Today, the depiction of mental illness and suicide in pop culture is placed under scrutiny more than ever before.

In 2017, the Netflix drama “13 Reasons Why” found widespread popularity among teenagers. But alongside the praise, many were concerned about how the show — which revolves around the suicide of a 17-year-old named Hannah — may affect vulnerable youth.

To be clear, such media content does not create suicidal feelings in those who had none in the first place. But what about those who are already at risk?

In a new survey of suicidal teens, conducted by the University of Michigan, 21 out of 43 participants said watching the show heightened their risk of suicide. Lead author Victor Hong, M.D., explained how many of the teens identified with Hannah, as the character experiences anxiety, bullying, and sexual assault on the show.

When controversy around the show was at its peak, many criticized the depiction of Hannah’s suicide, asking whether there was a need for the audience to witness it in explicit detail.

Nic Sheff, one of the show’s writers, defended this choice in a Vanity Fair op-ed. Sheff stated it was important to avoid censoring the brutal reality of suicide.

“It overwhelmingly seems to me that the most irresponsible thing we could’ve done would have been not to show the death at all,” he wrote, explaining how shying away could have falsely promoted suicide as a form of relief.

“I know it was right, because my own life was saved when the truth of suicide was finally held up for me to see in all its horror — and reality.”

Sheff is not alone in the point he makes, that the show could actually save lives. But disagreement prevailed, with further criticism over elements of the storyline such as the problematic use of death as a form of “revenge” against the bullies and the distracted adults.  

The core of the argument here essentially boils down to suicide contagion, or what is known as a “copycat” effect. For instance, estimates revealed a 10 percent spike in deaths after the highly publicized suicide of Hollywood actor Robin Williams, many of which involved his own demographic i.e. middle-aged men.

Among many factors, the media coverage was called out, highlighting the need to handle such subjects with more sensitivity. Guidelines for journalists highlight the importance of avoiding certain phrases and recommend caution when sharing details about the method of suicide.

While this debate is far from reaching a conclusion, senior author of the Michigan study Cheryl King, Ph.D., did offer some advice.

“Parents whose kids may be vulnerable or at a high risk for suicide should be even more diligent about what their kids watch and if they are being exposed to content that could trigger them,” she said.

Both parents and teachers should provide children with a comfortable environment where they can speak freely on their struggles rather than bottling them up in fear. One can start by becoming aware of warning signs and risk factors.

“They also shouldn’t shy away from open, honest and difficult conversations with their kids about these topics,” King added.

If you have thoughts of suicide, confidential help is available for free at the National Suicide Prevention Lifeline. Call 1-800-273-8255. The line is available 24 hours, every day.