
Release of “13 Reasons Why” Associated with Increase in Youth Suicide Rates - newsreview1
https://www.nimh.nih.gov/news/science-news/2019/release-of-13-reasons-why-associated-with-increase-in-youth-suicide-rates.shtml
======
sctb
Previous discussion:
[https://news.ycombinator.com/item?id=19788773](https://news.ycombinator.com/item?id=19788773).

------
aphextim
Same reason that when they show the shooter's face all over the media and they
give them tons and tons of attention, it typically spawns more copycats who
are just lonely/sad/broken teens looking for the same attention.

In the show, this teen's suicide was portrayed to have had an impact on many
students/families/teachers etc for a very long time after the incident. It
almost glorified the suicide and the methods of leaving tapes behind.

Real suicide is not so glorious and does not leave a much of an impact as you
would think, other than on the immediate family.

For example, when my mother committed suicide, my sister, grandparents and
myself were impacted severely for a bit, but outside of our family circle it
didn't have as much of an impact.

When I was in high school, we had a student commit suicide, which we ended up
having 1 school meeting regarding it, but after about a week it had been
forgotten by most and swept under the rug as everyone moved on to the next
thing.

I guess I am biased based on my two experiences with suicide, however
glorifying it in any way will only lead to more incidents.

~~~
umvi
The scary thing is that both this article and the example you cited are used
as reasons to limit constitutional freedoms:

Limit second amendment more to prevent mass shootings.

Limit first amendment more to prevent suicides.

Really though, we should be focusing on the root cause: lonely/sad/broken
people. Focus on helping/loving them and I bet suicide/mass shooting rates
drop significantly.

~~~
TheArcane
> Limit second amendment more to prevent more shootings.

I've always wondered the validity of a "constitutional freedom" that allows
random everyday people to own and operate tools that are essentially killing
machines.

~~~
mieseratte
> I've always wondered the validity of a "constitutional freedom" that allows
> random everyday people to own and operate tools that are essentially killing
> machines.

Not sure why you put quotes around constitutional freedom.

The reason for the amendment is such that when someone or someones come along
and attempt to abridge your rights you can kill them with the killing machine.

As simple as that.

~~~
TheArcane
> when someone or someones come along and attempt to abridge your rights

Isn't that what highly trained and professional law enforcement is for?

At least that's what they're for in my part of the world.

~~~
mieseratte
> Isn't that what highly trained and professional law enforcement is for?

That works fine and well until the police are the ones kicking in your door to
drag you away.

Fortunately for us all, that's not a thing that ever happens.

Since it clearly needs said, the 2A is not about day-to-day life. It's about
large-scale societal failure modes.

------
ggreer
The full text is on Sci-hub: [https://sci-
hub.tw/10.1016/j.jaac.2019.04.020](https://sci-
hub.tw/10.1016/j.jaac.2019.04.020)

I'm extremely skeptical. I don't know how many ways they carved up the data
before they found a segment of the population with increased suicide rates at
the right time. Also, the show is about a girl who kills herself, but the
female rate of suicide didn't increase enough to be considered statistically
significant. Lastly, the spike in suicides starts in March, which is a month
before the show was released. Their claim only makes sense if you think that
watching the trailer is enough to trigger suicides.

~~~
malandrew
Maybe I missed it in the article, but did they check the Netflix viewing
history of those that committed suicide. Seems like that would be a critical
causal link. If a show about suicide is available on Netflix and no one is
around to watch it...

~~~
ggreer
They did not. The CDC data on suicides only contains statistical information,
not identities. And even if the researchers did have the identities of
everyone who committed suicide, I doubt Netflix would share account data with
them. It would also be very noisy as many teens use their parents' Netflix
accounts.

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rightbyte
This is just bogus p-hacking and perverse causality analysis.

Look at their graph of monthly data.

[https://i.imgur.com/mc8PJW8.png](https://i.imgur.com/mc8PJW8.png)

You can't draw any conclusion from that but that it is an overall increasing
trend with cyclic tendencies by season.

March prior to the release in the end of March was already all time high rate
of suicides.

"Table 1. Association Between the Release of 13 Reasons Why and Suicide in the
United States, by Age Group"

I mean ... it's just stupid. The series' premiere date is also a arbitrary
point in time.

I don't refute that the series might have increased the suicide rate, but I
have no idea how to verify that or put a estimate on it. The authors surely
don't know either.

