“13 Reasons Why”: Increase in suicides in USA following TV series

Summary: The popular Netflix show “13 Reasons Why” has been linked to an increase in suicides in females between the ages of 10 and 19. Researchers said the numbers grew significantly within 3 months of the show’s release.

Source: Medical University of Vienna

Following the release of the Netflix TV series “13 Reasons Why”, in which a 17-year-old girl takes her own life, there has been a marked increase in the number of suicides in the USA. Lead investigator Thomas Niederkrotenthaler and Benedikt Till from the Suicide Research & Mental Health Promotion unit at MedUni Vienna’s Center for Public Health come to this conclusion in a study recently published in the leading journal JAMA Psychiatry. In terms of numbers: “In the 10 – 19 age group there was a 13% increase within three months, equating to 94.4 more suicides within this period.” Instead of the usual c. 720 suicides in this age group in a three-month period US-wide, there was a total of more than 800 associated with the TV series. Another US study published last month drew a similar conclusion, however, the new study was able to show that the increase concerned proportionally more girls than boys which was expected by researchers given the show’s female protagonist.

“It is important to portray the problem of suicide on TV in order to destigmatise it. But it all depends on ‘how’ it is done. It is important to show that there is always another solution, that there is always another way out of a difficult life situation” stress the MedUni Vienna researchers. This did not happen in this Netflix series, in which the everyday social issues faced by young people were portrayed as hopeless and consistently linked with the possibility of suicide. The Vienna researchers, who conducted the study in collaboration with scientists from Toronto, Melbourne, Michigan and Rochester, also complain that potential sources of help were all portrayed as being completely useless in the series. “Together with national and international organisations, we pointed out already soon after the release that this can produce the false impression that no help is available or that such help is not effective,” says Niederkrotenthaler. “However, if you are feeling suicidal, it makes sense to seek help.”

What is also interesting is that the increase in suicides was only present in the 10 – 19 age group. There was no apparent change in any other group. The study used monthly suicide data in the United States between 1999 and 2017.

Showing a way out, offering help

The international research group highlights that it is especially important to talk about media usage and to highlight the many sources of help that is available when speaking with young people – whether these be parents, teachers, doctors or other institutions. “It is extremely important to show that it is possible to take back control of your life by getting professional help and that there is always a way out.”

This shows a depressed girl sitting by a window
What is also interesting is that the increase in suicides was only present in the 10 – 19 age group. The image is in the public domain.

To this end, the researchers from the Medical University have worked together with colleagues under the umbrella of the Austrian Society for Suicide Prevention (ÖGS) to publish a brochure entitled “How to deal with the Netflix series ’13 Reasons Why’ in school”, which also serves as a model for teachers, doctors and even families to address other portrayals of suicide.

Talk to your children about their Internet and TV usage, ask them what they are looking at and why, and how they feel about it. Listen to your children and encourage them to get help if needed.” Says Niederkrotenthaler.

Urgent necessity to collaborate with the entertainment industry

“We hope this study helps shine spotlight on the ethical obligation of the entertainment industry to make sure that suicide-related content is safe.” says Mark Sinyor co-author of the study, psychiatrist at Sunnybrook Health Sciences Centre and assistant professor at the University of Toronto.

The international suicide researchers emphasize that the entertainment industry, improve their portrayal of suicide. “While the topic of suicide is important to address in the media, it is also imperative that it is done in a way that does not pose a risk to anyone who might be suicidal. This can be achieved by greater collaboration between the industry and suicide prevention experts”, they emphasize.

About this neuroscience research article

Medical University of Vienna
Media Contacts:
Thomas Niederkrotenthale – Medical University of Vienna
Image Source:
The image is in the public domain.

Original Research: Closed access
“Association of Increased Youth Suicides in the United States with Release of 13 Reasons Why”. Thomas Niederkrotenthaler, MD, PhD, MMSc; Steven Stack, PhD; Benedikt Till, DSc; Mark Sinyor, MSc, MD; Jane Pirkis, PhD; David Garcia, DSc; Ian R. H. Rockett, PhD, MPH; Ulrich S. Tran, DSc.
Cell. doi:10.100/jamapsychiatry.2019.0922


Association of Increased Youth Suicides in the United States with Release of 13 Reasons Why

Importance On March 31, 2017, Netflix released the show 13 Reasons Why, sparking immediate criticism from suicide prevention organizations for not following media recommendations for responsible suicide portrayal and for possible suicide contagion by media. To date, little research has been conducted into the associations between the show and suicide counts among its young target audience.

To analyze the changes in suicide counts after the release of 13 Reasons Why.

Design, Setting, and Participants For this time series analysis, monthly suicide data for the age groups 10 to 19 years, 20 to 29 years, and 30 years or older for both US males and females from January 1, 1999, to December 31, 2017, were extracted from the Centers for Disease Control and Prevention’s WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Twitter and Instagram posts were used as a proxy to estimate the amount of attention the show received through social media from April 1, 2017, to June 30, 2017. Autoregressive integrated moving average time series models were fitted to the pre–April 2017 period to estimate suicides among the age groups and to identify changes in specific suicide methods used. The models were fitted to the full time series with dummy variables for (1) April 2017 and (2) April 1, 2017, to June 30, 2017. Data were analyzed in December 2018 and January 2019.

Main Outcomes and Measures Suicide data before and after the release of the show in 2017.

Results Based on social media data, public interest in the show was highest in April 2017 and was negligible after June 2017. For 10- to 19-year-old males and females, increases in the observed values from April to June 2017 were outside the 95% confidence bands of forecasts. Models testing 3-month associated suicide mortality indicated 66 (95% CI, 16.3-115.7) excess suicides among males (12.4% increase; 95% CI, 3.1%-21.8%) and 37 (95% CI, 12.4-61.5) among females (21.7% increase; 95% CI, 7.3%-36.2%). No excess suicide mortality was seen in other age groups. The increase in the hanging suicide method was particularly high (26.9% increase; 95% CI, 15.3%-38.4%).

Conclusions and Relevance Caution must be taken in interpreting these findings; however, the suicide increase in youth only and the signal of a potentially larger increase in young females all appear to be consistent with a contagion by media and seem to reinforce the need for collaboration toward improving fictional portrayals of suicide.

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