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J Psychosom Res. 2012 Sep;73(3):191-6. doi: 10.1016/j.jpsychores.2012.06.007. Epub 2012 Jul 13.

Course and predictors of posttraumatic stress among male train drivers after the experience of 'person under the train' incidents.

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Department and Outpatient Clinic of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany.



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.


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 program and completed validated self-report questionnaires (e.g. Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Short-Form Health Survey).


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).


Findings emphasize the importance of rehabilitation programs for train drivers after railway-related incidents. However, research is needed to develop effective rehabilitation interventions particularly tailored to this patient group.

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