Another study points to link between '13 Reasons Why' and increased youth suicides

Last month, researchers published a study that found an association between the debut of Netflix's teen drama, 13 Reasons Why, and a subsequent uptick in youth suicides. The show depicted the grisly suicide of its protagonist, which alarmed mental health experts who were worried about the potential effect on young, vulnerable viewers.

A new study, conducted by different authors, came to a similar conclusion: In the three months after 13 Reasons Why launched, the youth suicide rate for 10- to 19-year-olds rose unexpectedly by 13 percent. Based on historical trends dating back to 1999, 94 more American adolescents and teens died by suicide during the three-month period than otherwise expected. Similarly, the study published last month looked at suicide deaths in the nine months following the show's launch and found an additional 195 fatalities.

The researchers who authored the latest study, published Wednesday in JAMA Psychiatry, used the same suicide data from the Centers for Disease Control and Prevention and similar methodology. They looked at the suicide rate amongst adolescents and teens between 10 and 19 years old, whereas the previous study analyzed trends amongst 10- to 17-year-olds. The new study found an increase in suicide in both male and female youth while the previous research observed that association only in boys.

"But both studies essentially have the same main finding — a clear increase of suicides among adolescents after the release of the series [at the] end of March 2017," Thomas Niederkrotenthaler, lead author of the JAMA Psychiatry study and an associate professor at the Medical University of Vienna, wrote in an email.

"So, there is now evidence from two independent teams who found the same main result. We hope that both of these studies' findings will now encourage collaborations between the entertainment industry and suicide prevention. We also hope that this will be a wake-up call to those who have not considered the relevance of these kinds of collaborations in the past."

Niederkrotenthaler and his co-authors looked at potential exposure to the show between April 1 to June 30, 2017, when the first season of 13 Reasons Why had just debuted and was most popular on Twitter and Instagram. Using social media data as a proxy for understanding peak interest in the show, the researchers suggest the show's portrayal of suicide created a "contagion effect." The phenomenon can happen when media coverage of suicide leads to suicide clusters.

While the researchers couldn't determine whether the children who took their own lives watched the series, an accompanying editorial written by researchers at Harvard and Stanford argues the study provides "strong evidence" that the Netflix show may have led to that increase.

"One cannot draw definitive causal conclusions from such data, but that no similar increase was seen in suicide rates other than for the age group to which the media portrayal pertained provides some further compelling evidence that the excess suicides may indeed have been owing to the series," the editorial's authors wrote.

Jeff Bridge, lead author of the study published last month, found the new research compelling.

"This study provides additional strong evidence of the importance of using best practices when portraying suicide in the media," Bridge, director of the Center for Suicide Prevention and Research at Nationwide Children's Hospital, wrote in an email.

Meanwhile, those affiliated with 13 Reasons Why continue to reject negative findings about the show's potential impact on certain viewers. The show's creator, Brian Yorkey, and Rebecca Hedrick, a psychiatrist and series adviser, published a column Tuesday in the Hollywood Reporter refuting the recent study last month as well as past research that found a spike in internet searches about suicide methods.

They rightfully point out that there is no single factor that causes suicide, but marshal in their defense Hedrick's clinical anecdotes of patients who felt the series was helpful. Yorkey and Hedrick also suggest alternate explanations, including the "detrimental impact" of the current political debate.

"We think that this response is unsatisfactory and disappointing," Niederkrotenthaler said of the Hollywood Reporter column.

In an interview with Mashable, Hedrick said she knew about but hadn't reviewed the forthcoming research when the Hollywood Reporter column was published. She said their pushback reflected frustration that the studies appear to suggest there's no benefit to watching 13 Reasons Why. Indeed, the authors of the study released in April wrote, "There is no discernible public health benefit associated with viewing the series, and caution regarding the exposure of children and adolescents is warranted."

Hedrick said research indicates the show positively influenced some viewers. A study published last month, for example, surveyed more than 500 college students who'd watched the series and found some developed greater knowledge about suicide as a result.

A Netflix spokesperson, who contested the studies' findings, said in an email that the show "tackles the uncomfortable reality of life for many young people today and we’ve heard from them, as well as medical experts, that it gave many viewers the courage to speak up and get help.”

Niederkrotenthaler said he hopes the entertainment industry takes seriously its power to promote "help-seeking and recovery" by creating more responsible depictions of suicidal thinking and behavior that offer hope. He recommended guidelines designed specifically for Hollywood and issued last year by the National Action Alliance for Suicide Prevention.

"Netflix said they wanted to start a conversation about suicide, but what they started was a conversation on their responsibilities in safely portraying suicide," said Niederkrotenthaler.

If you want to talk to someone or are experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources.