Months after it first debuted, the Netflix show “13 Reasons Why” is making headlines again.
A new study uncovered that internet searches centered around the term “suicide” increased in the weeks after the show premiered.
The online series, which follows the aftermath of a teen girl’s suicide, led to concerns from some parents and mental health experts that it glamorized suicide.
The study comes as teen suicide rates have been rising, according to the U.S. Centers for Disease Control and Prevention (CDC).
Today the CDC announced that older teen girls are dying by suicide at the highest rate in 40 years.
The impact of the show
Figuring out the actual impact of “13 Reasons Why” is difficult.
The study published this week in the JAMA Internal Medicine Journal set out to understand if there was any measurable impact, at least online.
The researchers from San Diego State University and other institutions, examined 20 popular Google search trends with the term “suicide.”
They found that in the 19 days after the show premiered on Netflix there was a 19 percent increase in different search terms that included the word “suicide.”
Included in the increase were search terms for prevention awareness like “suicide hotline,” but also for search terms that could indicate suicidal ideation like “how to commit suicide” and “how to kill yourself.”
At Healthline, we also saw an uptick in people viewing both content on suicide and depression compared with the three weeks before the show premiered.
Views of our suicide-related content and depression-related content increased 22 and 7 percent, respectively, from March 31 to April 18.
In a corresponding editorial in the JAMA journal, experts from Boston Children’s Hospital and Harvard Medical School, said the series and following study show the need for socially responsible programming in addition to better screening practices and early intervention to prevent teen suicide.
“We cannot ascertain whether the searches on ‘how to kill yourself’ were made out of idle curiosity or by suicidal individuals contemplating an attempt,” the editorial authors wrote. “While it is likely that far more were due to the former, the producers of the series should have taken steps to mitigate the latter, as encouraged by suicide prevention specialists.”
Joel Dvoskin, PhD, and chair of the Nevada Behavioral Health and Wellness Council, said the study on Google searches cannot really reveal whether or not people were actually considering suicide after watching the show or were just curious.
“I don't think we have a clue what this means. It certainly is a reason to do more research,” he told Healthline. “I think either side could be right … what you don’t want to do as a general matter is make suicide seem like a more practicable solution.”
Suicide rates on the rise
Teen suicide has increased for both boys and girls from 2007 to 2015, according to new data released by the CDC.
The researchers found that suicide rates for males aged 15-19 years increased 31 percent, from 10.8 per 100,000 by 2007 to 14.2 per 100,000 by 2015.
The percent change was even higher for teen girls between the ages of 15 to 19. That rate doubled from 2007 to 2015, going from 2.4 percent to 5.1 percent. It’s the highest suicide rate recorded for this group since 1975.
In light of these numbers, mental health experts who spoke to Healthline were divided about the show’s possible benefit or harm to teens’ mental health.
Joan Asarnow, a psychiatrist and director of the University of California, Los Angeles (UCLA) Youth Stress and Mood Program, said she was upset that the show depicted the suicide in a graphic and glamorized manner.
“It’s a very compelling show and it’s a very disturbing show,” Asarnow said. “It’s not going to affect every kid, but there are some kids who its really going to affect.”
Asarnow pointed out that studies have associated information or graphic details about suicide with increased thoughts of suicide ideation.
“It violates just about everything we know,” Asarnow said of how the show depicted suicide.
She pointed out that the show could have done more to highlight suicide prevention resources, and to show that some adults, especially the school counselors, could have made a difference.
“There's so much they could have done to make it better,” she said.
Other experts who work with teens felt the show opened up a way to talk about suicide without the associated stigma.
Caroline Fenkel, LCSW, psychotherapist at Newport Academy, which treats teens struggling with mental health issues, said she felt the series created an important channel for teens and adults to talk about this topic.
“I think the fact that Netflix capitalized on its popularity — to have discussions about how suicide affects teens and how sexual assault affects teens — needs to be applauded,” she said.
“This is a very, very misunderstood topic,” Fenkel said. “A lot of people when they hear someone committed suicide they can’t fathom the idea of taking their own lives.”
Fenkel said she was upset there weren’t trigger warnings when the show first was released and wishes the school counselor had been depicted in a way that showed how adults can help.
However, she thinks overall it could be a benefit to teens, even if it increased suicide-related search terms.
“The reason it increased search terms … it’s because no one watched the series and then went up to their teacher and said ‘I want to talk about suicide,’” said Fenkel. “We need to talk about suicide the way we talk about diabetes.”
Mental health experts stress that parents should open up lines of communication with their children early and be direct about suicidal thoughts.
Asarnow said she recommends that parents think of themselves as a protective seatbelt — there to be a buffer before a child starts to act on feelings of self-harm.
She explained parents should not take action only if they see clinical warning signs of suicide ideation. Instead, they should focus on looking for warning signs that the teen is troubled and address the problem early.
“I'll say the most important thing is any change positive or negative. If you see a change, watch them,” she said.
Other signs that teens or young adults are considering suicide is talking about wanting to die, cutting themselves, and expressing feelings that things will not get better.
She also advised parents to take the initiative to create open communication with their child so they feel comfortable talking with them about upsetting experiences.
“When they feel overwhelmed ... sometimes their ability to see options gets constricted,” Asarnow explained.
As a result, they can fixate on suicide as an option. But “if you can get them in that moment of time and just hold them in some way ... you can save their lives,” she said.
To reach the National Suicide Prevention Hotline, dial 1-800-273-8255.