Article

Association of Increased Youth Suicides in the United States With the Release of 13 Reasons Why

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Abstract

Importance On March 31, 2017, Netflix released the show 13 Reasons Why, sparking immediate criticism from suicide prevention organizations for not following media recommendations for responsible suicide portrayal and for possible suicide contagion by media. To date, little research has been conducted into the associations between the show and suicide counts among its young target audience. Objective To analyze the changes in suicide counts after the release of 13 Reasons Why. Design, Setting, and Participants For this time series analysis, monthly suicide data for the age groups 10 to 19 years, 20 to 29 years, and 30 years or older for both US males and females from January 1, 1999, to December 31, 2017, were extracted from the Centers for Disease Control and Prevention’s WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Twitter and Instagram posts were used as a proxy to estimate the amount of attention the show received through social media from April 1, 2017, to June 30, 2017. Autoregressive integrated moving average time series models were fitted to the pre–April 2017 period to estimate suicides among the age groups and to identify changes in specific suicide methods used. The models were fitted to the full time series with dummy variables for (1) April 2017 and (2) April 1, 2017, to June 30, 2017. Data were analyzed in December 2018 and January 2019. Main Outcomes and Measures Suicide data before and after the release of the show in 2017. Results Based on social media data, public interest in the show was highest in April 2017 and was negligible after June 2017. For 10- to 19-year-old males and females, increases in the observed values from April to June 2017 were outside the 95% confidence bands of forecasts. Models testing 3-month associated suicide mortality indicated 66 (95% CI, 16.3-115.7) excess suicides among males (12.4% increase; 95% CI, 3.1%-21.8%) and 37 (95% CI, 12.4-61.5) among females (21.7% increase; 95% CI, 7.3%-36.2%). No excess suicide mortality was seen in other age groups. The increase in the hanging suicide method was particularly high (26.9% increase; 95% CI, 15.3%-38.4%). Conclusions and Relevance Caution must be taken in interpreting these findings; however, the suicide increase in youth only and the signal of a potentially larger increase in young females all appear to be consistent with a contagion by media and seem to reinforce the need for collaboration toward improving fictional portrayals of suicide.

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... After duplicate removal, the electronic search yielded a total of 605 articles, of which 17 studies (Ayers et al., 2017;Bridge, Greenhouse, Ruch, et al., 2020;Carter et al., 2021;Chesin et al., 2020;Cooper et al., 2018;Hong et al., 2019;McKenzie et al., 2021;Nesi et al., 2020;Niederkrotenthaler et al., 2019;Plager et al., 2019;Rosa et al., 2019;Sinyor et al., 2019Sinyor et al., , 2021Swedo et al., 2021;Thompson et al., 2019;Till et al., 2019;Zimerman et al., 2018) met the inclusion criteria (see Figure 1). ...
... Most of the included studies (Ayers et al., 2017;Bridge, Greenhouse, Ruch, et al., 2020;Carter et al., 2021;Chesin et al., 2020;Cooper et al., 2018;Hong et al., 2019;Nesi et al., 2020;Niederkrotenthaler et al., 2019;Plager et al., 2019;Swedo et al., 2021;Thompson et al., 2019;Zimerman et al., 2018) (n ¼ 12) were performed in the United States. The characteristics and results of the included studies are given in Table 1. ...
... The characteristics and results of the included studies are given in Table 1. In the eight retrospective studies (Ayers et al., 2017;Bridge, Greenhouse, Ruch, et al., 2020;Cooper et al., 2018;Niederkrotenthaler et al., 2019;Plager et al., 2019;Sinyor et al., 2019Sinyor et al., , 2021Thompson et al., 2019), a total of 187,176 suicides, 806 casefiles from people who were hospitalized after attempting suicide, and 70,330 conversations on Crisis Text Line (CTL) were analyzed. In the seven cross-sectional studies (Carter et al., 2021;Chesin et al., 2020;Hong et al., 2019;Nesi et al., 2020;Rosa et al., 2019;Swedo et al., 2021;Zimerman et al., 2018), 42,553 participants were included. ...
Article
Background: The series 13 Reasons Why (13RW) raised critical concerns regarding the deleterious impact of fictional suicide portrayal on suicidal behaviors as it depicted the suicide of an adolescent without following the recommendations on media reporting of suicide portrayal. We aimed to assess the impact of 13RW on suicide rates, suicide attempts (SA), and suicidal ideation (SI) prevalence, mental health symptoms, and help-seeking behaviors in youths. Method: Following PRISMA guidelines, we systematically searched for articles on three databases up to January 2022. Results: A total of 17 articles met the inclusion criteria. Five large studies reported a significant increase in deaths by suicide and SA in youths in the United States and Canada after the release of 13RW. Mood deterioration or more intensive depressive symptoms were reported in vulnerable adolescents who watched 13RW. Youths with previous history of depression, SA, or SI, and those who identified themselves with the main character were at higher risk to report an increase in SI or mood deterioration. Help-seeking behaviors significantly decreased, but the effects on mental health awareness tended to be positive after the release of 13RW. Conclusion: Our review reveals critical results about the impact of 13RW on youths. We report an alarming harmful impact on suicide and SA rates, especially in more vulnerable youths. The reported positive effects do not balance the deleterious impact of 13RW.
... A convenient homogenous sampling technique was adopted. The sampling frame was intentionally constrained and was shared with students who fall into the age group (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). This was done because students are more likely to be heavy technology users and are at a greater risk of disturbed sleep [7]. ...
... Evidence is also available for changes in the subjective perception of time flow, increased digital media usage, and sleep pattern [7]. This study investigated these changes and associated these factors with students' emotional well-being and routine activities in students of the age group (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). ...
... This may have been because most of the respondents had received enough sleep; 47% slept for longer periods during quarantine, 35.1% reported their sleep lengths to be variable, and 17.9% claimed they were not sleeping for longer durations. Furthermore, it is also important to highlight that our sample population is different from those of previous findings, as we were targeting students [age group: [14][15][16][17][18][19][20][21][22][23][24]. This age group has been proven to have better sleep quality than older age groups [31], which possibly makes up for the effect that bedtime procrastination has on sleep quality. ...
Article
Introduction: Due to the COVID-19 pandemic, many countries imposed lockdowns on their citizens in an attempt to contain the disease. Pakistan is one of these countries. A government mandated lockdown can have mitigating psychological effects on young adults, out of which a large fraction is made up of students. This study aims to investigate the correlations between changes in sleep pattern, perception of time, and digital media usage. Furthermore, it explores the impact of these changes on the mental health of students of different educational levels. Methods: This cross-sectional study was conducted via a web-based questionnaire, from March 24 to April 26, 2020. The survey was targeted at students and 251 responses were obtained. It was a 5-section long questionnaire. The first section inquired about demographics of participants. Each of the other 4 section were devoted to changes in sleep pattern, perception of time flow, digital media usage and mental health status of students. Close ended questions with multiple choice responses, dichotomous, interval and 4-point Likert scales were used in the construction of the survey questionnaire. Chi square, T-tests multinomial and binary logistic regression were used as primary statistical tests. All data were analyzed using Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY). Results: Out of 251 adolescents that participated in our study, the majority (70.2%) were females. The mean age of the participants was 19.40+/- 1.62 years. Two-thirds of the respondents did not have much trouble falling asleep (66.5%). The analysis found no significant association between longer sleep periods and procrastination level (p = 0.054). Nearly three-fourths (72.9%) of our participants felt that getting through quarantine would have been more difficult if they did not have any electronic gadgets. Of these, a majority (85.8%) had a general feeling of tiredness and lacked motivation (p = 0.023). Additionally, a large number of students (69.7%) had reported that time is seemingly moving faster. A significant relationship between increased usage of electronic items and longer sleep periods was also noted (p = 0.005). With respect to the level of education statistically significant values were noted for alarm use both before and after quarantine began (p = 0.021 and p = 0.004, respectively). Further analysis showed that there was a significant difference in the median difference of time spent on social media before the outbreak (3.0+/-32.46) and time spent on social media after the outbreak (6.0+/-3.52) in a single day (p=0.000). Conclusions: Our research has revealed that due to the lockdown imposed by the government in response to COVID-19, the sleeping patterns of the students was affected the most. Our findings show that the increase in use of social media applications led to a widespread increase in the length of sleep, worsening of sleep habits (people sleeping at much later hours than usual), and a general feeling of tiredness. A general lack of recollection regarding what day of the week it was, as well as a change in the perceived flow of time were also notable. All these findings indicate the decline in mental health of students due to the lockdown. Promoting better sleep routines, minimizing the use of digital media, and encouragement of students to take up more hobbies could collectively improve the health and mood of students in self quarantine.
... Thus, adolescents smoke and drink more alcohol when in the presence of peers, and peers' substance consumption is a predictor of a teenager's own substance use 15,18,19 . The prevalence of self-injury behaviours, as well as unprotected sexual intercourse, are often related to a social contagion effect during adolescence [20][21][22] . However, recent alternative accounts frame susceptibility to social influence during adolescence in a less maladaptive context 23,6,[24][25][26][27] : social influence can change behaviour for the better, an effect widely used for adaptive ends in education and psychotherapy. ...
... drinking, reckless driving, delinquency, self-harming behaviours) [12][13][14][15]18,19 . Here, using a longitudinal design involving a large cohort of [14][15][16][17][18][19][20][21][22][23][24] year-olds, combined with a social delay discounting paradigm as well as quantitative brain imaging, we replicate a finding of increased social susceptibility in adolescents and characterise its computational and neuro-developmental correlates. ...
... Note that baseline age entered the model as a continuous regressor, here we plot 4-year-age bins ≤17 years old, >17 ≤21 years old, >21 years old, only for visualisation purposes. peer influence is suggested to lead to higher rates of delinquency, real-life risk-taking, unprotected sexual intercourse, substance consumption and self-harming behaviours [12][13][14][15][16][17][18][19]21,22 . In this study of healthy adolescents, however, our experimental measure of susceptibility to social influences did not relate significantly to substance consumption, nor did it predict such maladaptive behavioural tendencies in a longitudinal fashion. ...
Article
Full-text available
Adolescents are prone to social influence from peers, with implications for development, both adaptive and maladaptive. Here, using a computer-based paradigm, we replicate a cross-sectional effect of more susceptibility to peer influence in a large dataset of adolescents 14 to 24 years old. Crucially, we extend this finding by adopting a longitudinal perspective, showing that a within-person susceptibility to social influence decreases over a 1.5 year follow-up time period. Exploiting this longitudinal design, we show that susceptibility to social influences at baseline predicts an improvement in peer relations over the follow-up period. Using a Bayesian computational model, we show that in younger adolescents a greater tendency to adopt others' preferences arises out of a higher uncertainty about their own preferences in the paradigmatic case of delay discounting (a phenomenon called 'preference uncertainty'). This preference uncertainty decreases over time and, in turn, leads to a reduced susceptibility of one's own behaviour to an influence from others‟. Neuro-developmentally, we show that a measure of myelination within medial prefrontal cortex, estimated at baseline, predicts a developmental decrease in preference uncertainty at follow up. Thus, using computational and neural evidence, we reveal adaptive mechanisms underpinning susceptibility to social influence during adolescence.
... The 2017 Netflix series 13 Reasons Why, about the suicide of its fictional character, 17-year-old Hannah Baker, sparked strong criticism from mental health and suicide prevention organizations because it did not follow widely recognised media recommendations about how suicide should be portrayed in the media [2]. The concern was that the problematic narratives and messaging within the show could trigger additional youth suicides [3,4]. Specifically, concerns were based in the explicit imagery of a suicide method (cutting), the portrayal of help-seeking as being futile and counter-productive, and the notion that suicide might have a beneficial effect on others. ...
