Health

Netflix series 13 Reasons Why tied to more youth suicides, U.S. study suggests

Following the debut of the controversial Netflix series 13 Reasons Why, about a teen girl's suicide, a team of international and Canadian researchers estimate there was a 13.3 per cent increase in suicide among tweens and teens.

Entertainment industry urged 'to prevent further harmful suicide portrayals'

The Netflix series 13 Reasons Why traces the life and eventual suicide of teenager Hannah Baker, portrayed by Katherine Langford. (Netflix)

Following the debut of the controversial Netflix series 13 Reasons Why, about a teen girl's suicide, a team of international and Canadian researchers estimate there was a 13.3 per cent increase in suicide among tweens and teens.

In a study published in Wednesday's issue of the journal JAMA Psychiatry, Dr. Thomas Niederkrotenthaler of the Medical University of Vienna and his team say there were roughly 94 more suicides than expected in the U.S. among those aged 10 to 19 in the three months following the show's release. 

The authors focused on April to June 2017 because it coincided with the strongest interest in the show, which debuted in March, based on Instagram and Twitter data, compared with suicides over the previous 20 years.

"We can't prove that it's 13 Reasons Why but 13 Reasons Why is the obvious candidate," contributing to the increase, said study co-author Dr. Mark Sinyor, a psychiatrist at Sunnybrook Health Sciences Centre in Toronto.

"We expected in advance that there would be an increase in youth, and in particular young women because of the protagonist in the show, and what we saw was a sudden increase in suicides only in youth, not in older people, and in particular in young women."

For researchers, it's strong evidence that, like a contagion, suicide among identifiable people, whether real or fictional, can lead a small group of people to kill themselves. 

It presented Hannah Baker's suicide almost as like a good thing.- Dr. Mark Sinyor, psychiatrist, Sunnybrook Health Sciences Centre

In contrast, positive portrayals of getting help — such as stories of movie stars or athletes who recover from depression or suicidal thoughts — can be inspirational for young people who may be struggling, said Dr. Marshall Korenblum, an adolescent psychiatrist and associate professor at the University of Toronto. He wasn't involved in the study.

"The trouble with the show was … it was a disincentive to help seeking," said Korenblum. 

For Korenblum, who watched the first season, the biggest problem was how most of the parents and teachers were portrayed as ignorant at best and narcissistic at worst. In reality, most young people do have a trusted adult in their life to confide in and help lines and services are available, he says. 

Suicide wrongly glamorized

The study's authors called on public health and suicide experts to guide the entertainment industry "to prevent further harmful suicide portrayals."

Their estimates show a 12.4 per cent increase in suicides among males, an increase of 21.7 among females, in the three months when social media interest in the show was strongest. 

The Netflix show 13 Reasons Why is the subject of a new study co-authored by a Canadian, looking into suicides by teens and tweens before and after the show was released. Clarification: A previous version of this story did not include the full quote from Linda Schuyler at the 1:37 mark. 2:09

In public health terms, those increases are significant, Korenblum and Sinyor said, after accounting for expected seasonal changes in suicide rates.  

In a statement to CBC News, Netflix said there's no single reason people take their own lives and suicide rates have been increasing for years in the U.S.

"13 Reasons Why 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," a spokesperson for Netflix said in an email.

'Terrible message to send kids'

The company said the latest study, as well as one published last month suggesting a nearly 29 per cent increase among boys in the month after the show's premiere, raised important issues, but no cause-and-effect relationships can be drawn.

Sinyor countered that in public health terms, suicide deaths are ultimately the outcome that counts.

He said the show violated several best practices for safe reporting on suicide, including:

  • Glamorized and romanticized suicide.
  • Presented suicide methods.
  • Failed to describe how mental illnesses are treatable.

"Very troublingly, it presented Hannah Baker's suicide almost as like a good thing, as a positive because it hurt the [abusers] around her, which is completely erroneous and such a terrible message to send to kids," Sinyor said.

Korenblum said it would have been better if the authors had also done a "psychological autopsy" by asking parents of children who died by suicide whether their child watched the show to try to analyze the causes.  

While he says the study has weaknesses, Korenblum said the authors make an important point about portraying suicide better in fiction.

Given how the entertainment industry responds to ratings, Korenblum called for a "groundswell of protest" of people not watching the show to force changes. He gave the example of how Britain's magazine and fashion industries were forced to ease weight restrictions for models after people voiced their concerns about the images contributing to eating disorders.

Linda Schuyler, co-creator and executive producer of Degrassi, a Canadian drama that portrayed teen suicide with a focus on those left behind, says people writing or producing such shows shouldn't back away from the subject.

"Young people in particular want to hear about these tough subjects because if we don't talk openly about them, they're going to find other ways to talk about them," Schuyler said.

"But also make sure that all the choices you make in your storytelling are responsible choices."

Since Netflix does not publicly share viewership figures, the researchers indirectly estimated attention to the show from social media posts.


Where to get help:

Canada Suicide Prevention Service: 1-833-456-4566 (Phone) | 45645 (text) | crisisservicescanada.ca (chat)

In Quebec (French): Association québécoise de prévention du suicide: 1-866-APPELLE (1-866-277-3553)

Kids Help Phone: 1-800-668-6868 (phone), Live chat counselling at www.kidshelpphone.ca

Canadian Association for Suicide Prevention: Find a 24-hour crisis centre

If you're worried someone you know may be at risk of suicide, you should talk to them about it, says the Canadian Association for Suicide Prevention. Here are some warning signs: 

  • Suicidal thoughts.
  • Substance abuse.
  • Purposelessness.
  • Anxiety.
  • Feeling trapped.
  • Hopelessness and helplessness.
  • Withdrawal.
  • Anger.
  • Recklessness.
  • Mood changes.

With files from CBC's Amina Zafar and Deana Sumanac-Johnson