Release of ’13 Reasons Why’ associated with increase in youth suicide rates

The Netflix show “13 Reasons Why” was associated with a 28.9% increase in suicide rates among U.S. youth ages 10-17 in the month (April 2017) following the shows release, after accounting for ongoing trends in suicide rates, according to a study published today in Journal of the American Academy of Child and Adolescent Psychiatry. The findings highlight the necessity of using best practices when portraying suicide in popular entertainment and in the media. 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. NIMH also funded the study.

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. When researchers analyzed the data by sex, they found the increase in the suicide rate was primarily driven by significant increases in suicide in young males. While suicide rates for females increased after the show’s release, the increase was not statistically significant.

“The results of this study should raise awareness that young people are particularly vulnerable to the media,” said study author Lisa Horowitz, Ph.D., M.P.H., a clinical scientist in the NIMH Intramural Research Program. “All disciplines, including the media, need to take good care to be constructive and thoughtful about topics that intersect with public health crises.”

“13 Reasons Why” is a web-based series that tells the story of a young girl who kills herself and leaves behind a series of 13 tapes detailing the reasons why she chose to end her life. 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. The series premiered on Netflix on March 31, 2017.

To better understand the impact of “13 Reasons Why” on suicide rates, researchers analyzed annual and monthly data on deaths due to suicide sourced from the Centers for Disease Control and Prevention’s web-based Wide-ranging Online Data for Epidemiologic Research. These data included information about the deaths of individuals between the ages of 10 and 64 that occurred between Jan. 1, 2013, and Dec. 31, 2017, a timespan that encompassed the period before and after the release of the series.

The researchers examined whether the rates of suicide for the period after the release of “13 Reasons Why” were greater than would be expected based on suicide counts and trends observed in previous years. The researchers 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 Dec. 31, 2017. The observed suicide rate for March 2017 — the month prior to the release of “13 Reasons Why” — was also higher than forecast. The researchers note that the show was highly promoted during the month of March, exposing audiences to the show’s premise and content through trailers. The researchers did not find any significant trends in suicide rates in people 18- to 64 years of age.

As a comparison, the researchers also analyzed deaths due to homicide during the same period, to assess whether other worldly social or environmental events after the release of the show might have influenced suicide rates. Homicide rates can be influenced by some of the same social and environmental factors as suicide rates. 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 findings of this study add to a growing body of information suggesting that youth may be particularly sensitive to the way suicide is portrayed in popular entertainment and in the media. This 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. These guidelines recommend, for example, that the entertainment media should avoid depicting the suicide method used. The entertainment media are also urged to convey the message that help is available and to include accurate information about how people can seek help.

While compelling, this research had several limitations. For example, the study used a quasi-experimental design, meaning that the researchers cannot make a causal link between the release of “13 Reasons Why” and the observed changes in suicide rates. The researchers cannot, therefore, rule out the possibility that unmeasured events or factors influenced suicide rates during this period.

The second season of “13 Reasons Why” was released in May 2018, and a third season is currently in production and is expected to be released sometime this year. The findings from this study should serve as a reminder to be mindful of the possible unintended impacts of the portrayal of suicide, and as a call to the entertainment industry and the media to use best practices when engaging with this topic.

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Bridge, J. A., Greenhouse, J. B., Ruch, D., Stevens, J., Ackerman, J., Sheftall, A. H., Horowitz, L. M., Kelleher, K. J., & Campo, J. V. (in press). Association between the release of Netflix’s 13 Reasons Why and suicide rates in the united states: An interrupted times series analysis. Journal of the American Academy of Child and Adolescent Psychiatry.

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.