13 Reasons Why | watching suicide in TV can be contagious - CSH Vienna

13 Reasons Why | watching suicide in TV can be contagious


Jun 5, 2019

Study with CSH participation raises concerns about popular teenage drama

 

When Johann Wolfgang von Goethe published his novel “Die Leiden des jungen Werthers” (The Sorrows of Young Werther) in 1774, the story of a desperate young man committing suicide due to unfulfillable love reportedly provoked a wave of copycat suicides—the first known in history. 200 years later, suicide researcher David Phillips called this phenomenon “the Werther effect.”

 

Especially young people are susceptible to suicide contagion. This could be seen for instance in the 1980s in Vienna, when media reports on subway suicides led to a steep rise in the number of young people throwing themselves in front of a train. After a media ban on reporting these incidences, the number of subway suicides plummeted.

 

Problematic show 13 Reasons Why

 

Knowing all that, youth psychiatrists all over the world were highly alarmed when the Netflix teenage drama 13 Reasons Why went on-air in spring 2017. The series describes why high school student Hannah Baker felt forced to commit suicide; and it shows, in explicit pictures, how she sets an end to her life. The story adresses problems like bullying, gossip, or sexual assault and was exceptionally successful in adolescents. According to Netflix, 13 Reasons Why was the third most binge-watched series in 2017.

 

One of the early critics of the Netflix drama was Thomas Niederkrotenthaler from the Suicide Research & Mental Health Promotion unit at the Medical University of Vienna (MUW). Last week, Thomas, together with an international team of researchers, published a new study in the journal JAMA Psychiatry, that got worldwide attention. CSH researcher David Garcia, who has worked with Thomas before, was in charge of the Big Data part of the publication.

 

Thomas and colleagues criticize the Netflix drama for not following media recommendations for responsible suicide portrayal. “It is important to portray the problem of suicide on TV in order to destigmatise it,” the team says in a press release. “But it all depends on ‘how’ it is done.”

 

13 Reasons Why, the scientists argue, does not show the possibility of other solutions than suicide. It portrays the everyday life of its protagonists as hopeless and potential sources of help as useless. “Together with national and international organizations, we pointed out already soon after the release [of the show] that this can produce the false impression that no help is available or that such help is not effective,” says Thomas. “However, if you are feeling suicidal, it makes sense to seek help.”

 

New study shows rise in teenage suicides

 

For their JAMA publication, the scientists wanted to check a possible association between the release of the show and teenage suicides in the following weeks.

 

As Netflix does not share viewership data, the researchers came up with a different idea to track potential viewers of the show: “We did an extensive Twitter and Instagram search,” explains David Garcia, who was responsible for this part of the study. Twitter and Instagram are two of the most popular social media platforms used by US teenagers. “We think that references to the show on these platforms are a good proxy to the amount of attention the show received in different age groups.”

 

In an advanced search, David found more than 1,4 million Tweets, generated by more than 870,000 users, for the period April 1 to June 30, 2017. The major part of those Tweets, 84 percent, occurred in April.

 

From Instagram David derived a data set with more than 26,000 posts by 7,875 influencers, that is, people with more than 15,000 followers. Like on Twitter, the Instagram referrals to the Netflix drama peaked in April.

 

“After June there was no more social media attention for 13 Reasons Why. Therefor we defined the exposure window as April to June,” David explains.

 

22 percent more suicides in teenage girls

 

When the scientists matched the suicide numbers from US Centers for Disease Control and Prevention (CDC) with the assumed peak exposure to the show, they found an increase in suicides in the age group of 10 to 19 years—the target group of 13 Reasons Why. There was no rise in other age groups.

 

“We found more than 94 excess cases within these three months,” says Thomas. “These are 13 percent more suicides than we would have expected for that time of the year.”

 

In boys the raise was 12 percent, in females almost 22 percent. This was no surprise to the scientists, as the main character, Hannah, is a young woman. Translated to absolute numbers, 13 Reasons Why could have influenced 66 boys and 37 girls to successfully put an end to their lives.

 

When it comes to suicide methods, the increase was particularly high in hanging. Why not in slitting wrists, I asked David: This was the method used by Hannah. “Slitting is a suicide method that is most of the time unsuccessful,” says David. “People are often found before they die. Unfortunately we did not have data on attempted suicides. It would have been interesting to see if there was a similar spike in slitting in those three months.”

 

The researchers admit that they cannot know for sure if it was 13 Reasons Why that caused the increase in teenage suicides in 2017. But

  • knowing that adolescents are highly susceptible to the influence of their peers;
  • knowing that the explicit showing of suicides or suicide attempts in mass media provokes copycat suicides;
  • knowing that the show was (and still is) exceptionally popular in teenagers;
  • and given that the drama does not offer other solutions to the dreadful experience of bullying and sexual harassment than suicide,

it does not seem a stretch to connect the show with this suicide spike.

 

Avoiding suicide contagion in media

 

The scientists, in line with other suicide prevention institutions in the world, request the entertainment industry to be much more cautious with this difficult subject. “It is certainly not enough to put a simple disclaimer ahead of the show, like the one Netflix added to 13 Reasons Why,” says David. “There exists plenty of material for a responsible suicide portrayal in media. These rules should be followed.” In fact, Thomas Niederkrotenthaler was the lead author of the 2017 revision of the WHO recommendations. The booklet can be downloaded here.

 

Links to psychological helplines, brochures and other online material should be mandatory.

 

Parents as well as teachers are well adviced to watch 13 Reasons Why together with their kids and/or discuss reasons for, as well as possible ways out of, Hannahs desperate situation.

Additional information

 

Thomas Niederkrotenthaler’s team has developed a brochure with recommendations for teachers to discuss 13 Reasons Why (in German):

 

Empfehlung zum Umgang mit der Netflix-Serie „13 REASONS WHY – TOTE MÄDCHEN LÜGEN NICHT“ in der Schule

 

The study “Association of Increased Youth Suicides in the United States With the Release of 13 Reasons Why by Thomas Niederkrotenthaler, Steven Stack, Benedikt Till, Mark Sinyor, Jane Pirkis, David Garcia, Ian Rockett, and Ulrich Tran appeared in JAMA Psychiatry.

 

Follow this link to the MUW press release from May 29, 2019


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