A new study suggests that the Netflix drama '13 Reasons Why' may increase suicidal thoughts among teenagers.
Suicide is a serious public health concern. According to the latest data from the Centers for Disease Control and Prevention (CDC), suicide ranks as the 10th leading cause of death in the United States, across all age groups.
However, suicide becomes the third leading cause of death when zooming in on young people aged between 10 and 14. Furthermore, among those aged between 10 and 24 years, suicide rises to the second spot in the top causes of death.
Experts have expressed concern over the impressionability and susceptibility of young people to suicide. The phenomenon of "suicide contagion" is more pervasive among teenagers and adolescents, and exposure to certain media programs might increase the risk of copying suicidal behavior in this age group.
In particular, a new, popular Netflix drama that centers around a teenager who commits suicide has sparked controversy and worry over the psychological well-being of teenagers.
Now, a team of researchers led by John W. Ayers, an associate research professor at San Diego State University Graduate School of Public Health in California, set out to investigate the impact of this show - called "13 Reasons Why" - on suicide-related Internet searches.
The findings were published in JAMA Internal Medicine.
Examining Internet searches
Specifically, the study examined Google search trends in the days following the show's release. Prof. Ayers and team looked at searches for the word "suicide," excluding occurrences of the word "suicide" together with the word "squad," so as to avoid searches for the popular film "Suicide Squad."
Additionally, they monitored related search terms, avoiding unrelated or vague phrases that included the word suicide, such as "suicide slide" or "suicide bridge." The researchers also examined specific suicide-related search queries, such as "how to commit suicide" and "how to kill yourself."
Prof. Ayers and colleagues looked at the volume of Internet searches between March 31, 2017 and April 18, 2017. The end date of the period was chosen in order to avoid the date of April 19, 2017, which was when the American football player Aaron Hernandez committed suicide.
The researchers compared Internet search volumes after the show aired with what the search volumes would have been if the show had not been released. These volumes were estimated based on daily trends over 3 months, which were fed into an algorithm called "autoregressive integrated moving average," designed by Hyndman and Khandakar.
"This strategy allows us to isolate any effect '13 Reasons Why' had on how the public engaged with and thought of suicide," says study co-author Benjamin Althouse, a research scientist at the Institute for Disease Modeling in Bellevue, WA.
Suicide searches up by 19 percent
Overall, the study revealed a bump in all suicide-related searches after the show's premiere.
Specifically, all of the suicide-related queries were up by 19 percent, compared with what would have been expected if the show had not aired.
The search for phrases that indicate users' interest in suicide prevention strategies partially accounted for this increase. Namely, searches for phrases such as "suicide hotline" went up by 12 percent, and those for "suicide prevention" increased by 23 percent.
However, queries such as "how to commit suicide," "commit suicide," and "how to kill yourself" also increased considerably, by 26 percent, 18 percent, and 9 percent, respectively.
"In relative terms, it's hard to appreciate the magnitude of [the release of '13 Reasons Why']," says study co-author Mark Dredze, a professor of computer science at Johns Hopkins University in Baltimore, MD.
"In fact, there were between 900,000 and 1,500,000 more suicide-related searches than expected during the 19 days following the series' release."
"While it's heartening that the series' release concurred with increased awareness of suicide and suicide prevention [...] our results back up the worst fears of the show's critics: the show may have inspired many to act on their suicidal thoughts by seeking out information on how to commit suicide."
Prof. John W. Ayers
The researchers cannot determine whether or not the searches triggered actual suicide attempts.
However, the scientists point to previous studies that have indicated a correlation between suicide search trends and actual suicides, as well as studies showing that the more suicides are covered by the media, the more people try to commit suicide.
Finally, the researchers point to the World Health Organization's (WHO) guidelines for suicide prevention - specifically those aimed at the media - and urge the show's creators, as well as Netflix, to abide by these principles.
"It is critical that media makers follow these guidelines. For instance, these guidelines discourage content that dwells on the suicide or suicide act. '13 Reasons Why' dedicated 13 hours to a suicide victim, even showing the suicide in gruesome detail," says co-author Jon-Patrick Allem, a research scientist at the University of Southern California in Los Angeles.