To explore media effects research that examines the potential positive impact of media consumption. 1. Read the ‘Media Literacy Case Study’ on pages 450-451 in your textbook for

Authors: Jordan A. Levinson, MA

Elise M. Tsai, BA

Laurel Felt, PhD

Ellen Wartella, PhD

and Yalda T. Uhls, PhD

Based on experimental research to be

published in the Journal of Medical Internet Research (JMIR) summer, 2021, by

Yalda T. Uhls, PhD

Laurel Felt, PhD

Ellen Wartella, PhD

and Andrew Sanders, MA

and

a social listening study conducted by

MarketCast, LLC in 2019

Funders:

Seeking Support:

Evaluating the Impact of

on Adolescent Mental Health 13 Reasons Why

1

Content warning:

This report includes discussion of

mental health struggles and suicide.

Shows targeted at teenagers

portraying tough topics have the

potential to support them in a

time when the mental health crisis

is more pronounced than ever.

What if we can harness the power of stories to help young people searching for mental health information and support?

Media is such a powerful force in the lives of children and teens. Creating content that

normalizes and encourages seeking help from trusted adults and health professionals can

have a profound impact in helping young people struggling with mental health concerns.

As a pediatrician, I know that the entertainment industry reaches far more kids and

families than I do. What a benefit it would be to help families open critical conversations

and empower them to connect with needed resources to feel better and be healthy.

Indirectly, by destigmatizing mental health issues, modeling help-seeking behavior,

and supporting vulnerable youth so they feel less alone.

Directly, by providing resources.

At the Center for Scholars & Storytellers (CSS), we believe storytelling can play a

distinct role in meeting the challenges of the mental health crisis in two ways:

Nusheen Ameenuddin, MD, MPH, MPA, FAAP Pediatrician at Mayo Clinic and Chair of the AAP Council on

Communications and Media

1

45% of college students perceive stigma around receiving mental health

treatment.

Nearly one in three adolescents ages 13 to 18 will experience

an anxiety disorder.

1

TABLE OF CONTENTS

Throughout the COVID-19

pandemic, youth ages 11 to 17 have been more likely

than any other age group to report moderate-to-severe

anxiety and depression symptoms.

1

2

3

Note from our founder

Metholodology

Resources

Project description

Key findings

Limitations

Findings

Note from our donor

Acknowledgments

p. 2

p. 4

p. 6

p. 13

p. 15

p. 16

p. 8

p. 3

p. 18

References p. 17

Key takeaways p. 7

1

The Center for Scholars & Storytellers (CSS) offers evidence-based practices to support industry thought leaders striving to create content that maximizes the benefits of storytelling. Even before COVID-19, teen suicide rates were rising, along with reported symptoms of anxiety and depression. Since the pandemic hit, the prevalence of mental health challenges increased across every age group, with young people being hit hardest. Research shows that adolescence is a period of heightened risk for developing psychopathology. In addition, youth are consuming unprecedented levels of media. Taken together, our work at CSS is more critical than ever.

Global franchises reach teens at scale. In the past few years, CSS ran several studies examining Netflix’s 13 Reasons Why (13RW), a series that drew worldwide acclaim and condemnation. Given the reach of this highly successful franchise, we felt it was important to study exactly how it impacted youth, especially with respect to mental health.

Other research examined the impact of the show well after its release. Our study asked adolescents to watch Season 3 in real time during its initial broadcast run.

Our findings should have implications for the diverse stakeholders we serve, including entertainment content creators, public health experts, parents, and adolescents. Our hope is that by working together—well in advance of release—stakeholders can work towards harnessing the positive potential of these kinds of global franchises.

In a world where

streaming services

means content is

always available, shows

portraying mental

health issues have a

powerful opportunity to

provide support.

A Note from our Founder

2

Dr. Yalda T. Uhls, PhD Founding Director, CSS

Our results demonstrate that these kinds of challenging, realistic stories seem to inspire youth to talk and learn about mental health issues.

