When news media follow recommendations for safe reporting, the risk of copycat suicide decreases.
The Recommendations for Media Reporting on Suicide were developed by leading experts in suicide prevention and in collaboration with several international suicide prevention and public health organizations, schools of journalism, media organizations, and key journalists, as well as Internet safety experts (www.reportingonsuicide.org). The recommendations are based on >100 international studies on suicide contagion. Furthermore, in recent years, Niederkrotenthaler and others have specifically examined suicide-related media portrayals focused on messages of hope, recovery, or mastery over a crisis. Research demonstrates that following such portrayals, those exposed experience a decrease in suicidal ideation, diminished distress, and an increased sense of hope.
Importantly, in some cases, fewer suicides are observed across the exposed population.
In other words, both suicide and resilience are contagious behaviors, and the content of suicide-related news media messaging can and does prevent tragic deaths.
until recently the scientific basis for that conclusion was less robust. However, Netflix’s global release of Season 1 of the series 13 Reasons Why in the Spring of 2017, which was not in line with recommendations for safe depictions of suicide, presented a unique opportunity to study the phenomenon. When the series was released by Netflix, there was a substantial outcry from suicide prevention and mental health experts from around the world who expressed concern that the depiction of suicide and related behaviors would increase the risk of harm (copycat behaviors) among some vulnerable viewers.
Now, 2 years later, the data are in, and studies have shown a clear increase in suicide and suicide-related behaviors in young people immediately following the release.
Although research limitations make it impossible to draw causal conclusions, there can be little doubt that the release of 13 Reasons Why Season 1 was a significant contributing factor in online search-related behaviors, new and increased suicidal ideation, suicide attempts, and tragically, deaths by suicide.
Furthermore, whereas some studies using online surveys noted that some viewers of 13 Reasons Why may have benefited from watching the show, many viewers experienced increases in suicidal ideation and a worsening of mood after exposure, particularly vulnerable individuals.
The sensationalized and repetitive suicide-related content portrayed over 13 hours in the first season of the series was likely an important contributing factor to the increased risk for some viewers. For example, the series opened with the main character and narrator (Hannah) telling viewers that she was deceased and that she had died by suicide. The Series also opens with her locker being adorned with flowers, cards, etc, and this is shown throughout Season 1, which only adds to the memorializing of her suicide. Subsequently, she explains at length how common stressful life events in youth, including mistreatment by her peers, were the “reasons” for her suicide. Hannah’s efforts to seek help for her distress and suicidal ideation are presented as futile, even counter-productive, and lead to the hopelessness that precede the unnecessary graphic portrayal of her suicide.
There will always be differing reactions to fictional media such as a TV series. However, the risk of copycat suicides clearly applies to those audiences with increased pre-existing vulnerability and high identification with the characters and how the depictions of suicide-related content are presented.
The same social learning mechanism could be harnessed to encourage youths to find paths to resilience. A story that had focused on how to cope with suicidal ideation could have helped the same vulnerable individuals to identify healthy coping strategies and to manage their suicidal ideation, rather than, as the data show, to result in tragedies.
Following the Netflix release of 13 Reasons Why in 2017, many mental health, suicide prevention, and education experts from around the world expressed a common concern about the series’ graphic content and portrayal of difficult issues facing youths. Resources and tools to address these concerns were quickly and widely disseminated in an effort to help parents, educators, clinical professionals, and other adults engage in conversations with youths about the themes found in the show. In advance of the release of season 2, SAVE (Suicide Awareness Voices of Education) brought together a group of 75 leading experts in mental health, suicide prevention, and education, as well as health care professionals, to develop tools to help encourage positive responses to the series. This group has developed a toolkit providing practical guidance and reliable resources for parents, educators, clinicians, youths, and media related to the content of the series (suicide, school violence, sexual assault, bullying, substance abuse, etc), which can be found at www.13reasonswhytoolkit.org. Tools such as these can be used by professionals in their work with youths and families. Messages of hope, resiliency, recovery, and bereavement following a depicted suicide are all areas that the entertainment industry must begin to address in future productions to prevent further tragedies like those observed following 13 Reasons Why, season 1.
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The authors have reported no funding for this work.
Disclosure: Drs. Reidenberg, Niederkrotenthaler, Sinyor, Bridge, and Till have reported no biomedical financial interests or potential conflicts of interest.
All statements expressed in this column are those of the authors and do not reflect the opinions of the Journal of the American Academy of Child and Adolescent Psychiatry. See the Instructions for Authors for information about the preparation and submission of Commentaries.
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