... Specifically, concerns were based in the explicit imagery of a suicide method (cutting), the portrayal of help-seeking as being futile and counter-productive, and the notion that suicide might have a beneficial effect on others. Three subsequent studies found evidence that the series was indeed associated with a significant increase in suicides by young people in the United States [3,5] and Canada, [4] corroborating earlier clinical findings of increased presentations for self-harm amongst adolescents who had watched the series [3,4]. Sustained criticism from experts and these findings led the World Health Organization (WHO) and the US National Action Alliance for Suicide Prevention to develop specific media recommendations for the portrayal of suicide in entertainment media, [6,7] and Netflix responded by removing the controversial suicide scene from season one [8]. ...
... Specifically, concerns were based in the explicit imagery of a suicide method (cutting), the portrayal of help-seeking as being futile and counter-productive, and the notion that suicide might have a beneficial effect on others. Three subsequent studies found evidence that the series was indeed associated with a significant increase in suicides by young people in the United States [3,5] and Canada, [4] corroborating earlier clinical findings of increased presentations for self-harm amongst adolescents who had watched the series [3,4]. Sustained criticism from experts and these findings led the World Health Organization (WHO) and the US National Action Alliance for Suicide Prevention to develop specific media recommendations for the portrayal of suicide in entertainment media, [6,7] and Netflix responded by removing the controversial suicide scene from season one [8]. ...
Article
Full-text available
Background Guidelines to encourage responsible reporting of suicide in news media are a key component of suicide prevention strategies. Recent guidelines have been developed on portrayal of suicide in entertainment media although the relationship between these portrayals and subsequent suicidal behaviour has received considerably less attention in research. Methods We conducted a systematic review and meta-analysis to examine the association between portrayals of suicide and suicide attempt in entertainment media and suicidal behaviour in the population. We searched PubMed, Scopus, Embase, PsycInfo, Web of Science and Google Scholar until April 20, 2021. We included studies adopting interrupted time series or single/multiple arm pre-post designs. Separate analyses were undertaken for studies of suicide and suicide attempts. We synthesized studies at moderate risk of bias and included studies at serious risk in a sensitivity analysis. Using a random-effects meta-analysis, we synthesized studies at moderate risk of bias and included studies at serious risk in a sensitivity analysis. Study registration: PROSPERO (CRD42020221333). Findings Twelve studies met our inclusion criteria. Six studies were about suicide. Two of these were at moderate risk of bias and both examined the effects of the Netflix series 13 Reasons Why. The pooled rate ratio (RR) for these studies was 1·18 (95% CI 1·09 to 1·27, p<0·001). Heterogeneity was low (I² = 29%). Six studies focused on suicide attempts, and two of them were at moderate risk of bias. The pooled RR for these two studies was 1·33 (95% CI 0·84 to 2·09, p = 0·22). Heterogeneity was high (I² = 92%). Enhanced funnel plots indicated likely publication bias for studies of suicide and possible bias for studies of attempted suicide. Interpretation Portrayals of suicide in entertainment media may increase suicides and attempted suicide in the population. More studies that limit the potential sources of bias are needed to fully understand the circumstances under which fictional portrayals may influence suicidal behaviour.
... Cultural definitions, norms, values and role expectations can shape the degree of suicide risk in populations. Following Stack, 2000a, linkages between cultural constructs and suicide include the influence of media definitions of suicide (Fink et al., 2018;Niederkrotenthaler et al., 2019Niederkrotenthaler et al., , 2020Stack, 2003Stack, , 2005Stack, , 2009, gender role expectations (e.g., Alothman and Fogarty, 2020;Coleman et al., 2020;Lester, 2000;Stack, 2000a), the cultural attitudes supporting suicide, or the "culture of suicide" (Cutright and Fernquist, 2000Joe et al., 2007;Feigelman et al., 2014;Phillips and Luth, 2020;Stack and Kposowa, 2016), the value of firearms measured through their availability (Anestis and Houtsma, 2018;Anglemyer et al., 2014;Kleck, 2019), expectations surrounding the appropriate times for suicide (Gabennesch, 1988;Galvao et al., 2018), the value of alcohol measured through levels of consumption (Amiri and Behnezhad, 2020;Norstrom and Rossow, 2016), and beliefs about the very validity of suicide statistics (Klugman et al., 2013;Rockett et al., 2018). ...
... Media coverage of suicide stories generally do not predict subsequent suicide rates. However, coverage of celebrity suicide, especially entertainment celebrities such as actors (e.g., Robin Williams), and widely publicized suicides of fictional characters, can have large impacts on suicides among vulnerable members of the audience (Fink et al., 2018;Niederkrotenthaler et al., 2019Niederkrotenthaler et al., , 2020Stack, 2003Stack, , 2005Stack, , 2009. Research on the effect of exposure to suicide in popular feature films and television is underdeveloped (for an exception see work on 13 Reasons Why, Niederkrotenthaler et al., 2019), but may show promise. ...
... However, coverage of celebrity suicide, especially entertainment celebrities such as actors (e.g., Robin Williams), and widely publicized suicides of fictional characters, can have large impacts on suicides among vulnerable members of the audience (Fink et al., 2018;Niederkrotenthaler et al., 2019Niederkrotenthaler et al., , 2020Stack, 2003Stack, , 2005Stack, , 2009. Research on the effect of exposure to suicide in popular feature films and television is underdeveloped (for an exception see work on 13 Reasons Why, Niederkrotenthaler et al., 2019), but may show promise. Feature films stress social and economic factors as the contributing factors behind suicide (Stack and Bowman, 2011). ...
Article
This review summarizes recent research in four environmental areas affecting risk of deaths by suicide. Politically, the weight of the evidence suggests that laws increasing social welfare expenditures and other policies assisting persons with low incomes (e.g., minimum wage) tend to lower suicide rates. Other legal changes such as those restricting firearms and alcohol availability can also prevent suicides. The social institutions of marriage, as well as parenting, continue to serve as protective factors against suicide, although the degree of protection is often gendered. Religiousness tends to be inversely associated with suicide deaths at the individual level of analysis, but the mediators need exploration to determine what accounts for the association: social support, better mental health, better physical health, less divorce, or other covariates. Cultural definitions of the traditional male role (e.g., breadwinner culture) continue to help explain the high male to female suicide ratio. New work on the "culture of suicide" shows promise. The degree of approval of suicide is sometimes the single most important factor in predicting suicide. At the individual level of analysis, two of the strongest predictors of suicide are economic ones: unemployment and low socio-economic status. Attention is drawn to enhancing the minimum wage as a policy known to lower state suicide rates. Limitations of research include model mis-specification, conflicting results especially when ecological data are employed, and a need for more research exploring moderators of established patterns such as that between religiousness and suicide.
... Because of possible confounding by the release of 13 Reasons Why, a Netflix show that sparked strong criticism for violating media recommendations for safe portrayals of suicide, 12 -14 we included a dummy variable (coded 1 from the release date of 13 Reasons Why (31 March 2017 to 30 June 2017, and 0 otherwise). 12 Notably, previous research found that the show was associated with a noticeable increase of 5.5% in suicides (95% confidence interval 5.5% to 21.1%) in the US among 10 to 19 year olds in the three months after its release. 12 Our use of a three month period was consistent with social media data indicating that the show received the strongest attention in that period. ...
... 12 Notably, previous research found that the show was associated with a noticeable increase of 5.5% in suicides (95% confidence interval 5.5% to 21.1%) in the US among 10 to 19 year olds in the three months after its release. 12 Our use of a three month period was consistent with social media data indicating that the show received the strongest attention in that period. 12 To identify any further events that might be associated with Lifeline calls and suicides, we used a list of Wikipedia entries of suicides by well known people between 7 April 2017 (immediately before the song's release) and 31 December 2018 (end of observation period). ...
... 12 Our use of a three month period was consistent with social media data indicating that the show received the strongest attention in that period. 12 To identify any further events that might be associated with Lifeline calls and suicides, we used a list of Wikipedia entries of suicides by well known people between 7 April 2017 (immediately before the song's release) and 31 December 2018 (end of observation period). We accessed and assessed tweet volumes for all the identified (American and international) celebrities to identify the suicides that received strong public attention so that we could adjust for the occurrence of these confounding events in the model (supplementary table S1). ...
Article
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Objective To assess changes in daily call volumes to the US National Suicide Prevention Lifeline and in suicides during periods of wide scale public attention to the song “1-800-273-8255” by American hip hop artist Logic. Design Time series analysis. Setting United States, 1 January 2010 to 31 December 2018. Participants Total US population. Lifeline calls and suicide data were obtained from Lifeline and the Centers for Disease Control and Prevention. Main outcome measures Daily Lifeline calls and suicide data before and after the release of the song. Twitter posts were used to estimate the amount and duration of attention the song received. Seasonal autoregressive integrated moving average time series models were fitted to the pre-release period to estimate Lifeline calls and suicides. Models were fitted to the full time series with dummy variables for periods of strong attention to the song. Results In the 34 day period after the three events with the strongest public attention (the song’s release, the MTV Video Music Awards 2017, and Grammy Awards 2018), Lifeline received an excess of 9915 calls (95% confidence interval 6594 to 13 236), an increase of 6.9% (95% confidence interval 4.6% to 9.2%, P<0.001) over the expected number. A corresponding model for suicides indicated a reduction over the same period of 245 suicides (95% confidence interval 36 to 453) or 5.5% (95% confidence interval 0.8% to 10.1%, P=0.02) below the expected number of suicides. Conclusions Logic’s song “1-800-273-8255” was associated with a large increase in calls to Lifeline. A reduction in suicides was observed in the periods with the most social media discourse about the song.
... The first season of the Netflix show '13 Reasons Why' (13RW), which included a lengthy depiction of the suicide of a teenager, Hannah Baker, was released on 31 March 2017 (Yorkey, 2017) and was widely criticized by mental health experts for violating numerous recommendations for responsible portrayals of suicide (Arendt et al., 2017;Bridge et al., 2020;Feuer and Havens, 2017;Hong et al., 2019;Niederkrotenthaler et al., 2019;Rosa et al., 2019;Sinyor et al., 2019). The final episode, which depicts the character's suicide-she lies in a bathtub cutting her wrists with a razor blade and exsanguinates-was a focus of particular concern. ...
... The final episode, which depicts the character's suicide-she lies in a bathtub cutting her wrists with a razor blade and exsanguinates-was a focus of particular concern. Several studies have already investigated the impact of 13RW, Season 1, on suicide (Arendt et al., 2017;Ayers et al., 2017;Bridge et al., 2020;Feuer and Havens, 2017;Hong et al., 2019;Niederkrotenthaler et al., 2019;Rosa et al., 2019;Sinyor et al., 2019). Most importantly, the show was associated with increases in youth suicides of approximately 15% in the United States (Niederkrotenthaler et al., 2019) and 18% in Canada (Sinyor et al., 2019). ...
