key: cord-0882082-64629ko9 authors: Wang, Hua; Parris, Juliet J. title: Popular media as a double-edged sword: An entertainment narrative analysis of the controversial Netflix series 13 Reasons Why date: 2021-08-11 journal: PLoS One DOI: 10.1371/journal.pone.0255610 sha: 88833d458beb8fa78a2fcf409df6859ec505c0ef doc_id: 882082 cord_uid: 64629ko9 13 Reasons Why is a Netflix original series adapted from Jay Asher’s 2007 young adult novel with the same title. Season 1 premiered on March 31, 2017 and featured the sensitive issue of teen suicide along with bullying, substance use, depression, and sexual assault. Unlike the typical teen dramas on popular streaming platforms, this show was created not only for entertainment, but also to stimulate conversations about taboo topics that people often shy away from. However, it also caused significant controversy, especially criticism around the main character Hannah’s suicide scene. More than three years into the initial controversy and at least two dozen scholarly publications later, this study is the first to examine the entertainment narrative content of 13 Reasons Why Season 1 to better understand how these health and social issues were portrayed in the show, what specific examples we could identify as potential behavioral modeling, and to what degree it complied with the 2017 WHO guidelines for media professionals. We used the framing theory and social cognitive theory in communication research and media studies as our guiding conceptual frameworks and a narrative analysis approach to investigate a total of 660 cut scenes in all 13 episodes. Our findings provided empirical evidence, along with contextual information and detailed examples, to demonstrate that a popular entertainment program like the Netflix series 13 Reasons Why serves as a double-edged sword. The production team’s good will and due diligence are commendable. Yet, additional steps can be taken in the future to effectively promote professional resources and reduce viewers’ risks, especially the most vulnerable groups. Suicide is a serious global health concern, accounting for an annual loss of nearly 800,000 lives [1] . In the United States, approximately 48,000 people take their lives each year and millions more report suicidal ideation, plans, and attempts [2, 3] . Although the United States does not have the biggest share of deaths from suicide in the world [4] , suicide has been climbing at an alarming rate in recent decades [5] with an increase of 33% nationwide from 1999 to 2019 [2] . removed [34] . More than three years into the initial controversy and at least two dozen scholarly publications later, other than blatant blames and conceptual arguments [35] [36] [37] , not a single study has analyzed exactly how teen suicide was portrayed in 13 Reasons Why. As part of a larger research project, we conducted an in-depth investigation of 13 Reasons Why Season 1 using a narrative analysis approach. Our study conceptualization was guided by Entman's framing theory in mass media research [38] and Bandura's social cognitive theory used in the scholarship and praxis of entertainment-education [39, 40] . We examined all 13 episodes in Season 1, with cut scenes as our units of analysis and a theme-based inquiry focusing on major health and social issues portrayed in the narrative. In addition, we identified examples of positive and negative behavioral modeling and checked the media portrayal in 13 Reasons Why against the WHO's guidelines for media coverage of suicide [41] . In this article, we begin with a brief literature review on the two aforementioned theoretical frameworks along with the rationale that led to our research questions. We then provide descriptions of the entertainment content and our narrative analysis before detailing the results. We conclude with a discussion about the major findings, implications, and recommendations for future endeavors in research and practice. The notion of framing was initially developed by Goffman as a way to help people organize and process information in everyday life [42] . Gitlin further connected framing with mass media in the context of news coverage when reporters employ frames to draw public attention to certain aspects of a phenomenon [43] . Over the last four decades, framing has been regarded as a major theory of mass communication and media effects [44, 45] . Entman explicated that "to frame is to select some aspects of a perceived reality and make them more salient in a communicating text, in such a way as to promote a particular problem definition, causal interpretation, moral evaluation, and/or treatment recommendation for the item described" (p. 52) [38] . Therefore, the two essential elements of framing are selection and salience, which are the focus of the present study. It is important because what aspects of a phenomenon and how they are presented in the mass media can have significant psychological, political, and even societal impacts [46] [47] [48] [49] [50] . Message framing helps to reduce the complexity of issues, making them more accessible to the audiences by highlighting certain aspects of the content