Review of: Zimerman A et al, J Am Acad Child Adolesc Psychiatry 2018;57(8):610–613

13 Reasons Why, a popular Netflix series, stirred controversy when it portrayed the bullying and suicide of a teenager. Although the program increased awareness of these issues, some clinicians argued that it glamorized suicide and would be detrimental to vulnerable viewers. Analysis of Google searches completed following the program’s release demonstrated mixed results, with an increase in searches for terms such as suicidal ideation (SI; a 19% increase) and planning (26%) as well as for suicide prevention (23%) (Ayers JW et al, JAMA Intern Med 2017;177(10):1527–1529). To better understand the impact of the series, a recent study tried to directly examine the exposed young viewers.

Investigators studied American and Brazilian Facebook users ages 12–19 who had “liked” Facebook pages related to 13 Reasons Why and watched the show’s entire first season. The study assessed depression using the PHQ-2 scale, which scores recipients from 0 to 6; a score ≥ 3 is indicative of depression. Additionally, participants were asked if they had ever experienced SI or bullying and if the program had changed their thinking about bullying or suicide. To rule out bias, authors recruited a control group of 2,323 participants who liked Netflix’s Facebook page, but not that of 13 Reasons Why.

Of survey respondents, 21,062 met criteria and completed the study. Demographically, most respondents were Brazilian (80%) and female (90%) with a mean age of 16 years. Interestingly, of the 65% with a lifetime history of SI, most (60%) reported having less SI after watching the program, and only 16% reported having more SI. A majority (65%) screened positive for depression in the 2 weeks prior to the show, and those with severe depression had a higher rate of increased SI as compared to those not depressed but with a history of SI (21% vs 8%). Almost 80% of subjects had experienced bullying in the past, and nearly half of them felt better about it after watching the show. 41% of participants had bullied someone in the past, and over 90% of them reconsidered bullying or bullied less after the series. No significant difference was found regarding a reduction in SI or bullying compared to the control group.

CCPR’s Take
This extremely large study may open up an important conversation for some teens. While we need more nuance in our thinking about the impact of media on teen bullying and suicide, we must remember that in many countries, including the US, we are facing rising teen suicide rates. Some experts recommend limiting suicide attempt scenes, providing suicide hotline numbers as subtitles in such scenes, and showing the possibility of recovery following suicide attempts. Finally, vulnerable teens may require parental supervision and support after viewing such programs, which can be challenging in our age of easy, private media access across multiple devices.