Thirteen Reasons Why: The impact of suicide portrayal on adolescents' mental health.

We aimed to investigate the influence of media portrayals of suicide on adolescents' mood, focusing on the case of 13 Reasons Why, a webseries that raised concerns for approaching suicide explicitly for an audience mostly composed of adolescents. There is already evidence of an increase in suicide-related Internet searches shortly following its release. Our study included 7004 individuals aged 12-18 years. Participants were recruited through posts on 13 Reasons Why-themed social media groups. Volunteers filled an online questionnaire made available throughout May 2017 (54-71 days after the show was released). The questionnaire collected data on sociodemographic characteristics, mood (sadness and lack of motivation) in the month previous to watching the series, and prevalence of self-harm, suicidal ideation, or suicide attempts. Changes in mood were considered the main outcome; the variable was derived from a question asking about feelings of sadness and lack of motivation after watching the show. Overall, 23.7% reported worsening in mood after watching 13 Reasons Why. This rate was higher among individuals who, before watching the series, experienced more frequent and intense feelings of sadness and lack of motivation (OR 2.73 for frequent or daily feelings; OR 3.61 for intense feelings) or reported suicidal ideation/self-harm/suicide attempt (OR 1.38), even after controlling for sex and age. In times of easy access to digital content and binge-watching, the way mental health issues are portrayed in fiction needs to be carefully debated and thought out.