‘13 Reasons Why’ influenced the suicide rate? It’s not that simple

In the month after the Netflix series “13 Reasons Why” started streaming, the suicide rate for youths 10 to 17 increased by nearly a third, according to a newly released study funded by the National Institute of Mental Health. The findings prompted a slew of stories on Tuesday about the “troubling” association between the show and the statistic. But reality is more nuanced than the number.

“We know that suicide is complex and there’s no one thing that causes it,” says Dr. Christine Moutier of the American Foundation for Suicide Prevention, which collaborated with Netflix on its “13 Reasons Why” suicide-prevention website and efforts to raise awareness.

The series “13 Reasons Why” is about a 17-year-old girl who commits suicide and leaves behind 13 audio tapes that explain who and what sparked her to do it. After the first season was released March 31, 2017, Netflix added a graphic-content warning before the first episode and pointed viewers to a website offering a crisis counseling contact and a suicide-prevention hotline number.

In last year’s second season, writers shifted the focus from suicide toward the issue of teen sexual assault. The series has been renewed for a third season.

The study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, looked at five years of suicide rates for people ages 10 to 64, from Jan. 1, 2013, to Dec. 31, 2017, and accounted for ongoing trends in suicide rates.

While no variations in the suicide rate were found for people ages 18-64, the rate among people ages 10 to 17 increased by 28.9% in April 2017, the month after the series debuted, the study said. It was also up significantly in June and December of that year, and was higher than expected in March 2017, when the show was heavily promoted. The April 2017 rate was the highest in the five-year period that was studied.

The higher rates resulted in an estimated 195 more suicides than would have been expected between April 1, 2017, and Dec. 31, 2017, with the increase primarily among young males. But because the study was limited by a “quasi-experimental design,” according to the NIMH, a causal link could not be made between the show and the suicide rate, only an association. Researchers couldn’t rule out the influence of unmeasured events, the NIHM said.

Regarding the accuracy of the increase found by the study, Moutier says, “One would need to look at all other risk factors that come to bear for boys 10 to 17.”

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Outside events include things such as the much-covered suicides of Soundgarden’s Chris Cornell in May 2017 and Chester Bennington of Linkin Park in July of that year, and the death of musician Tom Petty by accidental overdose that October, Moutier says. Also, former NFL star Aaron Hernandez died by suicide in April 2017.

The new study “was not designed to find causality,” she says. “It found a weak association between the show and suicide in boys.”

Here’s how a 28.9% increase can also be described as a “weak association,” according to Moutier: The overall suicide rate of boys 10-17 is actually very low, she says, around 0.6 per 100,000 people. Therefore, any change could be seen as significant change.

“The results of this study should raise awareness that young people are particularly vulnerable to the media,” says study author Lisa Horowitz, 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.”

A Netflix spokesman said Monday, “We’ve just seen this study and are looking into the research, which conflicts with last week’s study from the University of Pennsylvania. This is a critically important topic and we have worked hard to ensure that we handle this sensitive issue responsibly.”

(The University of Pennsylvania study showed that suicide risk might decrease for students who watched “13 Reasons Why” all the way to the end of the second season.)

Stephanie Rogers, also with the AFSP, notes that “13 Reasons Why” opened up the conversation about suicide on a larger scale, and Moutier urged parents to talk to their children, especially if they’ve been struggling in any way, and model good practices when it comes to mental and physical health.

And if a child is at risk but insists on watching the show, Moutier says, a parent should “watch with them, debrief them, and don’t binge-watch — watch one episode and then discuss it” before watching another.

“There are cases,” she adds, “where a child or a parent will decide along the way, ‘This isn’t for me,’ and stop watching.”

The streaming network wasn’t alone in drawing attention over the story, by the way: Jay Asher’s book “Thirteen Reasons Why,” on which the Netflix show is based, topped the American Library Assn.’s list of the most banned books for 2017.

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