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Does the installation of blue lights on train platforms prevent suicide? A before-and-after observational study from Japan

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Does the installation of blue lights on train platforms prevent suicide? A before-and-after observational study from Japan

Abstract

BACKGROUND: Railway and metro suicides constitute a major problem in many parts of the world. Japan has experienced an increase in the number of suicides by persons diving in front of an oncoming train in the last several years. Some major railway operators in Japan have begun installing blue light-emitting-diode (LED) lamps on railway platforms and at railway crossings as a method of deterring suicides, which is less costly than installing platform screen doors. However, the effectiveness of the blue lights in this regard has not yet been proven. METHODS: This study evaluates the effect of blue lights on the number of suicides at 71 train stations by using panel data between 2000 and 2010 from a railway company in a metropolitan area of Japan. We use a regression model and compare the number of suicides before and after and with and without the intervention by the blue light. We used the number of suicides at 11 stations with the intervention as the treatment group and at the other 60 stations without the intervention as the control group. RESULTS: Our regression analysis shows that the introduction of blue lights resulted in a 84% decrease in the number of suicides (CI: 14-97%). LIMITATION: The analysis relies on data from a single railroad company and it does not examine the underlying suicide-mitigation mechanism of blue lights. CONCLUSION: As blue lights are easier and less expensive to install than platform screen doors, they can be a cost-effective method for suicide prevention.
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Preliminary communication
Does the installation of blue lights on train platforms prevent suicide?
A before-and-after observational study from Japan
Tetsuya Matsubayashi
a,1
, Yasuyuki Sawada
b,1
, Michiko Ueda
c,
n
,1
a
University of North Texas, USA
b
The University of Tokyo, Japan
c
Syracuse University, 100 Eggers Hall, Syracuse, NY 13244, USA
article info
Article history:
Received 31 July 2012
Accepted 16 August 2012
Available online 11 September 2012
Keywords:
Suicide
Railway
Suicide prevention
Blue lights
abstract
Background: Railway and metro suicides constitute a major problem in many parts of the world. Japan
has experienced an increase in the number of suicides by persons diving in front of an oncoming train
in the last several years. Some major railway operators in Japan have begun installing blue light-
emitting-diode (LED) lamps on railway platforms and at railway crossings as a method of deterring
suicides, which is less costly than installing platform screen doors. However, the effectiveness of the
blue lights in this regard has not yet been proven.
Methods: This study evaluates the effect of blue lights on the number of suicides at 71 train stations by
using panel data between 2000 and 2010 from a railway company in a metropolitan area of Japan.
We use a regression model and compare the number of suicides before and after and with and without
the intervention by the blue light. We used the number of suicides at 11 stations with the intervention
as the treatment group and at the other 60 stations without the intervention as the control group.
Results: Our regression analysis shows that the introduction of blue lights resulted in a 84% decrease in
the number of suicides (CI: 14–97%).
Limitation: The analysis relies on data from a single railroad company and it does not examine the
underlying suicide-mitigation mechanism of blue lights.
Conclusion: As blue lights are easier and less expensive to install than platform screen doors, they can
be a cost-effective method for suicide prevention.
&2012 Elsevier B.V. All rights reserved.
1. Introduction
Railway and metro suicides constitute a major problem in
many parts of the world (e.g. Mishara, 2007). Suicides at train
stations and on railroads pose a serious challenge to transporta-
tion safety and inflict severe economic losses by causing delays in
train operations. The costs associated with railway suicides can be
extremely high in places where trains serve as a major mode of
transportation for commuters and students, as in many metro-
politan areas of the world. In particular, Japan has experienced an
increase in the number of suicides by persons diving in front of an
oncoming train in the last several years. The Ministry of Land,
Infrastructure, Transport and Tourism in Japan reports that the
total number of cancelations and delays of train services due to
railway suicides increased from 534 in 2006 to 682 in 2009 (The
Ministry of Land, Infrastructure, Transport and Tourism, 2010).
