13 Reasons Why: Perceptions and Correlates of Media Influence in Psychiatrically Hospitalized Adolescents

Abstract

Objective

The Netflix series 13 Reasons Why (13RW) has sparked controversy due to graphic depictions of youth suicide, bullying, and sexual assault. However, further research is needed examining experiences of the show among youth with psychiatric illness. This exploratory, mixed-methods study examines adolescents’ perceptions of 13RW and associations among viewership, suicide-related media influence processes, and self-injurious thoughts and behaviors (SITBs).

Method

Participants were 242 adolescents hospitalized in a psychiatric inpatient facility; 60.7% female, 30.2% male, 9.1% other genders; ages 11 to 18; and 74.3% White, 7.5% Black, and 21.8% Hispanic. Participants completed measures of series viewership, media message processing, and SITBs. Participants who watched completed open-ended questions regarding beliefs and opinions about the series.

Results

In all, 50.4% of participants watched 13RW, with girls (63.3%) more likely to have watched than boys (26.0%). More than half (55.9%) of youth expressed negative reactions to the show, while approximately one-third (33.8%) expressed positive reactions. Having watched the series was associated with greater likelihood of past-year non-suicidal self-injury (NSSI), but not with suicidal ideation or past-year suicide attempts. Youth’s interpretation of media messages in 13RW, including greater identification with and perceived likeability of the main character, were associated with suicidal ideation and past-year NSSI.

Conclusions

Findings suggest high rates of 13RW viewership among psychiatrically hospitalized youth, particularly girls, and provide insight into factors that may affect youths’ vulnerability to suicide-related media effects.

Keywords:

• Adolescent
• media influence
• suicide
• self-injury
• inpatients

DISCLOSURE STATEMENT

The authors have no financial interests or potential conflicts of interest to declare.

Additional information

Funding

This research was supported in part by grant PDF-0-105-17 from the American Foundation for Suicide Prevention (Dr. Nesi). Dr. Nesi had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors have no financial relationships or conflicts of interest related to this study to disclose. The American Foundation for Suicide Prevention (AFSP) had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript or decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of AFSP.

Notes on contributors

Jacqueline Nesi

Jacqueline Nesi, Jeffrey Hunt, and Jennifer C. Wolff, Department of Psychiatry & Human Behavior, Division of Clinical Psychology, Brown University, Providence, Rhode Island, USA; Bradley/Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island, USA.

Sarah E. Johnson

Sarah E. Johnson, Department of Psychiatry & Human Behavior, Division of Clinical Psychology, Brown University, Providence, Rhode Island, USA.

Melanie Altemus

Melanie Altemus and Heather M. Thibeau, Bradley/Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island, USA.

Heather M. Thibeau

Melanie Altemus and Heather M. Thibeau, Bradley/Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island, USA.

Jeffrey Hunt

Jacqueline Nesi, Jeffrey Hunt, and Jennifer C. Wolff, Department of Psychiatry & Human Behavior, Division of Clinical Psychology, Brown University, Providence, Rhode Island, USA; Bradley/Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island, USA.

Jennifer C. Wolff

Jacqueline Nesi, Jeffrey Hunt, and Jennifer C. Wolff, Department of Psychiatry & Human Behavior, Division of Clinical Psychology, Brown University, Providence, Rhode Island, USA; Bradley/Hasbro Research Center, Rhode Island Hospital, Providence, Rhode Island, USA.