Tag Archives | Contagion

'13 Reasons Why' Probably Increased Emergency Room Visits for Self-Harm among Teenage Girls

Chris Felton

Sociological Science December 11, 2023
10.15195/v10.a33


I present evidence that the release of Netflix’s 13 Reasons Why—a fictional series about the aftermath of a teenage girl’s suicide—caused a temporary spike in emergency room (ER) visits for self-harm among teenage girls in the United States. I conduct an interrupted time series analysis using monthly counts of ER visits obtained from a large, nationally representative survey. I estimate that the show caused an increase of 1,297 self-harm visits (95 percent CI: 634 to 1,965) the month it was released, a 14 percent (6.5 percent, 23 percent) spike relative to the predicted counterfactual. The effect persisted for two months, and ER visits for intentional cutting—the method of suicide portrayed in the series—were unusually high following the show’s release. The findings indicate that fictional portrayals of suicide can influence real-life self-harm behavior, providing support for contagion-based explanations of suicide. Methodologically, the study showcases how to make credible causal claims when effect estimates are likely biased.
Creative Commons LicenseThis work is licensed under a Creative Commons Attribution 4.0 International License.

Chris Felton: Postdoctoral Fellow, Graduate School of Education, Harvard University. This study was completed while the author was a PhD student in the Department of Sociology and Office of Population Research at Princeton University.
E-mail: christopher_felton@gse.harvard.edu

Acknowledgements: For helpful discussions and feedback relevant to this project, I thank (in reverse-alphabetical order) Brandon Stewart, Varun Satish, Momoko Nishikido, Ian Lundberg, Marielle Côté-Gendreau, Dalton Conley, members of the Stewart Lab, the editor, and the anonymous referees. Replication data and code can be found at https://github.com/cmfelton/13rw. All errors are my own.

  • Citation: Felton, Chris. 2023. “’13 Reasons Why’ Probably Increased Emergency Room Visits for Self-Harm among Teenage Girls.” Sociological Science 10: 930-963.
  • Received: March 15, 2023
  • Accepted: March 31, 2023
  • Editors: Arnout van de Rijt, Peter Bearman
  • DOI: 10.15195/v10.a33


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