Crisis Text Line use following the release of Netflix series 13 Reasons Why Season 1: Time-series analysis of help-seeking behavior in youth

The availability of near real-time data from Crisis Text Line (CTL) and other technology-based platforms on crisis events provides an opportunity for targeted interventions prior to serious mental health outcomes (e.g., suicide, self-harm). This study examined the association between the release of the popular Netflix series 13 Reasons Why (13RW) and CTL usage in a national sample of youth in the US. We implemented interrupted time-series, autoregressive integrated moving average (ARIMA) modeling to examine this association at a daily scale. We observed a significant but momentary rise in CTL conversation volume following the release of 13RW on April 5 and 6, 2017 followed by a significant reduction (12.7%) in conversation volume for the overall study period. This reduction in call volume was sustained for 49 days and is the most sustained reduction in conversation volume in the 365 day dataset. This unexpected trough in conversation volume is concerning in light of elevated search engine volume for terms indicating an increase in suicidal thoughts in the days following the release of the show (Ayers et al., 2017). CTL was featured by the show as a resource for viewers in the recently released Season 2, and our results highlight the reasoning and need for such promotion. Future work should explore whether the promotion of CTL in Season 2 positively impacted conversation volume, as there is a clear need to harness the power of these digital technologies to detect population-based trends in mental health and expand the reach of life saving services.