~~~
vadansky
Worse part is the top comments contains the following, based on this p-hacking
garbage:

>The scary thing is that both this article and the example you cited are used
as reasons to limit constitutional freedoms

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pseudolus
Obviously horrific but a major failing of the study is that it doesn't state
what percentage of the teens who committed suicide actually watched or were
even aware of Netflix's "13 Reasons Why". The conclusions are drawn from very
indirect evidence.

~~~
jammygit
A randomized double bind study probably has ethical issues. I guess this is
the best we can do, unless Netflix volunteers viewing data for everyone

------
pgrote
"When researchers analyzed the data by sex, they found the increase in the
suicide rate was primarily driven by significant increases in suicide in young
males. While suicide rates for females increased after the show’s release, the
increase was not statistically significant."

I have watched the series. I wonder why males saw a significant increase in
suicides if the show revolved around a female suicide. And, yes, I understand
they didn't find direct causation.

There explanation at the end was refreshing.

"While compelling, this research had several limitations. For example, the
study used a quasi-experimental design, meaning that the researchers cannot
make a causal link between the release of “13 Reasons Why” and the observed
changes in suicide rates. The researchers cannot, therefore, rule out the
possibility that unmeasured events or factors influenced suicide rates during
this period."

~~~
Mikeb85
Males commit suicide more, in general (in western countries).
[https://en.wikipedia.org/wiki/Gender_differences_in_suicide](https://en.wikipedia.org/wiki/Gender_differences_in_suicide)

Edit - as for why there were more male suicides linked to this show, one
reason for male suicides in western countries is the increasing
marginalisation of men (whereas in countries with more female suicides or a
more equal ratio, women are highly marginalised). If the show glorifies
suicide as a way to gain more attention and de-marginalise the individual, it
makes sense that more young men would do it.

~~~
adrianN
Men are more successful, but women try more often.

~~~
mieseratte
> Men are more successful, but women try more often.

What's the source behind that, particularly how do they count "try," e.g. is
it self-reported or based on emergency services dispatched?

Does something like sitting in your closet with a 12GA in your mouth for 30
minutes only to emerge unscathed, to never speak of it again count as a try?

~~~
adrianN
The Wikipedia article linked above:

> Although females attempt suicide at a higher rate, they are more likely to
> use methods that are less immediately lethal.

[https://en.wikipedia.org/wiki/Gender_differences_in_suicide#...](https://en.wikipedia.org/wiki/Gender_differences_in_suicide#Differing_methods_by_gender)

~~~
mieseratte
I'm asking about methodology as relates to the statistic, not for the sentence
in a Wiki.

~~~
adrianN
Then perhaps check out the references the Wikipedia gives?

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ysleepy
Paper:
[https://webcache.googleusercontent.com/search?q=cache:gUa9-S...](https://webcache.googleusercontent.com/search?q=cache:gUa9-SNEkTgJ:https://www.jaacap.org/article/S0890-8567\(19\)30288-6/pdf+)

The Werther Effect was well known, from inception, filming and publishing, the
concerns seem to have been brushed aside. I really can't see how the studio,
netflix and the producers can reject the blame for the induced suicides.

The show distinctly glorifies suicide, playing on the emotional issues and
need for acknowledgment of teenagers.

Responsibility does not vanish if the effects are indirect or abstract.

"We produced the show true to the book." is no defense at all and there is a
higher moral standard if you sell a product to children still.

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tyingq
I'm curious if there's an unusual dip after the spike. In other words, it
might have accelerated some suicides, versus adding to the overall rate over a
longer time period.

~~~
asadlionpk
That would be true if all the population watched the series at t0. But in
reality the series is always _new_ to someone somewhere.

~~~
jfrankamp
I think the parent was implying that the show's effect was time shifting
imminent suicides to 'now'. Since the consumption of streaming media is big-
spike-on-release + long tail, that big spike when the show is released would
still be visible. It would look like a spike and then dip for suicides
averaging to the trend line on a larger time scale.