and playing to their existing schemas [51] . In mass media, television news frame events from a particular viewpoint, which may change the viewers' perceptions. The way health and social issues are framed in entertainment media and popular culture can influence the audience, especially the younger groups who may be vulnerable and underprepared for exposure to sensitive content without proper warning or guidance. For example, DuRant and colleagues found that tobacco and alcohol use was frequently glamorized in music videos and portrayed as socially desirable by the lead artists [52] . Collins and colleagues showed in a national longitudinal survey that exposure to sexual content in entertainment programming on television was a predictor of adolescent sexual initiation [53] . Many other media initiatives purposefully leverage the power of storytelling and address important issues through entertainment media by framing their message in unconventional ways [54] [55] [56] . For example, the protagonist in a popular Indian television crime series Jasoos Vijay (Detective Vijay) revealed that he was HIV positive and used this dramatic twist to help reframe the public discourse, raise awareness, and reduce sigma around HIV/AIDS [56] . Brusse and colleagues demonstrated when using a gain (as opposed to loss) frame in health messages about alcohol consumption, the Dutch participants reported a decrease in counterarguing and a higher level of intention for refraining from drunk cycling [54] . In the United States, institutions such as the Norman Lear Center has been monitoring health messaging in primetime television for decades; they provide expert consultation to creative writers and recognize outstanding work through the Sentinel Health Award every year [57, 58] . Based on the framing theory and empirical studies reviewed above, we proposed these research questions: : What health and social issues were portrayed in the Netflix series 13 Reasons Why? RQ2: How were these health and social issues portrayed in Netflix series 13 Reasons Why? For decades now, entertainment media for mass audiences have been used to raise awareness, increase knowledge, spur discussions, shift attitudes, and influence practice using a social and behavior change communication strategy called entertainment-education [56, [58] [59] [60] . Bandura's social cognitive theory (formerly known as social learning theory) [39] has been the most prominent theory for entertainment-education scholars and practitioners [61, 62] . Most people know about the famous bobo doll experiment that helped Bandura develop the social learning theory in the 1960s and 1970s in the context of understanding the media effects of violent behavioral modeling on children. In particular, the bobo doll experiment demonstrated the power of role modeling and observational learning when the modeled behavior was filmed rather than in real life (Singhal as quoted in Friedman [63] ). In fact, since the 1970s, this theory has also heavily influenced the design and research of numerous entertainment-education interventions around the world [61, 62] . A wide range of novel, effective, and healthy behaviors have been portrayed by popular characters in the entertainment-education radio and television dramas to facilitate positive individual and collective behavior change [56, 58, 60] . One exemplary project is Soul City in South Africa. In Season 4 of their popular television drama serial, Soul City modeled a collective action as the bystander intervention to curb domestic violence (i.e., neighbors banging pots and pans to demonstrate their disapproval of the abusive husband beating up his wife) and enabled villagers around the country to follow suit [58] . In the United States, primetime television producers have worked with expert consultants to tackle the controversy of abortion such as in Norman Lear's Maude [59] or promote organ donation through behavior modeling in the medical drama, Numb3rs [64] . Bandura called such entertainment-education dramatic serials "enabling media" [40] , which help create conditions for activating human agency and facilitating positive change. In that sense, with their producers' explicit intention to spur public discussions about taboo topics and their documented efforts to consult with subject experts (as shown in the 29-minute companion documentary), the Netflix series 13 Reasons Why may be viewed as an incidental entertainment-education drama series to address teen suicide and other related issues. However, good intentions do not necessarily guarantee good outcomes. The concerns surrounding 13 Reasons Why are certainly legitimate regarding its potential unintended negative influence on vulnerable and high-risk viewers. To avoid repeating the same mistakes, we ought to acknowledge the efforts made by the production team while taking a deep dive to investigate incidents that may be perceived as positive vs. negative behavioral modeling. Well-respected international and national health organizations have laid out guidelines for media coverage of suicide. For example, the WHO provides a resource with a list of six do's