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“13 Reasons Why”: An Analysis of Pediatric Psychiatric Visits Pre and Post Release of A Popular Netflix Show Detailing Pediatric Suicide

Background: Among Americans, child suicide is the second leading cause of death between the ages of 10-24 years. The release of “13 Reasons Why” (www.netflix.com/title/80117470), one of the most popular Netflix series, has caused controversy as proponents feel it serves as a catalyst for conversation for issues people with mental illness face. On the other hand, opponents state it may sensationalize or glamorize suicide. We hypothesized that after the release of “13 Reasons Why” on March 31, 2017, there may be an increase in the numbers of patients between 10 and 20 years of age presenting to Emergency Departments (EDs) with the chief complaint of suicide attempt (SA), suicide ideation (SI), self-harming (SH) and other psychiatric complaints. We hypothesize that admission rates for psychiatric illness during this time would simultaneously be higher.
Methods: Retrospective cohort protocol comparing the number of presentations to 26 emergency departments in the Northeast and Southeast USA for a 60-day period before and after release of “13 Reasons Why”. Data was collected from a proprietary electronic charting system and examined for the numbers of patients seen for SI/SA/SH and for all psychiatric evaluations, with a separate comparison for admission rates and age differences. We examined data from the matching time periods in 2016 to determine if there was a difference in 2017.
Results: 3362 patients met criteria for the 120-day period in 2017. 1880 (56%) were female, mean age was 15.9 (95% CI 15.7-16.2), IRQ of 14-17. The number of patients seen in the 60-day post release period was 1799 vs 1563 prerelease (proportion of 0.54 (95%CI 0.52 to 0.56); p value <0.0001) representing a 15% increase post release. There was no significant change in presentations for chief complaints with regards to the combination of SI/SA/SH before (n 218) and after release (n 257) (p <0.08). There was no difference in overall admission rates before and after release (p <0.08) or in admission rates for those who had SI/SA/SH. There was no change in age before or after release: 16.5 years vs 16 years respectively, mean difference 0 (95% CI -0.4 to 0.7, p 0.65). There was a significant difference in total presentation for the 60-day pre vs the post March 31, 2017 time frame, however more patients presented in the pre March 31 period for 2016. While no change in admission rates or SI/SA/SH occurred, there was a 15% increase in overall psychiatric presentations to EDs after release of “13 Reasons Why”.
Discussion and Conclusion: Although there was no increase in pediatric psychiatric visits specifically for SI/SA/SH after the release of “13 Reasons Why”, there was a significant increase in overall psychiatric visits in the pediatric ED after the release of this series. This is in line with our theory that media, and in particular this television show, may have a profound influence on young patients with regards to serious mental health issues. Whether these numbers represent a positive vs negative effect on the psychiatric health of children is unknown.