Health Effects of Person-Under-Train Incidents on Train Drivers-A Systematic Review

Background/Objectives: A person-under-train (PUT) incident is a traumatic event for train drivers that can result in serious health consequences. This systematic review aimed to identify and synthesize evidence on these health effects, including post-traumatic stress disorder (PTSD), sickness absence (SA), and other related mental health outcomes. Methods: Following the PECO scheme, we searched the PubMed, Web of Science, and Embase databases for studies published between 1980 and 2021. We included cross-sectional, case-control, prospective, and interventional studies focusing on train drivers exposed to PUT incidents. Data synthesis followed PRISMA guidelines, with quality appraisal using the Downs and Black checklist. Results: The search was conducted on 22 September 2022, resulting in 3673 records. Nine studies were included, involving a total of 3425 participants. PTSD prevalence ranged from 0% to 55.3%, depending on study design and timing of data collection. Risk factors included repeated exposure, lack of social support, and proximity to the victim. SA varied widely, with durations ranging from 1 day to over 6 months. Drivers frequently reported depression, somatoform disorders, and other long-term psychological impacts. Conclusions: PUT incidents significantly affect the mental health of train drivers and their ability to return to work, frequently leading to extended sickness absence. The timely identification of at-risk individuals and the implementation of best-practice interventions could mitigate long-term effects. Future research should explore standardized follow-up periods to improve comparability.