a1 Department of Public Health and Epidemiology; Academic Department of Psychiatry, Charing Cross and Westminster Medical School, University of London
People have jumped (or fallen) in front of trains on the London Underground system in increasing numbers throughout the twentieth century. During the past decade there have been about 100 such incidents each year, of which around 90 would involve the train driver witnessing his train strike the person on the track. Most are suicides or attempts at suicide. They represent major unexpected and violent events in the lives of the train drivers and it might be expected that some of them would respond by developing a post-traumatic stress reaction of the type identified by Horowitz (1976) or other adverse psychological reactions or both. The research reported in this paper was designed to characterize the range of responses of drivers to the experiences of killing or injuring members of the public during the course of their daily work. It was found that 16·3% of the drivers involved in incidents did develop post-traumatic stress disorder and that other diagnoses, e.g. depression and phobic states, were present in 39·5% of drivers when interviewed one month after the incident.
c1 Address for correspondence: Mr Troy Tranah, Department of Public Health and Epidemiology, Charing Cross and Westminster Medical School (University of London), 17 Horseferry Road, London SW1P 2AR.