Reuters Health - Online searches related to suicide spiked right after Netflix released “13 Reasons Why,” a popular series about a teen girl who takes her own life, a U.S. study suggests.

Google search volumes for queries about suicide were 19 percent higher than expected in the 19 days following the show’s release, reflecting 900,000 to 1.5 million more searches than there otherwise would have been, researchers report today in JAMA Internal Medicine.

“The more someone contemplates suicide, the more likely they are to act,” said lead study author John Ayers of San Diego State University in California. “Searches often foreshadow offline behaviors.”

Many of the searches in the study focused on suicidal thoughts.

For example, searches for “how to commit suicide” were 26 percent higher than expected after “13 Reasons Why” debuted, while searches for “commit suicide” were 18 percent higher than anticipated and queries on “how to kill yourself” were 9 percent higher.

At the same time, searches seeking help also increased.

Queries for “suicide hotline number” were 21 percent higher than expected after the series came out, and searches for “suicide prevention” were 23 percent higher than anticipated.

Searches for “teen suicide” were 34 percent higher than expected, the study also found.

In “13 Reasons Why,” high school student Hannah Baker kills herself and leaves behind cassette tapes describing the events that led to her death, which is shown in graphic detail in the series finale. The show deals with rape, drunk driving and bullying.

After its debut, many mental health experts raised concerns that watching the series could trigger copycat suicides, particularly among certain vulnerable teens who might already be struggling with depression or suicidal thoughts.

The series carries a TV-MA rating and Netflix added additional content warnings and information on suicide prevention resources in response to concerns about the series (here: 13reasonswhy.info/#usa). Netflix also encouraged parents to watch the show with teens and offered talking points (here: bit.ly/2quCH3Z).

“We always believed this show would increase discussion around this tough subject matter,” Netflix told Reuters Health in an emailed statement. “This is an interesting quasi experimental study that confirms this.”

Still, the show could have gone farther to avoid triggering suicidal thoughts or suicide attempts, said Kimberly McManama O’Brien, co-author of an accompanying editorial and a psychiatry researcher at Harvard Medical School in Boston.

“The choice to graphically depict the suicide death of the star of the series was a controversial decision,” McManama O’Brien said by email. “Research has shown that pictures or detailed descriptions of how or where a person died by suicide can be a factor in vulnerable individuals.”

To assess how much online searches about suicide changed after “13 Reasons Why,” researchers used an algorithm based on daily search trends from January 15 to March 30, the last day before the show’s premiere.

Then, they looked at search volumes from the March 31 debut date through April 18, a cutoff chosen to exclude any influence from the suicide of American football player Aaron Hernandez on April 19.

For 12 of the 19 days following March 31, all suicide searches rose more than expected, ranging from 15 percent to 44 percent higher than anticipated.

Out of 20 common queries related to suicide that researchers examined, 17 had higher than expected search volume during the study period.

It’s unclear whether any query preceded an actual suicide attempt, the authors note.

Because the study suggests the show increased both suicide awareness and suicidal thoughts, more warnings could be added to current and future seasons, the researchers conclude.

Media depictions of suicide should follow guidelines laid out by the World Health Organization to avoid triggering suicide attempts, Ayers recommended.

“Showing the suicide act, making the victim’s suicide the central focus, or blaming others for the victim’s suicide are all discouraged,” Ayers said.

Shows that portray suicide should direct viewers to resources for help, such as the National Suicide Prevention Lifeline (1-800-273-TALK), he added.

SOURCE: bit.ly/2tQQymh JAMA Internal Medicine, online July 31, 2017.