Ever since its release in 2017, the popular Netflix series 13 Reasons Why—a drama about teen suicide—has kept public-health officials concerned that the series might inspire some vulnerable viewers to take their own lives.
A new study provides the strongest evidence yet that these fears were justified.
"We estimate that the series' release was associated with approximately 195 additional suicide deaths," concludes a research team led by Jeffrey Bridge of Nationwide Children's Hospital.
This surge was restricted to 10- to 17-year-olds, and driven by boys, the researchers write in the Journal of the American Academy of Child and Adolescent Psychiatry.
"Young people are particularly vulnerable to the media," co-author Lisa Horowitz of the National Institute of Mental Health said in announcing the findings. While this study cannot definitively prove that exposure to the series directly caused the extra deaths, previous research found that watching the show heightened the risk of suicide among adolescents who were already thinking about taking their own lives.
Using data from the Centers for Disease Control and Prevention, the researchers analyzed monthly suicide data from January 1st, 2013, through December 31st, 2017. They grouped victims by age, placing them in one of three categories: childhood and adolescence (ages 10–17), emerging adulthood (ages 18–29), and adulthood (ages 30–64).
"After accounting for seasonal effects and an underlying increasing trend in monthly suicide rates, the overall suicide rate among 10- to 17-year-olds increased significantly in the month following the release of 13 Reasons Why," the researchers report. They also found elevated rates in the month before the release—when the program was being heavily promoted—and in the second and third months after it became available for streaming.
They found no similar increase in suicides among older people, or increased homicides among any group, during that same period.
The fact that the increased suicide rate was driven by boys but not girls is initially surprising, given that the series revolves around a teenage girl who commits suicide. But the researchers note that "a male adolescent character made a serious suicide attempt by firearm at the end of the series," which may have inspired troubled male youths to imitate him.
"Previous studies indicate that suicide contagion disproportionately affects those who strongly identify with the person who died by suicide," they write, noting there was a 10 percent increase in suicides in the five months following the death of Robin Williams.
A second season of the show is currently streaming on the site, and a third is expected to be released later this year. A University of Pennsylvania study released last week found some evidence that the second season had a more positive impact on young viewers—but only if they watched it in its entirety.
Adolescents who did so "were less likely to report recent self-harm and thoughts of ending their lives than comparable students who didn't watch the series at all," researchers announced. But those who stopped partway through were at greater risk of suicide than those who finished the season, or didn't see it at all.
As many experts have noted, media depictions of suicide can be constructive or destructive, depending on how the subject is handled. But even well-intentioned dramatists can't control when kids choose to opt out of a show—or know when a particular scene is resonating with a young viewer in an unbearable way.