According to one estimate by the Japanese government, a railway
suicide in the Tokyo area causes an average of 89 million JPY (1
million USD) of economic losses to other passengers and railway
companies. In addition, the psychological effects on train drivers
and passengers, which were not considered in the study, can be
immense (Schmidtke, 1994;Baumert et al., 2005).
One of the major strategies to prevent suicides has been to
restrict access to suicide means (Yip et al., 2012). In the case of
railway and metro suicides, restricting potential victims’ access to
the track by installing physical barriers is considered effective
(Mishara, 2007;Ladwig et al., 2009). These barriers are typically
platform screen doors that open only when the train stops at the
stations. While the platform screen doors are shown to be highly
effective for suicide prevention (Law et al., 2006), they have not
been widely adopted due to their significant cost. The installation
of these doors is generally very expensive and often requires that
the platforms be reinforced due to the weight of the doors,
imposing additional costs on railway companies (Mishara, 2007).
More recently, as a less expensive alternative measure for
suicide prevention, some major railway operators in Japan have
begun installing blue light-emitting-diode (LED) lamps on train
Contents lists available at SciVerse ScienceDirect
journal homepage: www.elsevier.com/locate/jad
Journal of Affective Disorders
0165-0327/$ - see front matter &2012 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.jad.2012.08.018
n
Corresponding author. Tel.: þ1 315 278 7704; fax: þ1 315 443 9082.
E-mail addresses: michiko.uedaballmer@gmail.com,
miueda@syr.edu (M. Ueda).
1
Authors’ Contributions: all authors contributed equally.
Journal of Affective Disorders 147 (2013) 385–388
Author's personal copy
platforms and at railway crossings with the expectation that they
may deter suicides. In an effort to decrease the number of suicides
by trains, the West Japan Railway Company, one of the major
railway companies in Japan, began installing blue lights at railway
crossings in 2006; the number of crossings with blue lights
reached 94 by the end of 2010. Similarly, the East Japan Railway
Company, Japan’s largest railway company, has placed blue lamps
at each end of the platform of all 29 stations on the central train
loop (the Yamanote line) in Tokyo, as well as at other major train
stations (The Associated Press, 2009). Other railway operators
followed suit, hoping the blue lights would deter people from
jumping in front of trains at stations and railway crossings.
The blue lamps were originally introduced in some towns and
cities in Japan as street lights to reduce crime rates (The
Associated Press, 2009). Although no definitive scientific evidence
exists yet, blue lights are believed to have a calming effect on
people (Suya, 2008). Blue lights were introduced to train station
platforms and railways crossings for a similar reason; they are
expected to calm people who are agitated. Despite the recent
popularity of blue lights among railway companies as a measure
to prevent railway suicides in Japan, the effectiveness of these
lights on deterring suicidal behavior is yet to be understood.
We aim to bridge this gap in the existing research by evaluat-
ing the effect of blue lights on the number of suicides by using
panel data from 71 train stations between 2000 and 2010
collected by a railway company in the Tokyo Metropolitan Area.
By doing so, we believe that we will make an important contribu-
tion academically and practically because a relatively easy and
inexpensive method of preventing railway suicide would benefit
many cities around the world that face problems of railway and
metro suicides.
More specifically, we adopt a difference-in-differences (DID)
approach to evaluate the effectiveness of blue lights to reduce the
incidence of suicide. We compare the number of suicides before and
after the intervention of blue lights at 11 stations, using other
stations without the intervention as a control group. To preview the
estimation results, our regression analysis shows that the introduc-
tion of blue lights resulted in a decrease in the number of suicides by
84% (CI: 14–97%). Our findings suggest that the use of blue lights
can be an effective method for preventing railway suicide.
2. Data
We obtained the data on railway suicide and blue lights from a
railway company in Japan that began installing blue lamps at some
of its stations and railway crossings in 2008. At the company’s
request, the name of the railway company remains anonymous in
this paper. The dataset we obtained contains the number of suicides
eachyearatallofits71stationsandthelocationandtimingofthe
installation of blue lamps between 2000 and 2010. We use yearly
data for our analysis, and our unit of observation is a station-year.