~~~
tyingq
That's a terrific summary. Thank you. I'm predicting a dip based on
acceleration versus any real additive effect. I could certainly be wrong but
the stats would be enlightening.

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kaffeemitsahne
Potentially OT. Why do people write

>"While suicide rates for females increased after the show’s release, the
increase was not statistically significant."

instead of

>"Suicide rates for females did not increase significantly after the show's
release."

?

I have seen this quite often and it always seems a bit misleading to me.

Edit: I should have written the 2nd version as "No statistically significant
increase in [...] was found". My point is not about the difference between
"significance" and "statistical significance" but about mentioning an effect,
while also saying the effect is not statistically significant. If it's not
statistically significant, why mention it?

~~~
dbatten
IMO, your proposed second option leaves ambiguity as to whether "significant"
means "statistically significant" or "materially significant." The original
option is clear on that point.

However, I would argue that the original text is also misleading, because if
the result wasn't statistically significant, there's no evidence that rates
for females increased. If anything, the first option could perhaps say "While
suicide rates for females IN THE STUDY increased after the show's release, the
increase was not statistically significant, so we have no evidence that it's a
real effect."

~~~
Majromax
> if the result wasn't statistically significant, there's no evidence that
> rates for females increased.

That's not quite right. A conclusion of no statistical significance is not a
conclusion that there is no evidence to support the hypothesis, but that there
is _insufficient_ evidence.

The study failed to disprove the null hypothesis, but "failure to disprove"
does not prove it to be true either. A more powerful study (with a larger
sample size, or one that includes this incident in a meta-study of similar
media events) might be able to use this data to support a positive conclusion.

------
boomboomsubban
These suicide studies are ridiculous. A 30% increase works out to something
like twenty additional suicides in a population of around forty million.
Trying to blame that on a television show seems far fetched.

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emtel
You should be _extremely_ skeptical of this finding.

1\. It's an observational, retrospective study.

2\. The control analysis is dubious, and its unclear if the control analysis
was selected in advance.

2\. It's an astonishingly high effect size.

3\. They do numerous sub-group analyses without any indication that such
analyses were pre-registered, and apparently without doing any multiple-
comparisons corrections (e.g. bonferroni).

3\. From the article: "The observed suicide rate for March 2017 — the month
prior to the release of “13 Reasons Why” — was also higher than forecast. The
researchers note that the show was highly promoted during the month of March,
exposing audiences to the show’s premise and content through trailers. The
researchers did not find any significant trends in suicide rates in people 18-
to 64 years of age."

We're being asked to believe not only that the show itself can have this huge
effect, but that the trailer can too. But only among males in a certain age
group.

This stinks.

~~~
Rapzid
Nothing about this "research" is compelling. This is 2019s Momo; hide your
kids!

------
pessimizer
It's a show that (at least from the title, and a quick summary of the plot)
agrees with the common, awful idea that what people do to you can _make_ you
kill yourself, and that killing yourself will somehow punish the people who
made you do it. You would expect it to increase teen suicides as much as you
would expect a slickly produced show about a suicide bombing in a shopping
mall causing an unjust government to fall and the bomber to be remembered
forever as a hero to increase suicide bombings.

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jgrowl
> NIH-supported study highlights the importance of responsible portrayal of
> suicide by the media

I'm not going to say that media doesn't play a part, but this is mostly a
symptom of an inadequate mental health system and a disfunctional society that
provides no sense of community/cohesion. Many of us are painfully alone and
directionless. We come from broken homes and experience neglect and abuse in
childhood.

Pointing the blame at a TV show just feels insulting.

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slg
>When researchers analyzed the data by sex, they found the increase in the
suicide rate was primarily driven by significant increases in suicide in young
males.

"13 Reasons Why" was a show about the suicide of a young girl and was
primarily aimed at a young female audience. If the studies numbers were
primarily driven by an increase in suicides among young males, the causation
implied seems rather dubious.

