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Show sparks talk on suicide

| Monday, May 15, 2017, 11:00 p.m.
'Thirteen Reasons Why' by Jay Asher

It's all the rage among teens, yet causing rage and concern among parents. The Netflix series “13 Reasons Why,” an adaptation of the bestselling 2007 book by Jay Asher, has been renewed for a second season. Mental health experts and school administrators are still reeling from the first season which featured a gruesome suicide scene.

We talked with Dr. Sansea L. Jacobson, assistant professor of psychiatry at the University of Pittsburgh School of Medicine, about concerns cropping up as the series gains viewers and popularity.

Why should parents be worried?

As a child and adolescent psychiatrist, and someone who has watched the entire season, I believe parents should be concerned and aware that the show has graphic and disturbing visual imagery portraying rape, self-injury, suicide, beatings and bullying. There are scenes that are gratuitously violent and likely emotionally distressing, especially for depressed and traumatized youth.

The series also romanticizes suicide, which places youthful viewers at risk for suicide contagion. We know from research that dramatized portrayals of suicide on television and in movies can lead to increased rates of suicide and suicide attempts using the same methods displayed on the screen. This impact is intensified when suicide is presented in the absence of information about mental illness.

While the show undermines the role of concerned parents, all parents need to know that there are mental health resources to support families when youths are struggling. Talking about suicide does not increase the risk of suicide and mental health interventions are evidence-based and effective.

It's important to highlight that suicide is uncommon, but parents should be aware of marked changes in behavior that could be a warning sign of depression. Depression in teens often looks different in teens than in adults so it's crucial to be aware of noticeable changes from their baseline. They might withdraw from social connections, have major changes in sleep or appetite, or a decline in grades. Very importantly, teens might present with anger or irritability as their primary mood symptom, as opposed to sadness. I've repeatedly heard from parents that “I didn't realize my teen was sad, I just thought he or she was mad.”

What are mistruths portrayed in the show?

First, the series focuses on blaming others, as opposed to recognizing that greater than 90 percent of individuals who complete suicide actually struggled with mental illness.

Secondly, the school's post-suicide intervention strategy doesn't come close to following national evidence-based guidelines or standards. For instance, allowing Hannah's locker to become a long-term mini-shrine inadvertently creates an emotionally charged reminder of the suicide, which experts warn could be internalized by particularly vulnerable youth as a means to gain recognition.

There is also a theme that suggests adults are somehow incapable of listening to youth at risk. It's important to recognize that teachers and school administrators are not only a resource for support, but are also very much part of the bereaved community.

Why do you think it is popular?

The characters and narrative are compelling and it is understandable why teens are drawn to it. The way the series is produced and publicized, teens are clearly the target audience, and yet the content is presented in a way that is very adult. The important thing to remember is that there is no one right way to talk to teens. Adults should simply and intentionally make time and space for open and honest conversations to happen. Follow the teens lead and really listen without judgement.

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