1

The Technology and Adolescent Mental Wellness (TAM) program was funded to advance our understanding of the role of technology and adolescent mental well- being. We achieve this through a collaboration with researchers, industry and organizational leaders, and youth themselves. Our three goals of the program include:

The project described in this report represents one of the shining stars of our funded projects in its innovation and significance. 13 Reasons Why is a well-known and recognized show among adolescents and their parents. As an adolescent medicine provider, we’ve heard about this show from our patients and discussions about whether to recommend or restrict adolescent access to this show are rampant across pediatric providers. Too often, these decisions and recommendations lack evidence or investigation. The social listening study that is part of the source material for this report sought to understand the conversations individuals were having about the topics represented in this show, and the experimental investigation used a real- time assessment of the impact of the show on mental health. This study provides much-needed evidence to advance the conversation about how a popular Netflix show can impact adolescent mental health.

A Note from our Donor

3

Dr. Megan Moreno, MD, MSEd, MPH Technology and Adolescent Media (TAM) Program Director

1)Provide funding for research projects that focus on the foundational question of how technology can improve the mental well-being of adolescents.

2) Dissemination of the findings from these projects to aid implementation strategies, including ways to leverage traditional research publication as well as

open-access and public-facing approaches.

3)Promote community and ongoing collaboration by building a community and collaborative platform around TAM for researchers, clinical providers,

educators, nonprofit organizations, the motion picture industry, and policy and

philanthropic organizations where best practices and new knowledge can be

shared while developing and nurturing a Youth Advisory Board.

1

Outline the conversation

surrounding on social media.

Provide data on some of the

positive and negative outcomes

from watching this show.

Identify some of the impacts the

show had on information seeking

and conversations around mental

health.

Suggest ways industry can support

adolescent mental health.

This report will:

13RW

CSS seeks to understand whether—and how—stories can support youth as they pursue mental wellness. Through our continuing research program, we hope to create tools that engage users around ancillary content related to key issues in storylines. This also has tremendous potential for marketers who want to leverage the scale and impact of social media to support adolescents’ well-being.

PROJECT DESCRIPTION

4

The Center for Scholars & Storytellers

(CSS) conducted two studies to

investigate how the popular, teen-

targeted show,

may affect adolescent mental health.

13 Reasons Why,

Findings by MarketCast, LLC.

Study 1:

A commissioned social listening study that examined the social conversation on Twitter (in 1,291,334 total mentions of key

topics) one week after release for Seasons

1 through 3.

Study 2:

An experimental study with 157 teens from across the country that is to be

published in The Journal of Medical Internet Research in the summer of 2021. Within this study, approximately half of our

participants watched Season 3 of 13RW while the other half did not. Before and

after having watched Season 3, or not having done so, all participants completed

a survey asking about their conversations

in the previous 30 days and whether the

show inspired them to seek out

information about mental health issues.

a

b

b For more information about the methodologies of both studies, see pages 14-15.

a

1

Whereas the first season shed light on the lead character’s death by suicide and the second season unpacked legal accountability for her death, the third season centered on sexual assault, bullying, and

recovery. It also opened space for survivors to speak up and demand justice. The season arc suggested that masculine role pressure might sanction teen violence.

Summary of 13 RW, Season 3

PROJECT DESCRIPTION

The first season of 13RW launched with huge fanfare.

But within a few weeks, the

backlash was relentless.

Ultimately, the first season

inspired record levels of

responses on Twitter, and

over 600,000 global news

reports, dozens of editorials

from experts and professional

organizations, and dozens of

scientific studies.

5

PROJECT DESCRIPTION

Credit: Instagram @13reasonswhy

1

A study found that a fictional storyline was more

effective at changing behavior than a

“documentary” with statistics and experts. In other

words, accurate information combined with emotional storytelling is a powerful mechanism for shifting behavior and attitudes!

Given the heightened risk of developing mental

health issues in adolescence, normalizing discussions about mental health can support destigmatizing help-seeking.

Why does this matter?

Of the teens who watched Season 3 of 13RW, 88% spoke about mental health topics.

During the first week after the launch of Season

1, the avalanche of social conversation on

Twitter was primarily positive.

Talking about it

Nearly every teen (92%) who watched Season 3

of 13RW looked for information on mental health topics.

Social engagement was particularly high when

talent used their platform to post helpline

resources.

Searching for answers

88 discussed mental

health topics

%

92 mental health information

6

4

5

% looked for

KEY FINDINGS

1

Because content drives conversations and information seeking,

Educational companion content to a show might include: Conversational toolkits developed by public health experts that are

designed to support teens in talking with friends and, separately,

with parents.

These should be shared beyond a “resource” webpage.

