A new study on the post traumatic stress experienced by railway crew members

A new study has been published on the effects of an inpatient programme to help traumatised crew members involved in a Person Under Train (PUT) incident.

Article Title: Course and predictors of posttraumatic stress among male train drivers after the experience of ‘person under the train' incidents

Authors: Anja Mehnert , Imke Nanning, Mathias Fauth, Ingo Schäfer

Publication date: 2012

Published by: Journal of Psychosomatic Research 73 (2012) 191–196

This article is interesting because it is a prospective study; it follows up train drivers for 19 months after a “Person Under Train” incident and assesses the effects of an inpatient rehabilitation programme. The results show improvements in traumatic reactions after the 3 weeks programme. However, a third of the patients still suffered from post traumatic stress 6 months after the treatment. This study cannot be used to determine the scope of traumatic reactions in the railway crew population because all participants were recruited while already in inpatient therapy. Therefore, they all had a diagnosis assocaited with a traumatic reaction. However, it analyses the role of several peri-event factors that can increase traumatic reactions. They found that having experienced previous traumatic events does not affect the length of recovery nor the severity of PTSD. However, the presence of anxiety, guilt and a sense of alienation just after the event makes it more difficult to recover. This study furthers our understanding of the recovery process and of factors that a support and care programme should take into consideration.

Abstract from the authors :

Objective: The present prospective study aimed to identify the frequency and course of posttraumatic stress

symptoms, anxiety, depression, and quality of life in train drivers after the experience of ‘person under the

train’ incidents. Furthermore, associations between predictors of posttraumatic stress stratified by pre-,

peri- and posttraumatic factors, psychological distress, quality of life (QoL), sense of coherence, lack of meaning

in life, and post-trauma thoughts are analyzed.

Methods: Patients (100% male, mean age 48 years) were assessed at the beginning (n=73), at the end

(n=71) and six months (n=49) after a four-week rehabilitation programme and completed validated selfreport

questionnaires (e.g. Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Short-

Form Health Survey).

Results: Train drivers experienced averagely 1.8 ‘person under the train’ incidents (range 1–8); the majority

(81%) was involved in a railway suicide. At the beginning of the rehabilitation, 44% of the patients were classified

as having moderate to severe PTSD, and 14% as having severe PTSD. Posttraumatic stress decreased significantly

over time (p=.003, η²=.17). We found no significant differences in the course of posttraumatic

stress, anxiety, depression, distress and QoL between patients who experienced one or more than one railway

related accident or suicide. Anxiety, sense of guilt and sense of alienation emerged as the most important factors

in predicting posttraumatic stress six months after rehabilitation (R²=0.55).

Conclusion: Findings emphasize the importance of rehabilitation programmes for train drivers after railwayrelated

incidents. However, research is needed to develop effective rehabilitation interventions particularly

tailored to this patient group.

To access this article, you may contact the CRISE.