and six don'ts for media professionals when reporting on suicide [41] . It is imperative to comply with these established guidelines. Therefore, we proposed two additional research questions: RQ3: Which incidents in 13 Reasons Why may be considered as positive vs. negative behavioral modeling for its audience? RQ4: Did 13 Reasons Why comply with the WHO's guidelines for covering the issue of suicide in mass media? We adopted a narrative analysis approach in this study to better understand the entertainment content in 13 Reasons Why Season 1. Narrative analysis is an analytic approach in social and behavioral sciences with a focus on the interpretation of information conveyed in the form of stories, and it has been used in social psychology, communication research, and media studies [65, 66] . Scholars have examined a wide range of elements from character development and overarching themes to narrative structure and dramatic performance, but these choices are usually made according to the study aims and research inquiries [65] . Television dramas are a popular narrative genre in entertainment media with tremendous values for research because they are an indispensable part of the popular culture and can have a significant impact on individual audiences, social norms, and even public policy [56, [67] [68] [69] [70] . For example, Freytag and Ramasubramanian used narrative analysis of 113 deaths portrayed in four popular medical dramas to examine the attributes of characters who died, their causes of death, the underlying themes in these death storylines, and their (dis)connections with the "good death" experiences in reality [71] . Similar to the approach used by Freytag and Ramasubramanian [71] , all episodes in our narrative analysis of 13 Reasons Why Season 1 were coded through multiple iterations. The initial rounds of coding involved identifying cut scenes in each episode, marking their starting and ending time, detailing the characters who appeared, their specific locations, time of the day when the event took place, and connections to any health and social issues. Knowing that the producers of 13 Reasons Why were well-intentioned but many news reporters and scholars disagreed on its audience response in reality, we reviewed the storylines and character dialogues closely based on each major health and social issue portrayed in the show to identify illustrative behavioral modeling examples for potential positive and negative impact. In addition, we compared the entertainment narrative content against the WHO guidelines for media coverage of suicide [41] . Based on a comprehensive literature review, field experiences, and expert recommendations, they provided a list of six dos and six don'ts regarding the type of information that can be helpful and the language and details to avoid. We created exclusionary criteria based on how the issue of teen suicide was portrayed in the narrative. From the do list, we selected three of six items where the issue was present, for example "Do provide accurate information about where to seek help". We excluded the other three items since they were not relevant to how teen suicide was portrayed such as "Do apply caution when reporting celebrity suicides". Similarly, from the don't list, we selected three of six items where the issue of teen suicide was present, but was not responsibly reported, such as "Don't use language which sensationalizes or normalizes suicide, or presents it as a constructive solution to problems". We excluded the other three items since they were not relevant to the narrative, such as "Don't use photographs, video footage or social media links". After agreeing on the list of do and don't' items, we compared them against the 65 related scenes covering teen suicide. All relevant scenes were reviewed multiple times and coded in three categories: WHO guidelines complied, not complied, and not applicable. What were portrayed and how RQ1 and RQ2 asked what specific health and social issues were portrayed in 13 Reasons Why Season 1 and how. As shown in Table 4 , the series covered several important issues in a total of 141 cut scenes: teen suicide (65 scenes, 46.1%), bullying (29 scenes, 20.6%), substance use (29 scenes, 20.6%), depression (12 scenes, 8.5%), and sexual assault (6 scenes, 4.3%). They were spread out across the entire Season 1, accounting for 21.4% of the entire air time. Every single one of the 13 episodes portrayed between two to five of these issues in multiple scenes (Range = 5-20, M = 10.85, SD = 5.01). This does validate the producers' intention about raising social awareness through storytelling to stimulate difficult dialogues in the American society. Our in-depth analysis also showed that each of these five themes was addressed from different angles. Teen suicide included five sub-themes: awareness of the connection between depression and suicide (6 scenes, 9.2%), the early signs of Hannah's suicidal ideation (2 scenes, 3.1%), Hannah's premeditation (3 scenes, 4.6%), Hannah's death by suicide (6 scenes, 9.2%), and coping with Hannah's death (48 scenes, 73.8%). Bullying included five sub-themes: spreading