It’s no news that a lot of us in the medical field watch TV shows and movies with a grain of salt, but what most of us don’t do is look at the potential impact of a show on behavioral changes. With tools like Google Trends which can provide data on internet search patterns and results, studying potential behavioral changes based on search patterns has become much easier. In a recent study published in JAMA Internal Medicine, Ayers et al took a look at the results from Google Trends to see if the recent Netflix show called 13 Reasons Why affected the frequency of suicide-related internet searches.1

13 Reasons Why describes the protagonist’s view of the events and experiences driving her to commit suicide. Having viewed the series myself, I found it particularly irritating that the entire show is about the protagonist trying to justify her suicide around experiences that many teenagers are bound to face growing up, and at the same time, making her friends feel miserable and responsible for her suicide. Although one could argue that the show was intended to increase suicide awareness, it would not be surprising that it triggered an increase in suicidal thoughts instead, reflected through related internet searches.

In fact, Ayers et al demonstrated that it did both. Indicative searches such as “suicide prevention” was increased by 23% shortly after the release of the show (from March 31, 2017, to April 18, 2017) compared with baseline, calculated based on search patterns from the three months before. However, the analysis also demonstrated that within two weeks of the release of the show, suicide-related searches based on 20 carefully selected key search terms increased by 19% (95% CI 14%–24%), which is 900,000 to 1.5 million more searches than baseline. A more detailed look at the searches revealed that search phrases such as “how to commit suicide”, “commit suicide”, and “how to kill yourself” increased by 26%, 18%, and 9%, respectively, all of which were significantly higher than baseline.

Although the authors of this paper do not take the analysis one step further by comparing search statistics with suicide rates within the same period of time, previous studies have shown that suicide-related searches are correlated with actual suicide acts.2,3 We should also caution that this finding is an association; causation is much harder to prove. Nonetheless, the authors of the analysis make a good point that producers should consider the potential consequences of TV shows on public behavior and consider the media guidelines recommended by the World Health Organization for preventing suicide, such as removing scenes showing suicide.4