Association of Increased Youth Suicides in the United States With the Release of 13 Reasons Why
Association of Increased Youth Suicides in the United States With the Release of 13 Reasons Why
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DOI：
10.1001/jamapsychiatry.2019.0922
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发表时间：
2019-09-01
期刊：
影响因子：
25.8
通讯作者：
Tran, Ulrich S.
中科院分区：
文献类型：
--
作者：
Niederkrotenthaler, Thomas;Stack, Steven;Tran, Ulrich S.
重要性 2017 年 3 月 31 日，Netflix 发布了节目《十三个原因》，立即引发了自杀预防组织的批评，因为他们没有遵循媒体关于负责任的自杀描述的建议，并认为媒体可能会传播自杀现象。迄今为止，对该节目与其年轻目标受众自杀人数之间的关联性进行的研究还很少。 目的 分析《十三个原因》上映后自杀人数的变化。 设计、背景和参与者 对于此时间序列分析，自 1 月 1 日起美国男性和女性 10 至 19 岁、20 至 29 岁以及 30 岁或以上年龄组的每月自杀数据， 1999年至2017年12月31日的数据摘自美国疾病控制与预防中心的WONDER（流行病学研究广泛在线数据）数据库。 Twitter 和 Instagram 帖子被用作估计该节目从 2017 年 4 月 1 日到 2017 年 6 月 30 日期间通过社交媒体获得的关注量的代理。自回归综合移动平均时间序列模型适合 2017 年 4 月之前的时期，以估计各年龄段的自杀率，并确定所使用的特定自杀方法的变化。将模型拟合到（1）2017年4月和（2）2017年4月1日至2017年6月30日的虚拟变量全时间序列。数据于2018年12月和2019年1月进行分析。主要结果和措施2017年节目发布前后的自杀数据。结果根据社交媒体数据，公众对该节目的兴趣在4月份最高2017 年，2017 年 6 月之后可以忽略不计。对于 10 至 19 岁的男性和女性，2017 年 4 月至 6 月观测值的增长超出了预测的 95% 置信区间。测试 3 个月相关自杀死亡率的模型显示，男性中有 66 例（95% CI，16.3-115.7）过度自杀（增加 12.4%；95% CI，3.1%-21.8%），女性中有 37 例（95% CI，12.4-61.5）过度自杀（增加 21.7%；95% CI，7.3%-36.2%）。其他年龄组的自杀死亡率并未出现过高。上吊自杀法的增加特别高（增加 26.9%；95% CI，15.3%-38.4%）。 结论和相关性 在解释这些发现时必须谨慎；然而，自杀率仅在青少年中增加，以及年轻女性自杀率可能大幅增加的信号似乎都与媒体的传播一致，并且似乎强化了合作改善自杀虚构描述的必要性。
IMPORTANCE On March 31, 2017, Netflix released the show 13 Reasons Why, sparking immediate criticism from suicide prevention organizations for not following media recommendations for responsible suicide portrayal and for possible suicide contagion by media. To date, little research has been conducted into the associations between the show and suicide counts among its young target audience.OBJECTIVE To analyze the changes in suicide counts after the release of 13 Reasons Why.DESIGN, SETTING, AND PARTICIPANTS For this time series analysis, monthly suicide data for the age groups 10 to 19 years, 20 to 29 years, and 30 years or older for both US males and females from January 1, 1999, to December 31, 2017, were extracted from the Centers for Disease Control and Prevention's WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Twitter and Instagram posts were used as a proxy to estimate the amount of attention the show received through social media from April 1, 2017, to June 30, 2017. Autoregressive integrated moving average time series models were fitted to the pre-April 2017 period to estimate suicides among the age groups and to identify changes in specific suicide methods used. The models were fitted to the full time series with dummy variables for (1) April 2017 and (2) April 1, 2017, to June 30, 2017. Data were analyzed in December 2018 and January 2019.MAIN OUTCOMES AND MEASURES Suicide data before and after the release of the show in 2017.RESULTS Based on social media data, public interest in the show was highest in April 2017 and was negligible after June 2017. For 10- to 19-year-old males and females, increases in the observed values from April to June 2017 were outside the 95% confidence bands of forecasts. Models testing 3-month associated suicide mortality indicated 66 (95% CI, 16.3-115.7) excess suicides among males (12.4% increase; 95% CI, 3.1%-21.8%) and 37 (95% CI, 12.4-61.5) among females (21.7% increase; 95% CI, 7.3%-36.2%). No excess suicide mortality was seen in other age groups. The increase in the hanging suicide method was particularly high (26.9% increase; 95% CI, 15.3%-38.4%).CONCLUSIONS AND RELEVANCE Caution must be taken in interpreting these findings; however, the suicide increase in youth only and the signal of a potentially larger increase in young females all appear to be consistent with a contagion by media and seem to reinforce the need for collaboration toward improving fictional portrayals of suicide.