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‘13 Reasons Why’ may influence suicide risk among vulnerable youths

In the first published study examining viewing patterns and reactions to the show “13 Reasons Why,” researchers found that about half of youth viewers presenting to a psychiatric ED with suicide-related concerns reported the series increased their suicide risk.

These results, published in Psychiatric Services, suggest that young people at risk of suicide may be vulnerable to the show’s themes, according to the researchers.

“We were seeing a spike in the number of youth presenting to the emergency room with increased suicide risk,” Victor Hong, MD, department of psychiatry, University of Michigan, told Healio Psychiatry. “When finding out that other institutions reported similar trends, and a number of youth were saying that watching '13 Reasons Why' had negatively impacted their mental health, we decided to set up the research study.”

Hong and colleagues assessed the exposure to and patterns of engagement with “13 Reasons Why” and its impact in a sample of young adults presenting to a psychiatric ED with suicide-related concerns in the year following the series’ premiere.

Participants included 87 parent-youth dyads — 71% of the youth were female — who completed a battery of questionnaires to examine their interaction with the show during their ED visit between July 2017 and March 2018. The questionnaire asked about access to and awareness of the show, the number of episodes watched, viewership timeline, reasons for watching or stopping the series, how youths viewed the series, with whom youths talked about the series, emotional responses and how much they identified with the lead characters.

The results revealed that 49% of the sample viewed at least one episode of the first season of “13 Reasons Why.” Hong and colleagues found that majority of youths (84%) watched the show alone and were more likely to discuss their reactions with peers (80%) than with a parent (34%).

In total, 21 respondents reported that the series increased their suicide risk. Most of those who watched the show reported identifying with at least one of the lead characters, Hannah (n = 40) and Clay (n = 37). Identification with Hannah was correlated with the perception that the series increased one’s suicide risk (P < .001), higher suicidal ideation (P = .001) and depressive symptoms (P = .004).

In addition, youth participants with depressive symptoms and suicidal ideation were more likely to identify with the lead characters and report negative affect while viewing. Overall, 12 youths reported that the series made them less likely to talk to others and 12 others reported that it made them more likely to talk to others about their personal mental health concerns.

“Given the vulnerability of youth already at risk for suicide, more care must be taken to monitor what they are involved in, including the media content they are consuming, so as to open a dialogue into the issues they are struggling with,” Hong told Healio Psychiatry. “Continued efforts to work with media companies are also important, to mitigate potentially harmful portrayals of suicide.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.