Update 7/19/2019: Netflix has decided to remove the scene depicting the main character's actual suicide, perhaps in response to data from this and other studies. Here's one story on the change.
The Netflix series "Thirteen reasons why" tells the story of a teenage girl who commits suicide, leaving behind audio recordings about people who contributed to her decision. When the series was released in April, 2017, mental health and school professionals became concerned about the possibility that young viewers of the show would experience increased risk of suicide themselves. The phenomenon of "suicide contagion" occurs when a publicized suicide leads to other suicide attempts. Young people may be particularly susceptible to its effects. Suicide is the third leading cause of death among American teenagers (ages 12 to 19, according to the CDC).
This Mashable journalist covers an empirical journal article published in JAMA Psychiatry in 2019. The Mashable story reports:
A new study, conducted by different authors, came to a similar conclusion: In the three months after 13 Reasons Why launched, the youth suicide rate for 10- to 19-year-olds rose unexpectedly by 13 percent. Based on historical trends dating back to 1999, 94 more American adolescents and teens died by suicide during the three-month period than otherwise expected. Similarly, the study published last month looked at suicide deaths in the nine months following the show's launch and found an additional 195 fatalities.
Students and instructors will find it useful to consult the publicly-available JAMA Psychiatry article that contains graphs of this study. Specifically, the solid orange lines in Figure 2 show the suicide rates for 24 months of time: 15 months before the show debuted, and about 9 months after.
a) This study used a quasi-experimental design. Which of the designs from Chapter 13 was it? (Non-equivalent control group posttest only? Non-equivalent control group pretest-posttest? Interrupted time series design? Non-equivalent control group posttest-only design?)
b) In the quote above, the journalist reported that an 13 percent increase in suicide equals an additional 94 adolescent teen deaths. This figure captures the effect size of the study's result. What do you think of this effect size? Would you call it small or large?
The empirical journal article also documents the publicity the show received via social media. Here's how the journalist describes the evidence:
Niederkrotenthaler and his co-authors looked at potential exposure to the show between April 1 to June 30, 2017, when the first season of 13 Reasons Why had just debuted and was most popular on Twitter and Instagram. Using social media data as a proxy for understanding peak interest in the show, the researchers suggest the show's portrayal of suicide created a 'contagion effect' The phenomenon can happen when media coverage of suicide leads to suicide clusters.
Students and instructors can consult the empirical article's Figure 1 to see the results of the social media analysis.
b) Why did the authors of the JAMA article include the social media piece? How does this evidence help them make their argument?
The researchers cannot establish for certain that viewing the show caused the increase in suicide. Here's the Mashable journalist:
While the researchers couldn't determine whether the children who took their own lives watched the series, an accompanying editorial written by researchers at Harvard and Stanford argues the study provides "strong evidence" that the Netflix show may have led to that increase.
"One cannot draw definitive causal conclusions from such data, but that no similar increase was seen in suicide rates other than for the age group to which the media portrayal pertained provides some further compelling evidence that the excess suicides may indeed have been owing to the series," the editorial's authors wrote.
c) The quote above adds an additional detail about the study. The researchers not only tracked the suicide rates of people aged 10-19; they also tracked suicide rates of people in the 20-29 and 30+ age group. The researchers found an increase in suicide after April 2017 only for the teenage group. How does this pattern of results support the argument that the show led to increased teen suicide?
If you want to talk to someone or are experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources.