rumors and gossips at school (7 scenes, 24.1%), invasion of privacy through stalking (3 scenes, 10.3%), physical abuse (6 scenes, 20.7%), verbal abuse (8 scenes, 27.6%), and cyberbullying (5 scenes, 17.2%). Substance use included two sub-themes: alcohol consumption such as underage and binge drinking (20 scenes, 69.0%) and marijuana use (9 scenes, 31.0%). Depression included three sub-themes: symptom recognition (9 scenes, 75.0%), teaching about symptoms (1 scene, 8.3%), and general knowledge (2 scenes, 16.7%). Sexual assault included two sub-themes: sexual harassment (5 scenes, 83.3%) and rape (1 scene, 16.7%). As shown in Table 5 , issue-related narrative elements centered around three types of characters: 18 teen characters in 360 scenes, eight parent characters in 62 scenes, and five educator characters in 21 scenes. Not surprisingly, among the most frequently appeared characters were the people closely connected to Hannah's suicide, including the people she named in the cassette tapes she left behind but also Clay's friend Tony. In particular, Clay was in 24.4% of the scenes, and Hannah was in 13.1% of the scenes related to the health and social issues. This was consistent with the way the series was presented, with Clay driving the suspense and Hannah being the narrator of her story. The Netflix series also added more weight to the parent characters as compared to the original novel, especially around Hannah's and Clay's parents. Such screenplay adaptation brought another critical layer of parent-children communication in addition to the peer-to-peer interactions among the teens. A few educator characters were also included. The counselor Mr. Porter was in 13 scenes as he was featured in Hannah's last tape and also the presenter of the coping workshop that school organized for parents after Hannah's death. Other characters such as Mrs. Bradley were featured in classroom scenes sharing suicide prevention resources with the students. Through them, the dramatic narrative incorporated the perspectives and dialogues between the educators and the teen students. As shown in Table 6 , issue-related events portrayed in this show were divided between 66 scenes (46.8%) in private such as homes and cars, and 92 scenes (53.2%) in public such as hallways at school and the Monet's coffee shop in the community. Moreover, out of 141 issuerelated cut scenes with a clear indication about the time of the day, 86 (61.0%) were daytime scenes and 55 (39.0%) were nighttime scenes. Taken together, Table 7 summarizes all issue-related scenes across the five themes, three types of characters, three types of locations, and two time periods of the day. Although these numbers are mere proxies of different ways the producers attempted to address these complex and difficult issues, these results provide more nuanced and contextual information on how the dramatic narrative was structured to tell the stories and prompt the audiences to engage in deeper reflections and open discussions. RQ3 asked which incidents in 13 Reasons Why may be considered as positive vs. negative behavioral modeling for its audience. Based on our review of the 141 issue-related cut scenes, we identified one positive example and one negative example for each of the five themes to illustrate their behavioral modeling potential (Table 8 ). Episode 4 Scene 8 was a good example to tackle teen suicide. In a few short lines, Clay's dad acknowledged that he understood his son was grieving a dear friend in pain, showing a parent's sincere concern and encouraging Clay to express his feelings. This kind of parent-child communication is critical for a teenager to cope with death from suicide. Similar approaches of being present and showing support as a parent can also help reduce a child's risk for psychological distress, mental health disorders, and ultimately suicide. On the other hand, Episode 13 Scene 6 was an example of negative behavior modeling. Showing any details about suicidal plans in terms method and location can increase the risk for the audience, especially those who are already highly susceptible. Episode 10 Scene 27 was a good example of bullying bystander intervention that Alex decisively stepped in to stop Montgomery's physical aggression towards Tyler. Unfortunately, Note. We kept the complete list of character names from the sample description to reduce confusion. Therefore, any character who appeared in Season 1 but not in the issue related cut scenes will show 0 count in this bullying is common in high school and Montgomery's character represented student athletes who are seen as strong and popular sometimes become bullies. Episode 1 Scene 40 was an example of negative behavior, showing how easy it could be for an innocent joke to spin out of control and turn into cyberbullying. Episode 9 Scene 9 was a good example related to substance use, showing when Jessica tried to numb her pain by hiding alcohol in her drinks at school during the day, her boyfriend Justin gently nudged her to reconsider her decision. Episode 10 Scene 41 recounted how, in a series of events from a night of partying, that drunk driving can cause