methods such as taking an
overdose.
Lethal
Road-related methods were also perceived as effective means of
taking one’s life. Of the three methods, jumping from a bridge in
particular was perceived as highly lethal.
‘I thought the fall would be fatal.’(SP)
Interview participants who had considered jumping from a bridge
expressed the view that there were several opportunities for fatal
injury within the one act.
‘So thinking the idea was like I would time it if I didn’t, the fall
wouldn’t kill me, then a car or a van ideally a van or something
would finish the job.’(Interview participant, IP)
On all of the online platforms, when people initially posted that they
were thinking about dying on the roads, they would describe it as a
quick or reliable method. They had seen videos and news stories
shared online, where someone had died by suicide on the road,
which appeared to have created the perception that this was a
lethal method. However, the reliability of road-related suicide was
often challenged by other community members.
Table 1 Characteristics of survey participants
Road suicide ideation (N= 323) Road suicide attempts (N= 50)
n/N%n/N%
Female (compared with men and other gender) 200/303 66.0% 29/50 58.0%
Median age (minimum to maximum) 32 16–69 32 16–70
White ethnicity (versus other ethnic groups) 266/323 82.4% 44/50 80.0%
Causing a collision while driving 125/323 38.7% 11/50 22%
Stepping in front of a moving vehicle 106/323 32.8% 21/50 42.0%
Jumping off or on to road infrastructure 130/323 40.2% 19/50 38.0%
Table 2 Characteristics of interviewees
Age Gender Employment
Method of suicidal
behaviour or ideation
P1 53 Female Employed Driving/bridge
P2 31 Male Student/self-employed Bridge
P3 56 Female Employed Bridge/stepping out in front of vehicle
P4 58 Male Employed Bridge
P5 50 Female Employed Stepping out in front of vehicle
P6 28 Female Employed Bridge/stepping out in front of vehicle
P7 29 Female Student Stepping out in front of vehicle
Factors prompting and deterring suicides on the roads
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Easy and accessible
The accessibility of the road network was a strong persuasive factor
to emerge from the survey (Fig. 1) and interviews.
‘Quick, easy/very little planning involved’(SP)
Among the survey participants who had attempted suicide, accessi-
bility appeared to be an important factor for those who had jumped
from a bridge (Fig. 2).
‘It’s right outside my house and took minimal effort’(SP)
A related theme to emerge from the interviews was the ubiquity of
road and bridge locations in daily life. If participants were to come
across potential places when feeling upset or suicidal, it might cause
them to view such locations differently.
‘Firstly it was I was I was just walking, to walk, to yeah to um get
anywhere, get just you know walk [laughs] never mind where
um and almost sort of unintentionally I ended up at that
place [road location]. The thought process being what it was
it was like …oh look just look what you could do with this!’(IP)
In the online ethnography, road-related methods were perceived as
more accessible than other methods. Some people explained that
35
Step under vehicle (N = 95)
Vehicle collision (N = 116)
Bridge (N = 115)
30
25
20
Percentage
15
10
5
0
Accessible
Easy to do
Lethal
Quick
Impulsive
Look like accident
Minimal physical impact
Control over death
'Freeing'
Painless
Minimal impact on family
Minimal emotional impact bystanders
Knowledge/exposure
Privacy/no intervention
Other methods failed
Personal meaning/preference
Don't know
Other
Fig. 1 Self-reported reasons for suicidal thoughts about a road or bridge location (N= 323).
0
10
20
30
40
50
60
70
Step under vehicle (N = 20)
Vehicle collision (N = 10)
Bridge (N = 17)
Accessible
Easy to do
Lethal
Quick
Impulsive
Look like accident
'Freeing'
Painless
Knowledge/exposure
Personal meaning/preference
Minimal physical impact
Time of day
Privacy/no intervention
Other methods failed
Other
Percentage
Fig. 2 Self-reported reasons for suicide attempts at a road or bridge location (N= 50).
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suicide on the roads or by car was their last resort. They spoke about
not being able to purchase substances or equipment required for
other suicide methods but had a car or a road nearby where they
could die by suicide. Some wrote that they thought about jumping
from a bridge, walking in front of a vehicle or crashing their car
every day, especially when they were on or by a road.
Appearing accidental…
Thoughts about dying by causing a collision in one’s vehicle were
particularly associated across all research strands with wanting the
death to appear accidental. This was for two main reasons. First,
on the suicide forums and subreddits relating to suicide and
mental health, some people were concerned that if their death
were deemed a suicide, their relatives would not be eligible for insur-
ance money. Second, people spoke about not wanting to cause dis-
tress to their families. They thought that dying by suicide in a way
which looked like an accident might carry less stigma. This senti-
ment was echoed by a third of the survey participants who had
attempted suicide by causing a collision.
