With the popularity of the Netflix hit teenage high school show, “13 Reasons Why,” there’s been debate among mental health care professionals and researchers as to whether an actual “suicide contagion” exists. Would such a contagion effect apply to something such as a fictional TV series?

Is suicide contagion a real thing? If so, is it really something we need to be concerned about as much in this day and age of instant entertainment and information available on the Internet, where people’s graphic depictions of self-harm and suicide stories are always just a single click away for any teen to view as much as they’d like?

We’ve previously written about the positive impact of ’13 Reasons Why’ and Haley Elizabeth Roberts, LBSW added many more reasons why this series is so important to understanding teens’ mental health. It’s an important topic and one that shouldn’t be hidden from public view because of a misunderstanding of research about the theory of “suicide contagion.”

The theory of ‘suicide contagion’ remains controversial among researchers, with mixed proof from the scientific research. As Randall et al. (2015) put it:

One particular area of sustained controversy has been whether the occurrence of suicide clusters indicates the existence of ‘suicide contagion’ (Davidson & Gould, 1989; Gould et al., 1994; Joiner, 2003, 1999; McKenzie et al., 2005; Robbins & Conroy, 1983; Wasserman, 1984). The existence of a causal effect from exposure to suicidal peers is contentious (Joiner, 2003).

For instance, researchers Mercy et al. (2001) found that exposure to media accounts of suicidal behavior and exposure to suicidal behavior in their social network were associated with a lower risk of youth suicide attempts compared to persons who had not recently attempted suicide.

Many of these researchers are discussing studies focused on people’s real lives and people they actually know. As you can imagine, there’s a lot less research examining the impact that fiction — whether it be a movie, book, play, musical, TV show, or video game — has on a person’s mental health or desire to commit suicide.

Celebrity Suicide

What about the impact of a celebrity’s death on people? Epidemiological research can help answer that question, since it examines suicide rates after the death by suicide of a known or local celebrity. One of the more recent studies looked at the suicide rate after the death of 25-year-old Lee Eun-ju, a famous actress in South Korean who died by hanging in 2005 (Ju Ji et al., 2014). The researchers found what they called a “copycat effect” following the intensive media coverage of Eun-ju’s death, especially significant for younger women who also used the same method of suicide.

Niederkrotenthaler et al. (2012), in a comprehensive meta-analysis of 10 studies containing data on 98 celebrity deaths due to suicide, also found a slight increase in population suicides. “The pooled estimate indicated a change in suicide rates (suicides per 100,000 population) of 0.26 (95% CI 0.09 to 0.43) in the month after a celebrity suicide,” the researchers wrote.

This isn’t so much a “contagion,” however, as it is simply an indicator of increased risk. The use of the provocative term “contagion” — suggesting “an influence that spreads rapidly” — is hyperbolic, meant to spur people to believe that even the mere mention of suicide without proper accompanying warnings and such will lead to widespread increased deaths. Research shows this simply isn’t the case, except perhaps for much-loved celebrities. You can’t “catch” suicidal thoughts and behaviors, like some sort of cold or disease.

Suicide in Fiction

A great deal of what we know about fictional accounts of suicide and the suicide contagion effect are largely anecdotal and not at all scientific. This Scientific American article about suicide contagion offers a good background on these anecdotal stories throughout history.

The scientific research is less clear on the impact that fictional stories have on people who read or view them. Only a handful of mostly-older studies have been done on this issue, the most recent I could find being from 1999 (pre-social networking and large-scale adoption of the Internet). In it, Hawton et al. (1999) found evidence for a 17 percent increase in emergency room admissions for a specific kind of self-poisoning — paracetamol (also known as acetaminophen or Tylenol) — that was portrayed on a UK television show, Casualty, in the first week after the show aired. In the second week after the show aired, that increase dropped to 9 percent. That’s a significant effect and one worth noting.

But would it hold up today, when young adults and youth already have ready access to everything they’ve ever wanted to know about suicide from online suicide communities that promote both suicidal methods and behavior?

Suicide in a Connected World

Andriessen et al. (2017) found that 1 in 20 people in any given year know someone in their social network who has died by suicide — and 1 in 5 during an entire person’s lifetime. That means that a significant minority of people will know someone who actually died by suicide. But most of us, myself included, live to talk about losing someone to suicide with others.

The challenge in our social networks today is recognizing that teenagers (and adults) have access to as much suicidal content online as they could ever want. They don’t need to wait for a TV show to come out. There are multiple online communities that graphically discuss suicide stories, attempts, and methods. To pretend like these communities don’t exist or aren’t accessible to most teens today via a single click is to live in denial, which is counterproductive. Children and adolescents no longer are growing up in a world insulated from tragedies of this nature. Instead, they have far more access to these stories and resources than any previous generation.

More recently, Facebook Live and other video streaming services have been grappling with live suicides being broadcast on their services. Who can stop such graphic scenes in real-time, when it can take only seconds to end one’s life? It seems like we’re focusing on the wrong thing altogether — depiction of suicide in a fictional TV series — when there is so much more — and more graphic — content available online today.

And to help prevent suicide? We can do so much more in our own social networks, by keeping in touch with other people’s real feelings. I know, these feelings can often be hard to get to. It’s not easy asking about another’s emotional health. But your concern may be something that a person drowning in suicidal thoughts can latch onto, giving them some hope for the future.

As Roberts wrote in her article last month, “We, as a society, need to slow down and pay more attention to those around us. We need to listen and not discount what people share with us.”

Good advice for us all.

If you or anyone you know is having suicidal thoughts, please reach out to National Suicide Prevention Lifeline: 800-273-TALK (8255) or text “help me” to the Crisis Text Line at 741741.

I am indebted to ScienceDirect for providing access to the research studies used as the basis for this article.

References

Karl Andriessen, Bayzidur Rahman, Brian Draper, Michael Dudley, Philip B. Mitchell. (2017). Prevalence of exposure to suicide: A meta-analysis of population-based studies. Journal of Psychiatric Research, 88, 113-120.

Hawton, K., Simkin, S., Deeks, J. J., O’Connor, S., Keen, A., & Altman, D. G. (1999). Effects of a drug overdose in a television drama on presentations to hospital for self poisoning: Time series and questionnaire study. BMJ, 318, 972–977.

Nam Ju Ji, Weon Young Lee, Maeng Seok Noh, Paul S.F. Yip. (2014). The impact of indiscriminate media coverage of a celebrity suicide on a society with a high suicide rate: Epidemiological findings on copycat suicides from South Korea. Journal of Affective Disorders, 156, 56-61.

Mercy, J. A., Kresnow, M. J., O’Carroll, P.W., Lee, R. K., Powell, K. E., Potter, L. B., et al. (2001). Is suicide contagious? A study of the relation between exposure to the suicidal behavior of others and nearly lethal suicide attempts. American Journal of Epidemiology, 154, 120-127.

Niederkrotenthaler, Thomas; Fu, King-wa; Yip, Paul S. F.; Fong, Daniel Y. T.; Stack, Steven; Cheng, Qijin; Pirkis, Jane. (2012). Changes in suicide rates following media reports on celebrity suicide: A meta-analysis. Journal of Epidemiology and Community Health, 66, 1037-1042.

Jason R. Randall, Nathan C. Nickel, Ian Colman. (2015). Contagion from peer suicidal behavior in a representative sample of American adolescents. Journal of Affective Disorders, 186, 219-225.

Is Suicide Contagion Real?