What are Some Contributing Factors to Suicide and Depression that

Should Be Considered When Portraying it in Film?

Luke Mick

Senior Project Advisor: Erin Skyles

Abstract
Few movies or series today have gained enough attention from the public to have the
opportunities to make any actual positive change in regards to suicide and depression. Those that
have managed to get anywhere significant have created little or no change at all, or have
managed to make the situation worse than it was before. To make a film or television series
centered around this intense topic, those that are involved in doing so should take caution and
pay attention to detail through extensive research and critique from mental health professionals.
Sadly, the film giants on this issue have either done quite the opposite, or just weren’t cautious
enough.

12th Grade Humanities

Animas High School
11 April, 2019
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Part I: Introduction

In the year of 2017, 1.4 million Americans attempted to commit suicide. Of those 1.4

million, 47,173 were successful. On today’s average, 129 suicides are committed every day.

With suicide being the tenth leading cause of death in the United States, many have tried their

hand in producing films and series’ focused on this topic. With film being one of the great

“escapes” in the medial world, it would seem to be a decent way to show people the true horrors

all around them. Sadly, the few that even manage to catch the eye of the public tend to do more

harm than good. Based on past attempts, as well as reviews by psychology experts, the previous

portrayals are meant more for entertainment purposes than reducing the suicide rate itself, and

lack the real issues and subtlety that most victims possess.

The most important step into creating a story around this topic that can actually possess

the potential to lower the rate of suicide is to include all that is necessary without causing any

rises in the overall rate. But before that can be done, it’s best to take a look at the more common

causes of suicide and depression: relationships, media, income, etc. Other significant things to

include are statistics. When making a film that is informative, it’s important to include any

necessary information that can positively affect the viewer’s perspective on the topic. In the case

of those affected by suicide and depression, the most crucial piece that requires an extremity of

care, is how it is all portrayed. Some scenes can be triggering for some audiences, and that can

potentially have a negative effect on the rate of suicide as it has done in the past.
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Part II: Historical Background/Context

When including the facts and statistics, it’s important to have something to compare them

to. In this context, I am taking a look at stats, factors, and solutions from the mid to late 20th

century, then comparing them with all that is current.

Starting in the mid 20th century, suicide rates were, to be expected, lower than they

currently are. According to the American Foundation for Suicide Prevention, from 1950 to 1975,

the average rate of suicide was 11.46 per 100,000 individuals. Throughout those years, there

weren’t any significant jumps or drops, which [can lead to] suggests that it wasn’t a well-known

problem like it is today. This may not come off as a surprise to some considering how American

families had been faring financially. The United States economy was doing very well for itself.

At least, that’s what former U.S. Labor Secretary Robert Reich tells us in his documentary

Inequality for All. If one adjusts for inflation, middle-class workers at the time were earning

more than they currently are, so family finances weren’t as big of an issue. [As an added bonus,

the lack of cellular communication forced friends to spend time with each other in person rather

than over the phone or through other online activities.]

At the beginning of 1976, the suicide rate lowered until the next year when the U.S.

experienced a jump to 12.7 per 100,000, leading to the new highest national average within a

year. This 1.66% increase could’ve come from a few major events during that year. Anita

Bryant’s anti-gay “Save Our Children” movement caused Miami Florida to repeal the gay rights

ordinance. With it being such a large movement at the time, it had effects throughout the

country, possibly causing suicides in the LGBTQ community. Also taking place that year,
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flooding in Johnstown, Pennsylvania, and Grundy, Virginia caused billions in damages, resulting

in a loss of homes and lives. This often results in families having to be relocated and struggle to

make a living. With such financial problems, many individuals can be led to depression, then

finally develop suicidal ideation. Sadly, details regarding the suicide rates during the 20th

century have become nigh impossible to find and details given above can only be classified as

mere educated guesses. However, the next few decades were almost completely still. Slight rises

and drops here and there, never too large until 1994-2000. Within those six years, the average

national rate decreased, resulting in 15% less suicides nationwide. Since then, no equally

significant drops have come to pass.

Instead of lowering, the suicide rates for the past several years have only increased. In

2017, rates rose to an all-time high of 14 suicides per 100,000. During this time, 547,000 adults

were hospitalized after attempting suicide. While the suicide rate for men is 3.54x higher than

women, the number of hospitalizations for women was larger by nearly 100,000. This is due to

the methods more commonly used by each gender. While more than half of attempts made by

men were done so using firearms, women typically attempted suicide by poisoning, which isn’t

always successful. Since 2017, no drops in the U.S. suicide rates have occurred. The Healthy

People 2020 goal is to reduce suicides rates to 10.2 per 100,000 by the year 2020, but with the

steadily increasing numbers, serious work and contributions would be needed before such a

target can be reached.

This continues to present a problem in some immensely obvious ways, and in ways that

we might not entirely expect. There are the issues most know; depression, anger, death, and other

symptoms that mainly affect the singular person and a few around them. Others are not quite as
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visible. Symptoms such as decreases in individual motivation and increases in government

spending are sometimes not as clear, but are still certainly drastic to both the victim and the

United States as a whole.

