The release of the controversial Netflix series 13 Reasons Why has been associated with an increase in suicide rates among US youth, according to a new study funded by the US-based National Institute of Mental Health (NIMH).

In a news release on Monday (Apr 29), the NIMH reported that the debut of the series corresponded with a 28.9 percent increase in suicide rates among US youth aged 10 to 17 for the month of April 2017.

The increase came even after accounting for ongoing trends in suicide rates. Spanning five years from 2013 to 2017, the study was conducted by researchers at several universities, hospitals, and the NIMH; and was published in the peer-reviewed Journal of the American Academy of Child and Adolescent Psychiatry.

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Controversial run

13 Reasons Why debuted on the streaming service on Mar 31, 2017 and was initially supposed to star Selena Gomez. The lead role was eventually passed to Katherine Langford, and Gomez served as the show’s executive producer.

Based on a 2007 novel of the same name by Jay Asher, the series follows a 17-year-old high school student, whose friend kills herself after facing bullying and sexual assault.

The graphic depiction of issues such as suicide and rape, along with other mature content prompted concerns from mental health professionals. In response, Netflix added a warning card to the show. From March 2018, a video plays at the start of each season of 13 Reasons Why, warning viewers about its themes.

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Research limitations

According to the researchers, there was no significant change in suicide rates for those 18 and older during that period. The study also found the rate of suicides was mostly driven by males.

“Youth may be particularly susceptible to suicide contagion, which can be fostered by stories that sensationalise or promote simplistic explanations of suicidal behaviour, glorify or romanticise the decedent, present suicide as a means of accomplishing a goal, or offer potential prescriptions of how-to die by suicide,” said Jeff Bridge, director of the Center for Suicide Prevention and Research at Nationwide Children’s Hospital and the lead author of the study.

While compelling, this research had several limitations, admitted the NIMH.

“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,” read the release.

“The researchers cannot, therefore, rule out the possibility that unmeasured events or factors influenced suicide rates during this period.”

Response to the study

Netflix has acknowledged the study in a statement, reported The New York Times. “We’ve just seen this study and are looking into the research, which conflicts with last week’s study from the University of Pennsylvania. It’s a critically important topic and we have worked hard to ensure that we handle this sensitive issue responsibly.”

That study revealed that viewers who stopped watching the second season of 13 Reasons Why exhibited greater suicide risk and less optimism about the future than those who continued to the end.

“However, unexpectedly, current students who watched the entire second season reported declines in suicide ideation and self-harm relative to those who did not watch the show at all,” read the study’s abstract.

“Moreover, those who watched the entire second season were also more likely to express interest in helping a suicidal person, especially compared to those who stopped watching.”

While the first season was lauded for its acting and directing, the second season of the Netflix series received a dismal 25 percent rating on Rotten Tomatoes, following a departure from the source material that shaped its debut season.

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