Study showing association between Netflix's 13 Reasons Why and youth suicide rates

cara susanna

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WisNeuro

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The issue with (relatively) low base rate phenomena is that there are wild swings in the data over time. Do they explain why there is an increase in April, June, and December? Kids watching it in batches? If they can replicate it based on numbers from Season 2, it may be a bit more compelling, but I'm not so sure it's not just noise in the data. Particularly in the one demographic group that is showing a rise over time, raises the chance for blips in the data that can look like something meaningful when they are really just a part of a trend over time.
 

DynamicDidactic

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I've talked with undergrads about this a few times. Theoretically, there isn't much evidence to support the idea that watching a show about suicide would lead to more suicide unless the show demonstrates methods/means. Typically, anything that would encourage discussion should actually help people seek treatment. The idea of a contagion is not well support by the research (but difficult to study). The problem is I haven't watched the show and don't actually know its content.
 

DynamicDidactic

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The issue with (relatively) low base rate phenomena is that there are wild swings
Agreed and to clarify for undergrads and nonpsychologists.

Instead of wild, we mean to say normal fluctuations in data are interpreted as wild because of low base rates.
 

WisNeuro

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Agreed and to clarify for undergrads and nonpsychologists.

Instead of wild, we mean to say normal fluctuations in data are interpreted as wild because of low base rates.
Yes, I should have clarified that the fluctuations may look like "wild swings" due to the low base rates.
 

Temperance

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Theoretically, there isn't much evidence to support the idea that watching a show about suicide would lead to more suicide unless the show demonstrates methods/means.
One of the major complaints when the first season was released was that there was a graphic scene of a character's suicide.
 
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cara susanna

cara susanna

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Yeah, the show violated a lot of the guidelines for depicting suicide in the media that are supposed to address contagion effects.
 
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DynamicDidactic

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Yeah, the show violated a lot of the guidelines for depicting suicide in the media that are supposed to address contagion effects.
Again, I don't think the evidence is strong in support of a contagion effect for suicide. Lots of anecdotal and media reports but not strong scientific evidence.
 
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When I was a counselor for Crisis Text Line, we saw a dramatic spike in clients when 13 reasons came out. They keep data on all kinds of things, and that was a noticeable bump.
 

DynamicDidactic

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Have you read the work of Madelyn Gould?
I am familiar with her work but not intimately. I know she is in the contagion camp. The evidence has not been strong enough to convince me. But, as I said, it is very difficult research to do. Theoretically, it is hard for me to digest. Unless you are showing people unknown methods/means or glorifying the experience, it should have a palliative effect. I am very open to changing my mind with more evidence.
 

Temperance

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Again, I don't think the evidence is strong in support of a contagion effect for suicide. Lots of anecdotal and media reports but not strong scientific evidence.
A group did a study with an undergraduate sample testing the effects of articles that report media reporting guidelines and apparently found that not only did participants not report feeling distress at one-month follow-up but also that participants with prior suicide ideation reported a lower likelihood of making a future attempt: https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.22199

Self-reported predictions are different from actual behaviors, but I have wondered how much of an effect that the guidelines have had on suicide risk overall; as you said, it's not exactly easy to test (or, I imagine, to ask an IRB about testing). There appears to be a contagion effect for self-injury based on qualitative studies, but that research seems to be more about non-suicidal self-injury than about suicide-related behaviors.

When I was a counselor for Crisis Text Line, we saw a dramatic spike in clients when 13 reasons came out. They keep data on all kinds of things, and that was a noticeable bump.
Does Crisis Text Line know if that effect was specifically due to 13 Reasons Why or if it was due to increased awareness of the service? Crisis Text Line is included in the list of resources that Netflix has on the website that they advertise at the end of each episode.
 
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cara susanna

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I know an adolescent DBT therapist who said that they had an increase in suicidal behavior and several of his patients told him that they'd attempted because the show gave them the idea.
 

DynamicDidactic

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There appears to be a contagion effect for self-injury based on qualitative studies, but that research seems to be more about non-suicidal self-injury than about suicide-related behaviors.
This I could see and anecdotally makes sense. For DBT groups, participants do not describe their NSSI behaviors explicitly and are instead asked too say target behavior.

I conceptualize NSSI as very different than suicide attempts (though obviously related and a major risk factor) but I am very DBT biased.
 

DynamicDidactic

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I know an adolescent DBT therapist who said that they had an increase in suicidal behavior and several of his patients told him that they'd attempted because the show gave them the idea.
Did these adolescents not think about attempting before the show? What exactly was the reasoning? If you get a chance to chat to that therapist again.
 

Ollie123

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Glad to see things moving in a more clearly operationalized direction here. Far outside my area, but I do dislike when I see "all things self-harm-y" folded under a single umbrella, which I think often happens when the general public discusses these issues.

Ideation does not equal help-seeking does not equal NSSI does not equal attempts does not equal completions. Contagion effects could very well emerge for one, but not the others. Ideation (depending on how defined) is not terribly uncommon even among psychologically healthy individuals and alone is at best a pretty mediocre predictor. A help-seeking contagion could actually be a positive for public health.

Not arguing for or against the effects of the show, just pointing out one way the broader discussion among the general public tends to be sloppy.
 

Temperance

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When I was a counselor for Crisis Text Line, we saw a dramatic spike in clients when 13 reasons came out. They keep data on all kinds of things, and that was a noticeable bump.
I am following up on this because I ran across a paper by chance that examined trends in Crisis Text Line messages around the time of the show. It appears that there was a statistically significant spike in conversation counts on April 5-6, 2017, approximately five days after the release of the show, which was followed by a significant and sustained decrease in conversation counts through May 18. The paper is open-access and can be found here.

The authors referenced a separate study (here) that asked youths who presented to an emergency department for suicide-related concern about their experiences with 13 Reasons Why. About half of the youths who responded to a question about the show's impact reported feeling that the show had increased their risk for suicide. Furthermore, identification with Hannah Baker was found to be correlated with perceiving that the show increased suicide risk. There were mixed results with whether or not youths were more likely to talk to others about mental health concerns.

Correlation is not causation, etc., but I find it interesting that the youths themselves are reporting increased risk due to the show.