Reconsider investment in PSAs and prioritize creating content that engages modern teens in more meaningful ways.

studios should create resources that amplify and support such outcomes.

3. Utilize research and resources in content creation

KEY TAKEAWAYS

Where Can We Go From Here:

Three Suggestions for the Entertainment Industry

When all stakeholders (e.g. industry, education, and public health officials) work

together—well in advance of release—they can better harness the content’s

potential to support adolescent wellness.

7

2. Provide credible, engaging resources with accurate information

1. Support adolescents’ narrative-inspired conversations

For more resources, visit: www.scholarsandstorytellers.com/teen-mental-health-report

www.scholarsandstorytellers.com/teen-mental-health-report-resources

In developing show specific resource pages and character focused

videos that the cast can then share on social media, expert information

can be curated to help support the fans needs, and, this study

concludes, it is energy well spent as viewers are very likely to use it.

6,7

This is a worthy

effort for content

creators for reasons

that are not simply

performative.

Dr. Jessica Gold MD, MS Assistant Professor and Director of Wellness, Engagement, and Outreach in the

Department of Psychiatry, Washington University School of Medicine in St. Louis

While a great deal of research focused on negative effects, our analysis found that

research claims pointing to an increase in suicides as a result of Season 1 were unconvincing.

Although it is difficult to rule out adverse

effects, we found no evidence that the show increased suicides in either male or female teens

at the time that the show launched.

spoke to their friends

spoke to their parents

spoke to a sibling

spoke to a partner

63%

47%

19%

13%

Unlike Season 1 or Season 2, the Season 3

storyline did not feature a suicide nor unpack

why a suicide happened. Yet somehow, this

storyline, which primarily focused on who killed

the antagonist Bryce Walker, inspired teens to

speak about this topic. Experts suggest that

talking about suicide can sometimes serve as a

protective factor.

FINDING #1:

CONVERSATIONS ABOUT MENTAL HEALTH

The vast majority of the teens who

watched reported discussing

issues featured in the storylines.

Teens who watched , Season 3,

spoke about suicide 166% more than

teens who did not watch it.

13RW

88 of teens discussed issues in the storylines

In particular, suicide, mental health, and bullying

were topics of discussion:

Interestingly enough, teen suicide

rates declined in 2019, the year

Season 3 of 13RW came out. 10

such as suicide, mental health, and bullying

%

8,9

8

Dan Romer Annenberg Public Policy Center of the U of Penn

c

13RW

c Experimental study.

92 mental health information

% of teens looked for

FINDING #2:

SEEKING MENTAL HEALTH INFORMATION d

Our findings indicate that teens who experienced sexual assault—or were close to someone who had—were particularly motivated to seek out information related to stories from the show. One of Season 3’s major storylines was about Jessica, a victim of sexual assault, becoming an advocate for others. In addition, the season documented Tyler’s emotional recovery from his own sexual assault.

People of all ages and backgrounds, but especially youth, young adults, and parents are eager to learn more about mental health. The

readiness to engage, shed stigma, and incorporate new learnings into every day practice has never

been as high as it is at this point in history.

Three males reported they had been subject to sexual assault. 9

e Sexual assault was defined as having ever been forced to do sexual things that you did not want to do (such things as kissing, touching).

d Experimental study.

f

Christine Yu Moutier, MD Chief Medical Officer

American Foundation for Suicide Prevention

Most teens who watched said they looked for mental health information due to something they saw in the show.

13RW

Season 3 showed how male heterosexual

stereotypes shaped the home life of the show’s

serial rapist.

Viewers may have learned from the show that

internalizing rigid masculine stereotypes

contributes to this kind of behavior.

Viewers who knew someone who had experienced sexual assault sought more information on gender stereotypes more frequently than those who did not.

e

The top 3 topics were:

Bullying

Mental health

Sexual assault

All of the male-identified viewers who reported

that they had been subject to sexual assault

sought out information on this topic. f

Credit: Instagram @13reasonswhy

Credit: Instagram @13reasonswhy

7

“I’ve watched like 5 episodes of 13 Reasons Why and I’m already talking about how to prevent suicide.”

“Every on e of us sh

ould watc h

@13Reaso nsWhy & t

hink a bit more abo

ut

how we in teract wit

h others.”

