When the Netflix series 13 Reasons Why debuted on March 31, 2017, doctors and people who study teen mental health immediately began to worry. The show focuses on teen suicide. It also covers other intense topics, such as sexual harassment, assault and school shootings. Experts were concerned that watching the show might raise viewers’ risk of suicide. Now the results of two studies looking at the show’s effects on suicides have been released. Neither study can prove the show increased or decreased youth suicides. But media should still cover tough topics with care, the scientists warn.
13 Reasons Why is based on a book with the same name by Jay Asher. It focuses on the suicide of a teen girl. The first season leads up to her suicide, which is shown in graphic detail. The show was immediately popular, and the first season was the third most-binged show on Netflix in 2017. A second season was released on May 18, 2018.
Lisa Horowitz and other scientists began to worry as soon as they heard about the show. Horowitz is a pediatric psychologist — someone who studies the thoughts and behaviors of children and teens. She works at the National Institute of Mental Health in Bethesda, Md. “I have to tell you, when I saw the trailer for the show … I was literally nauseous,” she says.
Horowitz was worried about suicide contagion. Research has shown that people may become more likely to show suicidal behavior after being exposed to suicide in their family, community or the media. Horowitz and her colleagues were therefore concerned that 13 Reasons Why might increase rates of teen suicide.
After the show aired, the researchers examined data that had been collected by the Centers for Disease Control and Prevention (CDC). This government agency tracks how and when people have died. The Horowitz team looked at how many people died by suicide between 2013 and the end of 2017. They divided those data into three age groups: 10 to 17, 18 to 29, and 30 to 64. Then, the scientists compared suicide rates before the show aired to those right around the time of its release.
In general, suicides increased over time. But for people over 18, there were no more suicides after the show aired than the scientists would have predicted. In contrast, there was a 29 percent increase in the suicide rate among 10- to 17-year-olds in April 2017. That was the month after the show came out. There also were more suicides among teens in March 2017, when the trailer for the show was spreading around the internet.
Overall, the researchers estimated that 195 more suicides occurred among 10- to 17-year-olds than would have been expected. And although the show focuses on the suicide of a teenage girl, the biggest increase occurred in teen boys. Horowitz and her colleagues published their results April 28 in the Journal of the American Academy of Child and Adolescent Psychiatry.
“Overall, it’s consistent with other research out there,” Patricia Ortiz said of the findings. She is a psychiatrist at George Washington University in Washington, D.C. However, she adds, the research does not prove that the show caused those extra deaths. That’s because there was only a correlation between an increase in suicides and the TV show. “We can’t prove these people [who committed suicide] saw the show or were exposed to it,” Ortiz explains. “Suicides are very rarely due to one thing. There are lots of factors.”
After mental-health professionals criticized Netflix for putting out the show in 2017, a message from the show’s cast was added to the beginning of each season. Each episode also has notes before it that warn viewers of potentially disturbing content. That note stresses that 13 Reasons Why addresses tough topics and encourages people to seek help if they need it. It also offers a website with resources to help.
Same show, different finding
Dan Romer is a psychologist at the University of Pennsylvania in Philadelphia. Like Horowitz, he also was very concerned about 13 Reasons Why. Instead of looking through death records, however, he and his colleagues decided to ask people who were watching the show how they were feeling.
They surveyed 729 people between the ages of 18 and 29. Each filled out surveys before and after watching the second season of the show. The second season — like the first — is pretty grim. “I couldn’t watch the whole thing,” Romer notes. “It’s just awful. Everything goes wrong all the time.” But the second season, at least, ends in a much more hopeful place than the first.
Romer found that people who watched some of the second season — but not all — were at a higher risk for suicide. They thought about it more often and were less hopeful about the future. But if people — especially students — watched the second season to the end, they had a lower risk of suicide. In fact, they had fewer suicidal thoughts than people who had never seen the show at all. Romer and his colleagues published their findings April 25 in the journal Social Science & Medicine.
The study “essentially found the opposite effect” from the first, says Kimberly O’Brien of Harvard Medical School in Cambridge, Mass. She’s a research scientist in the field of psychiatric social work. But this second study, too, found only a correlation. It doesn’t prove that watching the show leads to one feeling or another. Teens and young adults have many other stresses in their lives that might contribute to suicidal thoughts.
Correlation isn’t always contagion
In a May 3 statement, a Netflix spokesperson said the network was aware of both studies and that they may be seen as contradicting each other. It also acknowledged that suicide is “a critically important topic and we have worked hard to ensure that we handle this sensitive issue responsibly.”
