If you haven't heard of Netflix's television series "13 Reasons Why," just ask the nearest teenager. They'll tell you it's an immensely popular show among their young-adult peers, depicting the anguish and eventual suicide of a teenage girl as experienced by a friend listening to the series of audio-cassette journal entries she left behind.
The implications of the show have been heavily debated. Some praised the show for its frank content, while some claimed it depicted an idealized idea of suicide that viewers might emulate.
A new study published in JAMA Internal Medicine led by San Diego State University Graduate School of Public Health Associate Research Professor John W. Ayers delved into Americans' internet search history in the days after the series aired, and found that queries for suicide and how to commit suicide spiked in the show's wake.
Ayers and colleagues turned to data from Google Trends a public archive of aggregate Internet searches. The team focused on searches originating from the United States between March 31, 2017, the series' release date, and April 18, a date selected because the suicide of former NFL player Aaron Hernandez might have contaminated the trends.
All searches containing the word "suicide"--except for those accompanied by the word "squad," as those were most likely for the unrelated movie "Suicide Squad," released around the same time. Moreover, to understand how search content also changed they analyzed common specific search queries related to suicide.
The team then compared those phrases' search frequency over that time frame with a hypothetical scenario in which the "13 Reasons Why" had never been released, based on forecasts using historical search trends. "This strategy allows us to isolate any effect "13 Reasons Why" had on how the public engaged with and thought of suicide," said Benjamin Althouse, a research scientist at the Institute for Disease Modeling and study coauthor.
All suicide queries were 19 percent higher than expected following the show. Some of that bump came from higher-than-expected numbers of searches for phrases like "suicide hotline" (up 12 percent) or "suicide prevention" (up 23 percent). But an alarming percentage of the spike also came from phrases like "how to commit suicide" (up 26 percent), "commit suicide" (up 18%) and "how to kill yourself" (up 9 percent).
"In relative terms, it's hard to appreciate the magnitude of '13 Reasons Why's release," added study coauthor Mark Dredze, professor of computer science at Johns Hopkins University. "In fact there were between 900,000 and 1,500,000 more suicide related searches than expected during the 19 days following the series' release."
A public health challenge
It's not clear whether any of those searches led directly to suicide, Ayers said, but previous research has found that increases in internet searches for suicide methods are correlated with actual suicides.
"While it's heartening that the series' release concurred with increased awareness of suicide and suicide prevention, like those searching for "suicide prevention," our results back up the worst fears of the show's critics: The show may have inspired many to act on their suicidal thoughts by seeking out information on how to commit suicide," Ayers said.
The team notes that some of the harm potentially related to the series' release could have been avoided by following existing media standards. "The World Health Organization has developed guidelines for media makers to prevent this very problem," said coauthor Jon-Patrick Allem, a research scientist at the University of Southern California and an SDSU alum. "It is critical that media makers follow these guidelines. For instance, these guidelines discourage content that dwells on the suicide or suicide act. "13 Reasons Why" dedicated 13 hours to a suicide victim, even showing the suicide in gruesome detail."
"These problems are exacerbated because online media exists forever, meaning more people are being exposed to the series' potential harms even now," added Eric Leas, a recent graduate of the SDSU joint doctoral program in public health and coauthor.
"We are calling on Netflix to remove the show and edit its content to align with World Health Organization standards before reposting," concluded Ayers. "Moreover, the planned second season, and all suicide related media, might undergo testing before wide release to prevent well intended content from producing unintended results."
JAMA Internal Medicine