~~~
kaonashi
You don't think young men can find young women influencing?

~~~
slg
That isn't my point. My point was that young men are less likely to be aware
of or watch a show that isn't targeted at them. They can't really be inspired
to copy something that they aren't familiar with. Similarly if the show was
the cause of the spike and the audience was largely young girls, why wasn't
there a statistically significant spike in the suicide rate of girls?

~~~
cameronbrown
> They can't really be inspired to copy something that they aren't familiar
> with.

Can't they? Who's to say they weren't _more_ influenced because the
protagonist was female? The show still had a significant male viewership rate
of 35%. That's not the majority, but it isn't small either.

------
lwf
Interesting to ponder, but hard to draw any conclusions. There are too many
confounding factors, including other prominent suicides covered in the media.

LA Times article criticising the study[1]:

> While no variations in the suicide rate were found for people ages 18-64,
> the rate among people ages 10 to 17 increased by 28.9% in April 2017, the
> month after the series debuted, the study said. It was also up significantly
> in June and December of that year, and was higher than expected in March
> 2017, when the show was heavily promoted. The April 2017 rate was the
> highest in the five-year period that was studied.

> Outside events include things such as the much-covered suicides of
> Soundgarden’s Chris Cornell in May 2017 and Chester Bennington of Linkin
> Park in July of that year, and the death of musician Tom Petty by accidental
> overdose that October, Moutier says. Also, former NFL star Aaron Hernandez
> died by suicide in April 2017. […]

> Here’s how a 28.9% increase can also be described as a “weak association,”
> according to Moutier: The overall suicide rate of boys 10-17 is actually
> very low, she says, around 0.6 per 100,000 people. Therefore, any change
> could be seen as significant change.

Guest column from the executive producer of the show[2]:

> However, the research failed to substantiate the author's own hypothesis:
> that when the show launched on March 31, 2017, young females would be most
> affected, because it's a girl whose suicide is depicted onscreen. In fact,
> there was no increase in suicide rates for adolescent girls that spring —
> and for boys the increase started before the show even launched. As you can
> see from the chart below, which is based on the same government data,
> suicide counts for adolescent girls over the last decade have been much more
> stable than for boys, which have risen consistently. The highest recorded
> month for girls was November 2016, well before anyone had ever watched 13
> Reasons Why.

[1]: [https://www.latimes.com/entertainment/tv/la-et-
st-13-reasons...](https://www.latimes.com/entertainment/tv/la-et-
st-13-reasons-why-suicide-study-netflix-20190501-story.html)

[2]: [https://www.hollywoodreporter.com/live-feed/13-reasons-
why-c...](https://www.hollywoodreporter.com/live-feed/13-reasons-why-creator-
refutes-studies-linking-netflix-hit-suicide-increase-guest-column-1213858)

------
penagwin
Depression is a tough topic. Speaking from experience here, it's healthy to
talk about your feelings, etc. But if you look at the communities like #
depression on tumblr/reddit etc, I bet it will make healthy people feel a bit
depressed.

In kinda a cyclic issue, the problem is that depressed people need to
sorrounded them selves with happy people to talk to, consume more positive
media,etc.

Otherwise you end up feeding your own depression, producing and consuming more
depressive content and comments with others.

To anyone facing depression : Please talk to a therapist, and consider
avoiding needlessly negative communities/media. Sorrounding yourself with
depressing things won't help.

~~~
jammygit
I actually disagree somewhat: if I’m feeling terrible, happy music makes me
feel worse but something a little similar to my mood is soothing. I think
that’s why Marilyn Manson and NIN were so popular

Edit: this is to an extent only. Burying yourself in an extremely negative
place does make things worse if you spend too much time there or go in too
deep

~~~
penagwin
I understand that feeling for sure! One of the common coping strategies (this
is a real strategy) my doctors have tried with me is: "Think about how others
are in worse situations".

But for me that made me feel worse. I'm financially stable, decently
intelligent, have been given a great start at life, etc. yet I can't go to the
grocery store without having a panic attack? How pathetic is that? On paper I
should have nothing to complain about - but the depression SAID NO.

So I definitely understand how you feel. It's kinda like how if you just broke
up with somebody serious, watching a makeout scene in a movie would just suck.