The total number of station-year observations equals 781 (71
stations 11 years), of which 108 observations are associated with
at least one suicide and 673 observations are associated with zero
suicides between 2000 and 2010. The average number of suicides
per station-year observations between 2000 and 2010 is 0.164
(s.d¼0.443). The maximum number of suicides at a station per year
is three. The station with the highest number of suicides had a total
of 10 suicides between 2000 and 2010. The year in this dataset
refers to the Japanese fiscal year, which runs from April 1 to March
31 in the following year.
Because the unit of analysis is a station-year, we made the
following adjustment in the dataset for stations that experienced
cases of suicides in the same year that they installed blue lights.
During the period of our study, five cases of suicides occurred at
stations that eventually installed blue lamps in a subsequent
month of the same year. They occurred at three stations in 2008
and 2009, all in the month prior to the installation of the blue
lights. Because these three stations installed blue lights at the
very end of the fiscal year, we recoded the year of the blue light
installation as the following year. In one case, a suicide occurred
in July 2009; blue lights were later installed in February 2010 at
that station. In this case, we recoded the year of blue light
installation as the 2010 fiscal year (April 2010 to March 2011),
rather than the 2009 fiscal year (April 2009 to March 2010). This
recoding ensures that the dataset reflects the fact that the suicide
occurred prior to the blue light installation.
The railway company in our study installed blue lights at one
station in 2008. In 2009, blue lamps were installed at four
additional stations, and in 2010, at six more stations. In all cases,
the blue lights were installed at the edges of the platforms and
the lights stay on from sunset to sunrise. Thus, the effectiveness of
blue lights should be limited to the hours after dusk. By the end of
the 2010 fiscal year, blue lights were installed at 11 stations. Nine
out of the 11 stations with blue lights are located in a munici-
pality whose local government provided financial subsidies that
cover a significant proportion of the cost of the blue lamp
installation. According to the railway company, the blue light
installation at the current scale would have been financially
infeasible without the subsidy.
3. Descriptive analysis
We first present descriptive statistics for four groups of
stations in order to show the trend in the number of suicides
over time. The first group contains stations that had no blue lights
installed by 2010 (N¼60). The remaining three groups included
the stations that installed blue lights in the 2008, 2009, and 2010
fiscal years, respectively.
Table 1 presents the total number of suicides and the average
number of suicides per station in each year. The shaded areas
refer to the years when blue lights were present at those stations.
Two points are evident from the table. First, almost no incidents
of suicide have occurred at the stations after the installation of
blue lights. In the dataset, one suicide was recorded at one of the
stations that installed blue lights in 2009. However, the incident
happened in the daytime, when the blue lights were not on.
Table 1
The installation of blue lights and the number of suicides.
Fiscal year No blue
lights
(N¼60)
Blue lights
introduced in
2008 (N¼1)
Blue lights
introduced in
2009 (N¼4)
Blue lights
introduced in
2010 (N¼6)
NMean NMean NMean NMean
2000 6 0.098 0 0 1 0.250 2 0.333
2001 8 0.131 0 0 0 0.000 0 0.000
2002 7 0.115 1 1 1 0.250 1 0.167
2003 9 0.148 0 0 1 0.250 2 0.333
2004 13 0.213 1 1 2 0.500 0 0.000
2005 11 0.180 0 0 1 0.250 2 0.333
2006 9 0.148 2 2 3 0.750 1 0.167
2007 4 0.066 1 1 4 1.000 9 1.500
2008 5 0.082 0 0 3 0.750 3 0.500
2009 5 0.082 0 0 0 0.000 4 0.667
2010 5 0.082 0 0 1
*
0.250 0 0.000
Note: table entries are the total number of suicides and the average number of
suicides per station for each group. The shaded areas indicate that stations had
blue lights installed at the platforms during those years.
n
There was one case of suicide in 2010 at a station that has had blue lights
since 2009, but it occurred during the day, that is, when the blue lights were not on.
T. Matsubayashi et al. / Journal of Affective Disorders 147 (2013) 385–388386
Author's personal copy
Thus, no suicides occurred when the blue lights were on. Second,
the average number of suicides (prior to blue light installation)
was higher in groups where blue lights were eventually installed.
