Following the release of the first and second seasons of ‘13 Reasons Why,’ the controversial portrayal of suicide in adolescent culture is continuing to cause a stir among parents and medical professionals. Since its release, members of the medical community, including two psychiatrists for Atrium Health, Rodney Villanueva, MD, FAPA and Crystal Bullard, MD, have debated the mental health implications of glamorizing teen suicide. We asked them what they think about the data and how parents should prepare to discuss the show with their children.
“It is very concerning that there were increases in queries of how to die by suicide rather than queries on how to get help for suicidal ideation,” says Dr. Villanueva. “Many times, a reality is what is seen on a screen or a smartphone. Any media that romanticizes suicide should take this into account because there is a risk of portraying suicide as a legitimate, even poetic, way to resolve hopelessness.”
“Kids and teenagers are very impressionable, as we all know, and they often imitate what they see without truly grasping and perceiving the reality of that decision,” says Dr. Bullard. For that reason, Dr. Bullard strongly recommends that any adolescent watch the show with a parent or guardian if they choose to watch.
Dr. Bullard and Dr. Villanueva additionally stress that at-risk adolescents should not watch the show at all. “With or without a parent or trusted adult, at-risk youth shouldn’t watch this series,” says Dr. Bullard. “They may already be struggling with bullying or suicidal thoughts, and this series will only enhance those feelings in a negative way.”
What We Learned From Data
Since the release of the show, the online community has produced another trend captured by a paper published in JAMA Internal Medicine. A team of PhDs, using Google Trends, were able to show that suicide searches were significantly higher than expected, ranging from 15 to 44 percent depending on the day.
According to the research, 17 of the top 20 related queries were higher than expected, with the most rising searches focused on suicidal ideation. The report cites that searches for the phrases “commit suicide,” “how to commit suicide,” and “how to kill yourself” were all significantly higher.
Searches for “suicide hotline” and “suicide prevention” also were elevated, but concern remains as searches for suicidal ideation outpaced searches for prevention and help.
“Suicide is a significant problem. In fact, the Academy of Pediatrics in 2016 stated that suicide is the third leading cause of death form 15-24 year-olds,” said Villanueva. “With statistics like that, the creative teams behind entertainment must understand who their audience is and their ability to maturely process what they see as mere entertainment as opposed to an acceptable guide to resolving life’s problems.”
What Does All of This Mean?
According to the research, it is unclear whether any internet search term led to an actual suicide attempt, but it is concerning that searches indicating suicidal ideation also rose. The analysis shows the following:
- Suicide search trends are correlated with actual suicides
- Media coverage of suicides lead to increased suicide attempts
- Searches for suicide methods increased after the series’ release
While the development of any harmful thoughts or actions related to the show are unintentional, the show's producer, Selena Gomez, has been vocal about her passion to make a positive impact on this topic. We recommend that friends, families, and colleagues take the time to learn more about local resources like Mental Health First Aid and Atrium Health’s Behavioral Health Help Line. These resources, as well as your health care providers, are excellent means to education, which are helpful for starting a conversation about the graphic topics covered in Season 1 and Season 2.
What Can You Do?
“Clinicians, parents and school staff who work with teens should consider watching the series themselves in order to be better equipped to discuss the difficult content,” says Dr. Bullard.
Additionally, Dr. Villanueva recommends that parents and school staff better educate themselves on suicide. Not just education on the warning signs and how to get help, but on the demographics and risk factors for different age groups. Some children may have symptoms or home lives that place them at a higher risk for suicide:
- For example, a 2015 study in the journal Pediatrics showed that younger children who killed themselves were more likely to be African American and had a diagnosis of ADHD, rather than depression. These younger children also were more likely to have problems with family members.
“As far as how to prepare kids for the content of the show? Watch it with them if they are not high-risk and talk to them about it afterward,” says Villanueva. “Taking the subject of suicide out of the virtual world and having real, and frank discussions about it may open doors. We may learn something about our young people and what their struggles are.”
If you or a love one is in need of assistance, Atrium Health’s Behavioral Health Help Line is available 24/7 at 704-444-2400. Staffed by masters-level mental health professionals and registered nurses, the team is available to make referrals to behavioral health specialists, offer information to community behavioral health resources, or simply to talk through behavioral health problems.
You can additionally register for a free, eight-hour Mental Health First Aid (MHFA) course that teaches you how to identify, understand and respond to signs of suicide, mental illness and substance use disorders.
