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LOS ANGELES - A study funded by the National Institute of Mental Health suggested that the release of the Netflix show "13 Reasons Why" was associated with a 28.9 percent increase in suicides among youth ages 10 to 17 in the U.S. in April 2017.
The Netflix series, released on March 31, 2017, tells the story of a young girl who committed suicide and left behind 13 tapes that explain why she decided to end her life.
The findings highlight the necessity of using best practices when portraying suicide in popular entertainment and in the media, according to the National Institutes of Health, which the NIMH is a part of.
"The results of this study should raise awareness that young people are particularly vulnerable to the media," said study author Lisa Horowitz, Ph.D., M.P.H., a clinical scientist in the NIMH Intramural Research Program. "All disciplines, including the media, need to take good care to be constructive and thoughtful about topics that intersect with public health crises."
The study, published in Journal of the American Academy of Child and Adolescent Psychiatry, was conducted by researchers at several universities, hospitals and the National Institute of Mental Health. NIMH also funded the study.
The web-based show generated questions about how the portrayal of suicide affects young people who watch it, the NIH said.
For the study, researchers analyzed annual and monthly data on deaths due to suicide sourced from the Centers for Disease Control and Prevention. The data included information about the death of individuals between the ages of 10 to 64 that occurred between Jan. 1, 2013 and Dec. 31, 2017. That timespan encompassed the period before and after the release of "13 Reasons Why."
The researchers found that the rates of suicide for 10 to 17 year old adolescents were significantly higher than in the months of April, June and December 2017 than were expected based on the data, according to the NIH. The increase translated into an additional estimated 195 suicide deaths between April 1, 2017 and Dec. 31, 2017.
The number of deaths by suicide recorded in April 2017 was greater than the number seen in any single month during the five-year period. Researchers also found that the increase in suicide rate was primarily driven by significant increases in suicide in young males, according to the NIH.
The observed suicide rate for March 2017, which is the month prior to the release of the the web series, was also higher than forecast, the NIH said. The researchers noted that the show was highly promoted in March 2017, which exposed 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.
As a comparison, the study assessed the impact of the show's release on a control outcome of homicide deaths. It found that the release had no impact in the control analyses of homicide deaths within any age group. The lack of change in homicide rates during the period of interest "lends some strength to the idea that changes in suicide rates were influenced by the show" and not other environmental or social factors, the NIH said.
The research also has several limitations. The study used a quasi-experimental design, which means that the researchers cannot make a causal link between the release of the "13 Reasons Why" and the observed changes in suicide rates, the NIH said. Therefore, the researchers cannot rule out the possibility that unmeasured events or factors influenced suicide rates during this period.
The study's findings did 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, the NIH said. This increasing " recognition of entertainment and media influence" has lead to groups including the National Action Alliance for Suicide Prevention, the World Health Organization and reporting on suicide.org (http://suicide.org/) to create best practices for talking about and portraying suicide on screen, according to the NIH.
For example, the guidelines recommend that entertainment media should avoid depicting the suicide method used. The media is also urged to convey the message that help is available and to include accurate information on how the public can seek help. The study should also serve as a reminder "to be mindful of the possible unintended impacts" of the media's portrayal of suicide and for it to use best practices.
The National Suicide Prevention line is 1-800-273-TALK (8255), and with Crisis Text Line, the public can text "home" to 741741.
The second season of "13 Reasons Why" was released in May 2018, while the third season is in production and expected to be released this year.
Netflix did not immediately respond for comment to the study.