“Finished #13ReasonsWhy already and now I’m feeling all the feels. Wow. What an emotional rollercoaster and an absolute eye opener. Amazing.”

FINDING #3:

POSITIVE SOCIAL CONVERSATION

AFTER SEASON ONE

Overall, the social conversation

immediately after release was 93%

positive. No negative conversations

were found one week after the release.

Advocates were active on social

media, pointing out how important it is

to discuss sensitive issues openly (e.g.

depression, suicidal thoughts, sexual

assault) without shame.

On Twitter, the social conversation around Season 1 was overwhelmingly positive, in particular with respect to mental health and suicide.

10gSocial listening study.

687,556 total mentions of key topics related to the show after Season 1

93% around mental health, bullying, and suicide

social media conversations were

positive

SEASON 1

Positive conversations

were defined by MarketCast as viewers discussing the topics or

praising the show for addressing commonly taboo topics.

Negative conversations

were defined by MarketCast as discussions that raised questions

of whether the show represented topics accurately.

g

Credit: Instagram @13reasonswhy

SEASON 2

SEASON 3

497,794 total mentions of key topics related to the show after Season 2

50% negative

conversation

The social conversations about suicide

after the release of Season 2 and

Season 3 were much more negative,

even though suicide was not a focus in

either of those seasons. This could be

an indication that the theme of suicide is

ingrained in how some view the show

as a whole, even beyond the first

season.The amount of conversation

related to 13RW overall and its positive nature declined over time, indicating

that the show—and its accompanying

resources—may not have fully realized

its potential for positive outcomes.

While the Season 1 social

conversation was overwhelmingly

positive, it became more negative

during Season 2.

By Season 3, the conversation

leaned back to the positive.

FINDING #4:

NEGATIVE SOCIAL CONVERSATION

AFTER LAUNCH OF SEASONS TWO AND THREE

105,984 total mentions of key topics related to the show after Season 3

11

52%

35%

32%

positive conversation

positive conversation negative

conversation

“I hope teen boys/men

watch 13 Re asons Why

to see what rape

culture and male

entitlement looks like

from the ot her side.” “I’m starting @13ReasonsWhy

Season 3 and because of how last season made me I’m really nervous. I want to see how the show progresses but I might

not be able to make it through this season.”

“Bojack Horseman

portrays mental

illness better than

13 Reasons Why.”

“I do not

care wha

t

anyo ne s

ays, 13 R

easo ns

Why DOE

S NO T he

lp w ith

suici de a

ware ness

and is

VER Y tri

gger ing.

I DO NOT

REC OMM

END .”

h

h Social listening study.

13Reasonswhy.info

Devin Druid, the actor who plays Tyler (one

of the main characters), posted a thread of

helpline resources and shared an article

where he discussed sexual assault.

When a cast member shared resources, it was enthusiastically embraced.

FINDING #5:

TEENS USED THE RESOURCES OFFERED BY NETFLIX

Alisha Boe telling audiences to wake up

and tell themselves “I am strong” resonated with females.

More personal and empowering PSAs generated more engagement on Instagram.

On social media platforms that hosted PSAs related to the show,

viewers engaged with them significantly less than they did with

emotional or behind-the-scenes clips from the shows.

The social media profiles affiliated with the

show were visited by 52% of the

respondents.

12

Of teens who watched Season 3,

34% visited resource pages.

One-fifth reported that they watched the

short documentary Beyond the Reasons.

Over 15% said they visited 13Reasonswhy.info

i

i Experimental and social listening study.

Procedure Participants were randomly assigned to either:

1) Watch Season 3 of 13RW or 2) Not watch Season 3 of 13RW

Participants were asked to complete a pre-intervention survey and then

directed to watch or not watch Season 3. One month later, teens were

asked to complete another survey.

The pre- and post-survey included questions about depression, mental

wellness, self-efficacy, sexual assault, perpetration of bullying, and seeking

mental health help. Participants were also asked if (and with whom) they

had conversations about social and mental health issues such as suicide,

sexual assault, substance use, gender stereotypes, and sexuality. In the

post-survey, the group that watched the show also answered questions if,

and with whom, they discussed 13RW and whether what they saw on the show led them to seek further information on topics tied to its storylines.

