Release of the Netflix program 13 Reasons Why on March 31, 2017, was associated with an increase in suicides among youths between the ages of 10 and 19 years, and the signal of a potentially larger proportional increase among young women, according to a study published in JAMA Psychiatry. These findings are consistent with contagion by suicide.

13 Reasons Why was one of the most watched programs of 2017 and was aimed at youths between the ages of 10 and 19 years. It described the suicide of a 17-year-old girl and its consequences, sparking sharp criticism from mental health and suicide prevention organizations.

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The evidence on the association between fictional portrayals of suicide and increases in actual suicide has been inconclusive. Thomas Niederkrotenthaler, MD, PhD, MMSc, from the Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Unit Suicide Research & Mental Health Promotion, Austria, and colleagues conducted a time series analysis using monthly suicide data for the age groups 10 to 19 years, 20 to 29 years, and 30 years or older for both US males and females from 1999 to 2017 from the Centers for Disease Control and Prevention’s WONDER database. They used Twitter and Instagram posts as proxies to estimate the amount of attention the 13 Reasons Why show garnered from April 1, 2017, to June 30, 2017. The investigators used autoregressive integrated moving average time series models to estimate suicides among the different age groups and to distinguish changes in specific suicide methods used. Because social media attention ceased after June 2017, they identified the April to June timeframe as the exposure window.

The investigators found increases in suicides among 10- to 19-year olds. Suicides increased 12.4% among males and 21.7% among females in that age group during the April to June timeframe. The increase in suicide by hanging was particularly high, showing a 26.9% increase. However, although the fictional character died as a result of cutting, that suicide method was rare. No increase in suicides occurred in other age groups.

“The associations identified here must be interpreted with a substantial degree of caution, but they do appear to demonstrate an increase in suicides that is consistent with potential contagion by media,” the investigators wrote. They concluded, “Our findings appear to point to the need of engagement by public health and suicide experts to engage with members of the entertainment industry to prevent further harmful suicide portrayals.”

Reference

Niederkrotenthaler T, Stack S, Till B, et al. Association of increased youth suicides in the United States with the release of 13 Reasons Why [published online May 29, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.0922