Association Between the Release of Netflix's 13 Reasons Why and Suicide Rates in the United States: An Interrupted Time Series Analysis10.1016/j.jaac.2019.04.020

Objective To estimate the association between the release of the Netflix series 13 Reasons Why and suicide rates in the United States. Method 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, and 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. Results 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 apparent impact in the control analyses of homicide deaths within any age group. Conclusion The release of 13 Reasons Why was associated with a significant increase in monthly suicide rates among US youth aged 10 to 17 years. Caution regarding the exposure of children and adolescents to the series is warranted.