13 Reasons Why is an American web television series, based on the 2007 novel by Jay Asher. The story revolves around an high school student and his friend, Hannah Baker, a girl who committed suicide after suffering a series of demoralizing circumstances brought on by selected individuals at her school. A box of cassettes recorded by the main character details thirteen reasons why she ended her life.

Ayers at al. published on July 31, 2017 a Research Letter on JAMA, describing his study on how internet searches for suicides changed, both in and content, after the series’ release. Using Google Trends the Authors applied a “quasi-experimental approach”, comparing internet search volumes after the premiere of the TV series, with expected search volumes if the series had never been released. In the end, it is unclear whether any internet query preceded an actual self-harm attempt. Results and conclusions of their analyses suggest that 13 Reasons Why, in its present form, may have both increased suicide awareness while unintentionally increasing suicidal ideation.

It is widely acknowledge in the literature that the negative effects of TV shows, such as the one in question, could be avoided following the WHO’s media guidelines for preventing suicide, which suggest to remove explicit scenes and to include suicide hotline numbers in each episode. On July 31, in an Editorial published on JAMA Editorial, Kimberly H. et al. state that, considering the strong audience response to the mentioned TV series, it is probable that others may be encouraged to produce similar shows. Furthermore new patterns of utilization of TV series such as “binge watching” increase the emotional impact and immersion into the story. This makes more urgent the application of preventive screening strategies.

Ungar et al. (2017) argued that international guidance on suicide and media should be strenghtned, implemented and enforced; proposing a “human centered design”, encouraging viewers to seek help for mental health problems supported by their study evidence that the “edutainment” design works for prevention.

On the contrary, Scalvini and Rigamonti published a Letter on the BMJ in October 2017, affirming that fictions such as 13 Reasons why may be a starting point for inspiring dialogue between adolescents and their main role model, parents, educators and therapists, and not delegate educational roles to the media which should not be censored. These Authors suggest that such shows could be used to demand the  government investing more in mental health services for young people.

To know more, contact EPA- SSSP e-mail address:

epasectionsuicidology@gmail.com

References:

• https://en.wikipedia.org/wiki/13_Reasons_Why (Text and image)
• https://atomic-temporary-124612160.wpcomstaging.com/guidelines/
• https://atomic-temporary-124612160.wpcomstaging.com/2017/10/31/scientific-news-and-reading-suggestions-9/
• Why we must defend suicide in fiction. Marco Scalvini, Flandina Rigamonti, BMJ 2017; 359: j4743 (Published 18 Oct 2017)
• Using the power of the media to reduce the risk of suicide. Thomas Ungar, Stephanie Knaak, Cameron Norman, BMJ 2017; 359: j4742 (Published 17 Oct 2017)
• Internet Searches for Suicide Following the Release of 13 Reasons Why John W. Ayers, PhD, MA; Benjamin M. Althouse, PhD, ScM; Eric C. Leas, PhD, MPH; et al Mark Dredze, PhD; Jon-Patrick Allem, PhD, MA JAMA Intern Med. 2017;177(10):1527-1529. doi:10.1001/jamainternmed.2017.3333 Research Letter October 2017 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2646773
• A Call for Social Responsibility and Suicide Risk Screening, Prevention, and Early Intervention Following the Release of the Netflix Series 13 Reasons Why. O’Brien KHM, Knight JR Jr, Harris SK.
• https://pixabay.com/it/numero-annuncio-giallo-colore-437931/