‘It wouldn’t necessarily be seen as suicide. I wanted to avoid the
stigma for my two children.’(SP)
…or leaving it to fate and other people
An interesting angle on this theme is that some participants them-
selves did not want to take the final decision to die. The idea of death
occurring as a result of an ‘accident’, even one that occurred as a
result of their own behaviour, was appealing.
‘And I think probably you know, in the hope that I would crash
the car and I wouldn’t have to think about it, I almost like that
the whole decision would be taken away from me because I
would I would hit something and…And then my fate would
be decided.’(IP)
Online, particularly on Twitter, people wrote that they wanted to die
but could not or did not want to take their own life, and therefore
they wanted someone else to hit them with a car. Unlike many
other methods, road-related methods appeared to offer the chance
of dying without having to take the final action oneself.
Impulsive
Forty-four per cent of survey participants who had attempted to end
their lives on the roads described their suicide attempts as impulsive,
opportunistic or without prior reflection, particularly with regards
to attempts involving a road collision (60%) or stepping in the
path of a vehicle (55%, Fig. 2).
‘Turning my bike into the path of a car on an A road …I saw an
opportunity and didn’t think about making the decision.’(SP)
Thoughts relating to suicide on the roads were also described as
impulsive for 25% of participants who had thought about causing
a collision and 21% of people who had thought about stepping
out in front of a vehicle (Fig. 1).
Similarly, five of the seven interview participants used words
like instinct, impulse, urge, spontaneous or opportunistic to
describe their suicidal ideation on roads or bridges.
‘At times my mood is quite bad, I can go out for a walk and
there’s just that, I’m next to a road and there’s that I could
just do that and that quite strong urge.’(IP)
Although words like ‘spontaneous’,‘urge’or ‘opportunity’were
used to describe the thoughts or actions associated with specific
suicidal crises, it should be noted that three of the seven interview
participants had lived with suicidal thoughts for many years. For
these participants, urges experienced in a specific situation were
set against a backdrop of chronic suicidality and planning. One par-
ticipant described how they would walk from their house when they
felt suicidal and, in doing so, would come across potential locations
for suicide. The interviewer asked whether they would describe this
behaviour as premediated or spontaneous.
‘I spend my entire life, or have spent my entire life, planning and
looking and …so you ask me a method and I could probably tell
you about it. But the actual impulse to do …well it’s not an
im …is it an impulse? Not quite sure what it is, but the compul-
sion to do so is uncontrollable.’(IP)
Dissuasive factors
Of the 323 survey respondents who contemplated suicide on the
roads, just under half (159, 49.2%) also reported a suicide attempt
(as well as past suicidal ideation). In most cases (126/159, 79.2%),
this did not involve a road-related method. Forty individuals who
had contemplated a road-related method but had attempted
suicide in a different way commented on the reasons they did not
attempt to end their lives on the roads. Two main reasons were
given: the impact on others and the risk of surviving with injuries.
Impact on ‘innocent’others
The most cited dissuasive factor among survey participants (17/40
who gave reasons) was the impact on other people, particularly
drivers and other road users. This was also the main reason given
by interview participants.
‘As I’m standing on a road bridge and there’s all those cars
coming on or vans or lorries or whatever I jump out for I’m
affecting that person’s life too. And, through no fault, and I
said I didn’t–that it wasn’t the friends or the family that
snapped me out of it, it was the idea I was getting involved an
innocent, and I didn’t want to do that.’(IP)
The impact on other people was a strong theme on the online
suicide forums. In response to posts about dying by causing a colli-
sion in a car, many users tried to dissuade the individual from
choosing this suicide method because of the impact on the other
driver, including loss of license and job, long-term trauma and
mental health conditions. Community members commented that
suicide should be an individual act and not involve others. They
said that it was selfish if others were involved, and that innocent
people may be affected, such as passengers in the other car or the
people who had to clean the scene in the aftermath of a suicide.
Surviving with injuries
Another dissuasive factor observed online was the risk of surviving
with injuries. In some cases, people shared their own stories about
living with physical health problems, having, for example, tried to
end their life by jumping from a bridge. With regard to causing a
collision or stepping out in front of a vehicle, people online felt
there were many variables that were hard to control and which
might result in injury rather than death, such as the behaviour of
other road users, the speed of the car and the vehicle’s safety
features.
Twelve of 40 survey participants who gave reasons they did not
choose a road method for suicide cited the risk of surviving with
injuries.
‘I may just become paralysed’(SP)
However, in the in-depth interviews, the possibility of surviving
with life-changing injuries was only mentioned by one person and,
at the time, they had not seen this as a deterrent. Instead, even injury
was perceived to be a means of changing the situation they were in.
