‘13 Reasons Why’: No evidence series led to increase in suicides among US adolescents, says study
Contrary to the findings of a 2019 study which linked ‘13 Reasons Why’ to a 28.9% rise in youth suicide rates in the month after the show's release, a new analysis says there is no clear evidence to draw such an association.
According to the reanalysis - by Dr Dan Romer, research director, Annenberg Public Policy Center (APPC) of the University of Pennsylvania - after controlling for the dramatic increase in adolescent suicide in recent years, the show's release had no clear effect.
The 2019 study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, said that the web-based series was associated with a 28.9% increase in suicide rates among 10-to 17-year-olds in the US in April 2017 following the show's release, after accounting for ongoing trends in suicide rates. The researchers had estimated that the series' release was associated with approximately 195 additional suicide deaths in 2017 for 10- to 17-year-olds.
Dr Jeff Bridge, one of the author's of the 2019 study from the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, had told MEAWW (MEA WorldWide) that the suicide rate in the month after the show's release was higher than any month during the last 19 years.
However, the 2020 reanalysis found that the increase in the suicide rate for boys observed in the original study by Bridge and colleagues was no longer evident after controlling for the ongoing trend in adolescent suicide. In addition, the increase seen during the first month of the release began the month prior to the release, making it difficult to attribute the rise to the show, says the study. The reanalysis found no effects in the subsequent months of that year. "Our reanalysis casts considerable doubt on the show having an effect on boys," says Dr Romer. The findings of the reanalysis have been published in PLOS ONE.
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.
When the first season of the Netflix show appeared in 2017, it created widespread concern that its graphic portrayal of a teenage girl's suicide would lead to imitation among vulnerable young people, especially adolescent girls. This concern prompted researchers to see whether there was evidence of contagion in US suicide rates following the show's release.
The 2019 study did not find any effect of the series on suicide rates for girls. “This increase was surprising in that it was unique to male youth when the show focused on the suicide death of a high school girl and the many classmates whom she blamed for instigating her death,” says Romer.
The current study questioned the 2019 study for two reasons. “First, contagion would be expected to be stronger for girls than boys for this story, and second, their analysis did not take into account strong secular trends in suicide, especially in boys from 2016 to 2017,” says Romer in the findings. “I reanalyzed their data using a simple auto-regression model that tested for changes in rates after removing auto-correlation and national trends in suicide. I found that the increase for boys observed by Bridge et al. in April was no greater than the increase observed during the prior month before the show was released. There were also no effects in later months of that year,” he says.
Romer explains the 2019 analysis relied on a forecasting method to project the likely trend in suicide for 2017. But that forecast failed to anticipate the actual trend.
“One might ask why the Bridge et al. study attributed the April rise in boys to the show. Their analysis used a forecasting procedure to establish a baseline for evaluating changes in suicide in 2017. This forecast was notably insensitive to the secular change in suicide in youth. And thus predicted a flat trend for 2017. As a result, their model attributed the increases during 2017 to the show rather than to the secular change,” says the study.
A second study by different researchers had a similar problem, says Romer. That study found an effect on boys and girls (10 to 19 years) in the three months following the series' release. But it similarly failed to control for the secular trend in suicide, again making it difficult to separate the effects of the show from the trend, says the study.
Suicide rates for both adolescent males and females have been rising since 2008 and the rise in 2017 was particularly strong. The rate for young males ages 15 to 19 increased by 21% between 2016 and 2017. Suicide among female adolescents aged 15 to 19 increased by 7%, adds the study.
There has been disagreement about the causes of the recent rise in adolescent and young adult suicide. Some researchers have suggested that the rise is due to increased use of social media. But a recently published analysis by Romer suggested that the trend may be attributable in part to “lingering economic stress from the 2008 financial crisis in combination with increased pressure on teens from their parents to succeed academically.”
The reanalysis did find a modest rise in the suicide rate among adolescent girls during the first month following the release of ‘13 Reasons Why,’ but it was not statistically reliable, says Romer.
A previous study by Romer and colleagues that examined the effects of the second season of ‘13 Reasons Why’ had found that viewing the show had both beneficial and detrimental effects on young adult viewers. The small increase observed in girls in this current reanalysis of the first season data may have been the net result of these opposing effects, says the analysis.
In mid-2019, over two years after the release, Netflix edited a graphic suicide scene from the Season 1 finale and asserted that the show encouraged young people "to start conversations about difficult issues such as depression and suicide and get help - often for the first time."
"Despite that, it does not appear that the show reversed or slowed the ongoing increase in adolescent suicide. Even if the series also had a positive effect for some viewers, the producers should recognize the potential harm to vulnerable audience members. It should be possible to produce a show that highlights the challenges that young people face without also producing suicide contagion,” says Romer.