the life of a good friend. Note. We kept the complete list of location names from the sample description to reduce confusion. Therefore, any location that appeared in Season 1 but not in the issue related cut scenes will show 0 count in this table. https://doi.org/10.1371/journal.pone.0255610.t006 Episode 4 Scene 9 was a good example related to depression, showing a school assembly where the school counselor and principal discuss symptoms of depression, suicide and coping strategies with concerned parents. It included specific and scientific medical information. Episode 1 Scene 3 showed a flashback when Hannah was clearly suffering from depression but no one around her recognized. It may be considered as a counter example of the previous one, as the lack of awareness about Hannah's suffering eventually failed her. Episode 11 Scene 44 was a good example illustrating that young people can be sexually responsible while having a good time when Clay obtained Hannah's consent before moving further in their intimate moment. Episode 12 Scene 35, on the other hand, showed how an easy-going party could become so wrong when Bryce sexually assaulted Hannah in the hot tub, exacerbating her pain and suffering. For any of these selected cut scenes from 13 Reasons Why Season 1, there is the potential of reducing negative influence and facilitating positive change, if the modeled behaviors were unique, novel, and effective as a convincing alternative to the existing norm, a warning message was displayed before or after the episode, and they were all directly linked to proper resources as these narrative elements emerged in the folding storylines. RQ4 asked if 13 Reasons Why Season 1 complied with the WHO guidelines for portraying suicide in the media. Table 9 summarizes the results based on our review of the 65 suicide-related scenes. First, responsible professional practices do provide accurate information about where to seek help. The recommendation aims to disseminate resources about social services and support network, including suicide prevention centers, crisis helplines, other health and welfare professionals in public discussions about suicide. Access to support is also vital when providing information. In our study, 9.2% of the suicide-related scenes did report accurate information about where students could go to seek help. For example, Episode 1 had several scenes portraying Mrs. Bradley telling the students in class where they could find information on suicide prevention if they or someone they cared about needed help. Clusters" from the school and Clay not communicating with them that he might be in trouble. (2) DO educate the public about the facts of suicide and suicide prevention, without spreading myths. (2) DON'T explicitly describe the method used for suicide. Mr. Porter coordinated an informative presentation with Principal Bolton to educate concerned patients about suicide prevention and symptoms to recognize within their children such as moodiness, change of appearance, declining GPA. While grabbing another cassette from her parent's store, Hannah also secretly takes a pack of razor blades before telling her mother she is off. (3) DO report stories of how to cope with life stressors or suicidal thoughts, and how to get help. Second, responsible professional practices do educate the public about the facts of suicide and suicide prevention without spreading myths. This recommendation suggests that since there are many misconceptions about suicide, it is important to lead reports with facts than myths to avoid imitative behaviors. It is also advisable to report on suicide prevention and 75.4% of the suicide-related scenes in our study did exactly that. For example, Episode 4 had several scenes about the suicide prevention workshop the high school offered to concerned parents. Third, responsible professional practices to share stories of how to cope with life stressors or suicidal thoughts. This recommendation involves providing personal narratives that integrate educational materials describing various coping strategies to build psychological resilience and restore hope. These stories usually feature unique ways in which others overcome adversity. In our study, 10.7% of the suicide-related scenes did portray these narrative elements. For example, Episode 7 included scenes where Clay's parents demonstrated positive role modeling. His father shared his own high school experiences with him and how he survived the difficult time while his mother is willing to get him the necessary help with a physician. Moreover, we also identified the incidents where the suicide-related scenes in 13 Reasons Why violated the WHO guidelines. In fact, 12.0% of these scenes included language that could potentially normalize suicide or present it as a solution to problems. Also, out-of-context use of the word "suicide" is destructive and should be avoided as it may desensitize the weight of the issue when reported to the public. A common example is the expression "committing suicide", which criminalizes the behavior. The topic of "suicide contagion" and "suicide clusters" were included in the