Factors prompting and deterring suicides on the roads
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‘My pain would go away because either I would be dead or I
would be so much physical pain that I didn’t have to think
about the emotional pain I was experiencing.’(IP)
Discussion
To our knowledge, this is the first study to explore the persuasive
and dissuasive factors that might influence a person’s decision to
end their life on the roads. Across the three research strands
(survey, interview, online) we found that people held perceptions
that this would be a quick, lethal and accessible death that could
in some circumstances be interpreted as an accident. In addition,
thoughts and particularly behaviours relating to suicide on the
roads were frequently described as impulsive. The strongest dissua-
sive factors were the impact on other people and the risk of surviv-
ing with injuries.
Although there were similarities in the reasons given for choos-
ing or rejecting each of the three main road-related methods (step-
ping out in front of a vehicle, causing a collision or jumping from a
bridge), there were also marked differences. For example, the wish
to disguise the suicide as an accident related particularly to car colli-
sions. Jumping from a bridge was perceived to be a highly lethal
method. These differences suggest that road-related methods
should be treated separately for purposes of risk assessment and
prevention.
A notable finding from the survey was the high proportion of
participants who described their road-related suicidal behaviour
as impulsive (44% across all three method types). The current
sample was drawn from a wider survey examining thoughts and
actions relating to all suicide methods.
9
This wider survey found
that across all methods, only 12% of participants who had attempted
suicide described their actions as impulsive. The interviews suggest
that the ubiquity of the roads in everyday life may play a part in
making road suicide more impulsive than other methods. The fact
that participants described their experiences at a road or bridge
location as, to some extent, impulsive or opportunistic underlines
the importance of measures to delay or prevent action being
taken at the scene.
What constitutes an ‘impulsive’act is contested in the literature,
and different studies have used different measures, including degree
of preparation, duration of preceding suicidal ideation and, as in the
current study, self-report.
18
These measures do not appear to be
closely related to each other. May and Klonsky (2015) found that
self-reported impulsive motivation for a suicide attempt was not
related to the degree of preparation and only moderately related
to contemplation of suicide for more than 3 h prior to the
attempt.
19
Similarly, the interviews in the current study indicate
how, even where the thoughts or the actions were described as
impulsive, they may still have occurred in the context of pre-existing
suicidal ideation and even planning and research. Suicidal acts have
been associated with heightened impulsivity in the context of nega-
tive emotional states.
20
It may be, therefore, that someone with
existing suicidal ideation may experience impulsive suicidal
thoughts or behaviours when feeling distressed and confronted
with the opportunity for suicide on the roads.
The scale of the road network makes this an accessible method
of suicide, in comparison with other methods that might require
more planning or preparation. Access to means is a strong influen-
cing factor in choice of suicide method and underlies some of the
observed different national trends.
21
However, despite the relative
ease of access to cars and roads, road-related suicide methods
remain relatively rare in the UK.
22
This suggests that the dissuasive
factors identified in the current study may play an important part in
an individual’s choice of method. In particular, the study identified
the potential impact that a suicide can have on other people as a
strongly dissuasive factor. The same phenomenon was identified
in a study on the factors prompting and deterring the decision to
end one’s life on the railways.
10
Interestingly, we observed how
this argument was used actively online to dissuade people from
using this method. Sociocultural acceptability has been proposed
as a contributory factor in the choice of suicide method, explaining,
for example, gender differences such as the greater use of firearms
by men.
23
Implications
The findings outlined in this study suggest some measures that
could be helpful in reducing the number of people who attempt
suicide on the roads, which are discussed below. Although they
are focused on one specific method, the evidence is that restricting
recourse to one means of suicide does not result in displacement to a
different method
24
and can therefore lead to a general reduction in
suicides.
The findings of the current study suggest a need for preventive
measures that may restrict, delay or disrupt impulsive behaviour on
the road network. Although physical barriers are costly and difficult
to put in place everywhere, their use could help to address impulsive
suicidal urges at particular road or bridge locations known to be
high risk. An analysis of 13 observational before-and-after studies
across six countries found that measures to restrict access to
means of suicide by jumping saw suicides reduced by 91%.
25
Other ‘softer’and potentially less expensive measures designed to
disrupt suicidal thought processes such as signs, lighting or
‘pseudo-barriers’(e.g. lasers or motion sensors) have been piloted
in other settings, such as at railway locations.
26
However, the evi-
dence for the effectiveness of such measures is currently more
limited.
27–30
Online, we saw how people appeared to be dissuaded from a
road-related method by community members who stressed the
potential lethal impact on other people. Although this may be effect-
ive in a closed, peer-led discussion, it is a difficult message to employ
more widely because of the risk of appearing to dismiss or stigmatise
the distress of the suicidal individual.
31,32
In a more general way,
fostering a sense of community, care and responsibility towards
other road users might motivate individuals to consider the wider
impact of their behaviour. The revision to the UK Highway Code
may present an opportunity to promote such a message.
