Background Portrayals of suicidal behaviour in the media have been linked with copycat suicidal behaviour, a phenomenon referred to as the Werther Effect. In recent years, media reporting of high-profile suicides and portrayals of fictional suicides in film/television have been associated with increased deaths.
The Netflix series 13 Reasons Why was released on 31 March 2017 and received a lot of public attention, particularly for its detailed portrayal of the suicide of the female protagonist. We examined whether there was any evidence of an increase in hospital-presenting self-harm in Ireland following the release of the series.
Methods The National Self-Harm Registry Ireland records self-harm presentations to all Irish hospital emergency departments. Case ascertainment and data collection are carried out by trained data registration officers who follow standard operating procedures. We examined the temporal pattern of hospital-presenting self-harm by persons aged ≥10 years, stratified by sex and whether the self-harm involved sharp objects as depicted in 13 Reasons Why or other means. Poisson regression was used to compare the incidence in the three months after the series’ release compared to the rest of the calendar year 2017 and to make the same comparison for each of the preceding six years.
Results During 2011–2017, there was an annual average of 11,515 self-harm presentations to hospital from an annual average population of 3.99 million persons aged. Self-harm involving sharp objects accounted for one in four presentations (2,937 per year, 25.5%) and had an age-standardised female and male incidence rate of 79 and 75 per 100,000 person-years, respectively. Three quarters of presentations involved other means (8,578 per year, 74.5%), primarily intentional drug overdose, with a female and male incidence rate of 245 and 197 per 100,000 person-years, respectively.
The incidence of female self-harm involving sharp objects was 100 per 100,000 in the three months after the release of 13 Reasons Why, 20% higher than the incidence in the rest of 2017 (incidence rate ratio, IRR=1.20; 95% confidence interval=1.08–1.33). Such an increased rate was not observed for the same period in any of the previous six years (IRR range=0.95–1.07). The same three-month period showed no notable change in incidence in any year for male self-harm involving sharp objects or for female or male self-harm involving other means.
Conclusion The study findings show evidence of an increase in female hospital-presenting self-harm involving sharp objects following the release of the 13 Reasons Why series.
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