Recent suicides of high-profile celebrities lead experts to worry that young people will copy the act of taking their own lives.
"They think, 'Well, OK, that person hung themselves from a banister using 10-foot rope,' then that might be something that they want to emulate," said Blaise Aguirre, M.D., a psychiatrist specializing in mood and personality disorders in adolescents at McLean Hospital outside Boston.
"The sensationalism can make this option seem attractive," comedian Bridget Phetasy, who has struggled with suicidal thoughts, wrote in a New York Post op-ed. "In all these cases, I've heard more details about their deaths than I care to know, and I can't help but feel like the way we're covering these deaths isn't helping."
Suicide is the second-leading cause of death among 15- to 29-year-olds around the world, according to the World Health Organization (WHO) in Geneva, and has more than doubled in the past decade. Only road traffic fatalities top suicide as the primary cause of adolescent deaths, with boys accounting for 77 percent of those deaths worldwide.
Experts say they are frustrated by the attention given to celebrity suicides, such as travel TV host Anthony Bourdain and fashion designer Kate Spade last week, and the impact on youths at risk. High-profile suicide can trigger contagion, which acts like a virus and may push others to take their lives. After the 2014 suicide of Robin Williams, a popular comedian and actor, researchers saw a nearly 10 percent increase in suicides. People grieving a suicide were 65 percent more likely to attempt to take their own life, a study from the University of London showed.
No one is sure why the contagion effect exists, Aguirre said. He said he thinks that hearing or reading about a suicide "activates neurons that are correlated with suicide" and makes suicide more acceptable to those at risk. Contagion does not influence people who are not at risk, he said.
Many experts say media about suicide amplifies contagion. The popular show 13 Reasons Why, based on a young-adult novel by Jay Asher, follows 17-year-old Clay Jensen as he listens to tapes left by his deceased classmate Hannah, explaining why she killed herself. Asher's novel was published in 2007 and made the American Library Association's list of most banned books in 2012 and again in 2017, the year the Netflix show first aired.
Critics say the show and its explicit portrayal of Hannah's suicide is irresponsible. The suicide is more graphic in the TV series than the book.
"In a person who is not at risk, it's not a dangerous show," Aguirre said. "But in a person who is at risk, it's a very dangerous show."
Nic Sheff, who wrote the episode that portrays Hannah's suicide, defended himself in a Vanity Fair op-ed.
"Facing these issues head-on — talking about them, being open about them — will always be our best defense against losing another life," he wrote. "It overwhelmingly seems to me that the most irresponsible thing we could've done would have been not to show the death at all."
The controversy remains fresh. Katrina Sheffield, a Florida mom, said the show inspired her daughter's suicide attempt in May. Her daughter sent a text during her attempt, saying that it was "taking longer" than on 13 Reasons Why, and her method was similar to Hannah's.
"I have told our daughter that instead of finding 13 reasons why — let's find 14 on why not!" Sheffield wrote. In a Facebook video, she urged parents to talk to their children about suicide.
Research suggests that age and race are closely correlated with self-harm statistics. Black children aged 5 to 12 are twice as likely to commit suicide as their white peers, but black teens aged 13 to 17 are 50 percent less likely to do so than white teens.
Lesbian, gay, bisexual, transgender, queer and other (LGBTQ+) students are also at high-risk — they're more than twice as likely to consider suicide and over three times more likely to attempt it than their heterosexual peers. Nearly 45 percent of transgender respondents to a Canadian survey reported that they had planned an attempt at least once.
Facebook has released a program intended to spot users at risk of suicide or self-harm based on their posts, even if no one reports it.
The World Health Organization offers a guide on reporting suicide, advising the media to be cautious "in reporting celebrity suicides."
"Don't place stories about suicide prominently, and do not unduly repeat such stories," WHO advised. It discourages describing suicide details, such as method or location.
"The more detail that you give legitimizes that way of doing it. Why not just say the person died by suicide and have that be its own talking point?" Aguirre said. Describing the suicide in detail "doesn't tell you about the underlying mental health."
American mental health advocacy groups called for increased attention to and funding for mental health issues following news last week of the death of Bourdain and Spade.
"Too many people in America do not have access to mental health services, and too often we neglect the impacts of traumatic events that sometimes fester for decades before taking people's lives," Paul Gionfriddo, president and CEO of Mental Health America, said in a statement.
"With all of us working together, and by collectively making a massive investment in suicide prevention research, resources and quality mental health care, we can, and we will, reverse the rising suicide rate," the American Foundation for Suicide Prevention wrote.
"Suicide Prevention is a social justice Issue," tweeted mental health advocate Jacob Griffin.
South African law student, writer and activist Luke Waltham called for action.
"Actively make your spaces brave ones where people, including yourself, can speak about your feelings and experiences," Waltham tweeted.
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)