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Original Investigation
May 29, 2019

Association of Increased Youth Suicides in the United States With the Release of 13 Reasons Why

Author Affiliations
  • 1Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Unit Suicide Research & Mental Health Promotion, Vienna, Austria
  • 2Department of Criminal Justice, Wayne State University, Troy, Michigan
  • 3Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • 4Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  • 5Centre for Mental Health, Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
  • 6Centre for Mental Health in the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  • 7Complexity Science Hub Vienna, Vienna, Austria
  • 8Section for Science of Complex Systems, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  • 9Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
  • 10Department of Epidemiology, West Virginia University, Morgantown, West Virginia
  • 11School of Psychology, Department of Basic Psychological Research and Research Methods, University of Vienna, Vienna, Austria
JAMA Psychiatry. 2019;76(9):933-940. doi:10.1001/jamapsychiatry.2019.0922
Key Points

Question  Was the release of the Netflix show 13 Reasons Why associated with excess suicides in the United States?

Findings  In this time series analysis of monthly suicide data from 1999 to 2017, an immediate increase in suicides beyond the generally increasing trend was observed among the target audience of 10- to 19-year-old individuals in the 3 months after the show’s release. Age- and sex-specific models indicated that the association with suicide mortality was restricted to 10- to 19-year-old individuals, and proportional increases were stronger in females.

Meaning  The increase in suicides in only the youth population and the signal of a potentially larger proportional increase in young females all appeared to be consistent with media contagion and seem to reinforce the need for safer and more thoughtful portrayal of suicide in the media.

Abstract

Importance  On March 31, 2017, Netflix released the show 13 Reasons Why, sparking immediate criticism from suicide prevention organizations for not following media recommendations for responsible suicide portrayal and for possible suicide contagion by media. To date, little research has been conducted into the associations between the show and suicide counts among its young target audience.

Objective  To analyze the changes in suicide counts after the release of 13 Reasons Why.

Design, Setting, and Participants  For this time series analysis, 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 January 1, 1999, to December 31, 2017, were extracted from the Centers for Disease Control and Prevention’s WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Twitter and Instagram posts were used as a proxy to estimate the amount of attention the show received through social media from April 1, 2017, to June 30, 2017. Autoregressive integrated moving average time series models were fitted to the pre–April 2017 period to estimate suicides among the age groups and to identify changes in specific suicide methods used. The models were fitted to the full time series with dummy variables for (1) April 2017 and (2) April 1, 2017, to June 30, 2017. Data were analyzed in December 2018 and January 2019.

Main Outcomes and Measures  Suicide data before and after the release of the show in 2017.

Results  Based on social media data, public interest in the show was highest in April 2017 and was negligible after June 2017. For 10- to 19-year-old males and females, increases in the observed values from April to June 2017 were outside the 95% confidence bands of forecasts. Models testing 3-month associated suicide mortality indicated 66 (95% CI, 16.3-115.7) excess suicides among males (12.4% increase; 95% CI, 3.1%-21.8%) and 37 (95% CI, 12.4-61.5) among females (21.7% increase; 95% CI, 7.3%-36.2%). No excess suicide mortality was seen in other age groups. The increase in the hanging suicide method was particularly high (26.9% increase; 95% CI, 15.3%-38.4%).

Conclusions and Relevance  Caution must be taken in interpreting these findings; however, the suicide increase in youth only and the signal of a potentially larger increase in young females all appear to be consistent with a contagion by media and seem to reinforce the need for collaboration toward improving fictional portrayals of suicide.

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