I present evidence that the release of Netflix’s 13 Reasons Why—a fictional series about the aftermath of a teenage girl’s suicide—caused a temporary spike in emergency room (ER) visits for self-harm among teenage girls in the United States. I conduct an interrupted time series analysis using monthly counts of ER visits obtained from a large, nationally representative survey. I estimate that the show caused an increase of 1,297 self-harm visits (95 percent CI: 634 to 1,965) the month it was released, a 14 percent (6.5 percent, 23 percent) spike relative to the predicted counterfactual. The effect persisted for two months, and ER visits for intentional cutting—the method of suicide portrayed in the series—were unusually high following the show’s release. The findings indicate that fictional portrayals of suicide can influence real-life self-harm behavior, providing support for contagion-based explanations of suicide. Methodologically, the study showcases how to make credible causal claims when effect estimates are likely biased.

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我提供的证据表明，Netflix 的《十三个原因》（一部讲述少女自杀后果的虚构剧集）的上映，导致美国少女因自残而前往急诊室 (ER) 的人数暂时激增。我使用从一项大型全国代表性调查中获得的每月急诊就诊计数进行了中断时间序列分析。我估计，该剧在上映当月导致自残访问量增加了 1,297 次（95% CI：634 至 1,965），相对于预测的反事实增加了 14%（6.5%、23%）。这种效应持续了两个月，在剧集上映后，因故意切割（剧中描述的自杀方法）而到急诊室就诊的人数异常高。研究结果表明，虚构的自杀描述可以影响现实生活中的自残行为，为基于传染的自杀解释提供支持。从方法上讲，该研究展示了当效果估计可能有偏差时如何提出可信的因果关系。

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