Abby Gerber remembers that, during her sophomore year at Perry High School in Stark County, Ohio, some teachers told students not to watch the Netflix series “13 Reasons Why” — they cautioned “it might not be good” for the students, Gerber says. The show, which came out in March 2017, depicts a teenage girl’s suicide. When it was released, experts warned it could glamorize the issue for young people.

For Gerber, now 17, and the rest of the school, the issue was extremely personal. Throughout late 2017 and early 2018, six of their classmates, in six months, died by suicide. Gerber’s boyfriend, Nick, was one of them.

Research has long chronicled the prevalence of suicide contagion, in which exposure to suicide within one’s family, peer group or through media reports can result in an increase in suicides or suicidal thoughts.

A new study, released Monday in the Journal of the American Academy of Child & Adolescent Psychiatry, takes another look at the correlation between media and teen suicide. After accounting for seasonal effects and monthly trends, researchers found that suicide rates spiked for boys ages 10 to 17 in the month after the release of “13 Reasons Why.” It also found an aberrantly high rate for that same demographic through the end of 2017.

A separate study, released just days later, found that suicide attempts using poison have surged among young people, particularly girls, in the last decade.

Studies like this can be shocking. But, if sensationalized, they may make it easier to miss the larger message, according to Carol Glod, a professor of health sciences at Merrimack College in North Andover, Mass. “We all need to be aware of this, we need to look at the different risk factors and identify this early and not wait until we get a study like this,” she says. “These are tragedies that could have been prevented.”

Gerber, who has now had a year and a half to process her boyfriend’s death, has a similar message for fellow teens. “People just need to get help. Even if you don’t want to, it’s what you need to do,” she says.

“Because eventually, after a while, it’ll be like, ‘I needed that, and now I’m okay.’”

The impact of ‘13 Reasons Why’

Macy Klein, an 18-year-old student at the Classical Academy College Pathways in Colorado Springs, says the “only reason” she was emotionally able to watch “13 Reasons Why” was because, by the time the show was released, she had already started her suicide outreach program, Project Reasons.

Klein had struggled with suicidal thoughts and self-harm for years. After a “serious intervention” from her parents when she was 15, she says, she “really started fighting for my life and pushing myself towards healing.”

When “13 Reasons Why” first came out, Klein had recovered. She watched the series with her parents, who suggested doing so after they learned it centered on suicide. “I think that was a really wise idea, just because it is so graphic, and it’s so heavy,” Klein says. “I think it really would’ve triggered me if I hadn’t watched it with them.”

Educators and experts had been concerned about the potential impact of the show ahead of its release. The National Association of School Psychologists, for example, issued a statement recommending that “vulnerable youth, especially those who have any degree of suicidal ideation,” refrain from watching the series. “Its powerful storytelling may lead impressionable viewers to romanticize the choices made by the characters and/or develop revenge fantasies,” they said.

As NPR reported, Netflix, in response to the criticism, added a “viewer warning card” to the show. It also publicized a website providing resources. Now, actors from the show appear in a clip ahead of the first episode of Season 1, warning that, for viewers struggling with issues such as sexual assault, substance abuse, suicide and more, the show might not be right for them.

But damage may have already been done, according to the study released Monday. Researchers at Nationwide Children’s Hospital in Columbus, Ohio, found that, for boys ages 10 to 17, the suicide rate in April 2017, the month after the show was released, was the highest overall in the past five years. It also found a total of 195 more deaths than predicted for that age group for the whole of 2017.

The research team had anticipated that girls, identifying with the female star of the show, would have been more vulnerable, the New York Times reported. But the suicide rate for girls ages 10 to 17 did not increase significantly, the study found. (Experts have pointed out the study only takes into account completed suicides. Various studies show that men and boys are more likely to die by suicide, but women and girls are more likely to attempt it.)

In a statement, a Netflix spokesperson said that the company is “looking into the research” behind the latest study. They noted that some of it conflicts with a study released last week by the University of Pennsylvania, which found both helpful and harmful effects of “13 Reasons Why.” The show is currently in production for its third season.

Emerson Koblick is an eighth grader at Hall Middle School in Marin County, Calif., the area where much of “13 Reasons Why” was filmed. She has watched Seasons 1 and 2 of the show, and likes it, but says it might be “triggering” for students dealing with depression or suicidal thoughts. “But for me, and most of my friends who haven’t had to deal with that, it was something more to just spread awareness [around mental health],” she says.

Gerber, the student from Ohio, says a lot of her classmates couldn’t watch the show because of the trauma they’d been through. In particular, she didn’t like the way Season 1 portrayed death by suicide. “I think the first season kind of made it seem like, ‘If you kill yourself, everyone will feel bad and you’ll get your revenge,’” she says.

“And I don’t want any of my friends or anyone at my school to have that mindset, because that’s not what it should be.”

For Klein, the student from Colorado Springs, the show was troubling, too. She cites the fact that Hannah, the main character, is able to watch the people she left behind suffer — and even communicate with some of them. It makes it seem as though suicide is a viable option, not a permanent one, she says.

Klein also wishes the show focused more on the people around Hannah who are struggling with similar mental health issues, but who choose a different path. “What a beautiful story it would have been to share with the world how we can overcome through positive coping, when all we feel like doing is dying,” she says.

Helping others in the wake of tragedy

The aftermath of her boyfriend’s death was “terrible,” Gerber says. Many students blamed her and bullied her on social media and at school — staring at her, not talking to her, even spitting on her, she says. She also felt that people weren’t talking enough about her boyfriend’s death or any of the other students who died by suicide — as if no one knew how to handle it, she says.

“I gained a lot of maturity from that experience and going through that,” Gerber says. For her, going to therapy and taking medication have been integral in moving forward.

“It’s always important to turn negative things that have happened into positives — you can’t just keep them negative.”

Gerber says that many of her classmates haven’t had the same resources. She’d love to see mandatory classes teaching students what to do when a friend is suicidal, what not to do, and how to support yourself and others. “There’s no class that teaches you how to handle these things,” she says.

Perry High School, which Gerber attends, did not immediately reply to requests for comment.

According to Glod, the professor, there are some “consistent and clearly identifiable” signals to watch out for when it comes to suicide risk in teenagers. Warning signs can include dark writings or social media postings, sleep disturbance, withdrawing from friends, loss of energy and thoughts of death.

The next step, she says, is for adults — or anyone else — to address the issue when they recognize these behaviors. It’s a misconception that talking about suicide will plant an idea in someone’s head, she says — it could be the thing that pushes them to get help. “It’s important to say, ‘Have you thought about dying?’ or, ‘Have you had thoughts about hurting yourself?’”

For Klein, having the support of her parents was life-saving. After she expressed suicidal thoughts to them, they took her into their arms and held her: She says they listened to her, and tried to understand what she was feeling. That was the turning point that allowed her to slowly emerge from the darkness she felt.

And that’s largely why Klein is doing what she’s doing now. The idea behind Project Reasons, which she launched in 2015 with the help of her parents, came from a list she kept when she used to self-harm. The list included the names of people she knew her self-harm affected, and it became a collection of reasons to live. On the Project Reasons website, there are instructions for teens to create their own list. Klein also travels across the country with other Project Reasons student board members, speaking to fellow teens about coping skills and how to overcome suicidal feelings, depression and anxiety.

Her main message to others dealing with these issues? No matter how hopeless everything seems now, those feelings can change.

Teens, she says, “can really save their own lives — they have the power to do that, even if they’re scared, even if they don’t necessarily want to. They just have to fight for themselves, and they need to reach out to someone.”

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