Suicide-related searches on Google jumped significantly after the release of the show 13 Reasons Why, according to a report published Monday in JAMA Internal Medicine.
The show, which premiered in March on Netflix, follows the fictional story of Hannah Baker, a teenager who commits suicide and leaves behind 13 tapes detailing why she decided to end her life. Based on the popular Jay Asher novel of the same name, the series gained widespread interest in its depiction of suicide and the issues surrounding it. Some praised the show for spreading awareness and others accused Netflix of glamorizing suicide in a way that may promote self-harm.
“I felt that the debate wasn’t getting anywhere,” said John W. Ayers, the lead author of the study. “We needed data.”
He and four other researchers set out to determine whether Google searches related to suicide and suicidal ideation increased in the 19 days after the show’s release on Netflix.
They looked at searches that included the word “suicide,” removing results that included the word “squad” to control for searches of “Suicide Squad,” the 2016 film. They restricted their search to the time between the show’s premiere on March 31 and April 18, the day before the suicide of football player Aaron Hernandez.
The results were striking: During the weeks after the show’s release, suicide-related queries jumped by 19%, reflecting 900,000 to 1.5 million more searches than expected. Searches for the phrases “how to commit suicide,” “commit suicide” and “how to kill yourself” were all higher than expected. Searches for the terms “suicide hotline number, “suicide hotline” and “suicide prevention” were also up.
“13 Reason Why elevated suicide awareness, but it is concerning that searches indicating suicidal ideation also rose,” the researchers wrote.
The JAMA report suggested that 13 Reasons Why did not do enough to reduce the connection between the show and suicidal ideation, citing the World Health Organization’s (WHO) media guidelines for preventing suicide. Showmakers could have removed any scenes depicting suicide or addressed the issue by including suicide hotline numbers in each episode, the report said.
“Tragically, but unsurprisingly, we found the most dire consequences of this show: An increase in suicidal thoughts and thoughts known to be linked to suicide attempts,” Ayers said. He thinks the show is damaging in its current form and should be pulled from Netflix.
In a statement provided to USA TODAY, Netflix responded to the JAMA study, saying: "We always believed this show would increase discussion around this tough subject matter. This is an interesting quasi experimental study that confirms this. We are looking forward to more research and taking everything we learn to heart as we prepare for season 2."
The entertainment-streaming company said the show’s producers consulted several health professionals during production on their storytelling approach to suicide, sexual assault and bullying. The show was given a TV-MA rating, indicating that it is for mature audiences, and episodes containing more explicit material had specific warnings that were shown at the beginning.
Netflix also launched 13ReasonsWhy.Info, a website that points viewers to available mental health resources.
Although the JAMA study could not confirm whether any of the suicide-related searches preceded any actual suicide attempts, a 2011 paper looking at suicide death data from 2004 to 2009 in Taipei suggested that such searches could be tied to actual suicides. In that study, search terms like “complete guide of suicide” were correlated with actual suicide deaths.
Suicide is the third leading cause of death for youths from the ages of 10 to 24 in the U.S., resulting in 4,600 deaths each year, according to the Centers for Disease Control and Prevention (CDC). One nationwide survey of high school students published in 2012 by the CDC found that 16% reported seriously considering suicide, 13% reported creating an actual plan and 8% reported trying to take their own life in the past 12 months.
Past research confirms the existence of suicide “contagion,” where one suicide can set off multiple others. Often, celebrity suicides are the trigger, but there is also evidence that fictional dramatizations can do the same.
13 Reasons Why glamorized and sensationalized the act of suicide, said Daniel J. Reidenberg, executive director of Suicide Awareness Voices of Education (SAVE). In the show, Hannah Baker’s suicide is depicted as an act of revenge and the audience gets to see the results, but “that’s not what suicide is about," he said.
Reidenberg does not think the show’s first season should be pulled from Netflix’s offerings. So many people have already seen it and doing so could confer on the show “cult classic” status, driving even more young people to find ways watch it, he said. He has advised parents to watch the show with their children and to engage them in conversation between episodes. He said parents should do the same for the upcoming second season.