... Several studies have already investigated the impact of 13RW, Season 1, on suicide (Arendt et al., 2017;Ayers et al., 2017;Bridge et al., 2020;Feuer and Havens, 2017;Hong et al., 2019;Niederkrotenthaler et al., 2019;Rosa et al., 2019;Sinyor et al., 2019). Most importantly, the show was associated with increases in youth suicides of approximately 15% in the United States (Niederkrotenthaler et al., 2019) and 18% in Canada (Sinyor et al., 2019). These findings reinforce prior work demonstrating that 13RW was associated with an increase in Google searches such as 'how to commit suicide' (Ayers et al., 2017), online survey data showing worsening mood in one in four adolescents after they viewed the show (Rosa et al., 2019) and a survey of 87 adolescents presenting to a US emergency department (ED) in a suicidal crisis, of whom roughly one quarter believed that the show had increased their suicide risk (Hong et al., 2019). ...
Article
Full-text available
Objective To determine whether the release of the first season of the Netflix series ‘13 Reasons Why’ was associated with changes in emergency department presentations for self-harm. Methods Healthcare utilization databases were used to identify emergency department and outpatient presentations according to age and sex for residents of Ontario, Canada. Data from 2007 to 2018 were used in autoregressive integrated moving average models for time series forecasting with a pre-specified hypothesis that rates of emergency department presentations for self-harm would increase in the 3-month period following the release of 13 Reasons Why (1 April 2017 to 30 June 2017). Chi-square and t tests were used to identify demographic and health service use differences between those presenting to emergency department with self-harm during this epoch compared to a control period (1 April 2016 to 30 June 2016). Results There was a significant estimated excess of 75 self-harm-related emergency department visits (+6.4%) in the 3 months after 13 Reasons Why above what was predicted by the autoregressive integrated moving average model (standard error = 32.4; p = 0.02); adolescents aged 10–19 years had 60 excess visits (standard error = 30.7; p = 0.048), whereas adults demonstrated no significant change. Sex-stratified analyses demonstrated that these findings were largely driven by significant increases in females. There were no differences in demographic or health service use characteristics between those who presented to emergency department with self-harm in April to June 2017 vs April to June 2016. Conclusions This study demonstrated a significant increase in self-harm emergency department visits associated with the release of 13 Reasons Why. It adds to previously published mortality, survey and helpline data collectively demonstrating negative mental health outcomes associated with 13 Reasons Why.
... Thus, adolescents smoke and drink more alcohol when in the presence of peers, and peers' substance consumption is a predictor of a teenager's own substance use 15,18,19 . The prevalence of self-injury behaviours, as well as unprotected sexual intercourse, are often related to a social contagion effect during adolescence [20][21][22] . However, recent alternative accounts frame susceptibility to social influence during adolescence in a less maladaptive context 23,6,[24][25][26][27] : social influence can change behaviour for the better, an effect widely used for adaptive ends in education and psychotherapy. ...
... drinking, reckless driving, delinquency, self-harming behaviours) [12][13][14][15]18,19 . Here, using a longitudinal design involving a large cohort of [14][15][16][17][18][19][20][21][22][23][24] year-olds, combined with a social delay discounting paradigm as well as quantitative brain imaging, we replicate a finding of increased social susceptibility in adolescents and characterise its computational and neuro-developmental correlates. ...
... Note that baseline age entered the model as a continuous regressor, here we plot 4-year-age bins ≤17 years old, >17 ≤21 years old, >21 years old, only for visualisation purposes. peer influence is suggested to lead to higher rates of delinquency, real-life risk-taking, unprotected sexual intercourse, substance consumption and self-harming behaviours [12][13][14][15][16][17][18][19]21,22 . In this study of healthy adolescents, however, our experimental measure of susceptibility to social influences did not relate significantly to substance consumption, nor did it predict such maladaptive behavioural tendencies in a longitudinal fashion. ...
Article
Full-text available
Adolescents are prone to social influence from peers, with implications for development, both adaptive and maladaptive. Here, using a computer-based paradigm, we replicate a cross-sectional effect of more susceptibility to peer influence in a large dataset of adolescents 14 to 24 years old. Crucially, we extend this finding by adopting a longitudinal perspective, showing that a within-person susceptibility to social influence decreases over a 1.5 year follow-up time period. Exploiting this longitudinal design, we show that susceptibility to social influences at baseline predicts an improvement in peer relations over the follow-up period. Using a Bayesian computational model, we demonstrate that in younger adolescents a greater tendency to adopt others’ preferences arises out of a higher uncertainty about their own preferences in the paradigmatic case of delay discounting (a phenomenon called ‘preference uncertainty’). This preference uncertainty decreases over time and, in turn, leads to a reduced susceptibility of one’s own behaviour to an influence from others. Neuro-developmentally, we show that a measure of myelination within medial prefrontal cortex, estimated at baseline, predicts a developmental decrease in preference uncertainty at follow-up. Thus, using computational and neural evidence, we reveal adaptive mechanisms underpinning susceptibility to social influence during adolescence.
... Research on the first season of 13RW has depicted varied relations between viewing and adolescent and young adult behavior. Some studies have reported concerning findings related to viewing 13RW (e.g., Ayers, et al., 2016;Niederkrotenthaler, et al., 2019;Santana da Rosa et al., 2019;Bridge et al., 2020) while others have found no concerns related to viewing (e.g., Ferguson, 2019;Romer, 2020). Further, multiple other studies using large, non at-risk samples have found potentially prosocial correlates of viewing (e.g., Arendt et al., 2019;Carter et al., 2020). ...
... When studies sample from small, at-risk samples of adolescents and young adults, results demonstrate that exposure to 13RW relates to maladaptive mental and physical health outcomes (e.g., Hong et al., 2018;PlagerZarin-Pass and Pitt, 2019). Analysis of ecological data initially pointed to an increase in suicides relative to expectations (Niederkrotenthaler et al., 2019;Bridge et al., 2020), but a re-analysis of the Bridge et al. (2020) data showed no such increase (Romer, 2020). Other researchers have concluded that there is little current support for a suicide contagion effect stemming from exposure to fictional media (Ferguson, 2019). ...
Article
Full-text available
With increasing media choice, particularly through the rise of streaming services, it has become more important for empirical research to examine how youth decide which programs to view, particularly when the content focuses on difficult health topics such as suicide. The present study investigated why adolescents and young adults chose to view or not view season 1 of 13 Reasons Why and how individual-level variables related to adolescents’ and young adults’ viewing. Using survey data gathered from a sample of 1,100 adolescents and young adult viewers and non-viewers of the series in the United States, we examined how participants’ resilience, loneliness, and social anxiety related to whether participants viewed the first season or not. Our descriptive results indicate that adolescents who watched the show reported that it accurately depicted the social realities of their age group, they watched it because friends recommended it, and they found the subject matter to be interesting. Non-viewers reported that they chose not to view the show because the nature of the content was upsetting to them. In addition, results demonstrated that participants’ social anxiety and resilience related to participants’ viewing decisions, such that those with higher social anxiety and higher resilience were more likely to report watching season 1. Together, these data suggest that youth make intentional decisions about mental health-related media use in an attempt to choose content that is a good fit for based on individual characteristics.
... Though the peak came down, a sustained effect was seen globally and in India, as there was the release of a popular web series named "13 reasons why" on Netflix in March 2017 [13]. ...
... After the release of the web series, there have been reports of increased suicide among youths of the United States of America and several other parts of the globe [13][14][15][16]. The web series "13 reasons why" is based on a novel by Jay Asher. ...
... It is important to clarify that in a Western society with a predominant Christian background such as Brazil, a self-inflicted death has always been repudiated as a religious, cultural, and legal deviation 3 . Increasingly, however, sociological, psychological, and psychiatric studies show its occurrence as a plausible fact since childhood is associated with emotional distress, health problems and macro and microsocial issues [4][5][6][7][8][9] . However, the tendency of families, institutions and communities is to disregard, revealing an extreme difficulty and prejudice in dealing with suicide, or categorise as a problem of exclusive biomedical causality. ...
... However, the tendency of families, institutions and communities is to disregard, revealing an extreme difficulty and prejudice in dealing with suicide, or categorise as a problem of exclusive biomedical causality. On the one hand the risks of self-aggression within this age group have been amplified in the new media formats 8,10,11 , on the other hand, the inability to address the problem and the silence prevail 2 . ...
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Resumo Este artigo pretende compreender a construção e a repercussão dos tabus que envolvem o suicídio de crianças e adolescentes, considerando o incômodo, o silêncio e o pavor que esse tema provoca em toda a sociedade. Diante do reconhecimento de um continuum de tabus (tabu da morte < tabu do suicídio < tabu do suicídio infantojuvenil), propôs-se, como tentativa de clarificar essa questão, o conceito de um triplo tabu, valorizando a incomensurabilidade das mortes autoprovocadas que têm as crianças e os adolescentes como protagonistas. Tendo sido desenvolvido a partir de um estudo qualitativo com pediatras em formação, este documento se configura como um chamado aos profissionais que assistem crianças e adolescentes no país. É preciso que a formação pediátrica reconheça esses tabus e as dimensões do comportamento suicida como uma manifestação de violência e um agravo à saúde mental, identificando-o como um elemento crítico e urgente na assistência contemporânea a crianças e adolescentes.
... Based on this popularity, empirical research studies have examined correlates of viewing this particular series (e.g., Ayers et al., 2017;Cooper et al., 2018;Hong et al., 2018;Niederkrotenthaler et al., 2019). Most studies to date have focused on adolescent and young adult viewers, and to our knowledge, all sample from within the US. ...
... Previous samples are limited in their diversity in terms of gender (i.e., predominantly comprised of female subjects; Cooper et al., 2018;Hong et al., 2018) or based their findings on ecological data (e.g., Ayers et al., 2017;Cooper et al., 2018), with the exception of one study which used survey data (e.g., Chesin et al., 2020). All known studies used samples from within the US (e.g., Ayers et al., 2017;Chesin et al., 2020;Cooper et al., 2018;Hong et al., 2018;Niederkrotenthaler et al., 2019), despite the fact that the show was available and viewed globally. Finally, although the show was intended primarily for adolescent audiences, it is interesting that no known studies have assessed parents' own perceptions of the show, or the correlates of viewing on their attitudes and behaviors. ...
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A number of recent series airing on traditional and streaming platforms portray sensitive topics faced by adolescents, including depression and suicide. Research has suggested that these subjects may be difficult for parents and adolescents to discuss, given their stigmatized nature. It is possible, however, that series portraying these issues in a realistic way can influence parent viewers’ perceived understanding of and comfort discussing these topics, and subsequently, relate to self-reported conversations with their adolescents. In addition, it is likely that these relations may differ for participants from different countries, especially considering country differences in mental health, access to mental health care, and stigmatization about mental health. We tested these relations using data from 778 parent viewers of the series 13 Reasons Why. We sampled viewers from four countries: Australia, the United States, Brazil, and the United Kingdom. Results suggested an indirect association between self-reported topic understanding and starting a conversation with their adolescent about these topics via reports of comfort discussing these topics. Participants’ country of habitation at the time of the study did not significantly influence these associations. We discuss these findings in the context of parent-adolescent communication, particularly around sensitive health-related topics.
... The debate about 13RW within the global academic community has been heated. However, research results are rather mixed , be it primary data analysis (e.g., Carter et al. 2020;Chesin et al. 2019;da Rosa et al. 2018;Hong et al. 2019) or secondary data analysis (e.g., Ayers et al. 2017;Bridge et al. 2019;Niederkrotenthaler et al. 2019;Romer 2020). The only meta-analytic review to date has identified a number of methodological weaknesses, such as the lack of direct attribution to 13RW in aggregate studies and the biases introduced in traditional psychological research by pairing questions related to media exposure with questions about mood or suicide; and there was no evidence of suicide contagion as dangerous media effects at the population level (Ferguson 2019). ...