33
The
new Code advises that all road users should be ‘considerate to
other road users and understand their responsibility for the safety
of others’(Rule H1).
Future research in this area should focus on the differences in
the factors that prompt and deter use of each road-related
method to inform targeted interventions.
Limitations
The strength of the current study lies in the use of different methods,
which increases confidence in the triangulated findings. In addition,
participants were recruited from different environments. For
example, recruitment for the lived experience survey and interviews
relied largely on tweets and adverts featuring official organisations
such as Samaritans with a strong emphasis on suicide prevention.
By contrast, some online data were gathered from ‘pro-choice’
spaces which are explicitly critical of suicide prevention (‘pro-life’)
approaches. Nonetheless, the views and experiences of these differ-
ent groups do not necessarily reflect those of others who have con-
sidered or attempted to take their own lives on the roads.
The number of interviews conducted was relatively small
although consistent with other mixed-method studies of this
type.
34
In addition, there was heterogeneity among the interview
Norman et al
6
https://doi.org/10.1192/bjo.2023.52 Published online by Cambridge University Press

participants in terms of the type of road-related suicide method con-
sidered or attempted.
All the data analysed for this study were from people who have
had thoughts about suicide on the roads or who have survived an
attempt. The processes and experiences involved in a fatal attempt
could in some important ways be different. As with all research
on suicide, it is not possible to generalise from one group to
another with any certainty.
Summary of findings
Suicide by a road-related method was perceived to be quick, lethal
and accessible. The factors prompting a decision to attempt
suicide on the roads varied according to the method considered
(jumping from a bridge, stepping out in front of a vehicle, causing
a collision). Jumping from a bridge was associated with high lethal-
ity, whereas participants considered that stepping in front of a
vehicle was likely to be a quick means of dying. The possibility of
the death appearing accidental was a persuasive factor for those
who thought about causing a collision. Thoughts and particularly
attempts involving road-related methods were frequently described
as impulsive, suggesting that interventions to prevent access to
potentially lethal locations may be particularly important. Across
all three research strands, the potential impact on other people
was a strongly dissuasive factor. Through an exploration of lived
experience relating to the decision to attempt suicide on the
roads, these findings add to the emerging body of work on the char-
acteristics and circumstances of road suicides.
Hilary Norman , Faculty of Social Sciences and Humanities, Middlesex University,
London, UK; Lisa Marzano , Faculty of Science and Technology, Middlesex University,
London, UK; Rachel Winter, Faculty of Science and Technology, Middlesex University,
London, UK; Ioana Crivatu, Faculty of Social Sciences and Humanities, Middlesex
University, London, UK; Jay-Marie Mackenzie , Psychology Department,
University of Westminster, UK; Ian Marsh , Faculty of Med icine, Health and Social
Care, Canterbury Christ Church University, UK
Correspondence: Lisa Marzano. Email: l.marzano@mdx.ac.uk
First received 13 Dec 2022, final revision 22 Feb 2023, accepted 13 Mar 2023
Data availability
Owing to the sensitive nature of this research, participants of this study were not asked for con-
sent for their data to be made available to others for further research, so supporting data are
not available.
Acknowledgements
We thank the participants for sharing their experiences with us. The survey from which the sec-
ondary analysis in this study was derived was originally commissioned by Samaritans and
funded by Network Rail on behalf of the rail industry. This original project
10
benefited from a
Project Stakeholder Group and Advisory Group. With specific reference to the current study,
thanks are due to Samaritans, the National Suicide Prevention Alliance, Rethink and CALM
for their assistance with participant recruitment, and to Bob Fields, Ian Kruger, Andy Bardill,
Kate Herd and Kirsty Tither (Middlesex University) and Jo Borrill (formerly at University of
Westminster) for help with research design, recruitment materials and data analysis.
Interview participants were recruited following a second survey, also funded by Network Rail
on behalf of the rail industry.
13
We thank Dafni Katsampa for her assistance with this project.
Finally, we are grateful to Jo Porter for transcribing the interviews.
Author contributions
L.M. was the principal investigator on this project. I.C. extracted and coded secondary survey
data and assisted with data analysis (under L.M.’s supervision). H.N. and L.M. designed the
interviews. Recruitment, interviews and analysis of the interviews were carried out by H.N.
J.-M.M. coded two manuscripts, and the themes were discussed and agreed between H.N.,
L.M. and J.-M.M. R.W. and I.M. conducted the online ethnography and analysed the data. All
authors read and approved the final manuscript.
Funding
This study was funded by National Highways. The study involves secondary analysis of data col-
lected as part of a previous study which was commissioned by Samaritans and funded by
Network Rail on behalf of the rail industry. The funders had no role in any stage of the data col-
lection, analysis or writing up of the study.
Declaration of interest
None.
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