Suicides in Young People in Ontario Following the Release of “13 Reasons Why”

Abstract

Objective: “13 Reasons Why,” a Netflix series, included a controversial depiction of suicide that has raised fears about possible contagion. Studies of youth suicide in the United States found an increase on the order of 10% following release of the show, but this has not been replicated in other countries. This study aims to begin to address that gap by examining the relationship between the show’s release and youth suicide in Canada’s most populous province. Methods: Suicides in young people (under the age of 30) in the province of Ontario following the show’s release on March 31, 2017, were the outcome of interest. Time-series analyses were performed using data from January 2013 to March 2017 to predict expected deaths from April to December 2017 with a simple seasonal model (stationary R 2 = 0.732, Ljung-Box Q = 15.1, df = 16, P = 0.52, Bayesian information criterion = 3.09) providing the best fit/used for the primary analysis. Results: Modeling predicted 224 suicides; however, 264 were observed corresponding to 40 more deaths or an 18% increase. In the primary analysis, monthly suicides exceeded the 95% confidence limit for 3 of the 9 months (May, July, and October). Conclusion: The statistical strength of the findings here is limited by small numbers; however, the results are in line with what has been observed in the United States and what would be expected if contagion were occurring. Further research in other locations is needed to increase confidence that the associations found here are causal.

Systematic review and meta-analyses of suicidal outcomes following fictional portrayals of suicide and suicide attempt in entertainment media

“…The 2017 Netflix series 13 Reasons Why, about the suicide of its fictional character, 17-year-old Hannah Baker, sparked strong criticism from mental health and suicide prevention organizations because it did not follow widely recognised media recommendations about how suicide should be portrayed in the media [2]. The concern was that the problematic narratives and messaging within the show could trigger additional youth suicides [3,4]. Specifically, concerns were based in the explicit imagery of a suicide method (cutting), the portrayal of help-seeking as being futile and counter-productive, and the notion that suicide might have a beneficial effect on others.…”

The association between Twitter content and suicide

“…Suicide is a major cause of global mortality (World Health Organization (WHO), 2019) and exposure to suicide-related media content is known to influence suicide rates in some instances (Niederkrotenthaler et al, 2010, 2012; Pirkis et al, 2006). However, determining which specific exposures are most harmful or helpful and quantifying the magnitude of these effects remain subjects of active study (Bridge et al, 2020; Fink et al, 2018; Gould et al, 2014; Niederkrotenthaler et al, 2010, 2012, 2019; Pirkis et al, 2006; Sinyor et al, 2018, 2019). Typically, studies of suicide contagion have examined a sudden, widely disseminated suicide event such as the death of a celebrity (Fink et al, 2018; Niederkrotenthaler et al, 2012) or, less commonly, the release of a television show/film depicting suicide (Bridge et al, 2020; Niederkrotenthaler et al, 2019; Sinyor et al, 2019).…”

Crisis text patterns in youth following the release of 13 Reasons Why Season 2 and celebrity suicides: A case study of summer 2018

“…Similarly, in a time series analysis of suicides among young people (<30) from Ontario, Canada in the 4 years before the release of Season 1 and afterwards (April to December 2017), the model predicted 224 deaths. However, 264 suicide deaths were observed in the province of Ontario during the follow-up period, or 18% more than expected (Sinyor et al, 2019). On the other hand, a recent meta-analysis demonstrated inconsistencies in the current evidence-base for suicide in viewers exposed to fictional media due to a number of methodological (e.g., aggregate designs, ecological fallacy, publication bias) and data limitations (Ferguson, 2018).…”