Study links '13 Reasons Why' to possible increase in suicidal thoughts

Since it first aired in March, Netflix's 13 Reasons Why has inspired backlash and serious concerns from viewers and mental health experts alike. Now, a new study seems to support the argument that the series' graphic depiction and overall handling of suicide could be harmful.

Researchers analyzed internet searches immediately following the release of 13 Reasons Why, concluding that the show may be linked to a substantial increase in suicide-related searches and possibly suicidal ideation. Using the data tool Google Trends, the team found a spike of between 900,000 and 1.5 million more searches about suicide and suicide methods than expected over the first 19 days after the show aired.

The study, led by San Diego State University Graduate School of Public Health associate research professor John W. Ayers, was published Monday in the scientific journal JAMA Internal Medicine.

SEE ALSO: '13 Reasons Why' proves that good intentions aren't enough when it comes to portraying suicide

Ayers and his team of researchers focused on United States searches between March 31, 2017 (13 Reason Why's release date) and April 18, 2017 (so queries wouldn't coincide with the April 19 suicide death of former Patriots football player Aaron Hernandez). Every search phrase included the word "suicide," omitting the word "squad" so searches for the film Suicide Squad wouldn't contaminate the results.

Then they compared those results with searches and daily trends between January 15, 2017, and March 30, 2017 to get a baseline sense of what those searches are like generally.

The findings showed that after the release of 13 Reasons Why, which follows the events surrounding a fictional teenager's eventual suicide through a series of tapes she leaves behind, all suicide-related searches were 19 percent higher than expected.

While awareness-related phrases like "suicide hotline" and "suicide prevention" were up 12 percent and 23 percent, respectively, "how to commit suicide" increased by 26 percent, "commit suicide" by 18 percent, and "how to kill yourself" by 9 percent.

That said, it's unclear if these specific internet searches were definitely related to the show. It also isn't clear whether those searches actually led to suicide attempts or deaths. But Ayers noted that previous research has found a correlation between increased searches for suicide methods and actual suicides.  

"While it's heartening that the series' release concurred with increased awareness of suicide and suicide prevention ... our results back up the worst fears of the show's critics: The show may have inspired many to act on their suicidal thoughts by seeking out information on how to commit suicide," Ayers said in a statement.

Those fears have indeed dominated headlines over the past several months, as mental health organizations, experts, and survivors of suicide and suicide loss learned of the show.

In the first season's finale, the suicide of main character Hannah Baker is shown in graphic detail in a drawn-out scene, defying media standards and public health officials' recommendations to not provide detailed descriptions of suicide and methods used. As a result, experts worried the scene and the series' overall glamorization of suicide could lead to "contagion" — when exposure to news reports or media dramatizations of suicide lead to a temporary spike in suicides.

The researchers behind Monday's study are calling for more from Netflix, especially after it was announced that 13 Reasons Why would return for a second season.

"We are calling on Netflix to remove the show and edit its content to align with World Health Organization standards before reposting," Ayers said. "Moreover, the planned second season, and all suicide-related media, might undergo testing before wide release to prevent well intended content from producing unintended results."

Julie Cerel, a clinical psychologist and president of the American Association of Suicidology, who was not involved with this study, agrees with the authors' call for Netflix to be more responsible with its second season.

"I think that the show is not helpful and needs, at the very least, more information about how to get help as a part of each and every episode," Cerel said via email. "This includes not only resources for suicide, but also rape. I'm very worried the second season will have just as traumatic effects as the first."

Cerel believes the new study is exactly what is needed to show the effects of portrayals of suicide in media and entertainment. But she would have liked a little more transparency about why the authors made the decisions they made in the study. 

For example, she's unclear on why they used January 15, 2017 to March 30, 2017 as their hypothetical control scenario, instead of the prior year. Suicide rates peak in the spring, so searches might be expected to be slightly higher in April than in January.

"I also wonder if all the press around 13 Reasons Why was associated with some of the increase in searches," she said. "If the show had not been covered so extensively, maybe it might not have gotten amplified to the extent it was."

The research letter notes that the series has generated more than 600,000 news reports.

Ultimately, Cerel agreed with the study's conclusions, saying that the entertainment industry needs to be more responsible with the way it portrays suicide. It's crucial to understand that irresponsible portrayals can lead people who are already vulnerable to see suicide as a more readily available option. 

"Similarly to how cigarette smoking is no longer portrayed in entertainment geared at youth, we might consider portrayals of suicide be limited," she said. "It is important to show that suicide is preventable and that friends, family, and adults can be helpful in identifying people at risk and getting them to help before they die."

13 Reasons Why's cast and producers have been vocal about the show's potential for increasing awareness around such a serious topic. The series did use mental health professionals as consultants, but even though psychologists and psychiatrists may treat suicidal patients, that doesn't mean they've received specialized training in suicide.

To their credit, the show's creators launched 13ReasonsWhy.info at the same time as the series to offer viewers mental health resources, as well as a 30-minute behind-the-scenes episode called Beyond the Reasons that delved into these heavy topics. Plus, when it was first released, content warnings did appear on certain episodes. 

But some experts said that wasn't enough and that warnings and resources should accompany every episode so viewers have access to those resources when they actually need them. In May, Netflix announced it would introduce additional content warnings for the show.

Image: Courtesy of Julie Cerel; American Association of Suicidology

In a statement issued to Mashable in response to the study's findings, Netflix said the new study proves the show has sparked conversations.

"We always believed this show would increase discussion around this tough subject matter. This is an interesting quasi experimental study that confirms this," Netflix said in the statement, using the word "quasi experimental" from the research letter itself. 

"We are looking forward to more research and taking everything we learn to heart as we prepare for season 2."

The 13-episode second season of 13 Reasons Why is slated for release in 2018.

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. 

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