White

56.5%

Hispanic/Latinx

19.5%

Black

17.5%

Multiracial

6.6%Sample There were 157 participants from across the country who

completed the experimental study, with 68 in the

intervention group (who watched the show) and 89 in the

control group. Participants were 13 to 17 years old, about 15

years old on average, and were 52% female and 48% male.

The majority of the sample was White (about 55%), while

19% were Hispanic/Latinx, 17% Black, and 6.4% multiracial.

We recruited this sample through NORC at the University of

Chicago, which has a nationally representative pool of

participants.

13

METHODOLOGY

We first conducted an experimental study to determine the effects of 13 Reasons Why on adolescents’ mental health and pro-social behaviors.

Experimental Study

Procedure MarketCast provided the frequency for which each topic was mentioned and categorized each

mention as positive, negative, neutral or mixed in nature. Positive conversations were defined as

viewers discussing the topics or praising the show for addressing commonly taboo topics. Negative

conversations were defined as discussions that raised questions of whether the show represented

topics accurately.

Note: Data were calculated using human sentiment analysis, so a trained analyst researched a

statistically relevant sample size for each season’s conversation to ensure 99% accuracy in sentiment

analysis. MarketCast also analyzed the social media accounts and posts of the show’s talent, social

media influencers, and hotlines and helplines to uncover how these influenced the conversation.

We also commissioned a social listening study, tracking social media

for mentions of specific topics on specific platforms, to examine the

conversation around 13RW. Our goal was to examine the natural conversation that took place about the show, exploring how such

discussions changed while investigating why such changes were

occurring. In order to find this information, CSS partnered up with

MarketCast’s Real-Time Analytics team, which specializes in social

media monitoring and research.

Sample MarketCast identified Twitter conversations one week after the premiere of each season (Seasons 1–3)

that included keywords and phrases that we provided to them.

These included: mental health; depression; anxiety; anorexia; PTSD; grief; suicide (considering and

attempting); abortion/parenthood planning; teen pregnancy; preventing teen pregnancy; social media

pressure; social media; bullying (online and offline); gender stereotypes (toxic masculinity); sexual

harassment; sexual assault; sexual abuse; youth-on-youth violence; substance abuse; sexuality;

immigration; school shootings/guns; socioeconomic status; body image; good people vs. bad people;

homelessness; and race.

MarketCast identified 687,556 mentions related to Season 1; 497,794 mentions related to Season 2;

and 105,984 mentions related to Season 3. We were not able to gather demographic data (gender,

age, or race) on those who posted about these topics.

14

METHODOLOGY

Social Listening Study

There were limitations regarding both of our studies. In the experimental study, for

safety reasons, we excluded any teens who had experienced, or were at the time

experiencing, serious suicidal ideation. As such, our results may not apply to a

population struggling with very severe mental health symptoms. We were also unable

to measure whether conversations or steps taken to seek information were positive or

negative.

The social listening study gave us important insights into the conversations that the

public was having on social media after the initial release of each season. While the

experimental study above was focused on adolescents, it is unknown if the social

listening study had a purely adolescent sample. We are not able to make

generalizations about how a certain group of people communicated on Twitter about

the show, as we do not have demographic data (e.g. age, gender, location) on those

who mentioned key topics related to the show. Additionally, we were only able to

analyze mentions from public Twitter accounts, which does not include private

accounts or mentions on any other social media platforms.

15

LIMITATIONS

1

Youth Resources: American Academy of Child & Adolescent Psychiatry

Crisis Text Line: Text “HOME” to 741741 to speak with a crisis counselor

Suicide Prevention Lifeline: 1-800-273-8255

TeenLine: Emotional support for youth

The Jed Foundation: Helpline text “START” to 741-741 call 1-800-273-TALK (8255)

The Trevor Project: Lifeline 1-866-488-7386

16

American Academy of Child & Adolescent Psychiatry: Facts for Families

Child Mind Institute: Parents Guide to Good Care

HealthyChildren.org: Resources from the American Academy of Pediatrics

KidsHealth: How to Understand Your Child’s Emotions and Behavior

MentalHealth.gov: For Parents and Caregivers

National Alliance on Mental Illness: Helpline — 888.950.NAMI (6264)

Mental Health Resources for Teens

Mental Health Resources For Parents

For more resources, visit: www.scholarsandstorytellers.com/teen-mental-health-report

www.scholarsandstorytellers.com/teen-mental-health-report-resources

RESOURCES