The Netflix hit "13 Reasons Why" spurred wide public debate this spring — and many a cautionary letter home from school — because of how it portrayed teen suicide: graphically and, some said, dangerously.
Now a new study offers some data points for future debates: It finds that Google searches on suicide spiked by about 19 percent overall in the days after the series was released, with a rise both in queries about "how to commit suicide" and questions about prevention and hotlines.
The study is out this week in the journal JAMA Internal Medicine, accompanied by a commentary calling for "social responsibility" on suicide prevention. I spoke with commentary co-author Kimberly O'Brien, a research scientist at Education Development Center and Boston Children's Hospital.
Our conversation, lightly edited, follows.
What is your commentary's central message?
Our commentary really was stressing how shows and movies hold great power, and that's why the creators of them, especially of those with suicide content, have a really important social and ethical responsibility to their viewers. There are safe messaging guidelines for suicide prevention that really need to be used, and they emphasize things like help-seeking as well, and provide information on how to find help by listing concrete steps before and after each episode. Calling the National Suicide Prevention lifeline at 1-800-273-TALK really needs to be emphasized when you have shows like this with suicide-related content.
Specific to "13 Reasons Why," the choice to graphically depict the suicide death of the star of the series was a really controversial decision. The reason for that is that a lot of research shows that pictures or detailed descriptions where a person dies by suicide can be a factor in vulnerable individuals imitating the attempt.
So the bottom line is that there's really a huge potential for impact here, and whether it's positive or negative, the creators of these shows need to find ways to create opportunities for the positive things and to do so in a responsible way.
Some takeaways from this commentary: For professionals, we just really emphasize the importance of screening, intervention and referral to treatment for suicide. This is something that clinicians really needs to take ownership of, to be trained in, and to develop comfort in.
For parents, they need to know about warning signs and about how to ask questions about suicide, because it can be a very intimidating and difficult thing for parents. They feel like they don't really know how to do that. But it is important that parents learn to become more comfortable with asking these questions of their children.
And for kids: Parents and kids need to work together on how to better communicate around these issues, which can be a really difficult thing. But luckily, there have been some really good resources that have been developed after the "13 Reasons Why" series came out on how to discuss these issues together. There's one by DeQuincy Lezine who put together a whole book, episode by episode, on how to discuss it with your teens, which I would recommend.
There was so much discussion when "13 Reasons Why" came out. What do we know now from this data that we didn't know before?
One thing that's difficult to ascertain from this study is we don't know if the people who made those searches did it just out of idle curiosity or if they did it because they were planning to actually kill themselves. But what we do know is that there was this spike, which could possibly mean that there was an increase in awareness, which is certainly something positive.
But what we really need to be careful of is the fact that for your typically developing child, a show like this may not be a huge concern, and it may actually have more positive than negative effects. However, for those who are particularly vulnerable — meaning they've had suicide-related thoughts or behaviors in the past, or they're currently considering suicide — to see a series like this can be very triggering. Especially when the creators of the series decided to graphically depict the suicide death of the star.
With this study, it's not clear whether or not there is a direct link, whether the spike means that more kids are considering suicide. We don't know that but it makes you speculate things on both the positive and negative sides.
When could we know that?
To be honest, I don't now how you could know that. The only way you could possibly know is if someone did a study where they looked from the date of the release of "13 Reasons Why" and they looked at actual suicide attempt rates, to see if there was a change. And this is really virtually impossible to do. We can get suicide death rates. But in terms of getting actual attempt rates, there's not surveillance data everywhere. Some places do collect those data, but in a lot of places they don't. So it's a question that I don't know if we can ever answer.
I suppose you could survey attempters and ask them if they were influenced?
You certainly could do that. Although a study like that — you couldn't ask every single person who's considered attempting. You could take a representative sample, but even then it would be difficult to do that and really find out truly if the series did cause, on the whole, individuals to consider suicide when they didn't before. It would be a hard thing to do.
Do you think having this data could help next time there's a controversy like the one over "13 Reasons Why"? There's reportedly a sequel in the works...
The hope is that when this sequel comes out, the producers will consult with multiple suicide prevention specialists, and do so during the development of the sequel, not just afterwards. Because movies and shows hold so much power, and they could do some amazing things with this, as they intended to do the first time. But if they get correct consultation, they'll be able to make the good TV that they want to make, and to also be ethically and socially responsible for the aftermath.
Readers, what have you been left thinking about the series?