This could be because the railway company chose to install blue
lights at stations where suicide rates were high. In order to
separate the effect of such station-specific factors from that of
the blue lights, we control for such confounding factors in the
regression analysis below.
4. Regression analysis
Next, we estimate the effect of the installed blue lights on the
number of suicides in the subsequent years by using a regression
model based on a DID framework. If the blue lamps were
expected to have an impact on the number of suicides, we should
observe a reduction in the average number of suicides at the
stations with blue lights after the installation, while we should
not see a major change in the average number of suicides at the
stations where the lamps were not installed. In order to make
such a comparison, the model that we use explains the number of
suicides by the presence of blue lights. Thus, the dependent
variable is the number of suicides in each station-year and the
main explanatory variable is a dummy variable for the presence
of blue lights. This dummy variable takes a value of one after the
station has blue lights installed in a particular year, and a value of
zero otherwise.
Because the number of suicides is likely determined by other
factors as well, we also include two types of dummy variables in
our regression model. First, in order to take into account the
possibility that the attributes of each station can affect the
number of suicides, we include station-specific dummy variables.
Such attributes represent whether rapid trains stop at the station
(if not, trains pass the station at a high speed, and thus, the
incidence of suicide is higher), and whether the station is close to
a psychiatric hospital (such stations tend to have more suicides),
among others. By including these variables, we can separate the
effect of blue lights on suicide from that of these station-specific
unobserved factors effectively. This method allows us to estimate
a temporal difference in the mean number of suicides before and
after the installation of blue lights. The regression coefficient
obtained in this model ultimately reflects a difference in the
average number of suicides between two groups, with and with-
out the blue lights.
Second, because factors that vary over time (e.g., macroeco-
nomic conditions) can also affect the total number of suicides, the
model includes dummy variables for each year. By including the
year-specific dummies, the effect of such time-varying factors is
taken into account, enabling us to isolate the effect of blue lights
from that of other common time-dependent factors.
We estimate a Poisson regression model because our depen-
dent variable is the number of suicides. Moreover, in order to
address the potential heterogeneity and autocorrelation in the
error terms within each station, we adjust standard errors by
using a heteroskedasticity-autocorrelation consistent estimator.
Table 2 reports estimation results by the Poisson regression.
The station- and year-specific dummy variables are included in
the estimation, but they are not reported in the table. The
regression coefficient associated with the blue lamp dummy
variable is estimated to be negative, indicating that the average
number of suicides decreased after the installation of the blue
lamps. To interpret the substantive effect of the blue lights, we
compute the Incident Relative Ratio (IRR), which equals 0.167
with a 95% confidence interval (0.032–0.867). This suggests that
the introduction of blue lights resulted in a decrease in the
number of suicides by 84% (CI: 14–97%).
5. Discussion
We evaluate the effects of blue lights at train stations on the
number of suicides by using panel data from a railway company
in Japan. Our study constitutes the first systematic analysis of the
effectiveness of blue lights as a suicide prevention method. The
introduction of blue lights is associated with a statistically
significant decrease in the number of suicides, indicating that
the use of blue lights can be an effective method of preventing
suicides. Our point estimate suggests that station blue lights
might even completely eliminate railway suicides. Since blue
lights are easier and less expensive to install than other measures,
they can be a practically useful and cost-effective suicide preven-
tion measure.
Our findings should be interpreted with caution owing to a
few limitations in our research design. First, the external validity
of the results is limited because our analysis relies on data from a
single railroad company. The installation of blue lights may not be
as effective in other areas. The blue lights installed by other
railway companies may not be as effective owing to the differ-
ences in the number, locations, and types of blue lights. Future
studies should evaluate the robustness of our results with data
from other railway companies that installed blue lights in other
metropolitan areas.
Second, our study does not examine the underlying suicide–
mitigation mechanism of blue lights. While our results are
consistent with the hypothesis that blue lights have a calming
effect on people who consider suicide, this particular hypothesis
has not yet been systematically examined. The psychological
impact of blue lights on human beings should be evaluated
carefully in the future.
