One followed by many?-Long-term effects of a celebrity suicide on the number of suicidal acts on the German railway net

Background: Following the railway suicide of Robert Enke, a famous German football goal keeper, short-term copycat effects have been found. Main aims of the present study were to analyze long-term effects of this incidence and to compare them with overall national suicide data, as well as to investigate possible anniversary effects. Methods: For long-term effects, the number of railway suicidal acts in the two years before and after Robert Enke's suicide (10th November 2009) were compared. For anniversary effects, the corresponding 2-week-periods in 2009, 2010 and 2011 were analyzed. Incidence ratios with 95% confidence intervals were computed. Results: Compared to the two years before Enke's suicide the incidence ratio of the number of railway suicidal acts in the 2-year-period following this event increased by 18.8% (95% confidence interval (CI)=11.0-27.1%; p < 0.001). The median number of suicidal acts per day increased from 2 to 3 (p < 0.001). This effect remains significant after excluding short-term 2-week effects of Enke's suicide. An anniversary effect was not present. The increase of fatal railway suicides between 2007 and 2010 (25%) was significantly different from that for the total number of suicides in Germany (6.6%) (p < 0.0001). Limitations: Due to missing data, analyses regarding gender were limited and regarding age not feasible. Conclusions: Long-term effects of Enke's suicide on railway suicidal acts in Germany in the sense of copycat behavior are probable as this increase cannot be explained by corresponding changes of the total number of suicides in Germany. (C) 2012 Elsevier B.V. All rights reserved.