All statistics given regarding suicide rates per year courtesy of ghdx.healthdata.org

Part III: Research and Analysis

When figuring out what factors should be included in a story around suicide and

depression, it is best to start by identifying a few. In this section, several different factors will be

focused on, each lying in one of three main categories: environmental, economic, and social,

respectively.

The most prevalent environmental cause to look at is elevation. Believe it or not, one’s

elevation can often have a negative impact on their mental health. Researchers from the

University of Utah analyzed 12 different studies regarding altitude and depression. They found

that the suicide rate increases by 0.4 per 100,000 individuals for every 100-meter increase in

altitude. Once the math is done, the numbers begin to rapidly add up, causing the suicide rates in

mountainous towns to become significantly larger. In more detail, as described by David Railton

with Medical News Today,

[“]Living at higher altitudes could cause a condition known as “chronic hypobaric

hypoxia,” which occurs when atmospheric pressure results in low blood oxygen. Chronic

hypobaric hypoxia could have an adverse effect on the brain or perhaps alter how it

processes serotonin.[”] (15)

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This can prove to be mentally devastating as serotonin, a neurotransmitter, is a big part of

maintaining mood balance, and low serotonin levels have been linked to depression.

https://www.robertreeveslaw.com/blog/causing-suicide/

Above is a representation of the suicide rates by state, providing evidence that elevation

can play a significant role. States in red represent those with the highest suicide rates per

100,000, while states in grey represent those with the lowest rates.

Another more well-known factor is income. Naturally, it comes to no surprise that more

suicides are reported amongst individuals with a lower income. More specifically, research done

by the Federal Reserve Bank of San Francisco suggests that “individuals with family incomes

below $34,000 are significantly more likely to commit suicide than those with incomes above
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$34,000[.]” ([pg.] 20). However, those with low incomes aren’t the only ones suffering. People

with higher incomes and social status are still susceptible to depression and anxiety. Judi Cineas,

Ph.D., who works as a psychotherapist and clinical social worker in Palm Beach, Florida, told

Brian Krans with Healthline,

[“]The high performers are under great pressure to continue to excel. The higher they are,

the greater the pressure to keep excelling. There is also the threat to consistently be a cut

above because there are many others lined up and waiting for the opportunity to take the

spot. Sadly, many face this pressure alone.[”] (19)

The article in which Cineas talks of the higher class speaks to the fairly recent suicides of

Kate Spade, famous fashion designer, and Anthony Bourdain, renowned chef and author. Krans,

the article’s author, even goes into how some groups, mentioning the American Association of

Suicidology, omit details of the suicides for public safety concern and to avoid any replications

of the suicides. This is a big topic regarding idolization, which will be spoken to later.

While income focuses almost entirely on adults, this next topic focuses mostly on

adolescents. [Just about any social cause of suicide can be traced back to one’s school.] The

more common causes being bullying and loneliness. I’ll first speak to the former.

Bullying isn’t near as easy to identify as one may believe. Many who haven’t been

involved would most likely think of the “stereotypical bully” that is often seen in film. This type

of bully can resort to any length of physical contact from a shoulder bump to actual fighting.

Other stereotypical bullies often use childish pranks or name-calling. While these can be the case
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in real life, you would typically find that most bullies don’t resort to physical contact or call

people names [continuously], but instead, purposely exclude others or spread rumors. However,

the observable victim isn’t always the only one at risk of suicidal ideation. According to the

National Center for Injury Prevention and Control (CDC), “Youth who report both bullying

others and being bullied (bully-victims) have the highest risk for suicide-related behavior of any

groups that report involvement in bullying[.]” (2). This suggests that any of those involved in the

act of bullying are at risk of suicidal behavior.

Loneliness is another matter entirely. While many causes of depression and suicide are

observable, conditions such as loneliness and hopelessness are sometimes incredibly hard to

spot. To make it easier, it’s helpful to learn some of the different ways in which one can develop

feelings of loneliness. While there is the obvious sense of loneliness that develops when you’re

physically alone, the more common and complex case is when one feels out-of-place. This can

take place when one is alongside a single person or residing in a large group and can cause them

to attempt to “fit in,” which can force them to change something about themselves. This change

can be large or small, from clothing to entire personalities, and more than often present

themselves as negative changes.

The main reason that one should look more deeply into the causes of suicide and

depression are because of the representation that is shown on screen. How it is portrayed is a

major factor that dictates whether or not a film or series can have a positive impact. If it is

portrayed poorly, it can often be seen as immature or unrealistic. This can steer the viewer’s

attention away from what their attention should be focused on.

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There are a great many other factors to positive and negative mental health (media,

extracurricular activities, relationships, PTSD, etc.), but those discussed are some of the more

relevant issues. A significant amount of these problems can be positively portrayed on screen if

one manages to write a script with immense research and care. In doing so, a great first step is to

examine similar past attempts. Many have tried their hand in producing films based on this topic,

but the few that have grabbed society’s attention have had very little positive impact. The biggest

and most well known of these is the Netflix original series ​13 Reasons Why​.