Neither study can prove that 13 Reasons Why increased — or decreased — the risk for suicide. “We couldn’t prove it,” Horowitz says. Still, she says, “I think it needs to be a wakeup call.” That wakeup call is for the media to think about how they are depicting suicide and how it might affect teens and young adults. “We’re trying to decrease the suicide rate,” she notes. “We do not need something that’s increasing it.”
This means that the media — whether it’s Netflix (there will be a third season of 13 Reasons Why), people writing about the show or journalists writing about suicide in general — need to be careful about how they discuss suicide.
But that doesn’t mean no one should bring up the topic. It only means that people should do so carefully. “There’s a myth that if you talk to someone about suicide, you put the thought in their head,” says Horowitz. “That’s a myth. It’s not true.” The best way to help someone who might be at risk, she explains, is to talk to them about it.
Suicide is the second leading cause of death among young adults ages 15 to 29 as of 2016. If you or someone you know is suffering from suicidal thoughts, please seek help. In the United States, you can call the National Suicide Prevention Hotline, 1-800-273-TALK (8255). Or you can text 741-741. Please do not suffer in silence.
adolescent Someone in that transitional stage of physical and psychological development that begins at the onset of puberty, typically between the ages of 11 and 13, and ends with adulthood.
behavior The way something, often a person or other organism, acts towards others, or conducts itself.
Centers for Disease Control and Prevention, or CDC An agency of the U.S. Department of Health and Human Services, CDC is charged with protecting public health and safety by working to control and prevent disease, injury and disabilities. It does this by investigating disease outbreaks, tracking exposures by Americans to infections and toxic chemicals, and regularly surveying diet and other habits among a representative cross-section of all Americans.
colleague Someone who works with another; a co-worker or team member.
correlation A mutual relationship or connection between two variables. When there is a positive correlation, an increase in one variable is associated with an increase in the other. (For instance, scientists might correlate an increase in time spent watching TV with an increase in rates of obesity.) Where there is an inverse correlation, an increase in one value is associated with a drop in the other. (Scientists might correlate an increase in TV watching with a decrease in time spent exercising each week.) A correlation between two variables does not necessarily mean one is causing the other.
factor Something that plays a role in a particular condition or event; a contributor.
media (in the social sciences) A term for the ways information is delivered and shared within a society. It encompasses not only the traditional media — newspapers, magazines, radio and television — but also Internet- and smartphone-based outlets, such as blogs, Twitter, Facebook and more. The newer, digital media are sometimes referred to as social media. The singular form of this term is medium.
mental health A term for someone’s emotional, psychological and social well-being. It refers to how people behave on their own and how they interact with others. It includes how people make choices, handle stress and manage fear or anxiety. Poor mental health can be triggered by disease or merely reflect a short-term response to life’s challenges. It can occur in people of any age, from babies to the elderly.
psychiatrist A medical doctor who spends many years learning to study and treat diseases of the human mind. Treatments may consist of talking therapies, prescription drugs or both. This medical field is known as psychiatry.
psychologist A scientist or mental-health professional who studies the human mind, especially in relation to actions and behaviors.
risk The chance or mathematical likelihood that some bad thing might happen. For instance, exposure to radiation poses a risk of cancer. Or the hazard — or peril — itself. (For instance: Among cancer risks that the people faced were radiation and drinking water tainted with arsenic.)
social science The scientific study of people and their relationships to each other.
suicidal A mental state in which a person feels a strong impulse to take his or her own life (also known as committing suicide). Warning signs may include talking about wanting to die or about making plans to commit suicide; saying goodbye to people as if this person won’t ever see them again; taking steps to make it possible to commit suicide, such as obtaining a gun or drugs that could cause death; being obsessed with the subject of death or dying; and withdrawing from social contact in a way that is unusual for that person.
suicide contagion The concept that some people may become more likely to exhibit suicidal thoughts or behaviors after learning of friends or family members who become suicidal or after encountering suicides in books, movies and other media.
survey To view, examine, measure or evaluate something, often land or broad aspects of a landscape. (with people) To ask questions that glean data on the opinions, practices (such as dining or sleeping habits), knowledge or skills of a broad range of people. Researchers select the number and types of people questioned in hopes that the answers these individuals give will be representative of others who are their age, belong to the same ethnic group or live in the same region. (n.) The list of questions that will be offered to glean those data.
Journal: J.A. Bridge et al. Association between the release of Netflix’s 13 Reasons Why and suicide rates in the United States: An interrupted time series analysis. Journal of the American Academy of Adolescent and Child Psychiatry. Published online April 28, 2019. doi: 10.1016/j.jaac.2019.04.020.
Journal: F. Arendt et al. Investigating harmful and helpful effects of watching season 2 of 13 Reasons Why: Results of a two-wave U.S. panel survey. Social Science & Medicine. Published online April 25, 2019. doi: 10.1016/j.socscimed.2019.04.007.