13 Reasons Why: Viewing Patterns and Perceived Impact Among Youths at Risk of Suicide

Hong V, Ewell Foster CJ, Magness CS, McGuire TC, Smith PK, King CA

Abstract
Objective: The streaming series 13 Reasons Why generated controversy because of its depiction of teen suicide and concerns about its impact on vulnerable youths. This study examined exposure to and patterns of engagement with the show and the show’s perceived impact in a sample of youths presenting to a psychiatric emergency department (ED) with suicide-related concerns in the year after the series’ premiere.

Methods: Participants were 87 parent-youth dyads (youths’ mean±SD age=14.6±1.8; 71% of youths were female, 26% male, and 2% gender nonconforming) who completed a battery of questionnaires during their ED visit.

Results: Half (49%) of the sample viewed at least one episode of 13 Reasons Why, season 1. Most youths (84%) viewed the show alone and were more likely to discuss their reactions with peers (80%) than with a parent (34%). Over half of youth viewers (51%) believed the series increased their suicide risk to a nonzero degree; having a stronger identification with the lead female character was significantly related to this belief (r=.63, df=41, p<0.001). Youths with more depressive symptoms and suicidal ideation were more likely to identify with the lead characters and report negative affect while viewing.

Conclusions: To date, this is the first published study examining viewing patterns and reactions to 13 Reasons Why in a high-risk sample. Although further research is needed, the findings suggest a particular vulnerability to the show’s themes among youths at risk of suicide and the importance of prevention strategies to ameliorate risk among these viewers.

Keywords: Child psychiatry/general, Emergency psychiatry, Media, Prevention, Suicide-adolescent, 13 Reasons Why