This image released by Netflix shows Katherine Langford in a scene from the series, "13 Reasons Why,” about a 17-year-old teenager, Hannah Baker, who commits suicide. (Beth Dubber/Netflix via AP)

In the season finale of the popular Netflix TV series “13 Reasons Why,” 17-year-old student Hannah Baker kills herself in a prolonged three-minute scene.

Even though the entire story, much of it told through flashbacks, has been leading up to this moment, and viewers already know Hannah is dead, the graphic sequence is a torment to watch. New research suggests that the show — perhaps this very scene — could have triggered suicidal thoughts in its viewers, many of whom are young people.

The 13-episode series, which was released all at once, chronicles 13 tapes that Hannah sends to those she blames for her actions. The series has captured the imagination of kids across the country. In April, it set a record for the most-tweeted-about show in 2017, when it was mentioned more than 11 million times within three weeks of its March 31 launch.

The Washington Post's Moriah Balingit explains why some educators and psychologists are saying the show about teen suicide should not be watched by young people. (Whitney Shefte/The Washington Post)

Now a study published in JAMA Internal Medicine has found that within the same three weeks, Internet searches about suicide were significantly higher than expected.

“Our analyses suggest 13 Reasons Why, in its present form, has both increased suicidal awareness while unintentionally increasing suicidal ideation,” the authors wrote. “The most rising queries focused on suicidal ideation. For instance, ‘how to commit suicide’, ‘commit suicide’ and ‘how to kill yourself’ were all significantly higher.”

Overall, suicide queries were 19 percent higher in the 19 days following the series’ release, “reflecting 900,000 to 1.5 million more searches than expected,” the paper reported.

John Ayers, professor of public health at San Diego State University, decided to analyze the impact of the show after it sparked a spirited debate between its creators and mental health professionals and educators about its potentially damaging influence on children. His goal was to use near-real-time data to assess any damage quickly.

Past studies have validated that Internet searches mirror real-world suicide rates, so suicide rates have likely gone up as a result of this program,” said Ayers. “For me, as a data-driven public health scientist, I see this troubling data as a strong call to action. The show must be taken down.”

Netflix replied in a statement: “We always believed this show would increase discussion around this tough subject matter. This is an interesting quasi-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.”

Netflix has also included warnings ahead of its three most graphic episodes, including the finale with the suicide scene, and links to suicide prevention websites and a hotline.

Since its release, hundreds of school superintendents across the United States have sent warnings to parents about the show’s possible effects on their children’s mental health.

“As a father of a teenager and tween, I am very concerned about a dangerous trend we have observed in our schools in recent days,” Palm Beach County Schools Superintendent Robert M. Avossa wrote to parents. “School District personnel have observed an increase in youth at-risk behavior at the elementary and middle school levels to include self-mutilation, threats of suicide, and multiple Baker Act incidents.” (The Baker Act is a Florida law that allows the involuntary commitment of people who may have mental illness and are deemed a danger to themselves or others.) “Students involved in the recent incidents have articulated associations of their at-risk behavior to the '13 Reasons Why' Netflix series.”

The National Association of School Psychologists put out a public caution, recommending that young people with known suicidal thoughts stay away from the show completely.

The fear of Hannah Baker-copycats is not just theoretical — several child psychiatrists have already begun to see suicidal patients who bring up the show during treatment.

Dan Nelson, medical director of the child psychiatry inpatient unit at Cincinnati Children’s Hospital, says “13 Reasons Why” first caused him alarm when he spoke with a 12-year-old patient about it in May.

“She said to me, ‘I saw that show and it really convinced me that suicide was a normal thing to do,’” he said. “I’ve never heard that. In 30 years, I’ve never heard a child say this thing made me think suicide is normal. That really got my attention.”

Kimberly O’Brien, a researcher at Boston Children’s Hospital and an instructor in psychiatry at Harvard Medical School, agreed. “I personally have seen multiple psychiatric admissions where the admission note details the fact that the teen said that they wanted to ‘kill myself the way the girl in 13 Reason Why did,’” she said. “This is extremely concerning because it is showing us, just like it has in research studies, that pictures or detailed descriptions of how or where a person died by suicide can be a factor in vulnerable individuals imitating the attempt.”

Heidi Anderson, an 18-year-old high school student from northern Kentucky, said that, as the survivor of a suicide attempt, she could only make herself watch bits of the series. “I feel it very much glamorizes it,” she said. “I feel it shows how much attention you get, and I don’t think it’s bringing attention to the right parts of suicide.”

According to researchers, including Ayers and O’Brien, the effects of the show could be curtailed, for instance by removing the scenes showing suicide.

“I’m not a proponent of censorship, but if there’s a way to retrofit it, they should. The story line and certain scenes would have to be changed considerably before it would be safe and responsible,” said Madelyn Gould, youth suicide expert and professor of epidemiology in psychiatry at Columbia University, who was not involved with the research. “Even if the series raised some awareness, the question the creators need to ask is — at what price?”

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