Netflix’s hit show 13 Reasons Why broke the mould when it premiered in March 2017. It gave us a glimpse into the mindset of a teen who died by suicide and subsequently left 13 tapes behind to explain her reasoning for doing so. A study published Monday in the Journal of the American Academy of Child and Adolescent Psychiatry found that show may be associated with a national increase in suicide among kids and teens. The study found there was a nearly 30 percent increase in suicide rates among U.S. youth ages 10 to 17 in April 2017, the month following the show's release, a press release about the study states. It specifically noted an increase among boys.
The study can’t actually prove that 13 Reasons Why was the cause of the increase, and the press release notes that the researchers can’t rule out the possibility that unmeasured events contributed. However, the National Institute of Mental Health press release notes that “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.”
Study author Lisa Horowitz, Ph.D., M.P.H., and a clinical scientist in the NIMH Intramural Research Program, noted that youth might be particularly sensitive to the way suicide is shown in popular culture. “The results of this study should raise awareness that young people are particularly vulnerable to the media,” noted Horowitz. “All disciplines, including the media, need to take good care to be constructive and thoughtful about topics that intersect with public health crises.” Groups such as National Action Alliance for Suicide Prevention, and the World Health Organisation have worked to create guidelines for media to follow that include avoiding the depiction of suicide methods — a rule the show breaks in season one.
“The media has a difficult task of providing accurate information about an event, like death by suicide, with an additional burden of potentially contributing to sensationalising the death or contributing to contagion,” Carly Claney, a clinical psychologist in Seattle, tells Refinery29. “There can be a way that suicide is glamorised or popularised in media, increasing its positive or desirable features to a greater degree than the factors we would consider "protective" against attempting suicide.”
A spokesperson for Netflix pointed to some slightly more positive data about the show from a study published last week. That study, published in the Elsevier Journal Social Science and Medicine, found that young adults who watched the entire second season were less likely to "report recent self-harm and thoughts of ending their lives than comparable students who didn’t watch the series at all."
"Although there’s some good news about the effects of 13 Reasons Why, our findings confirm concerns about the show’s potential for adverse effects on vulnerable viewers," said Dan Romer, the study’s senior author and the Annenberg Public Policy Center of the University of Pennsylvania’s research director in a release about the study.
And another study of more than 5,000 teens, young adults, and parents in four regions found that watching the series prompted teen and parent conversations about bullying, suicide and mental health. This study was conducted by Northwestern University’s Center on Media and Human Development, and it came out in March of 2018.
When asked for comment about the newest study showing an association between the show's premiere and increased suicide, the Netflix spokesperson said: "We've just seen this study, and are looking into the research, which conflicts with last week’s study from the University of Pennsylvania,” he said. “This is a critically important topic and we have worked hard to ensure that we handle this sensitive issue responsibly.”
The National Association of School Psychologists has been issuing guidance about the show since it originally came out. They issued a warning statement, noting: "We do not recommend that vulnerable youth, especially those who have any degree of suicidal ideation, watch this series. Its powerful storytelling may lead impressionable viewers to romanticise the choices made by the characters and/or develop revenge fantasies.”
The show has included warning messages at the beginning of some episodes, and "13 Reasons Why" created a website with resources for those in crisis. Christine Moutier, M.D. and chief medical officer for American Foundation for Suicide Prevention, advised Netflix on the resources website and consulted for free as Netflix devised the plot of the second season.
“Suicide is really complex, and it’s actually never the case that one factor or one experience will lead to suicide,” Moutier tells Refinery29. “It’s always multiple risk factors that converge.” Speaking to the latest study, Moutier said: “One film or show is not likely to cause someone to become at risk for suicide, but it can impact their openness to seeking information about mental health and talking to others, which would be a positive,” she said. “The show sparked a lot of conversation and an opportunity to educate and discuss suicide and warning signs about it in homes, over dinner conversations, and in schools.”