Background: The objective of this study is to investigate mental healthcare status and psychiatric disorders in train suicides. Methods: Data of 4 published train suicide studies were combined with a study of 57 train suicides in The Netherlands. Results: 53% of all train suicides received psychiatric care at the time of suicide, with 49% of them being inpatients. These values are higher than those found in general suicides. When compared to general suicides, functional non-affective psychoses are overrepresented by 25% vs 14%. The percentage of affective disorders approximates that of general suicides namely: 39% vs 42%. "Other diagnoses" are underrepresented by 23% vs 40%. Limitations: All psychiatric diagnoses were based on clinical data, which may not accurately reflect the patient's psychiatric condition at the time of suicide. Conclusions: Train suicides receive mental healthcare more often than general suicides and are more often characterized by severe psychopathology. The study indicates that patients with affective and psychotic disorders in particular should be targeted in order to prevent train suicide. © 2007 Elsevier B.V. All rights reserved.