'13 Reasons Why' linked to 28.9% rise in youth suicide rates in the month after show's release, says study
The web-based series '13 Reasons Why' was associated with a 28.9% increase in suicide rates among 10 -to 17-year-olds in the US in the month (April 2017) following the show's release, after accounting for ongoing trends in suicide rates, according to a study published in the Journal of the American Academy of Child and Adolescent Psychiatry.
The suicide rate in the month after the show's release was higher than any month during the last 19 years, Dr. Jeff Bridge, one of the author's of the study from the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, told MEA WorldWide (MEAWW).
The researchers estimated that the series' release was associated with approximately 195 additional suicide deaths in 2017 for 10- to 17-year-olds.
"There was a significant increase in the suicide rate among 10- to 17-year-olds in the month after release of 13 Reasons Why, with suicide rates in two subsequent months remaining elevated over forecasted rates. The suicide rate in the month after release was higher than the rate of any month during the five-year study period. Although this wasn't part of our study, the suicide rate in the month after the show's release was higher than any month during the last 19 years," Dr. Bridge told MEAWW.
Suicide is a major public health concern in the US. “Stories profiling someone who died by suicide appear to carry the greatest risk, as vulnerable individuals may identify with the person in the report, with youth potentially more susceptible to this effect,” said the paper.
On March 31, 2017, Netflix released the series '13 Reasons Why' based on the bestselling book of the same name. The series portrays the story of an adolescent girl who kills herself following a sequence of traumatic life events that she catalogs before her death on 13 audiotapes and leaves behind for those she believes are at least partially to blame for her suicide.
Although this show has received critical acclaim, it has also generated questions regarding how the show's portrayal of suicide affects young people who watch it.
"Since its release, the critically acclaimed and widely viewed series has generated substantial debate and controversy, largely due to concerns about its potential for increasing suicide contagion. We hypothesized the release would have an immediate and sustained impact on suicide rates in youth and emerging adults because media failure to incorporate best suicide prevention practices is associated with increases in suicide in these age groups relative to adults," says the paper.
According to Dr. Bridge, one of the main concerns with the show is that it failed in multiple ways to adhere to media guidelines for depicting suicide, which can increase the risk for what is known as suicide contagion.
"Contagion is when direct or indirect exposure to suicide can increase the risk for subsequent suicidal behavior, especially among young vulnerable youth," Dr Bridge explained.
The study was conducted by researchers at several universities, hospitals, and the National Institute of Mental Health (NIMH), part of the National Institutes of Health. It was funded by NIMH. The research team assessed monthly rates of suicide among individuals aged 10 to 64 years grouped into three age categories (10-17, 18-29, 30-64 years) between January 1, 2013, and December 31, 2017.
The number of deaths by suicide recorded in April 2017 was greater than the number seen in any single month during the five-year period examined by the researchers.
They found that the rates of suicide for 10- to 17- year-olds was significantly higher in the months of April, June, and December 2017 than were expected based on past data.
This increase translated into an additional estimated 195 suicide deaths between April 1, 2017, and December 31, 2017.
“Caution regarding the exposure of children and adolescents to the series is warranted,” said the paper.
According to an NIMH release, when the research team analyzed the data by sex, they found the increase in the suicide rate was primarily driven by significant increase in suicide in young males.
While suicide rates for females increased after the show's release, the increase was not statistically significant. The findings further show that among 18- to 29-year-olds and 30- to 64-year-olds, there was no significant change in level or trend of suicide after the show's release, both overall and by sex.
"The observed suicide rate for March 2017 — the month prior to the show's release — was also higher than forecast. The researchers note that the show was highly promoted during March, exposing audiences to the show's premise and content through trailers," said the NIMH release.
As a comparison, the researchers also assessed deaths due to homicide during the same period, to understand whether other "worldly social or environmental events" after the show’s release influenced the rates. Homicide rates can be influenced by some of the same social and environmental factors as suicide rates, said experts. The researchers did not find any significant changes in homicide rates following the release of the show.
"The lack of change in homicide rates during the period of interest lends some strength to the idea that changes in suicide rates were influenced by the show and not some other environmental or social factor that occurred during this period," the release said.
According to the paper, the increase in the youth suicide rate that occurred after the initial release of '13 Reasons Why' provides an example of “potential unintended negative consequences of media portrayals of suicide” that do not adhere to best practices.
Dr. Bridge said that the findings add to a growing number of studies that youth may be particularly sensitive to the way suicide is portrayed in the media.
“The other key takeaway is that these findings should serve as a call to media to use best practices when depicting or reporting suicide," added Dr. Bridge.
One established public health approach to suicide prevention, according to experts, is accurate and responsible reporting of suicide in the news media and entertainment industry.
The increasing recognition of entertainment and media influence has led a variety of groups, such as National Action Alliance for Suicide Prevention, the World Health Organization, and reporting on suicide.org, to create best practices for talking about and portraying suicide on screen.