In the last few months, there has been a lot of conversations about teen suicide, primarily driven by a new Netflix series, 13 Reasons Why. Experts have both praised the series for providing a focal point for discussing teen suicide and condemned it for glamorizing self-destruction. There are a lot of resources readily available (including below) that guide conversations about suicide, so I’m going to take a different angle in this post.

The core concern about this series is whether impressionable minds, especially adolescents and young adults, will identify with the series’ protagonist such that they may try to emulate her behavior and attempt suicide themselves. This “copycat” behavior is more formally known as suicide contagion, and in this blog, we will discuss what the scientific literature says about whether suicide contagion exists and whether it represents a real risk or not.

In a general sense, people, including trained therapists, often feel uncomfortable talking openly about suicide to someone who they suspect is having such thoughts. Aside from the obvious awkwardness of the topic, people are afraid that broaching the topic of suicide with someone will “plant the seed” of self-destruction as though the person never considered it. “I don’t want to give them any ideas” is often heard from laypeople and therapists alike. This type of thinking is unfortunate because the exact opposite is true – that someone considering suicide will usually be relieved that they can finally discuss their feelings openly. But more to the current point, this concern about “giving them the idea” is an individualized version of fear of suicide contagion.

In a larger sociological context, suicide contagion is very real. When real-life celebrities kill themselves, copycat suicides can increase. For many years, the prevailing wisdom was that this would occur anyway, but recent research has shown that the media can have a significant impact on the rates of suicide – in both directions.

When Marilyn Monroe died in 1962 and suicide was the presumptive cause of death, suicide rates jumped by approximately 12 percent.  In 1994, Nirvana rock star Kurt Cobain committed suicide in Seattle. Concerned about the possibility of copycat suicide attempts, the community made a concerted attempt to impact this phenomenon. Newly developed suicide reporting guidelines for journalists were used in the media. These guidelines recommended that news articles be accompanied by suicide help numbers and suicide prevention resources. The result was twofold: an actual decrease in the number of suicides compared to previous and subsequent years and an increase in calls to suicide hotlines and crisis resources. A similar phenomenon occurred in 2014 following comedian Robin Williams’ death when the National Suicide Prevention Lifeline saw a doubling in the number of calls received.

So, in general, there does appear to be a relationship between celebrity deaths in copycat suicide attempts that is directly related to how much media coverage is present. But this is a result of real people taking their lives. What does the data show about fictional representations of suicide?

The evidence for suicide contagion following fictional events is compelling but not unequivocal. Studies that track suicide contagion following fictional representations of suicide have consistently found increases in suicide attempts. For example, a 1999 study found an increase of 17 percent and 9 percent in rates of copycat overdoses in the first and second weeks following a self-poisoning depicted in a British drama.

The reason the study is noteworthy is that the protagonist used ethylene glycol or antifreeze as the suicide agent. Antifreeze is not a commonly used method for overdosing, and as a result tracking these copycats become much easier. Some researchers have discounted the suggested relationship between fictional suicides and copycats, often on methodological grounds but the majority of evidence seems to support that the relationship is real.

Contributing to the contagion effect is the fact that children who know a friend or family member who has attempted suicide are three times more likely to attempt suicide than those who do not know such a person. In the 1970’s the prevailing knowledge suggested that suicide touched the lives of six other people, usually family members. Today, that number is closer to 135 and about one-third will be significantly affected by the event.

There is evidence that fictional representations of suicide are increasing, especially in film. From the 1900s through the 1950s the percent of movies that showed suicide or suicide attempts was trending downwards towards approximately 2 percent. But that changed in the 1960s. From the 1960s through the 1990s, the numbers of movies showing suicide attempts begin approaching 4 percent. But in recent decades, nearly one in 10 movies shows some depiction of suicide and those are largely skewed primarily towards characters under 25 years old.

What can we take away about suicide contagion?

  • Suicide contagion is real for both actual people and fictional characters
  • There’s a strong media interaction effect that can exacerbate or mitigate suicide contagion
  • Suicide completers are often experiencing other life stressors (g., emotional or substance use problems, lack of residential stability, recent end or expected end of a relationship) compared to non-completers.
  • Resources are available for parents and teens about suicide to help them understand suicide and cope with its effects
  • Guidelines for journalists about how to report on suicide are available and should be used whenever the topic becomes a news item.

Resources for Families
Mental Health First Aid Training
13 Reasons Why Talking Points. Jed Foundation
Teachable Moment Using “13 Reasons Why” to Initiate a Helpful Conversation About Suicide Prevention and Mental Health (Webinar). American Foundation for Suicide Prevention
Risk Factors and Warning Signs. American Foundation for Suicide Prevention 2017
National Suicide Prevention Lifeline
13 Reasons Why – Resources Dequincy Lezine May 5, 2017

Resources for Journalists
Recommendations for Journalists for Reporting on Suicide. American Foundation for Suicide Prevention Jan 2016
Suicide Contagion and the Reporting of Suicide: Recommendations from a National Workshop CDC April 1994