------
ta0xdeadbeef
Throwaway and vagueness for hopefully obvious reasons.

I was loosely involved in the production of this show. I didn't find out about
it until after our contribution was finished.

If I had known what content we were working on I would voiced my concern. I'm
deeply ashamed I had anything to do with this and if I had known, I wish I
could have verbalized my objection and voiced concern over being affiliated
with the reckless disregard the production staff has for a leading cause of
death among people in America that has taken the lives of friends and family.

------
thinkcontext
A pet peeve of mine is the noble suicide trope used often in film and tv.
Armageddon, Aliens, Endgame, 7 Pounds, its everywhere. I haven't seen any
research but I imagine it could normalize suicide in the minds of the
impressionable young.

I get that's its an effective (though artistically blunt) plot device but I
would prefer that it be used less.

~~~
chasd00
lots of heroic stories result in the death of the hero. I suppose suicide is
technically correct but the story is a heroic sacrifice not a suicide.

------
stunt
The movies we watch can affect our decisions and choices we make in our life.
And the affect is different for different people.

In the same way that those sponsored scenes already did to smoking and
drinking trends. Bad driving styles, attraction to martial art etc.

------
onychomys
Here's the study itself, although it's not open access, so you'll need to be
somewhere that can get you access to it.

[https://www.jaacap.org/article/S0890-8567(19)30288-6/fulltex...](https://www.jaacap.org/article/S0890-8567\(19\)30288-6/fulltext)

~~~
coolspot
Hey, I just found someone - [https://sci-
hub.tw/https://doi.org/10.1016/j.jaac.2019.04.02...](https://sci-
hub.tw/https://doi.org/10.1016/j.jaac.2019.04.020)

------
sigstoat
the title of the paper is at the bottom of the nih page. plugging that into
google produces this page:

[https://www.jaacap.org/article/S0890-8567(19)30288-6/pdf](https://www.jaacap.org/article/S0890-8567\(19\)30288-6/pdf)

which combined with sci-hub, gets you full text.

------
kart23
Yeah no cap they kinda glorified suicide. I don't mean like the gritty
details, but like the concept. The show romanticizes suicide as a way to get
back at the people who harmed you, solve your problems, and make a huge impact
on all the people around you, for better or worse.

------
bpfrh
This is not suprising and not the first time something like this happend.

There is even a term for that "Werther Effekt"

[https://en.wikipedia.org/wiki/Copycat_suicide](https://en.wikipedia.org/wiki/Copycat_suicide)

------
zzaacchh
This news marks the end of my Netflix subscription. This news should have
everyone at the company questioning why they are contributing to service that
claimed the lives of nearly two hundred children.

------
stjohnswarts
So I suppose that we should ban series about suicide... Also the more people
that drive, also increases the number of people who die on the road, thus it
follows that we ban driving.

------
devin
I seem to remember suicide being considered cool in the grunge era of the 90s,
especially after Kurt Cobain took his life. I wonder if there’s data on that.

------
ryanmercer
But how many people realized they were depressed, or someone around them had
suicidal tendencies, and got help as a result of this program?

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Havoc
This must be brutal for the producers & actors. I'd be crushed.

~~~
roywiggins
Netflix was told over and over that it would be prudent to remove the most
graphic scene, and it refused to... for _two years_. Until they did.

[https://www.theverge.com/2019/7/16/20696151/13-reasons-
why-n...](https://www.theverge.com/2019/7/16/20696151/13-reasons-why-netflix-
suicide-scene-removed-controversy-medical-experts)

~~~
mffnbs
Wow, this was recent, too.

------
gberger
Where can I find the full text of the study?

~~~
coolspot
[https://sci-hub.tw/https://doi.org/10.1016/j.jaac.2019.04.02...](https://sci-
hub.tw/https://doi.org/10.1016/j.jaac.2019.04.020)

------
aledalgrande
Funny how one tv series would have induced many suicides, while currently
family situation and society have nothing to do with it? Please...

------
MattSteelblade
Is there a link to the study?

------
acf_plot
But how many of those students watched the series? Or was it less direct?
Maybe the show’s popularity led to a higher number of suicide discussions,
insults, references etc?

