To estimate the association between the release of the Netflix series 13 Reasons
Why and suicide
rates in the US. Using segmented quasi-Poisson regression and Holt-Winters forecasting
models, we assessed monthly rates of suicide
among individuals aged 10 to 64 years grouped into 3 age categories (10-17, 18-29,
30-64 years) between January 1, 2013, and
December 31, 2017, before and after the release of 13 Reasons Why on March 31, 2017.
We also assessed the
impact of the show’s release on a control outcome, homicide deaths. After accounting
for seasonal effects and an underlying increasing trend in monthly suicide rates,
the overall suicide
rate among 10- to 17-year-olds increased significantly in the month immediately following
the release of 13 Reasons
Why (incidence rate ratio [IRR], 1.29; 95% CI, 1.09-1.53); Holt-Winters forecasting
revealed elevated observed
suicide rates in the month after release and in two subsequent months, relative to
corresponding forecasted rates. Contrary to
expectations, these associations were restricted to boys. Among 18- to 29-year-olds
and 30- to 64-year-olds, we found no
significant change in level or trend of suicide after the show’s release, both overall
and by sex. The show’s
release had no impact in the control analyses of homicide deaths within any age group.
The release of 13 Reasons Why was associated with a significant increase in monthly
suicide rates
among U.S. youth aged 10 to 17 years. Caution regarding the exposure of children and
adolescents to the series is
warranted.