conversation between Clay's parents but the connotation of infectious disease may be expressions of concern by some and should be avoided [9] . In addition, 9.0% of the suicide-related scenes described the method used. The WHO urges media professionals to be cautious when it comes to the method of suicide because it may trigger copycat behavior, especially some stories can spread like a wild fire on social media. In our study, the guideline was violated when details of Hannah's suicide plans played out on the screen, including picking up razor blades from her parents' drugstore in Episode 13 . Worse yet, 6.0% of the suicide-related scenes provided details about the site or location. Responsible media professionals would avoid including information about the site or location of the suicide to reduce the risk for vulnerable populations. Instead, care is recommended to avoid promoting or glamorizing such sites or locations. The most criticized scene of Season 1 was the elaborate scene of Hannah taking her own life in the bathtub at home in Episode 13 and was eventually removed from the original version due to a strong backlash from suicide prevention advocates over its graphic nature. In this study, we examined the entertainment content of the controversial Netflix original series 13 Reasons Why Season 1 using a narrative analysis approach. We aimed to better understand how teen suicide and other related health and social issues were portrayed in the show, what specific examples we could identify as potential behavioral modeling, and to what degree it complied with the WHO guidelines for media professionals [41] . Our results suggest that in a 12-hour entertainment program, on average, more than one in every five scenes in 13 Reasons Why Season 1 (a total of 141 out of 660 scenes, 21.4%) included narrative elements to tackle a critical issue. The five health and social issues featured themes were: teen suicide (46.1%), bullying (20.6%), substance use (20.6%), depression (8.5%), and sexual assault (4.3%). Each of the 13 episodes covered at least two if not all five of these themes. Each issue was portrayed through a whole host of key characters, storylines, and sub-themes. We learned that issue-related scenes about teen suicide (46.2%), bullying (58.6%), and depression (75.0%) occurred at school; substance abuse (55.2%) and sexual assault (66.6%) occurred mainly in private homes. In addition, 61.0% of the issue-related scenes occurred during the day, while substance abuse (62.1%) and sexual assault (83.3%) occurred more often at night. These results are consistent with previous research. For example, there is a close linkage between suicide and adolescents suffering from major depressive disorder, bullying, and sexual assault [11] . With increasingly pervasive technologies and the popularity of social media, cyberbullying has detrimental effects to suicide amongst teens [11, 16] . Most sexual assault victims were attacked in the evening and while at home [72] . Overall, the issue-related scenes were organized around three types of characters: driven by 18 teen characters and supported by eight parent characters and five educator characters; the events mostly took place between private residences at night or school facilities and other popular public locations in the community during the day. A great majority of these issue-related portrayals were honest, intentional, and educational. Most criticism in the mainstream news reports and scholarly publications have only focused on the one scene of Hannah's suicide in the bathtub and not any of the other 140 scenes. And to date, there has not been any acknowledgement or appreciation for the production team's effort to consult with the subject experts while making difficult creative decisions, as documented in the show's companion program Beyond the Reasons. Moreover, parents (44.0%) and educators (14.9%) were included in many of the issuerelated scenes as part of this Netflix original series, although they didn't carry much weight in the 2007 novel. These efforts were well-intended and captured in our research findings, although the response in reality from many adult viewers of the show were not necessarily positive, especially regarding how the school counselor, Mr. Porter, was portrayed as the last reason why Hannah couldn't find any alternative but to end her own life. Criticism of Mr. Porter's character was linked to the lack of mental health resources established by Hannah's school as she sought help before her suicide [35, 73] . This muting effect or dismissive behavior highlighted the need for better trained professionals and counseling services in public schools where students spend most of their days [35, 73] . Our narrative analysis also revealed that there were multiple examples for each of the five major issues that could potentially serve as behavioral modeling. Teen characters, parent characters, and educator characters were all included in the positive examples, such as peer support, parent-child communication, and school-based prevention efforts. Most of them could be easily strengthened based on entertainment-education