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. 2020 Feb;59(2):236-243.
doi: 10.1016/j.jaac.2019.04.020. Epub 2019 Apr 28.

Association Between the Release of Netflix's 13 Reasons Why and Suicide Rates in the United States: An Interrupted Time Series Analysis

Jeffrey A Bridge  1 , Joel B Greenhouse  2 , Donna Ruch  3 , Jack Stevens  4 , John Ackerman  5 , Arielle H Sheftall  4 , Lisa M Horowitz  6 , Kelly J Kelleher  4 , John V Campo  7
Affiliations

Association Between the Release of Netflix's 13 Reasons Why and Suicide Rates in the United States: An Interrupted Time Series Analysis

Jeffrey A Bridge et al. J Am Acad Child Adolesc Psychiatry. 2020 Feb.

Abstract

Objective: To estimate the association between the release of the Netflix series 13 Reasons Why and suicide rates in the United States.

Method: Using segmented quasi-Poisson regression and Holt-Winters forecasting models, we assessed monthly rates of suicide among individuals aged 10 to 64 years grouped into 3 age categories (10-17, 18-29, and 30-64 years) between January 1, 2013, and December 31, 2017, before and after the release of 13 Reasons Why on March 31, 2017. We also assessed the impact of the show's release on a control outcome, homicide deaths.

Results: After accounting for seasonal effects and an underlying increasing trend in monthly suicide rates, the overall suicide rate among 10- to 17-year-olds increased significantly in the month immediately following the release of 13 Reasons Why (incidence rate ratio [IRR], 1.29; 95% CI, 1.09-1.53); Holt-Winters forecasting revealed elevated observed suicide rates in the month after release and in two subsequent months, relative to corresponding forecasted rates. Contrary to expectations, these associations were restricted to boys. Among 18- to 29-year-olds and 30- to 64-year-olds, we found no significant change in level or trend of suicide after the show's release, both overall and by sex. The show's release had no apparent impact in the control analyses of homicide deaths within any age group.

Conclusion: The release of 13 Reasons Why was associated with a significant increase in monthly suicide rates among US youth aged 10 to 17 years. Caution regarding the exposure of children and adolescents to the series is warranted.

Keywords: 13 Reasons Why; suicide; suicide media reporting guidelines; time series.

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Conflict of interest statement

Disclosures:

Dr. Bridge has served on the Scientific Advisory Board of Clarigent Health.

Drs. Greenhouse, Ruch, Stevens, Ackerman, Sheftall, Horowitz, Kelleher, and Campo report no biomedical financial interests or potential conflicts of interest.

Figures

Figure 1.
Figure 1.. Association Between the Release of 13 Reasons Why and Suicide Rates in 10- to 17-Year-Old Children and Adolescents in the United States
Note: Blue circles indicate observed suicide rates between January 1, 2013 and December 31, 2017. Orange solid line indicates fitted values that best account for underlying level, trend, and seasonal variation prior to release. The leading edge of the shaded area indicates the initial airing of the 13 Reasons Why trailer. The trailing edge of the shaded area indicates the release date of 13 Reasons Why. Orange triangles indicate forecasted suicide rates; curved orange dashed lines indicate the upper and lower 95% prediction intervals. Observed suicide rates in March, April, June, and December 2017 were significantly higher than corresponding forecasted rates.
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