References to Netflix’ “13 Reasons Why” at clinical presentation among 31 pediatric patients

The popular Netflix show 13 Reasons Why graphically depicts the story of a teenager who commits suicide. As media and fictional portrayals of suicide are known to influence suicidal behaviors, professional organizations expressed concern that the show would lead to a spike in suicidality among its viewers. We wished to understand the context to any documented references to 13 Reasons Why among pediatric patients in a large healthcare system. We searched all clinical documentation for patients under 18 for the terms “13 (or Thirteen) Reasons Why” for the six months surroundings the show’s release, recording demographics, location, and clinical context for each reference. This search yielded 63 separate clinical notes of 31 unique patients where 13 Reasons Why was explicitly documented. All but one reference took place during an encounter related primarily to the patient’s mental health, with most patients making these references during an encounter related to suicide (71%; 22). The most common context of the reference (55%; 17) was the patient or guardian reporting that the show contributed to their worsening mental health symptoms. Analysis of references to 13 Reasons Why among pediatric patients in our health system raises concerns about the show’s potential impact on vulnerable youth.