The association between 13 Reasons Why and suicidal ideation and behaviors, mental health symptoms, and help-seeking behaviors in youths: An integrative systematic review

Abstract Background: The series 13 Reasons Why (13RW) raised critical concerns regarding the deleterious impact of fictional suicide portrayal on suicidal behaviors as it depicted the suicide of an adolescent without following the recommendations on media reporting of suicide portrayal. We aimed to assess the impact of 13RW on suicide rates, suicide attempts (SA), and suicidal ideation (SI) prevalence, mental health symptoms, and help-seeking behaviors in youths. Method: Following PRISMA guidelines, we systematically searched for articles on three databases up to January 2022. Results: A total of 17 articles met the inclusion criteria. Five large studies reported a significant increase in deaths by suicide and SA in youths in the United States and Canada after the release of 13RW. Mood deterioration or more intensive depressive symptoms were reported in vulnerable adolescents who watched 13RW. Youths with previous history of depression, SA, or SI, and those who identified themselves with the main character were at higher risk to report an increase in SI or mood deterioration. Help-seeking behaviors significantly decreased, but the effects on mental health awareness tended to be positive after the release of 13RW. Conclusion: Our review reveals critical results about the impact of 13RW on youths. We report an alarming harmful impact on suicide and SA rates, especially in more vulnerable youths. The reported positive effects do not balance the deleterious impact of 13RW.