Third, we based our analysis on observational data, and thus, it
may not necessarily indicate a causal relationship between the
installation of blue lights and decreased suicide rates. The
installation of blue lights might be conditional on observable
and unobservable factors, which could make the relationship
spurious. Most importantly, the decision to install blue lights at
particular stations may have been affected by the number of
suicides at the stations in previous years. To address this concern,
we reexamined the effect of blue lights on the number of suicides
by controlling for the number of suicides in the previous year or
the previous three years. This sensitivity analysis using the
Poisson regression models reveals almost identical results, as
reported in Table 2.
Finally, our study does not rule out the possibility that the
installation of blue lights has no impact on the total number of
suicides in the area, because those who consider suicide at the
station with blue lights might go to other railway stations or use
other methods to kill themselves. Accordingly, our findings
indicate that the installation of blue lights could be effective
in discouraging people from committing suicide at a particular
place but may not necessarily be a way to reduce the overall
suicide rate.
Table 2
The estimated effect of blue lights on the number of suicides.
Effect 95% CI P-value
Blue lights 1.788 3.431, 0.143 0.033
Constant 18.373 20.477, 16.269 o0.000
Note: table entries are the Poisson regression estimates. The dependent variable is
the total number of suicides at each station in a single year. Data represent the
number of suicides at 71 stations between 2000 and 2010. The total number of
observations is 781. The 95% confidence intervals are based on robust standard
errors. Station- and year-specific fixed effects are included in all estimations.
T. Matsubayashi et al. / Journal of Affective Disorders 147 (2013) 385–388 387
Author's personal copy
Role of funding source
This research was funded by the Japan Society for the Promotion of Science
and the Nomura Foundation in Japan. The funding was spent for the analysis and
interpretation of the data and the writing of the paper.
Conflict of interest
There is no conflict of interest.
Acknowledgments
Preliminary results of this study were presented at a workshop "Economics of
Suicide Prevention in Korea and Japan," held at Graduate School of Economics,
University of Tokyo on March 23, 2012. We acknowledge useful comments and
suggestions made by the workshop participants. Usual disclaimers apply.
References
Baumert, J., Erazo, N., Ladwig, K.H., 2005. Ten-year incidence and time trends of
railway suicides in Germany from 1991 to 2000. European Journal of Public
Health 16, 173–178.
Ladwig, K., Ruf, E., Baumert, J., Erazo, N., 2009. Prevention of metropolitan and
railway suicide. In: Wasserman, D., Wasserman, C. (Eds.), Suicidology and
Suicide Prevention: A Global Perspective. Oxford University Press, Oxford,
pp. 589–594.
Law, C.K., Yip, P.S.F., Chan, W.S.C., Fu, K., Wong, P.W.C., Law, Y.W., 2006. Evaluating
the effectiveness of barrier installation for preventing railway suicides in Hong
Kong. Journal of Affective Disorders 114, 254–262.
Mishara, B.L., 2007. Railway and metro suicides: understanding the problem and
prevention potential. Crisis: Journal of Crisis Intervention and Suicide
Prevention 28, 36–43, Suppl. 1.
Schmidtke, A., 1994. Suicidal behaviour on railways in the FRG. Social Science and
Medicine 38, 419–426.
Suya, S., 2008. Aoiro bouhantou no donyu haikei to zenkoku jittai chousa (Report
on the introduction of blue lights). Shomei Gakkaishi 92, 631–636.
The Associated Press, 2009. Japanese Railways Hope Soothing Lights will Curb
Suicides, November 4 2009.
The Ministry of Land, Infrastructure, Transport and Tourism, Japan, 2010. Tetsudou
yusou toraburu niyoru eikyo ni kansuru chousa houkoku no gaiyou. (Report on
the effect of troubles in railway transportations).
Yip, P.S.F., Caine, E., Yousuf, S., Chang, S.S., Wu, K.C.C., Chen, Y.Y., 2012. Means
restriction for suicide prevention. Lancet 379, 2393–2399.
T. Matsubayashi et al. / Journal of Affective Disorders 147 (2013) 385–388388
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