The popular Netflix series 13 Reasons Why caused a furore when it was shown in 2017, with critics saying its fictional portrayal of the suicide of a 17-year-old girl could lead to teenagers doing so in real life.
So, did it? The answer, according to one group of researchers, is a qualified “yes”.
Their time series analysis revealed an immediate 13% increase in suicides in the US beyond the generally increasing trend among the target audience of 10-to-19-year-olds in the three months after the show’s release. That, they say, corresponds to 94 more suicides than would be expected.
There was no such increase among people in their twenties or older. Gender-specific analyses suggest larger proportional increases among females.
The results “should be interpreted with caution”, however, in part because the study was based on data that makes it impossible to know whether those who died actually watched the show.
Nevertheless, the researchers – who were led by Thomas Niederkrotenthaler from the Medical University of Vienna, Austria – say the study points to the need for public health and suicide experts to work with the entertainment industry to prevent harmful portrayals of suicide.
The findings are reported in the journal JAMA Psychiatry.
For their analysis, the researchers used suicide data dating back to 1999 for US males and females extracted from the Centres for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER) database.
Twitter and Instagram posts were used as proxies to estimate the amount of attention the show received through social media from 1 April, 2017, the day after its release, to 30 June, 2017.
It was one of the most watched shows for the year, generating more than 11 million tweets in the first three weeks alone.
Mental health and suicide prevention organisations immediately criticised it for not following recommendations on responsible media portrayal of suicide. They expressed particular concern about the graphic depiction of the girl cutting her wrists, and the implication that seeking help for suicidal thoughts is futile.
The researchers note that the increase in suicides observed was concurrent with the period of strongest interest in the show, as reflected by Instagram and Twitter data, and occurred only in the age group targeted by the show.
“This study does not provide definitive proof that 13 Reasons Why is associated with harmful outcomes, but the findings are sufficiently concerning so as to warrant greater care and attention by Netflix and other entertainment producers,” they write.
“These findings support the urgent necessity for active engagement between those in the entertainment industry and mental health and suicide prevention experts to minimise or avoid potentially harmful suicide portrayals.
“In particular, media recommendations for responsible reporting of suicide in the news are readily available, but few resources are provided for those who create content in the entertainment industry.”
If this story has raised any issues for you or someone you love, please call these numbers:
In Australia, Lifeline: 13 11 14
In the US, national Suicide Prevention Lifeline: 1-800-273-TALK 
In the UK, Samaritans: 116 123
In India, Lifeline Foundation: +91 33 2474 4704
In Canada, Canadian Association for Suicide Prevention: (613)702-4446, or for a list of regional contacts: https://suicideprevention.ca/need-help/