‘13 Rea­sons Why,’ more doc vis­its on sui­cide

USA TODAY US Edition - - NEWS - Anu­pam B. Jena, Josh Gray and Cass R. Sun­stein

On March 31, 2017, Net­flix re­leased the se­ries 13 Rea­sons Why, a pro­gram doc­u­ment­ing events lead­ing to the sui­cide of a fic­tional teen. The se­ries gen­er­ated enor­mous de­bate over whether its graphic content could spur self­harm among vul­ner­a­ble view­ers.

And rightly so. One study demon­strated a 19% rise in Google searches re­lated to sui­cide af­ter the show’s re­lease, in­clud­ing “how to com­mit sui­cide,” “com­mit sui­cide” and “how to kill your­self.” The study sug­gests that the show could have led some peo­ple to ac­tively con­tem­plate sui­cide.

With the ar­rival of Sea­son 2 to­day, is there re­newed cause for con­cern? We be­lieve so, based on our study of mil­lions of doc­tors’ vis­its by 14- to 20-yearolds dur­ing the weeks be­fore and af­ter the re­lease of Sea­son 1.

Us­ing elec­tronic data from AthenaHealth, an in­for­ma­tion tech­nol­ogy com­pany that sup­ports more than 4,500 physi­cian prac­tices na­tion­ally, we an­a­lyzed the pro­por­tion of doc­tor vis­its for sui­ci­dal ideation. We hy­poth­e­sized that these vis­its would in­crease in the months fol­low­ing the re­lease of 13

Rea­sons Why (we com­pared Jan­uaryMarch 2017 with April-June 2017). We stud­ied the same pe­ri­ods in 2016.

The pro­por­tion of vis­its in­volv­ing sui­ci­dal ideation was stable from Jan­uary to March 2017 (about 0.19% of all vis­its). Fol­low­ing the re­lease of 13 Rea

sons Why, such vis­its in­creased sharply to 0.27% in April and 0.29% of vis­its in May — a more than 40% rel­a­tive in­crease. A sim­i­lar pat­tern wasn’t ob­served in 2016.

These find­ings are wor­ri­some. To be sure, they could re­flect an in­crease in the num­ber of teens seek­ing help as a re­sult of view­ing the show. Even so, taken to­gether with the doc­u­mented jump in on­line searches for ways to com­mit sui­cide, the al­ter­na­tive ex­pla­na­tion of con­ta­gion in sui­ci­dal think­ing is im­pos­si­ble to ig­nore. Un­for­tu­nately, na­tional mor­tal­ity statis­tics lag by sev­eral years, so we don’t know whether ac­tual sui­cides in­creased af­ter the show’s 2017 re­lease.

The World Health Or­ga­ni­za­tion has rec­og­nized the im­por­tance of care­ful de­pic­tions of sui­cide by the me­dia and has pub­lished sui­cide pre­ven­tion guide­lines that specif­i­cally op­pose re­al­is­tic por­tray­als of sui­cide.

To its credit, Net­flix re­sponded to these and other con­cerns by com­mis­sion­ing re­search to pro­duce a bet­ter un­der­stand­ing of how teens and par­ents re­lated to the orig­i­nal 13 Rea­sons Why se­ries — and to in­form how Sea­son 2 could be most safely pre­sented.

Among sev­eral ini­tia­tives, cast mem­bers in Sea­son 2 will come out of char­ac­ter at the start of the sea­son to dis­cuss is­sues of de­pres­sion, sui­ci­dal think­ing and how to get help.

That’s good, but not enough. Health care providers, par­tic­u­larly those car­ing for vul­ner­a­ble teens, should be aware of the Sea­son 2 re­lease and the im­pact it might have on sui­ci­dal think­ing and be­hav­ior. Some have rec­om­mended that at-risk youth not view the show. That could be good ad­vice.

Ev­ery­one should agree that bet­ter data are also crit­i­cal. We do not yet know whether Sea­son 1 ac­tu­ally in­creased sui­cides or sui­cide at­tempts. But the cur­rent ev­i­dence, in­clud­ing our own, of­fers rea­son for con­cern. It jus­ti­fies a gen­eral warn­ing for both dis­sem­i­na­tors and view­ers of shows of this kind: Han­dle with ex­treme care.

Anu­pam B. Jena teaches at Har­vard Med­i­cal School. Josh Gray di­rects re­search at AthenaHealth. Cass R. Sun­stein teaches at Har­vard Law School.


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