Does Watching “13 Reasons Why” Increase Youth Suicide Risk?
Megan Chesin, Ph.D., William Patterson University
(originally published 3/7/2019)
13 Reasons Why (13RW) is a recent, popular, fictional television series that depicts suicide. The first season of 13RW was the second most in-demand digital series in the United States in 2017 [1], and it significantly engaged public interest in the topic of suicide[2]. Professional organizations released statements of concern that 13RW glorified suicide and might lead to increased suicide behavior, particularly among vulnerable adolescents and college-aged adults[3].
The media is increasingly a source of health information. How adolescents and emerging adults learn about suicide is no exception: More emerging adults and adolescents learn about suicide from the media than from professionals, friends, and family [4]. Thus, there is potential to educate about suicide through the media. However, pitfalls exist. Theory and research show media depictions of suicide are associated with the following:
· Suicide clustering, defined as an increase in the rates of suicide attempts and suicides in the space and time around the media depiction of the suicide; and,
· Suicide contagion, defined as an increase in the rates of suicide attempts and suicides among individuals who were definitely exposed to the suicide. That is, suicide contagion requires contact with the suicide, i.e., reading about or viewing the suicide in the media, whereas suicide clustering does not.
Suicide clustering and contagion are particularly common among adolescents and emerging adults relative to other age groups [5, 6], and the aforementioned phenomena are consistently observed when the media depiction is a non-fiction suicide (e.g., a depiction of a celebrity who dies by suicide)[7]. Associations between suicidal behavior and media depictions of fictional suicide are not consistently observed [8]. Given the popularity of 13RW, a fictional television series about the suicide of an adolescent that was released on Netflix in the spring of 2017 [1], however, further examination of whether and for whom media exposure to fictional suicide in general, and 13RW in particular, is associated with suicide behavior risk is important for suicide prevention in adolescents and emerging adults.
Associations between Exposure to 13RW and Suicide Behavior Risk
Specific to 13RW, preliminary evidence of suicide clustering in pediatric Emergency Departments in the 30 days after the release of 13RW was found [9]. In contrast, in a recent study that is forthcoming in the Journal of American College Health, we [10] found no evidence of suicidal behavior contagion among college students who watched 13RW. Specifically, we found no relationship between media exposure to the fictional suicide in 13RW and current suicide ideation severity or suicidal behavior risk among college students. While the absence of an association between suicide ideation and watching 13RW is encouraging, caution is warranted pending further study, particularly given the aforementioned study showing evidence for suicide clustering around the release of 13RW.
Alarm Among Professional Organizations About Suicide Behavior Risk When 13RW Was Released. Upon the release of 13RW (and prior to any research study of 13RW and suicidal behavior), professional organizations such as the National Association of School Psychologists [3] released statements of concern that 13RW glorified suicide and might lead to increased suicidal behavior, particularly among vulnerable adolescents and emerging adults. And, in fact, there remains good reason for such concern.
According to social learning theory, a psychological theory that explains how and when others’ behavior is imitated [11], or in this case, when and for whom suicidal behavior risk would be associated with exposure to the fictional suicide in 13RW—imitation is more likely occur when the viewer identifies with the model. Model celebrity status increases identification, as do shared characteristics and experiences with the model. Thus, future study of individual characteristics that may change the relationship between exposure to fictional suicide in 13RW and suicide behavior is warranted.
On The Flip Side: Associations between Exposure to 13RW and Suicide Knowledge
To the extent that education on risk factors for suicide and crisis management resources are effective parts of suicide prevention [12, 13], 13RW and other media depictions of fictional suicide may provide a platform for education on suicide and ultimately aide in suicide prevention. And, in fact, we [10] found suicide knowledge, i.e., knowledge of risk factors for suicide such as isolation, loneliness and disconnection, was positively related to watching 13RW among those with no personal exposure to suicide. This finding extends findings from a recent survey of emerging adults that found increased self-reported understanding of suicide with viewing of 13RW [14]. Interest in suicide prevention and internet research into suicide hotlines also increased after the release of 13RW[2], further suggesting that suicide knowledge is positively associated with viewing 13RW.
Resources for Discussing Suicide with Adolescents and Emerging Adults Exposed to Fictional Suicide in 13RW
Another positive consequence of 13RW and particularly early concern by professional organizations about the impact of 13RW on suicidal behavior among viewers was provision by Netflix of a companion episode, “Beyond the Reasons,” and a webpage with suicide crisis management resources. Moreover, professional organizations now provide multimedia resources for professionals, parents, and emerging adult and adolescent viewers who are interested in learning more about suicide, suicide risk factors, and how to discuss mental illness and suicide in the context of 13RW. Thus, resources exist to increase the likelihood that the benefits to suicide prevention of 13RW will outweigh the potential risk, at least for most adolescent and emerging adult viewers.
Conclusions
In sum, at this time, we need more research on whether exposure to the fictional suicide in 13RW is safe. Our research did not find evidence for a relationship between viewing 13RW and suicide ideation or suicidal behavior risk among college students. Caution is warranted, however, given the limited available data, and future study, particularly of vulnerable individuals (e.g., those with risk factors for suicide) and those who share characteristics with the main character are warranted. It is promising that suicide knowledge is associated with exposure to 13RW, particularly given the importance of education in suicide prevention. Resources are available to aide discussion and the likelihood that suicide knowledge is gained by viewers. Lessons learned during the release and broadcast of 13RW are applicable to future media depictions of suicide and include providing education on warning signs of and resources for managing a suicide crisis at the outset of broadcast. These lessons are consistent with evidence-based guidelines for media reporting of non-fiction suicides.
For Further Reading:
Chesin, M., Cascardi, M., Rosselli, M., Tsang, W., & Jeglic, E. (in press). Knowledge of suicide risk factors, but not suicide risk, is greater among college students who viewed 13 Reasons Why. Journal of American College Health.
Lauricella, A. R., Cingel, D. P., & Wartella, E. (2018). Exploring how teens and parents responded to 13 Reasons Why: United States. Retrieved from Evanston, IL: Northwestern University, Center on Media and Human Development.
Tools from Professional Organizations to Use When Discussing 13RW with Adolescents and Emerging Adults:
From the Jed Foundation
From the American School Counselor Association
Evidence-Based Guidelines for Media Reporting of Non-Fiction Suicides
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