The controversial series 13 Reasons Why triggered an increase in Google searches for specific methods of suicide and suicide hotline queries, US researchers suggest.
The findings follow months of public speculation and stern warnings from youth mental health groups that the blockbuster Netflix show could cause more harm than good, especially among its target teenage audience.
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Suicide-related searches were 19 per cent higher than expected in the days following the premiere, amounting to 900,000 to 1.5 million more searches, the researchers reported in a research letter in JAMA on Monday.
The researchers at San Diego State University used Google trends to compare the volume of US-based suicide-related Google searches in the weeks before and after the premiere of the show on March 31.
![Google searches for suicide topics rose after the premiere of Netflix series <i>13 Reasons Why</I>.](http://web.archive.org./web/20170802143014im_/https://www.fairfaxstatic.com.au/content/dam/images/g/x/l/9/g/e/image.related.articleLeadwide.620x349.gxl9en.png/1501620114146.jpg)
The MA15+-rated series depicts the events leading up to, and following the suicide of a 16-year-old girl, including a graphic three-minute scene of her death.
It sparked both emotional and reasoned debate over responsible media representations of suicide, and questioned whether the show glamorised teenage suicide or raised awareness about the leading cause of death among Australians aged 15 to 24 years old.
For 12 of the 19 days analysed, suicide searches were significantly higher than expected, ranging from 15 per cent on April 15 to 44 per cent on April 18.
The study excluded any searches mentioning 'Suicide Squad', the 2016 action film, so as not to contaminate the findings.
![Katherine Langford in a scene from the controversial series <i>13 Reasons Why</I>.](http://web.archive.org./web/20170802143014im_/https://www.fairfaxstatic.com.au/content/dam/images/g/v/z/i/h/k/image.related.articleLeadwide.620x349.gxl9en.png/1501620114146.jpg)
Seventeen of the top 20 suicide-related searches were higher than the researchers expected, with most focusing on suicidal ideation.
"How to commit suicide" was 26 per cent higher, "commit suicide" was 18 per cent higher, and "how to kill yourself" was 9 per cent higher.
![Lily Collins in Netflix's <i>To The Bone</I>, which has drawn fire from youth mental health groups for its depiction of ...](http://web.archive.org./web/20170802143014im_/https://www.fairfaxstatic.com.au/content/dam/images/g/x/4/2/5/t/image.related.articleLeadwide.620x349.gxl9en.png/1501620114146.jpg)
Searches for suicide hotlines also rose, including "suicide hotline number" (21 per cent) and suicide "hotline" (12 per cent).
Public awareness-related searches were also up, with "suicide prevention" rising by 23 per cent and "teen suicide" 34 per cent higher.
"13 Reasons Why elevated suicide awareness, but it is concerning that searches indicating suicidal ideation also rose," the researchers wrote.
It was not clear if any searchers attempted suicide after googling, but suicide search trends were correlated with actual suicides, media coverage of suicides were associated with an increase in suicide attempts, and searches for specific methods of suicide increased after the show's release, the authors said.
"The deleterious effects of shows such as 13 Reasons Why could possibly be curtailed by following the World Health Organisation's media guidelines for preventing suicide," the authors suggested.
They included removing scenes showing suicide, and including a suicide hotline in every episode.
The authors wanted the series retro-fitted with these changes, and included in the planned second season.
US youth mental health experts warned that the show's success would foster similar "binge-watching" series.
"This immersion into the story and images may have a particularly strong effect on adolescents, whose brains are still developing the ability to inhibit certain emotions, desires and actions," they wrote in a JAMA editorial.
Australia's Mindframe media guidelines strongly urge against including explicit content, method and location details about suicide.
In April, Australian youth mental health foundation Headspace reported an increase in the number of calls to its counselling services helplines from young people, parents and schools in the days after the show's release.
Headspace issued a strong warning to viewers over the graphic scenes in the show.
"There is a responsibility for broadcasters to know what they are showing and the impact that certain content can have on an audience – and a young audience in particular," said head of Headspace's online counselling service, Dr Steven Leicester.
The findings follows the release of Netflix's latest foray into youth mental illness, To The Bone, which prompted another stern warning from youth mental health groups over its depiction of anorexia.
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