... In the United States, suicide rates have been consistently rising (National Institute of Mental Health 2020); CDC reported that the death rates due to suicide among 10-24-year-olds increased an alarming 56% from 2007 to 2017 (Curtin and Heron 2019). After its initial release in March 2017, 13RW received considerable criticism that the program itself is partly responsible for the increase of risky social contagion such as suicidal ideation and attempts (e.g., Cooper et al. 2018;Niederkrotenthaler et al. 2019). Suicide, however, is a complex concept, given that it involves connections with fundamental notions of life, death, personal identity, interpersonal relationships, and other high mass concepts. ...
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The Netflix series 13 Reasons Why (13RW) stirred up considerable controversy when it was first released in 2017. Although researchers across disciplines have published their work from different perspectives, results are rather mixed. The only meta-analytic review to date has identified methodological weaknesses, such as the lack of direct attribution to 13RW in aggregate studies and the biases in traditional psychological research. In this article, we contribute to the evolving scholarly investigations of 13RW by providing an alternative approach: the Galileo Model of cognitive mapping and precise measurements. We offer an overview of the Galileo theory and method, highlighting advantages of a multidimensional and non-Euclidean approach based on nearly 50 years of social scientific research. We also detail how the Galileo Model was used to study 13RW, by framing Season 1 as “compound suicide messages.” We found that self-concept was very close to 13RW main character HANNAH and SUICIDE among highly suicide-prone individuals who posted on Reddit online forums both related to 13RW and suicide watch. However, when we used the Galileo software suite and a ratio-scaled instrument with college freshmen in a quasi-experiment, we found no significant difference between viewers and non-viewers overall, although female viewers perceived themselves to be closer to SUICIDE than male viewers. The Galileo Model demonstrated its sophistication to capture and detect the nuances in understanding the complexity of suicide for different population groups and showed tremendous potential for more informative media effects evaluation and formative research to tailor compound messages with social consciousness before they reach the mass audiences.
... Although time series analyses were conducted in 2 studies [31,37], the limitations of these analyses indicate the need for further studies to examine the impact of self-harm imagery. Although the evidence for social contagion is lacking in the papers described here, recent studies relating to the release of the TV series 13 Reasons Why, in which the suicide of a young female is graphically depicted, found this to be associated with a significant increase in adolescent suicide rates [49] concordant with the period in which social media discussions of the series were greatest [50]. This increase in deaths was found despite some individuals reporting positive impacts [51]. ...
... Future research should aim to understand the long-term effects of continual exposure to such images, as the nature of immediate impacts may change over time. This is highlighted by the recent literature related to 13 Reasons Why, where an increase in suicide rates was found [50], despite some individuals reporting a positive impact of the show [51]. Web-based content has the potential to reach a large audience; as such, a range of emotional reactions is to be expected. ...
Article
Background Given recent moves to remove or blur self-harm imagery or content on the web, it is important to understand the impact of posting, viewing, and reposting self-harm images on young people. Objective The aim of this study is to systematically review research related to the emotional and behavioral impact on children and young people who view or share web-based self-harm–related videos or images. Methods We searched databases (including Embase, PsychINFO, and MEDLINE) from January 1991 to February 2019. Search terms were categorized into internet use, images nonspecific and specific to the internet, and self-harm and suicide. Stepwise screening against specified criteria and data extraction were completed by two independent reviewers. Eligible articles were quality assessed, and a narrative synthesis was conducted. ResultsA total of 19 independent studies (20 articles) were included. Of these, 4 studies focused on images, 10 (11 articles) on videos, and 5 on both. There were 4 quantitative, 9 qualitative, and 7 mixed methods articles. In total, 11 articles were rated as high quality. There has been an increase in graphic self-harm imagery over time. Potentially harmful content congregated on platforms with little moderation, anonymity, and easy search functions for images. A range of reactions and intentions were reported in relation to posting or viewing images of self-harm: from empathy, a sense of solidarity, and the use of images to give or receive help to potentially harmful ones suggesting new methods, normalization, and exacerbation of self-harm. Viewing images as an alternative to self-harm or a creative outlet were regarded in 2 studies as positive impacts. Reactions of anger, hostility, and ambivalence have been reported. There was some evidence of the role of imitation and reinforcement, driven partly by the number of comments and wound severity, but this was not supported by time series analyses. Conclusions Although the results of this review support concern related to safety and exacerbation of self-harm through viewing images of self-harm, there may be potential for positive impacts in some of those exposed. Future research should evaluate the effectiveness and potential harms of current posting restrictions, incorporate user perspectives, and develop recovery-oriented content. Clinicians assessing distressed young people should ask about internet use, including access to self-harm images, as part of their assessment.
... Suicidal behavior exceeding expected patterns, which is consistent with, although not definitely demonstrating, a causal effect and has been observed across other countries (Pirkis et al., 2020a(Pirkis et al., , 2020bWhitley, Fink, Santaella-Tenorio, & Keyes, 2019). Netflix's show 13 Reasons Why was also associated with anomalous increases in suicide death, especially among adolescent girls (Bridge et al., 2019;Niederkrotenthaler et al., 2019), although more data are needed. Conversely, responsible media reporting of suicide prevents contagion and spread of suicidal behavior (Niederkrotenthaler, 2016). ...
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Suicide in the US has increased in the last decade, across virtually every age and demographic group. Parallel increases have occurred in non-fatal self-harm as well. Research on suicide across the world has consistently demonstrated that suicide shares many properties with a communicable disease, including person-to-person transmission and point-source outbreaks. This essay illustrates the communicable nature of suicide through analogy to basic infectious disease principles, including evidence for transmission and vulnerability through the agent–host–environment triad. We describe how mathematical modeling, a suite of epidemiological methods, which the COVID-19 pandemic has brought into renewed focus, can and should be applied to suicide in order to understand the dynamics of transmission and to forecast emerging risk areas. We describe how new and innovative sources of data, including social media and search engine data, can be used to augment traditional suicide surveillance, as well as the opportunities and challenges for modeling suicide as a communicable disease process in an effort to guide clinical and public health suicide prevention efforts.
... The primary aim of all the identified studies was the statistical verification of increased suicides within a population (i.e., the detection of mass clusters). The most employed statistical analyses include a time-series model such as the Seasonal Autoregressive Integrated Moving Average (SARIMA) model (n = 11) [74][75][76][77][78][79][80][81][82][83], a regression model (n = 8) [82][83][84][85][86][87][88][89], a Poisson model (n = 4) [84,[87][88][89], and non-parametric tests (n = 3) [87,90,91]. When comparing statistical models to detect mass clusters, a time-series regression model will capture the parameters of mass clustering as accurately as possible, based on temporal data. ...
Article
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Suicide and self-harm clusters exist in various forms, including point, mass, and echo clusters. The early identification of clusters is important to mitigate contagion and allocate timely interventions. A systematic review was conducted to synthesize existing evidence of quantitative analyses of suicide and self-harm clusters. Electronic databases including Medline, Embase, Web of Science, and Scopus were searched from date of inception to December 2020 for studies that statistically analyzed the presence of suicide or self-harm clusters. Extracted data were narratively synthesized due to heterogeneity among the statistical methods applied. Of 7268 identified studies, 79 were eligible for narrative synthesis. Most studies quantitatively verified the presence of suicide and self-harm clusters based on the scale of the data and type of cluster. A Poisson-based scan statistical model was found to be effective in accurately detecting point and echo clusters. Mass clusters are typically detected by a time-series regression model, although limitations exist. Recently, the statistical analysis of suicide and self-harm clusters has progressed due to advances in quantitative methods and geospatial analytical techniques, most notably spatial scanning software. The application of such techniques to real-time surveillance data could effectively detect emerging clusters and provide timely intervention.
... Furthermore, the data are based on self-report measures that might be subject to report-bias, such as the tendency to comply with social norms and response more positively when the thought or behavior is believed to be acceptable or desirable within a particular social context (Huang et al., 1998;Zalsman et al., 2005). Therefore, while it was demonstrated that focusing on individual perceptions of the social context is highly important in understanding NSSI (Madjar, Shabat et al., 2017) and suicidal ideation (Madjar et al., 2018) in adolescents, future research might also use additional methods of assessment -particularly for social support -as well as controlling for other social aspects that are related to suicidal ideation and behaviors, such as exposure to detailed suicide cases on the media (Niederkrotenthaler et al., 2019;Shoval et al., 2005). Lastly, these findings should be replicated among additional populations, to consider the role of diverse cultural backgrounds and developmental stages. ...
Article
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The purpose of the current study was to explore whether depression symptoms mediate the relationships between perceptions of social support from three sources; namely parents, teachers, and peers, and non-suicidal self-injury (NSSI) and suicidal ideation. We also tested the interactions between the different sources of support. Focusing on the Arab-Israeli population is unique as it is an ethnic minority characterized with strong familial support, and less access to mental health services compared to the ethnic majority. Adolescents (N = 276; 65.6% girls; mean age 15.1 years) from the Arab minority in northern Israel were sampled (74% response rate). Participants were evaluated using validated scales assessing perceived social support, NSSI and suicidal ideation. Path analysis with Bayesian estimation supported the hypothesized model. Depression symptoms fully mediated the relationships between school-related social support (i.e., teachers and peers) and NSSI, and partially between parents’ support and suicidal ideation. Interactions between the social support sources were not significant, and cluster analysis indicated that each source is independently essential to understand NSSI and suicide ideation. This model emphasizes the importance of school-related factors in adolescents’ particular aspects of mental health, and suggests that one source of social support may not compensate for a lack of another.
... In research conducted by Niederkrotenthaler et al., the researchers examine the possible correlation between 13 Reasons Why and the suicide rate among U.S teenagers [9]. By extracting suicide rate data of 10-19 years old U.S teenagers who have identification with the protagonist of the series between 1999 to 2017, researchers find a pattern that the suicide rate of teenagers drastically increased. ...
... A reduction in suicides was observed during the time periods with the most social media discourse about the song. The harmful 'Werther' effect was examined as related to the Netflix show '13 Reasons Why' (Niederkrotenthaler et al., 2019). The results indicated associations between the show and subsequent suicide counts among its young target audience. ...
Article
Objectives When journalists report on the details of a suicide, the way that they contextualize the meaning of the event (i.e. the ‘narrative’) can have significant consequences for readers. The ‘Werther’ and ‘Papageno’ narrative effects refer to increases and decreases in suicides across populations following media reports on suicidal acts or mastery of crises, respectively. The goal of this study was to investigate the impact of these different narrative constructs on subsequent suicides. Methods This study examined the change in suicide counts over time in Toronto, Canada. It used latent difference score analysis, examining suicide-related print media reports in the Toronto media market (2011–2014). Articles ( N = 6367) were coded as having a potentially harmful narrative if they described suicide in a celebrity or described a suicide death in a non-celebrity and included the suicide method. Articles were coded as having potentially protective narratives if they included at least one element of protective content (e.g. alternatives to suicide) without including any information about suicidal behaviour (i.e. suicide attempts or death). Results Latent difference score longitudinal multigroup analyses identified a dose–response relationship in which the trajectory of suicides following harmful ‘Werther’ narrative reports increased over time, while protective ‘Papageno’ narrative reports declined. The latent difference score model demonstrated significant goodness of fit and parameter estimates, with each group demonstrating different trajectories of change in reported suicides over time: (χ ² [6], N = 6367) = 13.16; χ ² /df = 2.19; Akaike information criterion = 97.16, comparative fit index = 0.96, root mean square error of approximation = 0.03. Conclusion Our findings support the notion that the ‘narrative’ matters when reporting on suicide. Specifically, ‘Werther’ narratives of suicides in celebrities and suicides in non-celebrities where the methods were described were associated with more subsequent suicides while ‘Papageno’ narratives of survival and crisis mastery without depictions of suicidal behaviours were associated with fewer subsequent suicides. These results may inform efforts to prevent imitation suicides.
