Opinion

For years, we worried 13 Reasons Why could provoke suicidal behaviours. Now we have the evidence

Numerous mental health experts have long expressed concern about the "copycat" effect. We now have several studies that found that suicide rates increased following the release of the show's first season.

As clinical psychologists, we feel strongly that potential viewers should be aware of the available research

Numerous mental health experts have long expressed concern about the 'copycat' effect. We now have several studies that found that suicide rates increased following the release of the show's first season. (Beth Dubber/Netflix)

When the Netflix series 13 Reasons Why debuted a few years ago, there was wide concern that the show's depiction of suicide, which forms the basis of the plot, could provoke young viewers to engage in similar suicidal behaviours.
 
A few years later, we have evidence, instead of just speculation. And yet, Netflix nevertheless just released its third season of the show. 
 
Numerous mental health experts have long expressed concern about the "copycat" effect; that is, that depictions of suicide inadvertently promote suicidal behaviour in young viewers. We now have several studies that found that suicide rates increased — depending on the study, by as much as 29 per cent — following the release of the show's
first season. 

These studies examined national death rate data and found higher than expected suicide rates among pre-teens and adolescents in the months immediately following the release of the first season, even after accounting for seasonal effects and recent increasing trends in suicide rates.

There were also spikes in other indicators of suicide risk, such as admissions to a children's hospital for self-harm or suicidal behaviour, and internet searches for phrases such as "how to commit suicide" and "how to kill yourself."

At the same time, more positive internet searches regarding suicide also increased following season one (for example, searches such as "suicide prevention" and "suicide hotline number"). And some studies found a few positive effects of watching the show, such as reduced suicide ideation after watching all of season two, and greater knowledge of suicide risk factors after viewing season one.

More harm than good

But while it might sound like the findings are mixed, more and more research in this area suggest that for young people who may be struggling with mental health difficulties and thoughts of suicide, viewing the show may cause more psychological harm than good.

To an extent, Netflix did hear the concerns of mental health professionals and pediatricians, and in response, agreed to delete one scene from an episode in the first season that graphically depicted death by suicide. However, that was hardly the only problematic scene. 

Indeed, many additional components of the show did not adhere to existing media guidelines for the safe reporting of suicide, which include, for example, providing information about alternatives to suicide when someone is going through a hard time. While these guidelines were primarily developed for journalists and news reporters, there is a scene in 13 Reasons Why where the main character tries to go to her school counsellor for help, only for the counsellor to minimize how much she is struggling. Such scenes could convey the message that it won't help to ask for help.

For young people who may be struggling with mental health difficulties and thoughts of suicide, viewing the show may cause more psychological harm than good. (Netflix)

Another recommendation is to not glorify or sensationalize suicide when reporting about it, nor to discuss it as a solution to life challenges. Yet the entire premise of earlier seasons of the show is about how suicide is used as a revenge tactic against those who deeply hurt the main character. Several effective treatments to reduce suicidal thoughts and behaviours are out there, and we have the science to back them up. Depicting suicide as the only way out is a myth.

Further, in both seasons one and two, the show depicts two separate, graphic sexual assault scenes that were disturbing to watch, particularly when considering the young target audience for this show. No doubt those scenes would be re-traumatizing for the many survivors of sexual violence.

The end of season two also shows one character plotting a school shooting in retaliation against his frequent bullying, which we know can elicit a similar "copycat" effect to suicide. Research has shown that if media reporting of a mass shooting includes information such as the shooter's identity, life story and motive, it can increase the likelihood of an imitation effect for others, though we do not know if this effect translates to fictionalized media. 

In response to criticism, Netflix added an extended "trigger warning" to season two intended to prepare the viewer for the fact that some of the content may be distressing. While these warnings may help viewers make an informed decision about whether they want to proceed with watching, emerging research is showing that trigger warnings do not actually protect against or decrease negative emotional responses that individuals may experience if they decide to watch anyway. 

Additional research will likely shed greater light on the impact of this show, particularly after the airing of its third season. However, the current evidence warrants caution for future viewing. As clinical psychologists, we feel strongly that potential viewers should be aware of the available research on the potential psychological impact of the previous seasons before choosing to watch.

While we recognize the efforts Netflix has taken to address some of the show's problematic depictions of mental health, including the addition of a message containing mental health resources to each episode, we hope consultations with mental health professionals continue. We also hope to see the inclusion of plot lines that feature characters seeking help and overcoming adversity, which could lead to reductions in suicide rates — as opposed to elevated ones.


Dr. Natalie Mota and Dr. Christine Henriksen work as clinical psychologists in Winnipeg and are assistant professors in the Department of Clinical Health Psychology at the University of Manitoba. Their research focuses on the impact of stressors and trauma on mental health and on developing interventions to reduce mental health symptoms and suicidal behaviour.

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