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

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.