The TV adaptation of the YA novel 13 Reasons Why debuted on Netflix at the end of March 2017, amid criticism that the show’s depiction of suicide might inspire “copycat” suicides. Though Netflix added content warnings ahead of potentially triggering episodes and directed viewers to mental health resources online, experts and advocates were cautious that these measures might not be enough to help at-risk young people. Now, a new study has found that there was a nearly 30% increase in suicides among teens in April 2017, the month after the show was released, and rates of suicide were also higher than expected in March 2017.
The study, published in the Journal of the American Academy of Child and Adolescent Psychiatry with support from the National Institutes of Health (NIH), found that the increase in suicides was driven primarily by boys aged 10-17. The increase in risk for girls the same age was not statistically significant, and researchers didn’t find a similar increase in people over 18. The study’s authors also explicitly noted that the study could not prove that watching the show caused this increase in suicide, just that the two events coincided in timing.
"We've just seen this study and are looking into the research, which conflicts with last week’s study from the University of Pennsylvania," a spokesperson for Netflix tells Bustle. "This is a critically important topic and we have worked hard to ensure that we handle this sensitive issue responsibly.”
That University of Pennsylvania study found that finishing the second season of the show was associated with a decrease in suicidal ideation and self-harm in women ages 18-29 who watched the show compared to those who didn’t. But it also found that people who did not finish the second season showed a greater risk for suicidal behaviors. This study looked at a sample of over 700 young women who completed surveys before and after watching the show.
April Foreman, a psychologist and board member of American Association of Suicidology, tells Bustle that it’s important to take both pieces of research in context. “No one TV show causes a suicide,” she says. People at risk, however, “might be influenced by stories [where] suicide is shown as a solution to problems.” For people who might be at risk for suicide, or who need help with their mental health, Foreman says that consuming this type of media can be triggering, especially compared to shows or media about recovery.
Further, shows that present suicide in the context of other serious issues, like sexual assault or bullying, run the risk of presenting suicide as something that’s “relatable,” Foreman says. The majority of people who’ve experienced sexual assault or bullying, as depicted on 13 Reasons Why, “don't go on to be suicidal and they don't go on to die by suicide. Many people experience trauma and recover. As a matter of fact, that is the more common thing that happens. And for some reason, 13 Reasons Why and other other media use suicide to … falsely give people the narrative that if something bad happened, then [someone] died by suicide, it’s just an understandable or relatable outcome when it's actually an extremely rare outcome.”
The study’s authors write that their findings should be taken as a call to action around using best practices when talking about suicide. “The results of this study should raise awareness that young people are particularly vulnerable to the media,” study author Lisa Horowitz, Ph.D., M.P.H., a clinical scientist in the National Institutes of Mental Health (NIMH) Intramural Research Program, was quoted as saying in a press release on the study. “All disciplines, including the media, need to take good care to be constructive and thoughtful about topics that intersect with public health crises.” These best practices include avoiding graphic descriptions or depictions of suicide or self-harm, and using neutral language to discuss suicide.
Despite the fact that many people in the suicide prevention community agree on these best practices, there’s less research on how to prevent contagion or “copycat” suicides than you might think. “Evidence has accumulated to support the idea that suicidal behavior is ‘contagious’ in that it can be transmitted, directly or indirectly, from one person to another,” writes a 2013 report on suicide published in the journal Contagion of Violence. Beyond that, though, the scientific community isn’t sure what specifically triggers this transmission. “We do not know for sure what drives suicide. […] We don't have good clear scientific answers” because there isn’t funding for these kinds of studies, Foreman says.
Ultimately, while more research works on understanding the impact of TV shows on real-life suicides, people at risk for suicide can take caution to avoid shows or media that might be triggering, and seek support for their mental health. “We need to do more science so we can better understand who is impacted," Foreman says, "and then we can make recommendations.”
If you or someone you know is experiencing suicidal thoughts, call the National Suicide Prevention Hotline at 1-800-273-8255 or text HOME to the Crisis Text Line at 741741. You can also reach out to the Trans Lifeline at 877-565-8860 or the Trevor Lifeline at 1-866-488-7386, or to your local suicide crisis center.