... To map possible antecedents of moral rumination, we chose a popular example of a morally conflicted and highly controversial type of media content, namely the Netflix series 13 Reasons Why. As previously outlined, the show has sparked worldwide concerns regarding the possible negative effects that the (graphic and unpunished) depiction of controversial content-such as suicide, rape, (cyber)bullying, and slut-shaming-might have on (young, at-risk) viewers (e.g., Jacobson, 2017;Tolentino, 2017;Arendt et al., 2019;Hong et al., 2019;Niederkrotenthaler et al., 2019;Bridge et al., 2020). While recent meta-analytical research has argued that there is no evidence to support the belief that fictional media with suicide themes lead to a suicide contagion among viewers (Ferguson, 2019), the concerns regarding the potential for suicide contagion effects remain (Stafford, 2017;Arendt et al., 2019;Scalvini, 2020). ...
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Controversial media content has mainly been dealt with in relation to concerns about how the media we consume might be detrimental to its viewers as individuals and society at large. Nevertheless, researchers have started to take a different approach to these types of content, namely that these might lead to processes of reflective appropriation, meaning-making, and moral rumination. Via qualitative in-depth interviews with young adults (N = 45, age 18–24), we sought to gain deeper insights into the experiences of and reflective thoughts (i.e., moral rumination) about controversial media content. To map when and what forms of moral rumination are incited in viewers, we chose a popular example of a morally conflicted and highly controversial type of media content, namely the Netflix series 13 Reasons Why. The results reveal that moral rumination can exist in at least two forms, morally conclusive (i.e., rumination that ends in a moral judgment) and morally inconclusive (i.e., rumination that does not formulate a moral judgment but remains morally in doubt) rumination. The grounds for the ruminations are mostly text-based or based on the interaction of text and viewer characteristics, and are mostly focused on the show's central themes, such as suicide, guilt and responsibility, sexually transgressive behaviors, and themes tied to identity formation. Overall, the tendency of morally complex entertainment to promote moral rumination suggests that such material should be examined as a type of eudaimonic entertainment, which argues that viewers reflect on how the meaning of the content relates to their own lives.
... Najafi and colleagues also showed that about half of the elderly studied in Tehran had low mental health (37). However, Rashidi et al. (38), Nabavi et al. (39), Alavi et al., Nakano (41), and Heine and Browning (42) indicated the favorable mental health of the elderly that is different from the results of the present study. It seems that the main reason for the difference in the findings is the time period of conducting this research. ...
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Introduction: The recent Covid-19 pandemic has caused a great deal of stress and anxiety around the world. Changes in lifestyle as a result of the global outbreak of Covid-19 disease have affected children and the elderly along with psychological consequences. The health of children and the elderly is a top priority in all countries. Therefore, the present study was to review the health promotion of children and the elderly during coronavirus disease. Materials and Methods: This is a review using the keywords Covid-19 and health promotion in children to search papers in Sid, Scholar Google, Medline, Science direct and Pubmed databases. The articles from 2008-2020 were extracted according to the inclusion criteria, and the results were classified, summarized and reported. Conclusion: Evaluation of the articles showed an increase in behavioral problems, self-regulation problems, anxiety and fear, problems with adjustment and coping strategies, the experience of abuse and emotional harassment, the severity of mental disorders and depression, and post-traumatic stress as the psychological consequences of the pandemic among children and the elderly. Considering the negative psychological consequences of the Covid-19 outbreak, it is recommended to design and plan intervention and support strategies to reduce the adverse impacts.
... First, during the COVID-19 pandemic, misinformation and fake reports about the disease have bombarded social media, and have created baseless fears in people (79), which may confuse them and harm their mental health (80). Second, many people express their negative emotions such as fear, concerns, and anxiety on social media, thereby increasing fear, concerns, and anxiety in society (81)(82)(83). Governments and health-related organizations such as the WHO should play a more effective role and be present in social networks during pandemics such as COVID-19. Some measures that must be taken for disseminating accurate and reliable information on the Internet include sharing reliable information and recommending credible sources of information on governmental websites (56). ...
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COVID-19 has created major health-related, economic, and social challenges in societies, and its high contagion has dramatically altered access to healthcare. COVID-19 management can be improved by the use of telehealth. This study aimed to examine different telehealth technologies in the management of COVID-19 disease in the domains of surveillance, diagnosis, screening, treatment, monitoring, tracking, and follow-up and investigate the challenges to the application of telehealth in COVID-19 management. This scoping review was conducted based on Arksey and O’Malley's framework. Searches were performed in Web of Science, PubMed, and Scopus databases to examine the evidence on the effectiveness of telehealth in COVID-19 management. Eventually, 36 articles were selected based on the inclusion criteria. The majority of these studies (33%) were conducted in China. Most services offered via telehealth focused on surveillance, tracking, and follow-up, in that order. Moreover, the most frequently used technologies were social networks, web-based apps, and mobile apps, respectively. The use of telehealth in COVID-19 disease management plays a key role in surveillance, diagnosis, screening, treatment, monitoring, tracking, and follow-up.
... Indeed, there is a demonstrated relationship between media reports of celebrity deaths by suicide and publication of methods with increases in suicide risk in the general population (Niederkrotenthaler et al., 2020). Popular shows focused on the topic of suicide (i.e. 13 Reasons Why), are associated with notable increases of suicides among young people (Bridge et al., 2020;Niederkrotenthaler et al., 2019). Constrained suicide talk can extend to the client-therapist relationship as many clients actively conceal or self-censor suicidal thoughts in psychotherapy (Blanchard and Farber, 2020). ...
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Following the implementation of a provincial suicide prevention gatekeeper training initiative in western Canada between 2015 and 2018, we conducted a focused ethnography designed to capture the post-initiative context within one small community. Analyses of our field observations and interviews with community members suggest suicide prevention work is represented in multiple informal or coordinated actions to generate innovative pathways to provoke open conversations about suicide. Simultaneously, suicide talk is constrained and managed to limit vulnerability and exposure and adhere to community privacy norms. Further, parameters around suicide talk may be employed in efforts to construct the community and mental health care in livable ways. As the research process paralleled existing representations of suicide prevention work in the community, this paper explores our entanglement in the bounds of suicide talk during phases of recruitment, data collection and knowledge translation activities.
... 57 These efforts should include adherence to media guidelines for reporting on suicide, 58 and monitoring of the portrayal of suicide in the entertainment industry/social media, 59 as hanging was specifically associated with increased suicides among youth ages 10 to 19 years in the months following the release of 13 Reasons Why in 2017. 60 Seventy-five percent of cases of medically serious self-harm in this study were by overdose, ∼30% with a personal psychotropic prescription. National trends indicate the age-specific rate of suicide by poisoning among ages 10 to 19 has been decreasing slowly since 1981. ...
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Objective To evaluate the clinical features of Canadian adolescents admitted to the intensive care unit (ICU) for medically serious self-harm. Methods 2700 Canadian paediatricians were surveyed monthly over two years (January 2017 to December 2018) through the Canadian Paediatric Surveillance Program to ascertain data from eligible cases. Results Ninety-three cases (73 female; age 15.2 ± 1.5) met the case definition. Four provinces reported the majority of cases: Quebec (n = 27), Ontario (n = 26), Alberta (n = 21), and British Columbia (n = 8). There were 10 deaths, 9 by hanging. Overdose and hanging were the most frequently reported methods of self-harm (74.2% and 19.4%, respectively). Overdose was more common in females (80.8% females vs. 50% males; χ ² = 7.8 (1), p = .005), whereas hanging was more common in males (35% males vs. 15.1% females, χ ² = 3.9 (1), p = .04). More females than males had a past psychiatric diagnosis (79% vs. 58%; χ ² = 4.1 (1), p = .06), a previous suicide attempt (55.9% vs. 29.4%, χ ² = 3.8 (1), p = .05), and prior use of mental health service (69.7% vs. 27.8%, χ ² = 10.4 (1), p = .001). Family conflict was the most commonly identified precipitating factor (43%) of self-harm. Conclusions Among Canadian adolescents admitted to the ICU with medically serious self-harm, females demonstrate a higher rate of suicide attempts and prior mental health care engagement, whereas males are more likely to die by suicide. These findings are consistent with data from other adolescent samples, as well as data from working-age and older adults. Therefore, a sex-specific approach to suicide prevention is warranted as part of a national suicide prevention strategy; family conflict may be a specific target for suicide prevention interventions among adolescents.
... Person-based research showed mixed findings about the relationship between young people's Internet and social media use and mental health problems (Keles et al., 2020;Sedgwick et al., 2019). Several factors may contribute to increased risk of suicidality among young Internet users: (1) the dissemination of suicide-related information on the Internet that may trigger imitation or the use of lethal methods for suicide (Biddle et al., 2016); (2) imitative suicidal behaviors triggered by media reporting of celebrity suicides or popular web series or movies available on the Internet that include dramatic depictions of suicidal behaviors (Niederkrotenthaler et al., 2019(Niederkrotenthaler et al., , 2020; and (3) the emergence of cyberbullying (John et al., 2018). Harmful Internet content such as irresponsible media reporting (World Health Organization and International Association for Suicide Prevention, 2017) or inappropriate drama representations of suicidal behavior (World Health Organization, 2019a) should be regulated. ...
Article
Objective We investigated recent trends in youth suicide and their associations with societal and psychological factors in Taiwan. Methods Suicide data (1971-2019) for 10-24-year-olds were extracted from Taiwan’s national cause-of-death data files. We investigated changes in trends in youth suicide rates, societal factors (GDP per capita, GINI index, overall and youth unemployment rates, divorce rates in people aged 40-59 years [i.e., the age of most 15-24-year-olds’ parents], and internet use rates), and psychological distress indicators (youth selfharm rates and the prevalence of worry-related insomnia, and suicide ideation, plan, and attempt) using joinpoint regression and graphic examinations. The associations of these factors with youth suicide rates were examined using Prais-Winsten regression. Results Suicide rates in Taiwan’s 10-24-year-olds changed from a downward trend (2005-2014) to an upward trend in 2014 and increased 11.5% (95% confidence interval [CI] 5.2%-18.1%) annually between 2014-2019. There was also an upturn in divorce rates amongst females aged 40-59 years in 2014 and self-harm rates amongst 15-24-yearold youth in 2013. The prevalence of self-reported insomnia and suicide ideation, plan, and attempt in youth started to increase from 2013-2016. In the regression analysis, internet use, female divorce rates, and youth self-harm rates were positively associated with youth suicide rates. Conclusions Suicide rates and the prevalence of suicidal behaviours began to increase in Taiwanese youth in the 2010s. These increases may be associated with concurrent rises in parental divorce rates, internet use, and poor sleep. Further research is needed to examine the mechanisms underlying recent increases in youth suicide risk.
... Niederkotenthaler and colleagues found that despite content warnings and the identification of suicide prevention services during the airings, there was an immediate increase in suicides that exceeded the generally increasing trend in the target audience of the program of 10-to 19-year-old individuals in the 3-month period after the show's release. The increase was greater in females and the younger the viewer the greater the impact found [29]. ...
