There was a significant increase in suicide rates among U.S. children and adolescents in the month after the first season release of the Netflix series “13 Reasons Why,” findings from a study published in Journal of the American Academy of Child and Adolescent Psychiatry showed.
“It was important to conduct this research because there were concerns that the series may actually promote suicide,” Jeffrey A. Bridge, PhD, from the Research Institute at Nationwide Children’s Hospital Center for Suicide Prevention and Research, told Healio Psychiatry.
In an interrupted times series analysis, the researchers examined the connection between the release of “13 Reasons Why” on March 31, 2017, and suicide rates in U.S. individuals aged 10 to 64 years.
Specifically, investigators used segmented quasi-Poisson regression and Holt-Winters forecasting models to evaluate the monthly rates of suicide before and after the show’s release among individuals grouped into three age categories — 10 to 17 years, 18 to 29 years and 30 to 64 years) from 2013 to the end of 2017. They also conducted a control analysis using homicide deaths as the outcome to distinguish any association with the release of “13 Reasons Why” from other concurrent events.
Within the study period, 180,655 suicide deaths occurred in U.S. individuals aged 10 to 64 years.
Suicide rates among those aged 10 to 17 years showed a significantly increasing trend in the months before the series’ release. After adjusting for seasonal effects and the underlying trend, analysis indicated that the release of “13 Reasons Why” was linked to a 28.9% step increase in the April 2017 suicide rate (incidence rate ratio = 1.29; 95% CI, 1.09-1.53) among this age group. In addition, the April 2017 suicide rate (0.57 per 100,000 persons) was the highest monthly suicide rate of any month over the 5-year study period.
Analysis revealed no statistically significant increase in suicide rates among those aged 18 to 64 years.
Based on the Holt-Winters analysis, Bridge and colleagues observed a statistically significant effect of the release of “13 Reasons Why” on later suicide. After the series’ release, they estimated 195 (95% CI, 168-222) additional suicide deaths among children and teenagers aged 10 to 17 years occurred between April 1 and December 31, 2017.
The researchers also calculated the difference in observed and expected suicide deaths removing April 2017 to determine whether the spike in suicides observed during this month accounted for the excess number of suicide deaths after the release of the first season; however, they still observed 137 excess suicide deaths (95% CI, 114-160) between May and December 2017.
“A take-home message for clinicians is that it’s important to ask patients the direct question, ‘Are you thinking of killing yourself?’ if there is a concern about suicide risk,” Bridge told Healio Psychiatry. “If the answer is ‘yes,’ developing a safety plan with the child and knowing where and how the family can access support and crisis resources is critical.” – by Savannah Demko
Disclosures: Bridge reports serving on the scientific advisory board of Clarigent Health; no other authors report any relevant financial disclosures.