On March 31, 2017, a controversial series called, 13 Reasons Why premiered on Netflix. The show tells the story of a young high schooler who commits suicide and leaves behind a series of 13 cassette tapes for the people she held responsible. In the month following the show’s 2017 release, mental health experts, superintendents, and school counselors criticized the series for its glorification of suicide and worried it would lead to an increase in copycat behavior of self-harm among vulnerable individuals. After researchers examined data from the past five years, the show was found to be linked to a spike in suicide rates among US youths aged 10-17.
The National Institutes of Health published the study earlier this week, conducted by researchers at universities, hospitals, and the National Institute of Mental Health (NIMH). They examined whether the show’s release impacted rates of suicide, based on annual and monthly data on suicide-related deaths of individuals between ages 10 and 64 that occurred between January 1, 2013 and December 31, 2017—a time span encompassing the period before and after the show’s first 13 episodes.
The researchers found that the rates of suicide for 10- to 17- year-olds was significantly higher in the months of April, June, and December 2017 than were expected based on past data. This increase translated into an additional estimated 195 suicide deaths between April 1, 2017, and Dec. 31, 2017. The observed suicide rate for March 2017 — the month prior to the release of 13 Reasons Why — was also higher than forecast. The researchers note that the show was highly promoted during the month of March, exposing audiences to the show’s premise and content through trailers. The researchers did not find any significant trends in suicide rates in people 18- to 64 years of age.
Study author and clinical scientist at NIMH Lisa Horowitz, Ph.D., M.P.H., said, “The results of this study should raise awareness that young people are particularly vulnerable to the media … All disciplines, including the media, need to take good care to be constructive and thoughtful about topics that intersect with public health crises.”
The show’s creators defended 13 Reasons Why, saying they “aimed to make the drama helpful to struggling kids.” The hard-to-watch scenes, with graphic dramatizations of rape and suicide, and backlash for the series’ influence, led to a partnership of organizations in creating guidelines for portraying suicide in the media:
The findings of this study add to a growing body of information suggesting that youth may be particularly sensitive to the way suicide is portrayed in popular entertainment and in the media. This increasing recognition of entertainment and media influence has led a variety of groups, such as National Action Alliance for Suicide Prevention, the World Health Organization, and reporting on suicide.org, to create best practices for talking about and portraying suicide on screen. These guidelines recommend, for example, that the entertainment media should avoid depicting the suicide method used. The entertainment media are also urged to convey the message that help is available and to include accurate information about how people can seek help.
One year after the show’s premiere, Netflix added a short warning video at the start of each episode to promote resources for young viewers and their parents to address the show’s themes of sexual assault, substance abuse, and suicide. The show, which is based on the 2007 novel, 13 Reasons Why by Jay Asher, also produced 13 episodes in a second season and is planning a third season beginning in June 2019.
In 2001, we published a Cerebrum article on “Suicide in the Young” by Kay Redfield Jamison, Ph.D. Jamison, who specializes in suicide, depression, and manic-depressive illness, is a Dana Alliance member and professor of psychiatry at Johns Hopkins University. She writes:
We understand—up to a point—the mental states of those who kill themselves: the despair, depression, irritability, agitation, and sheer hopelessness. We have learned a great deal about the suicidal experience from the victims’ legacies—notes, diaries, psychological autopsies, and clinical interviews with people who have survived severe suicide attempts. We have compelling evidence from a large number of studies that the single most important factor in suicide is psychopathology: More than 90 percent of all people who kill themselves suffered from a major psychiatric or addictive illness (depression, manic-depression, schizophrenia, or alcohol and drug abuse), a severe anxiety disorder, or borderline or antisocial personality disorder.
Violence is, unquestionably, an integral part of many suicides. Poet Sylvia Plath, who was treated for depression and later killed herself, described a terrible violence within her: “I have a violence in me that is hot as death-blood,” she wrote, after an argument with a stranger in a park. “I can kill myself or—I know it now—even kill another. I could kill a woman, or wound a man. I think I could. I gritted to control my hands, but had a ﬂash of bloody stars in my head as I stared that sassy girl down, and a blood-longing to rush at her and tear her to bloody beating bits.” Igniting such a volatile temperament with psychological stress, or with depressive illness or other psychiatric disorder, is often deadly.
According to the Center for Disease Control, suicide is the third leading cause of death for 15- to 24-year-old Americans. May is Mental Health Month, and to help raise awareness about suicide among youths, the Department of Health & Human Services is holding an essay competition for students ages 16-18. The contest asks for high school students to describe a teen’s understanding of a specific mental health issue and ideas to promote better health and wellbeing in their communities. Submissions are open, and the deadline is May 31, 2019.
Suicidal thoughts or actions (even in very young children) are a sign of extreme distress and should not be ignored. If you or someone you know needs immediate help, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or Crisis Text Line: text “home” to 741 741.
Learn more about ways you can help someone who might be at risk for self-harm.
– Seimi Rurup