Article
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Purpose of Review Suicide is a serious healthcare concern worldwide. In the USA, suicide was the tenth leading cause of death prior to 2020 when it was displaced as a result of the death toll from COVID-19. Recent Findings Suicide behavior is the result of the interaction between the individual’s predisposing factors and precipitating factors. A recognized precipitating factor is the knowledge of the suicidal act of another, termed suicide contagion. Another precipitating factor is the physiological impact of an acute inflammatory response to disease, for example that seen in patients with COVID-19. Summary Risk identification of persons at increased risk for suicidal actions is an essential goal in medical care so that protective measures can be employed to prevent suicide.
... The suicide content in fictional media and its effects on viewers have recently received a high level of attention in the USA, with the release of the TV series 13 Reasons Why associated with an increase in suicides in the population. 41 The WHO has also released guidelines for filmmakers and others around portraying suicide in visual media. 42 However, this phenomenon remains underexamined in India, where suicide is a common theme in films and TV series with narratives that have a strong cultural resonance. ...
Article
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Objectives Crime reports of suicide incidents routinely feature in the Indian mass media, with minimal coverage of suicide as a broader public health issue. To supplement our recently published content analysis study, we undertook qualitative interviews to examine media professionals' perspectives and experiences in relation to media reporting of suicide-related news in India. Design and setting In 2017–2018, we undertook semistructured qualitative interviews with media professionals with experience reporting on suicide-related news. A semistructured interview guide was designed to initiate discussions around their perspectives and experiences in relation to reporting on suicide. Interviews were digitally audio-recorded and transcribed, and a deductive and inductive approach to thematic analysis was used. Participants Twenty-eight interviews were undertaken with media professionals in Delhi, Chandigarh and Chennai. Results A clear role for media in suicide prevention framed around educating and informing the public was articulated by several participants and a majority of participants also reported concerns and anecdotal accounts that their reporting may negatively influence vulnerable people in the population. Nonetheless, a fatalistic attitude towards suicide was evident among several participants including dismissing or minimising concerns around imitation suicides. Several participants also expressed doubts around the quality of suicide helplines in India and were hesitant to add such contact details to their reports. Participants were largely very receptive to the idea of developing voluntary media guidelines for the Indian context, although doubts were raised around compliance unless additional initiatives were taken to engage media professionals at the highest levels. Conclusions Our findings reveal the perspectives of media professionals operating in the Indian context and can be used to support constructive partnerships between media professionals and suicide prevention experts. There is a clear need for a genuine and sustained partnership between suicide prevention experts and media professionals at all levels.
... It is worth mentioning that the mediatized information can originate from reliable or unreliable sources. Along with other public health crises and mass traumas (terrorism, H1N1 epidemic or SARS-COV), exposure to mediated information about this virus causes psychiatric disorders, including anxiety and reduced well-being [4][5][6]. ...
Article
Introduction: Discovered in December 2019, COVID has affected the entire planet, through direct exposure to its virus; SARS-COV-2, or indirectly through the media, Indeed, on January 20, 2020, the World Health Organization declared COVID-19 "a public health emergency of international concern." Along with other public health crises and collective traumas (terrorism, H1N1 epidemic or SARS-COV), exposure to mediated information about this virus causes psychiatric disorders, including anxiety and lack of well-being. Objective: To link exposure to information about this pandemic through social networks to anxiety and lack of well-being. Methodology: The use of a questionnaire composed of three items, status and individual conditions, the GAD-7 scale for anxiety and the WHO 5-item well-being index (WHO-5). This questionnaire is dedicated to the general population that has not been in direct contact with the virus, but through social networks. Results: We were able to collect 209 participants, they were mainly women with an average age of 28 years, 17.7% had a psychiatric history of anxiety and depression, the median use of social media was 5.7 hours per day. And they were mainly getting their information about the pandemic from Instagram, Facebook, the Moroccan Ministry of Health website, and electronic newspapers. 31.1% of our participants were anxious female gender and history of mood disorder favored this disorder. Increasing age in years decreased the risk of depression in our study. We found a strong negative correlation between anxiety and well-being (p<0.001), and a moderate negative correlation between duration of exposure to social networks and well-being (p<0.001).
... Other studies have also suggested that spending more time in social media or following COVID-19-related news, insufficient social support, insufficient protective behaviors and jobs with high infection risks are also related to high risk of mental and psychological disorders (37)(38)(39)(40)(41) which are in accordance with our results. Social media plays a vital role in spreading information and news; however, it can also be used to spread misinformation, resulting in unnecessary panic (42)(43)(44)(45). In this study, the mean depression and anxiety scores of children with working mothers and fathers who had an office job was lower than those with mothers who were housewives and parents who had private jobs; however, this relationship was not statistically significant. ...
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Objective: This study aimed to assess anxiety and depression during the COVID-19 outbreak among students aged 8 to 18 years and to determine related demographic and other related factors. Method: A descriptive and analytical cross sectional study was conducted through web-based data collection which included 348 students aged 8 to 18 years in the state of Mazandaran, Iran during the first peak of COVID-19. Demographic and Revised Children's Anxiety and Depression Scale (RCADS-P) questionnaires were used to collect the data. The statistical tests including independent sample t test, ANOVA as well as linear regression were employed. Results: The average age of the subjects was reported to be 12.2 ± 3.59 years. Age, father’s occupation, following COVID-19 related news, and also nervousness related to infection were predictors of anxiety (11%). Moreover, age, mother’s occupation, family communication and also the safety protocols practiced by the family were found to be predictors of depression in students (17%). A significant relationship was also found between the effect of quarantine on family communication and the anxiety and depression in students (P < 0.001). Conclusion: Demographic characteristics affect student mental health during the COVID-19 outbreak. Moreover, family preventive protocols can predict depression in students aged 8 to 18 years. Better preventive precautions encourage less anxiety and depression.
... 28 Social network being very much contagious contributed to the spread of worry, as most of netizens share their negative feelings on social networks. 29,30 CONCLUSION As per results of this paper, 40% individuals reported mild to severe depression in this COVID-19 pandemic. As per eligibility criteria of this study participants having known history of any mental illness were excluded, which means these 40 % cases were new cases which certainly deserves attention of Govt. ...
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Background: Apart from the known physical impact COVID-19 pandemic also has had a significant psychic impact on the psychological health of the general population.Methods: The study was planned as a multi-centre cross sectional study and conducted between April 2020 and August 2020 at dedicated COVID-19 hospitals in India. Patients and accompanying relatives more than 18 years, of any gender visiting COVID hospital and willing to consent for the study were enrolled in the study. Study included three questionnaires namely, Generalized Anxiety and Depression Scale (GAD-7 Scale), questionnaire to evaluate anxiety and worry related to COVID-19 and socio demographics and COVID-19 related awareness questionnaire.Results: The patient health questionnaire (PHQ) indicated that while 25% experienced no anxiety highly significant number of 75% experienced varying degrees of psychological impact. On the GAD-7 scale 42% experienced no generalized anxiety; however, a significant remaining 58% experienced variable degree of psychological impact. While 77% people were reasonably aware about Government initiatives, however 73% were concerned about their families or themselves getting affected.Conclusions: Professional health care workers and Government agencies need to be keenly aware about the above results while devising treatment protocols and policy decisions.
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We conducted a cross-sectional study among 1 040 Egyptian adults (female = 56.0%; mean age = 28.8 years, SD = 7.7 years, age range 21–70 years) to assess their anxiety and depressive symptoms two weeks after the partial lockdown due to COVID-19 outbreak in Egypt. Additionally, we explored possible risk factors related to the emergence of these symptoms. The participants completed COVID-19-related questions, the Patient Health Questionnaire, and the Generalised Anxiety Disorder scale. Multiple logistic regression analysis indicated that females were more likely to develop anxiety and depression symptoms compared to males. Moreover, participants who reported following the news about COVID-19 for the whole day were 4.2 times more likely to develop anxiety and depression. Fearing stigma and worries about the nature of sanitary isolation were associated with anxiety and depression.
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ABSTRACT: The term "media" used to explain the mass media provides the transmission of messages and information regarding the society. According to the researches, media has an important power in influencing the masses in terms of public interests and policies. By addressing the media as a priority, through individual or professional organizations, nurses can be effective in exposing the profession's image in the media and policy issues affecting the profession. A more consistent approach to presenting nursing research to the public and using the media for this purpose will enable the public to perceive nursing as it is and support the use of research. In this review, basic knowledge tried to be provided by the nurses about what to do through the media and, the actions are taken in the media related to the novel coronavirus disease which emerged first at the end of 2019 in Wuhan Province of China and in March 2020 in Turkey, were examined. ÖZET: Kitle iletişim araçlarını anlatmak için kullanılan medya, topluma ilişkin mesajların ve bilgilerin aktarılmasını sağlamaktadır. Yapılan araştırmalara göre medya, kamu çıkarları ve politikalar konularında kitleleri etkilemede önemli bir güce sahiptir. Hemşireler, bireysel veya mesleki kuruluşlar aracılığıyla medyayı öncelikli olarak ele alarak, mesleğin medyadaki imajını ve mesleği etkileyen politika sorunlarını ortaya koymada etkili olabilirler. Hemşirelik araştırmalarını kamu-oyuna sunmaya ve medyayı bu amaçla kullanmaya yönelik daha tutarlı bir yaklaşım, halkın hemşireliği olduğu gibi algılamasını sağlayacak ve araştırma kullanımını destekleyecektir. Bu derlemede, hemşirelerin medya aracılığıyla neler yapabileceği konusunda temel bilgiler veril-meye çalışılmış ve 2019 yılı sonunda Çin'in Wuhan kentinde Mart 2020'de de Türkiye'de ilk kez ortaya çıkan yeni Koronavirüs hastalığı sürecinde medyada yer alan hemşirelikle ilgili eylemler incelenmiştir.
Chapter
Suicide is a leading cause of adolescent death worldwide. This article summarizes many of the factors that contribute to adolescent death by suicide and suicide attempts. The first portion of this article discusses factors associated with death by suicide and attempted suicide. The second portion of the article describes the clinical evaluation and treatment of adolescents who attempt suicide, with a focus on the use of evidence-based practices. The article concludes with a discussion of future research directions and clinical applications of adolescent suicide research.
Article
Objective In light of the current national mental health crisis, we use Google Trends, Twitter and data obtained from the National Suicide Prevention Lifeline to evaluate the effect of ‘1-800-273-8255’ on public awareness for the National Suicide Prevention Lifeline. Design Cross-sectional analysis. Main outcome measures We extracted data from Google Trends and Twitter for terms related to suicide following the release of Logic’s song, ‘1-800-273-8255’. We then used a forecasting autoregressive integrated moving algorithm model to determine the greater than expected search interest. Results Google searches for ‘Suicide Hotline’ increased 49% more than expected the day after Logic’s song was released and sustained increase of queries resulted in an average relative search volume of 59.5%–9.1% higher than the mean forecasted value of 50.4% for the 28 days following the release. Tweets that engaged with the account ‘@800 273talk’ on Twitter increased by 10 450% more than expected the day after the song was released and increased by a mean of 1497% greater than expected the week after the songs released. Conclusion Findings from our study suggest that the entertainment industry can play an important role in increasing awareness of hotline numbers. Logic’s song provides an example of a positive influence on public health and provides support for further development and standards for proper awareness of suicide in the public view.