principles to facilitate positive change, while a few others could also be seen as reinforcing current teen cultural norms that might lead to health and social problems. When checking the 65 suicide-related scenes against the WHO guidelines [41] , we found a cumulative of 95.3% of these scenes were in compliance with what WHO recommended to DO, with the best efforts in educating the public about suicide prevention (75.4%) followed by recognizing suicidal thoughts and developing coping strategies (10.7%) and providing accurate information about resources for seeking help (9.2%). We also found a cumulative of 27.7% of these suicide-related scenes to have violated the DON'Ts in the WHO guidelines [41] , with the worst part of using language that might sensitize or normalize suicide (12.3%) followed by detailing the method (9.2%) or the site/location (6.2%). These findings are qualitatively insightful in response to our research questions. However, we want to acknowledge that the theme-based coding procedures were not completed without any challenge during the iterative process of our narrative analysis. Disagreements occurred mainly when certain characters appeared in a particular scene without speaking a word. We decided to make an exception for inclusion if a character showed nonverbal expressions that were a meaningful part of the narrative in that scene. For example, Bryce winked at Hannah in the hallway at school as if nothing happened between them although he actually sexually assaulted Hannah just the other night at his private party. In rare incidents like this, even though Bryce did not speak in this scene, his nonverbal expression was relevant to the issue of sexual assault and ultimately contributed to Hannah's suicide. Therefore, Bryce was included in our calculation of characters in this scene. In other scenes such as a teacher discussing school resources for suicide prevention while Hannah's grieving parents walk by the classroom door on their way to their daughter's locker, since the narrative focus of this scene was about the discussion in the classroom, the non-speaking characters were not included in the final coding. Once any discrepancies in the initial rounds of coding were resolved and the focal themes of teen suicide, bullying, substance use, depression, and sexual assault were decided, scenes connected to the focal themes were watched and coded again to examine the types of characters featured, contextual factors like location and time, as well as specific angles or aspects used to portray each theme. Our analytical procedures and final codes are available through OSF (https://bit.ly/3xLKFaZ). For the first time, our findings provide empirical evidence, along with contextual information and detailed examples, to support the arguments made by scholars such as Mueller [36] and Krebs [35] that a popular entertainment program like the Netflix series 13 Reasons Why serves as a double-edged sword. This study is also timely, with the COVID-19 pandemic magnifying many risk factors (e.g., economic distress, social isolation, lack of mental health resources), many have deep concerns about suicide rates and the physical, emotional, financial, and societal toll that will take on our communities around the globe [74] [75] [76] . Although these trends were relatively stable in the early months of pandemic lockdowns, [6, 74, 77, 78] , some have reported that COVID-19 increase risks linked to suicide among the youth groups [79] . Our study filled in a critical gap in the scholarly investigations of the controversial Netflix series 13 Reasons Why by providing a detailed account of its media portrayal of teen suicide and related issues of bullying, substance use, depression, and sexual assault. The production team's goodwill and due diligence are commendable. Unfortunately, good intentions and efforts cannot guarantee positive audience response as one would hope. Additional steps can be taken to enhance effective behavioral modeling in the media portrayal, offer warning messages before and/or after viewing, and promote professional resources directly and promptly linked to the specific health and social issues during and/or immediately after viewing. Results of this study will be compared with how the show was covered in mainstream news media to explore the similarities and differences on the focus of framing in the entertainment narratives as opposed to the content of news reports about this series. Taken together, the lessons learned from the controversy stirred by 13 Reasons Why will help both the entertainment producers and the public, especially young audiences, their parents, educators, and other adult viewers, to better understand how to discuss difficult health and social issues sensibly, responsibly, and effectively. Suicide: Key Facts Underlying Cause of Death The National Institute of Mental Health Share of deaths from suicide from 1990-2017. Data published by Global Burden of Disease Collaborative Network. Results from the Institute for Health Metrics and Evaluation (IHME) US Department of Health and Human Services, Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System (WISQARS) [data set Suicide Rates Among Adolescents and Young Adults in the United States National vital statistics reports: from the Centers for Disease Control and Prevention Suicide and Youth: Risk Factors Alcohol, firearms, and suicide among youth Epidemiology of youth suicide and suicidal behavior Preventing multiple forms of violence: A strategic vision for connecting the dots Economic evaluations of public health interventions to improve mental health and prevent suicidal thoughts and behaviours: A systematic literature review. Administration and Policy in Mental Health and Mental Health Services Research Adolescent Suicide from an International Perspective Introduction to special issue on youth and suicide Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset Suicide Prevention Resource Center The economic cost of suicide A review of the clinical, economic, and societal burden of treatment-resistant depression Suicide and Suicidal Attempts in the United States: Costs and Policy Implications Economic impact of youth suicides and suicide attempts Media reporting of suicide and adherence to media guidelines Suicide and the news and information media: A critical review Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review Social media, internet use and suicide attempts in adolescents This is the most Tweeted-about show of 2017 so far Netflix's '13 Reasons Why' is most tweeted about show of 2017 13 Reasons Why' officially renewed for season 2 at Netflix. The Hollywood Reporter Suicide on TV: Minimizing the risk to vulnerable viewers Teen suicide: Fanning the flames of a public health crisis 13 Reasons Why" pediatric psychiatric presentations to an emergency department in relation to release date 13 Reasons Why' depicts a graphic suicide Families blame '13 Reasons Why' for teen daughters' suicides Netflix deletes '13 Reasons Why' suicide scene. The New York Times 13 Reasons Why as a vehicle for public understandings of suicide Why Thirteen Reasons Why may elicit suicidal ideation in some viewers, but help others 13 Reasons Why: Can a TV show about suicide be 'dangerous'? What are the moral obligations of a producer? Framing: Toward clarification of a fractured paradigm Social foundations of thought and action: A social cognitive theory Social cognitive theory for personal and social change by enabling media Preventing suicide: A resource for media professionals Frame analysis: An essay on the organization of experience The whole world is watching: Mass media in the making & unmaking of the new left Framing as a theory of media effects Framing, agenda setting, and priming: The evolution of three media effects models News framing: Theory and typology The implications of framing effects for citizen competence Framing US coverage of international news: Contrasts in narratives of the KAL and Iran air incidents Prospect theory: An analysis of decision under risk Choices, values, and frames Framing, agenda setting, and priming: The evolution of three media effects models Tobacco and alcohol use behaviors portrayed in music videos: a content analysis Does Watching sex on television predicts adolescent initiation of sexual behavior? Framing in Entertainment-Education: Effects on Processes of Narrative Persuasion Mass media and social change: Can we use television to fight poverty Entertainment-education and social change: History, research, and practice Health messages on prime-time television: A longitudinal content analysis The rising tide of entertainment-education in communication campaigns Entertainment-education: A communication strategy for social change Mind the gap! Confronting the challenges of translational communication research in entertainment-education The theory behind entertainment-education Entertainment-education and health and risk messaging Poor Consuelo Conquers the World [Documentary Film Motivating television viewers to become organ donors. Cases in Public Health Communication & Marketing Narrative analysis Social psychology: Research methods Human communication as narration: Toward a philosophy of reason, value, and action Television drama and popular film as medica narrative Two aspirins and a comedy: How television can enhance health and society Using television drama as entertainment education to tackle domestic violence in China Are television deaths good deaths? A narrative analysis of hospital death and dying in popular medical dramas Female victims of sexual violence Thirteen reasons why revisited: A monograph for teens, parents, and mental health professionals Suicide Risk in the COVID-19 Pandemic Suicide mortality and coronavirus disease 2019-A perfect storm? The impact of the COVID-19 pandemic on suicide rates Trends in suicide during the COVID-19 pandemic Suicide trends in the early months of the COVID-19 pandemic: An interrupted time-series analysis of preliminary data from 21 countries. The Lancet Psychiatry Child suicide rates during the covid-19 pandemic in England: real-time surveillance We wish to thank Divya S, Zoey Zhiying Yue, Chris Haoran Chu, and Vivian Sixiao Liu for their team support during this research project.