It’s a highly controversial show: a teenage girl dies by suicide, leaving behind a series of tapes that chronicle her plight and those who hurt her in her downward spiral.

Now, a new study suggests that the popular Netflix series 13 Reasons Why triggered a steep spike in searches on suicide. In the show’s wake, searches for “how to kill yourself” to “painless suicide” shot up, according to scientists out of San Diego State University.

The West Coast researchers are even urging Netflix to pull the show until it can meet global guidelines on how to portray suicide in the media.

“The data shows that 13 Reasons Why isn’t fit for public health. Even though it’s causing somewhat of an increase in suicide awareness and people seeking information on how to prevent suicide, we saw an increase in searches on how to commit suicide, literally, how to have a painless suicide,” Dr. John Ayers, the study’s lead author, told Global News.

“Our study allowed us to see what people are thinking and when they’re thinking it. The act of searching itself is moving that person one step closer to a suicide act. Searches often foreshadow offline behaviour,” Ayers said.

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He noted that aggregate search trends are tied to suicide rates at the population level.

Ayers specializes in what he calls “rapid response public health.” Earlier this year, he led the research behind the “Charlie Sheen effect.” Turns out, the actor may have inadvertently shed light on testing and practicing safe sex after he told the world he was HIV-positive during an interview.

This time around, Ayers zeroed in on whether suicide ideation cropped up in Google searches after the show’s release on March 31.

The researchers measured how often people were searching terms containing the word “suicide” from March 31 until April 18. That’s when Aaron Hernandez, a former NFL player, died by suicide.

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Within that 19-day timeframe, there were between 900,000 and 1,500,000 more suicide-related searches.

Across the board, suicide-related queries were 19 per cent higher than the baseline. There were “higher than expected” searches for a handful of terms:

  • “Suicide hotline” (up 12 per cent)
  • “Suicide prevention” (up 23 per cent)
  • “How to commit suicide” (up 26 per cent)
  • “Commit suicide” (up 18 per cent)
  • “How to kill yourself” (up nine per cent)

“We saw a small collateral increase in searches for help or resources. What we saw was levels of suicide ideation queries eclipsing prevention,” Ayers said.

The researchers can’t measure if these Internet searches led to actual deaths by suicide, but they’re certain “suicide contagion” – the notion that media about suicide drives depressed people to kill themselves – is real.

Following the show’s release, a handful of copycat deaths by suicide were reported. While supporters say the show sheds light on mental health, Ayers isn’t convinced.

“One hundred per cent it did more harm than good. It should be taken down,” Ayers said.

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The series also defies World Health Organization guidelines for media makers on suicide. The guidelines discourage content that dwells on the suicide or zeroes in on the suicide act. The show, on the other hand, dedicates 13 hours to the main character who takes her life, and even shows the act in the final moments of the season.

At one point, the main character reaches out to a guidance counsellor at school and is turned away. That’s a bad message to send to viewers, especially the target audience of adolescents and teenagers, Ayers said.

“The mental health advocate ignores her. We don’t want to send that message to people, that they won’t get help if they speak up,” Ayers said.

He’s not insisting that programs can’t touch on mental health – they need to consider their overall message, though.

READ MORE: Why the WHO chose depression as its focus this year

“I would tell a story that those contemplating suicide need to hear – a success story. A story of someone who was on the edge and contemplating suicide who sought help and was given care…who came back from the edge and lived a long life,” he said.

“That’s a far more common story than 13 Reasons Why,” he said.

Following on the heels of criticism, Netflix added trigger warnings to some of the show’s episodes, and built a website on mental health resources.

Ayers suggests that isn’t enough. He wants the show makers to rethink the series so that it aligns with WHO guidelines – its second season is already in the works.

“The show makers must swiftly change their course of action, including removing the show and postponing a second season. If not, subscribers should consider cancelling their subscriptions so not to support unhealthy programming,” Ayers said.

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Dr. Shimi Kang, a Vancouver-based registered psychologist and author, said she’s not surprised by the findings.

“There are definitely better ways of [raising awareness about mental health] without the major drawback of increased suicide ideation. We don’t need graphic imagery to increase suicide awareness. It can be done in a positive, proactive way,” she said.

“As a psychiatrist that works with youth, my concern is the ‘at risk’ youth – many of who are already struggling with anxiety, depression, self-esteem, bullying issues. If we pull these youth out and study them specifically, I would expect more suicide ideation, searches, and depressive symptoms,” she warned.

Netflix said it “always believed this show would increase discussion around this tough subject matter.”

“This is an interesting experimental study that confirms this. We are looking forward to more research and taking everything we learn to heart as we prepare for season 2,” a spokesperson said in an email to Global News.

Netflix said that during production, the show’s executive producers consulted with several mental health professionals who helped guide their storytelling approach to suicide, sexual assault and bullying.

All 13 episodes received a TV-MA eating, while the final few episodes had warnings for explicit material.

Ayers’ full findings were published in the journal JAMA Internal Medicine.

Where to get help

If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.

The Canadian Association for Suicide PreventionDepression Hurts and Kids Help Phone 1-800-668-6868  all offer ways for getting help if you, or someone you know, is suffering from mental health issues.