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Adolescents and children engage in suicidal and self-harm behavior at alarmingly high and increasing rates. Using a biopsychosocial lens, this overview provides a summary of researchers’ current understanding of the motivations underlying child and adolescent suicidality; the epidemiology of pediatric suicide deaths, non-fatal suicidal behavior, and non-suicidal self-harm; the major biological, psychological, interpersonal, and community-level risk factors for these behaviors; and evidence-based suicide prevention and intervention approaches. It also outlines common tools for assessing suicidal risk in pediatric populations. Controversies and future directions for research and practice in this field are delineated.
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In Mexico, suicidal behavior is a matter of concern because, although the rates of death by suicide are below global mean (11.4 vs. 4.1 x 100,000 population), between 1970 and 2007 they increased by 175 %, especially among young people, in whom it is the third leading cause of death. For this reason, several preventive actions have been developed but have not had the expected success, because they are poorly designed. They lack a uniform and clear case definition. Their approach is reductionist, it focuses only on the public health aspect and does not go beyond traditional plans of primary, secondary and tertiary prevention. This review aims to offer different options, such as adopting the case definition provided by Atlanta's Centers for Disease Control and Prevention (CDC). It aims to broaden the vision in order to include philosophical, psychosocial and psychiatric aspects, as well as to include, as a theoretical framework, the "diathesis-stress" psychological model and propose a population-based intervention preventive strategy.
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Objectives: Low media literacy and exposure to media-produced content during the Coronavirus Disease 2019 (COVID-19) pandemic can affect the health of people in the community. This study aims to investigate the psychological effects of media use on the mental health of community-dwelling older adults. Methods & Materials: In this descriptive-analytical study with a cross-sectional design, 200 elderly people aged ≥60 years participated who were selected from daycare rehabilitation centers and retirement centers in Kerman, Iran in 2020 using a convenience sampling method. Data were collected using a demographic form (Surveying age, gender, education, occupation, marital status, income, and media use), and the 12-item General Health Questionnaire. Results: The mean age of participants was 66.60 ± 5.08 years. More than three-quarters of them were following the latest COVID-19 news via media (Local radio and television). Most of them (77.4%) had poor mental health status. Higher educational level (P
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Because it has been associated with significant increases [through the Werther Effect (WE)] or decreases [through the Papageno Effect (PE)] of suicide rates, media coverage of suicide-related events is recognized as a prevention leverage. Unfortunately, the recommendations that the World Health Organization (WHO) has published to help journalists reporting on suicide remain poorly applied. The Mini Media Training (MMT) is a short media training session designed to increase psychiatrists’ ability to communicate about suicide during interviews. We aimed at assessing the effect of the MMT on psychiatrists’ ability to help journalists complying with the WHO recommendations. From June 2017 to December 2019, 173 physicians and residents in psychiatry were recruited during French national congresses. At baseline (T0) and 1 and 3 months later (T1), participants received the MMT, which consisted in a simulated interview where they we asked to answer a journalist about a mock suicide. Communication skills were measured with a score summing the number of delivered pieces of advice in relation to the WHO recommendations, with a maximum score of 33. A weighted score was also derived based on the degree of directivity needed for the participant to provide these items, again with a possible maximum of 33. A total of 132 psychiatrists participated in the study at T0 and T1. Both the weighted and unweighted score significantly increased from T0 to T1 ( d = +2.08, p < 0.001, and d = +1.24, p < 0.001, respectively). Having a history of contacts with journalists, a short professional experience (<3 years) and prior knowledge of the WE, PE, and WHO recommendations were significantly associated with greater unweighted and weighted scores at baseline. The latter two variables also predicted greater T0–T1 improvement of the weighted score. These results suggest that the MMT could be effective for improving the ability of psychiatrists to guide journalists toward more responsible media coverage of suicide. As a short, easy to implement educational activity, the MMT could therefore be considered in association with other measures to help media professionals mitigating the WE and promoting the PE.
Article
Suicide is a major public health concern in the United States. Between 2000 and 2018, US suicide rates increased by 35%, contributing to the stagnation and subsequent decrease in US life expectancy. During 2019, suicide declined modestly, mostly owing to slight reductions in suicides among Whites. Suicide rates, however, continued to increase or remained stable among all other racial/ethnic groups, and little is known about recent suicide trends among other vulnerable groups. This article ( a) summarizes US suicide mortality trends over the twentieth and early twenty-first centuries, ( b) reviews potential group-level causes of increased suicide risk among subpopulations characterized by markers of vulnerability to suicide, and ( c) advocates for combining recent advances in population-based suicide prevention with a socially conscious perspective that captures the social, economic, and political contexts in which suicide risk unfolds over the life course of vulnerable individuals. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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The relationship between social media use, suicide, and self-injurious behaviors has received public and academic attention. Social media are platforms that facilitate social connection and support around life challenges, including self-injurious thoughts and behaviors, and spaces where they may encounter content or interactions increasing risk. This chapter’s purposes are twofold: (1) to summarize research on the risks and benefits of social media use for SITB-related outcomes, including what is and is not known about primary mechanisms in these relationships; (2) to identify high-level implications, including opportunities and challenges for future research, intervention and prevention efforts. The first section overviews the prevalence and presentation of SITB in adolescence and the role of social media in SITB, while the second section summarizes findings on risks and benefits of social media use for SITB, and key mechanisms involved in these relationships. The final section covers implications for research, practice, and policy, through high-level opportunities.
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Internationally, there are indications of an increasing trend in suicide contagion and clustering, which has been associated with contemporary communication technology and continuous communication across jurisdictions. Research has indicated varying effects related to different types of media and media contents in terms of impacts on suicidal behaviour. A comprehensive literature search was conducted into research addressing different types of media and media contents and the impact on suicide contagion and clustering, covering January 2003 - February 2021. Across the 41 selected studies, we identified consistency in terms of both increased quantity of media reports and portrayal of specific details of suicide cases, including celebrities and fictional cases, to be significantly associated with suicide contagion and increased suicide rates or mass clusters, with significant impacts on increased risk of suicide contagion within the first days up to the first three monthsfollowing the media coverage. The impact of potentially harmful content and the portrayal of suicide and self-harm via internet sites and social media on suicide contagion and clustering was largely consistent with research into impacts involving traditional media. The findings underline the need to prioritise implementation and adherence to media guidelines for reporting suicide for media professionals, online and social media outlets.
Article
Background There is strong evidence that suicides increase after media stories about suicides by celebrities, particularly those that highlight the suicide method (the Werther effect). Much less is known about the Papageno effect—the protective effects of media stories of hope and recovery from suicidal crises. A synthesis of the retrievable evidence is lacking. We aim to summarise findings from randomised controlled trials about the effects of stories of hope and recovery on individuals with some degree of vulnerability to suicide. Methods For this systematic review and individual participant data meta-analysis, we searched PubMed (including MEDLINE), Scopus, Embase, PsycInfo, Web of Science, and Google Scholar published from inception to Sept 6, 2021, without language restrictions. We included trials that reported suicidal ideation (the primary outcome) or help-seeking attitudes or intentions (the secondary outcome) and tested a media narrative of hope and recovery. Studies were excluded if they did not feature a clearly positive story of hope and recovery, or had a control group exposed to suicide-related stimulus material. We contacted the lead or senior authors of all original studies to obtain participant-level data for this study. The primary analysis was restricted to individuals with some vulnerability to suicide. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomised trials. The study is registered with PROSPERO, number CRD42020221341. Findings Our search yielded 7347 records. 3920 records were screened by title and abstract, and 25 full-text records assessed for eligibility. There were eight eligible studies with 2350 participants for which individual participant data were sought. For suicidal ideation, six studies met the inclusion criteria for the primary analysis. Follow-up responses were available for 569 (90%) of 633 participants who were randomised with high vulnerability (345 [55%] allocated to the intervention group and 288 [45%] to the control group). The pooled standardised mean difference (SMD) indicated a small reduction in suicidal ideation of –0·22 (95% CI –0·39 to –0·04, p=0·017; six studies) in the intervention group. For help-seeking attitudes and intentions, four studies met the inclusion criteria and follow-up data were available for 362 (86%) of 420 participants (247 [59%] allocated to the intervention group and 173 [41%] to the control group). The pooled SMD showed no evidence of a difference between the groups (SMD=0·14, 95% CI –0·15 to 0·43, p=0·35; four studies). Low levels of cross-study heterogeneity effects were observed for both analyses (I²=5% [suicidal ideation] and I²=36% [help-seeking attitudes and intentions]). We found no evidence of publication bias. Interpretation Media narratives of hope and recovery from suicidal crises appear to have a beneficial effect on suicidal ideation in individuals with some vulnerability, but there is insufficient evidence regarding help-seeking attitudes and intentions. These findings provide new evidence about narratives for suicide prevention. Funding None.
Article
Works of art and information judged as obscene can be censored or banned. This brief review evaluates the costs and benefits of censorship and the banning of artwork and information. In the history of psychology, Frederick Wiseman's film Titicut Follies epitomizes the disadvantages of concealing art content. Despite protecting the privacy of patients, the ban of Titicut Follies delayed the reform of psychiatric treatment practices and hospitals. The decision to censor or ban artistic and scientific information can result in the loss of knowledge and potential improvements to social, political, and economic institution practices.
Article
Background To evaluate the impact of the series 13Reasons Why on depression and suicidal behaviors in children and adolescents. Methods Data from the 2016–2018 Nationwide Inpatient Sample (NIS) and the Nationwide Emergency Department Sample (NEDS) of the Healthcare Cost and Utilization Project (HCUP) from 2016 to 2018 was used to determine the presentation in both settings for depression and suicidal thoughts and behavior. This was compared to predictive modeling for presentations in the same time frame. Results Following the release of 13 Reasons Why both hospital admissions and presentations to the Emergency Department (ED) increased for complaints of worsening depression or suicidal thoughts and behavior. This was more pronounced for youth aged 10–17 years, Black race, and female sex. There were no significant findings, overall, for females 6–9 years, but in-patient visits for depression increased in May 2017 for Black females 6–9 years. Males 6–9 years had higher rates of ED visits for depression and both ED and in-patient visits for suicidal behaviors. Limitations Secondary data analyses have known limitations including inability to track over time, inclusion of only visit-level data, and failure to collect variables of interest. Conclusions The series 13 Reasons Why was likely associated with exacerbations of both depressive illnesses and suicidal behavior in youth, particularly for female and Black youth from 10 to 17 years. This study adds to known concerns regarding the role of media in influencing suicidal behavioral in vulnerable children and has important implications for youth monitoring and parent and youth education. More research is needed to identify specific targets for prevention.
Article
Objective: The aim of this study was to assess associations of various content areas of Twitter posts with help-seeking from the US National Suicide Prevention Lifeline (Lifeline) and with suicides. Methods: We retrieved 7,150,610 suicide-related tweets geolocated to the United States and posted between 1 January 2016 and 31 December 2018. Using a specially devised machine-learning approach, we categorized posts into content about prevention, suicide awareness, personal suicidal ideation without coping, personal coping and recovery, suicide cases and other. We then applied seasonal autoregressive integrated moving average analyses to assess associations of tweet categories with daily calls to the US National Suicide Prevention Lifeline (Lifeline) and suicides on the same day. We hypothesized that coping-related and prevention-related tweets are associated with greater help-seeking and potentially fewer suicides. Results: The percentage of posts per category was 15.4% (standard deviation: 7.6%) for awareness, 13.8% (standard deviation: 9.4%) for prevention, 12.3% (standard deviation: 9.1%) for suicide cases, 2.4% (standard deviation: 2.1%) for suicidal ideation without coping and 0.8% (standard deviation: 1.7%) for coping posts. Tweets about prevention were positively associated with Lifeline calls (B = 1.94, SE = 0.73, p = 0.008) and negatively associated with suicides (B = -0.11, standard error = 0.05, p = 0.038). Total number of tweets were negatively associated with calls (B = -0.01, standard error = 0.0003, p = 0.007) and positively associated with suicide, (B = 6.4 × 10-5, standard error = 2.6 × 10-5, p = 0.015). Conclusion: This is the first large-scale study to suggest that daily volume of specific suicide-prevention-related social media content on Twitter corresponds to higher daily levels of help-seeking behaviour and lower daily number of suicide deaths. Preregistration: As Predicted, #66922, 26 May 2021.
