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Figure.  Internet and Twitter Searches Before and After “Silent All These Years”
Internet and Twitter Searches Before and After “Silent All These Years”

A, Daily search interest for the terms “Rape, Abuse, and Incest National Network” or “RAINN” leading up to and after the release of the television episode “Silent All These Years” (blue vertical line), including the expected forecast, calculated with the autoregressive integrated moving average algorithm (orange line). B, Estimated interest at greater-than-expected levels for searches of “Rape, Abuse, and Incest National Network” or “RAINN,” calculated using autoregressive integrated moving average algorithm. The mean increase in searches after the episode was released was estimated to equal 41% (95% CI, 17%-65%). C, Daily tweets mentioning “RAINN (excluding Wilson)” the RAINN hotline Twitter account (@RAINN), and the term “sexual assault hotline.” The dashed vertical line indicates the release of the Grey’s Anatomy episode “Silent All These Years.”

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    Research Letter
    December 2, 2019

    Public Awareness for a Sexual Assault Hotline Following a Grey’s Anatomy Episode

    Author Affiliations
    • 1Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa
    • 2Research, Evaluation, Measurement and Statistics, Oklahoma State University–Tulsa, Tulsa
    JAMA Intern Med. 2020;180(3):456-458. doi:10.1001/jamainternmed.2019.5280

    Results from the National Intimate Partner and Sexual Violence Survey indicate that 18.3% of US women and 1.4% of men have experienced rape.1 Trauma from sexual assault can lead to severe, long-standing negative sequelae, particularly when left untreated.2 Further complicating matters, only 23% of sexual assault crimes are reported to the police, in part because of a lack of awareness of how to obtain help.3,4

    On March 28, 2019, the television show Grey’s Anatomy aired an episode entitled “Silent All These Years” about sexual assault. At the end of the episode, actress Ellen Pompeo urged viewers to seek help and provided the contact number for the Rape, Abuse, and Incest National Network (RAINN) hotline (1-800-656-4673). Using data from Google Trends and Twitter, we assessed the influence of a popular television series episode on the public’s awareness of this sexual assault resource.


    We used Google Trends ( to search the terms “Rape, Abuse, and Incest National Network” (including “RAINN”), “sexual assault,” and “rape” between March 14, 2019, and April 4, 2019 (2 weeks before and 1 week after the episode aired). We used Sprout Social ( to search Twitter with the terms “sexual assault hotline” and “RAINN (excluding Wilson)” (to remove results about the well-known actor Rainn Wilson) and tweets referencing the account @RAINN. We chose this time frame to minimize other news stories associated with sexual assault that could confound results. We also contacted RAINN to determine telephone call volumes in the 48 hours after the episode aired. We used the autoregressive integrated moving average algorithm (R version 3.2.1 [R Foundation for Statistical Computing]) to forecast expected search and tweet volumes in the same 3-week period had the episode not aired.

    This study does not constitute human subjects research. It was therefore exempt from institutional review board approval and informed consent procedures.


    Inquiries for the term “RAINN” were 41% (95% CI, 17%-65%) greater than expected in the episode aftermath; search interest in the term “rape” was 8% (95% CI, 2%-13%) greater than the expected volume and searches for “sexual assault” increased 9% (95% CI, −3% to 21%) more than was expected. On the day after “Silent All These Years” aired, tweets mentioning the organizational Twitter account @RAINN increased to 1097% (95% CI, 676%-2512%) more than the expected volume. Tweets mentioning “sexual assault hotline” and “RAINN (excluding Wilson)” increased to 1955% (95% CI, 406%-207 600%) and 292% (95% CI, 120%-1731%) more than the expected volumes, respectively. Complete representation of relative search interest and Twitter searches for each inquiry are depicted in the Figure. Telephone calls to the RAINN sexual assault hotline increased 43% in the 48 hours after the episode released, per RAINN data.


    Results from this observational study suggest that this Grey’s Anatomy episode was associated with increased public awareness of sexual assault and the RAINN hotline. Increasing accurate portrayals of sexual assault in the media, coupled with increased awareness of organizations similar to RAINN, may positively affect public health.

    Google Trends and Twitter are only 2 factors associated with public awareness. Therefore, additional investigations into the episode's association with sexual assault reporting and hotline usage are warranted.

    However, Hollywood may be poised to help put the public back into public health. Organizations such as the Entertainment Industries Council already promote public health causes in Hollywood by providing depiction suggestions and tip sheets for a variety of issues, although not yet sexual assault. The World Health Organization has implemented guidelines for media to standardize the inclusion of suicide hotline numbers.5 Ayers et al6 recommended development of similar guidelines for substance abuse. We believe this recommendation can be extended to sexual assault as well. Additional possibilities to promote exposure include updating resources provided by the National Sexual Violence Resource Center and the National Center for Injury Prevention and Control.

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    Article Information

    Accepted for Publication: September 13, 2019.

    Corresponding Author: Trevor Torgerson, BS, Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK 74107 (

    Published Online: December 2, 2019. doi:10.1001/jamainternmed.2019.5280

    Author Contributions: Mr Torgerson and Dr Vassar had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Torgerson, Vassar.

    Acquisition, analysis, or interpretation of data: Torgerson, Khojasteh.

    Drafting of the manuscript: All authors.

    Critical revision of the manuscript for important intellectual content: Torgerson, Vassar.

    Statistical analysis: Torgerson, Khojasteh.

    Administrative, technical, or material support: Vassar.

    Supervision: Torgerson, Vassar.

    Conflict of Interest Disclosures: None reported.

    Additional Contributions: We thank the Rape, Abuse, and Incest National Network for providing telephone call data from around the time of “Silent All These Years.”

    Black  M, Basile  K, Breiding  M,  et al. National intimate partner and sexual violence survey: 2010 summary report. Published 2011. Accessed October 25, 2019.
    Finn  J, Garner  MD, Wilson  J.  Volunteer and user evaluation of the National Sexual Assault Online Hotline.  Eval Program Plann. 2011;34(3):266-272. doi:10.1016/j.evalprogplan.2010.09.002PubMedGoogle ScholarCrossref
    Young  SM, Pruett  JA, Colvin  ML.  Comparing help-seeking behavior of male and female survivors of sexual assault: a content analysis of a hotline.  Sex Abuse. 2018;30(4):454-474.PubMedGoogle Scholar
    Rape, Abuse & Incest National Network. The nation’s largest anti-sexual violence organization. Accessed August 27, 2019.
    World Health Organization Department of Mental Health and Substance Abuse; International Association for Suicide Prevention. Preventing suicide: a resource for media professionals. Published 2017. Accessed October 28, 2019.
    Ayers  JW, Nobles  AL, Dredze  M.  Media trends for the Substance Abuse and Mental Health Services Administration 800-662-HELP addiction treatment referral services after a celebrity overdose.  JAMA Intern Med. 2019;179(3):441-442. doi:10.1001/jamainternmed.2018.6562PubMedGoogle ScholarCrossref