Chapter
This chapter introduces media effects research as it relates to suicide. In light of such research, Seggi discusses the media guidelines produced by a variety of national and international associations aimed at aiding media professionals in reporting on suicides in responsible and careful ways that do not trigger copycat suicides. Seggi lays the groundwork for her proactive approach (to be discussed in Chap. 5). Instead of suggesting these media guidelines be followed by media professionals, Seggi uses them (together with a variety of other tools) to frame her media literacy strategy to empower audiences to think for themselves.Keywords 13 Reasons Why AdvertisingCopycat suicidesEcological fallacyFictional accounts of suicideKabuki effectMedia effects researchMedia effects research methodologiesMedia guidelinesMedia literacyNon-fictional accounts of suicidePapageno effectProactive approachReactive prescriptionsSuicideSuicide clusterSuicide media contagionSuicide statisticsWerther effect
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This chapter frames the Netflix series 13 Reasons Why as a conundrum. Changes made to the series over three consecutive years of programming testify to both the complexity of teen suicidality and the difficulty of addressing it in a sensitive manner on screen, while being subject to profit-making imperatives. This chapter analyzes the series’ constitutive elements in terms of suicidality. Related issues such as bullying, sexual violence and peer pressure are also discussed. The mechanism of self-fulfilling prophecy and the bystander approach are highlighted in relation to the series.Keywords 13 Reasons Why BullyingBystander approachExploitation of suicideGlorification of suicideGriefLossMedia literacy strategyMedia literacy strategy questionsPeer pressureProfit motiveRelationalitySelf-fulfilling prophecySensationalismSexual violenceSilenceSuicideSuicide notesSuicide of revengeViolence
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The Netflix series 13 Reasons Why explores the suicide of a fictional teen, and the finale graphically shows the suicide over a 3-minute scene.
Article
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The national suicide rate has risen steadily in recent decades, making suicide now the second leading cause of death among young people, accounting for more than 1 in 6 deaths.¹ Adolescent reports of suicide ideation and attempts are on the rise. According to national high school Youth Risk Behavior Survey,² the percentage of high school respondents who reported that they seriously considered attempting suicide during the 12 months preceding the survey rose from 13.8% in 2009 to 17.7% in 2015; during this same interval, the percentage of high school students making a plan for how they would attempt suicide increased (10.9% to 14.6%), as did the percentage who actually attempted suicide (6.3% to 8.6%).
Article
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Online product reviews may be subject to self-selection biases that impact consumer purchase behavior, online ratings’ time series, and consumer surplus. This occurs if early buyers hold different preferences than do later consumers about the quality of a given product. Readers of early product reviews may not successfully correct for these preference differences when interpreting ratings and making purchases. In this study, we develop a model that examines how idiosyncratic preferences of early buyers can affect long-term consumer purchase behavior as well as the social welfare created by review systems. Our model provides an explanation for the structure of product ratings over time, which we empirically test using online book reviews posted on Amazon.com. Our analysis suggests that firms could benefit from altering their marketing strategies such as pricing, advertising, or product design to encourage consumers likely to yield positive reports to self-select into the market early and generate positive word-of-mouth for new products. On the other hand, self-selection bias, if not corrected, decreases consumer surplus.
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Suicide is the third leading cause of death among young people in the U.S. and represents a significant public health problem worldwide. This review focuses on recent developments in our understanding of the epidemiology and risk factors for adolescent suicide and suicidal behavior. The suicide rate among children and adolescents in the U.S. has increased dramatically in recent years and has been accompanied by substantial changes in the leading methods of youth suicide, especially among young girls. Much work is currently underway to elucidate the relationships between psychopathology, substance use, child abuse, bullying, internet use, and youth suicidal behavior. Recent evidence also suggests sex-specific and moderating roles of sex in influencing risk for suicide and suicidal behavior. Empirical research into the causal mechanisms underlying youth suicide and suicidal behavior is needed to inform early identification and prevention efforts.
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This study examined incidence rates of medically identified suicide acts (self-inflicted injuries, either fatal or nonfatal) and case fatality rates by age, sex, race, and method used. The authors analyzed data on 10,892 suicides and 57,439 attempted suicides among hospital-admitted individuals in 8 states, along with 6219 attempted suicides among individuals released from emergency departments in 2 states. The 8 states experienced a mean of 11 suicides and 119 attempted suicides per 100,000 residents each year. Groups with high suicide rates were men, the elderly, and Whites; groups with high attempted suicide rates were teenagers, young adults, women, and Blacks and Whites aged 25 to 44 years. Blacks aged 15 to 44 years evidenced high attempted suicide rates undocumented in previous studies. Poisoning and firearm were the most common methods used among those attempting suicide and those completing suicide acts, respectively. The most lethal method was firearm. The characteristics of suicides and attempted suicides differ dramatically. Method used is important in the lethality of the act.
Article
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.
Article
Purpose: Release of the Netflix series 13 Reasons Why in March 2017 raised concern over associated suicide attempts. This study aimed to identify trends in self-harm admissions to a tertiary children's hospital with special attention paid to the time after series release. Methods: Records for admitted patients ages 4-18 years from January 2012 to October 2017 were identified based on ICD codes indicating self-harm. Admissions were grouped by month, and the ARMA (Auto Regression and Moving Average) model was used in analysis. Log transformation was used to obtain a constant variance, and seasonal terms were added for adjustment. A "postintervention" level shift, temporary shift, and linear growth term were incorporated as predictors in ARMA models to test for differences using the series premier as the intervention. Terms from the best fitting model (without intervention effects) were fit to preintervention data and forecast predictions were compared to the observed data from the postintervention period. Results: Seven hundred seventy-five records were included in analysis. There was an increase of .024 in the log of suicide admission counts per month (p < .001). The model that best explained the data was an ARMA (2,2) model with cubic growth curve terms, a post-intervention level shift, and a postintervention linear growth term, indicating an increase in observed over expected admissions following the premiere. Conclusions: Suicide admission counts increased over the time series. Actual suicide admissions following March 2017 were higher than predicted using the optimal model, suggesting an effect that temporally coincides with the release of 13 Reasons Why.
Article
We aimed to investigate the influence of media portrayals of suicide on adolescents' mood, focusing on the case of 13 Reasons Why, a webseries that raised concerns for approaching suicide explicitly for an audience mostly composed of adolescents. There is already evidence of an increase in suicide-related Internet searches shortly following its release. Our study included 7004 individuals aged 12-18 years. Participants were recruited through posts on 13 Reasons Why-themed social media groups. Volunteers filled an online questionnaire made available throughout May 2017 (54-71 days after the show was released). The questionnaire collected data on sociodemographic characteristics, mood (sadness and lack of motivation) in the month previous to watching the series, and prevalence of self-harm, suicidal ideation, or suicide attempts. Changes in mood were considered the main outcome; the variable was derived from a question asking about feelings of sadness and lack of motivation after watching the show. Overall, 23.7% reported worsening in mood after watching 13 Reasons Why. This rate was higher among individuals who, before watching the series, experienced more frequent and intense feelings of sadness and lack of motivation (OR 2.73 for frequent or daily feelings; OR 3.61 for intense feelings) or reported suicidal ideation/self-harm/suicide attempt (OR 1.38), even after controlling for sex and age. In times of easy access to digital content and binge-watching, the way mental health issues are portrayed in fiction needs to be carefully debated and thought out.
Article
Background For decades, policymakers and suicide prevention advocates have questioned whether exposure to media with suicide themes, whether television, movies, or music, could increase suicide risk among youth. To date, no clear picture has emerged, with data inconsistent Aims To access whether current evidence can support concerns that fictional media increases risk of viewer suicidal ideation. Materials & Methods Two broad forms of data consider the issue, namely society‐level aggregate data, and data from smaller correlational and experimental studies. The current article examined the evidence for suicide contagion by fictional media with a methodological and meta‐analytic review. Results Results suggest that current data do not support the theory that suicide contagion by fictional media occurs. Discussion In addition to lack of consistency in current research results, widespread methodological concerns limit confidence in conclusions from many studies. A commitment to better methods and open science is warranted. Conclusion It is recommended that individuals exercise caution in public statements linking suicide‐themed fictional media to suicide contagion as data may not be able to support such claims.
Article
Unlike most leading causes of death in the United States, suicide rates have not declined during the past 50 years.1 Among young people the situation is even more dramatic, because suicide rates are rising,2 and suicide is now the second cause of death in 15- to 29-year-olds globally.3 It has been suggested that descriptions of suicide in the media might affect behavior and that the young might be more vulnerable to this effect.4.
Article
It is the position of the National Association of School Nurses that the registered professional school nurse (hereinafter referred to as the school nurse) is a crucial member of the team participating in the prevention of bullying in schools. School nurses are the experts in pediatric health in schools and, therefore, can have an impact on the health and safety of all students, including students who bully, students who are bullied, or students who both bully and are bullied by others (Centers for Disease Control and Prevention [CDC], 2011a, 2011b). The school nurse role includes the prevention of bullying and the identification of students who are bullied, bully others, or both. The school nurse has a significant leadership role in the implementation of bullying prevention policies and strategies.
Article
Synopsis In this study it was possible to prove the Werther effect in suicides after watching fictional models for the first time. A twice-broadcast (1981, 1982) six-episode weekly serial showing the railway suicide of a 19-year-old male student provided a quasi-experimental ABABA design to investigate differential effects of suicide imitation. Imitation effects were most clearly observable in the groups whose age and sex were closest to those of the model. Over extended periods (up to 70 days after the first episode), the number of railway suicides increased most sharply among 15- to 19-year-old males (up to 175%); the effect steadily decreased in the older age groups, so that no effect was observable for males over 40 years and females over 30 years. Also, the imitation effects remained detectable for longer periods in the groups closest in age to the model. The increases observed after the first and second broadcast for males aged > 30 years closely corresponded with the respective audience figures for the two showings.
Article
The association between the portrayal of suicide in fictional media and actual suicide has been debated since 1774, when it was asserted that Goethe's The Sorrows of Young Werther had led people to take their own lives. Since that time, a plethora of studies considering the association has been conducted. This review considered 34 studies examining the impact of fictional portrayal of suicide (in film and television, music, and plays) on actual suicidal behavior. It asked the question: "Is there any association, and if so, can it be considered causal?" Using strict criteria to establish causality, we found that the evidence was more equivocal than was the case for nonfictional reporting.
13 Reasons Why renewed for a second season at Netflix
  • Variety
Variety. 13 Reasons Why renewed for a second season at Netflix. 2017. http://variety.com/2017/tv/ news/13-reasons-why-renewed-season-2-netflix-2-1202411389. Accessed November 8, 2017.
Thirteen Reasons Why: the impact of suicide portrayal on adolescents' mental health
  • Gsd Rosa
  • G S Andrades
  • A Caye
  • M P Hidalgo
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