The series became an instant hit, particularly with adolescents. But what was disguised as

a means to help those in need, did more harm than good. The story behind the show is about a

girl, Hannah, who commits suicide and leaves thirteen tapes for the people that steered her

towards making that decision. It [immediately] starts off positively with the cast warning the

viewer of what the show consists of. They even provide a number that you can call if you’re

facing depression or suicidal ideation. However, even a great start couldn’t save them from what

took place all around the country afterward. With the release of the show, the U.S. suicide rate

increased by 0.54 per 100,000, resulting in the all-time high rate of 14.00. Some have attempted

to argue that the show isn’t the cause for such a high rate, and they may be slightly right. While

the show itself probably isn’t entirely to blame, a study done by JAMA Internal Medicine was

done using Google search trends not long after the show was released. Google searches

regarding the topic rose by 20 percent after just 19 days of the show’s release. This represents an

increase of between 900,000 and 1.5 million searches in regards to the topic. As said in an article

by Sophie Gilbert, featured on ​The Atlantic​,

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[“]It’s unclear whether an increase in searches regarding suicide meant an increase in

actual suicide attempts, although JAMA notes that there’s typically a correlation between

the two, and that “searches for precise suicide methods increased after the series’

release.” Their analyses, the authors concluded, “suggest 13 Reasons Why, in its present

form, has both increased suicide awareness while unintentionally increasing suicidal

ideation.[”]

The final episode even shows the graphic death of the main character, portraying it as if it

was the right decision, or not even a decision at all, but the only option. This is the instance in

which psychologists use the term “romanticizing suicide” in regards to the show. Other

unnecessary pieces to the show that can be potentially traumatizing are as follows; violent

bullying, detailed rape scenes, and a slew of adults and counselors that are depicted as the

villains rather than people that can be trusted.

The main issue regarding the series is the connectability that some can experience with

Hannah. In the show, the viewer is able to follow her on her journey through depression until

reaching the tipping point of suicide. She faces an extremity of problems, so much so that many

can relate to some of the things that she experiences. This can cause the people that “connect

with her” to look up to her. This is where idolization, mentioned previously during the topic of

income and suicide, comes into play. In the media, it is not always an issue when someone looks

up to another, but in a popular series where the main character is a depressed, suicidal teen who

is written to seemingly care more about revenge than getting help, it can and did have drastically
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negative effects. Of course, it does not help to ignore mental health experts when they say the

show is not ready to be released. Sadly, that is exactly the mistake Netflix had made.

Part IV: Discussion and Conclusion

When going through my research, specifically that which involved the suicide spike in

regards to ​13 Reasons Why,​ I was quite appalled to see that anyone would put an immense

amount of work into a series based on teen suicide and depression, but ignore putting in the

necessary research that would allow the show to have a more positive impact. Furthermore, when

experts warned of the dangers of releasing the show in such a state, Netflix displayed their true

ignorance by setting aside those concerns and releasing the series anyways. It is not impossible

to write a well-written script while also providing the public with a trusted resource regarding the

topic of suicide and depression. All that is necessary is research and trusted critique by those that

really know about these situations.

There are no sensible arguments suggesting that the fight against suicide and depression

is not worth it. The loss of life should always be put at the top of our issues that need to be

tackled, and suicide is one of the leading causes of death in the United States. If government

spending is an issue one would prefer to tackle first, they would do well to keep in mind that

suicide and self-injury now cost the government around $70 billion a year. If equality is more

important, then it is time to find out why the suicide rate for whites and natives are so much

higher than anyone else. If someone is concerned about gun violence, they should take a look at

how many deaths by firearms are related to suicide and other mental health problems. This is an
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issue that is present in more places than one would initially realize, making it a big step to

solving a multitude of different problems.

One of the many reasons that people choose not to get help is because they see it as a sign

of weakness, men in particular. It has been proven time and time again that simply speaking out

about one’s issues, whether to trusted adults or organizations, reduces the risk of developing

suicidal ideation, and can even get rid of it entirely. Below is a list of resources that anyone can

use to help themselves:

National Suicide Prevention Lifeline: 1-800-273-8255

Veterans Crisis Line: 1-800-273-8255 and press 1, or text 838255

The Trevor Project for LGBTQ youth: 1-866-488-7386

SAMHSA’s National Helpline for substance abuse: 1-800-662-4357

Befrienders.org

When the people responsible for assisting those in need begin to fail, that duty begins to

fall upon the unaffected. This can consist of friends, family, etc. Not only do they typically face

issues of their own, but the victims themselves, as mentioned previously, often feel that seeking

help is a sign of weakness. This causes those that wish to help the victims to push the matter

further in the fear that the situation could become worse, and in turn, accidentally end up

worsening the situation themselves. This doesn’t necessarily cause a loop, but creates the same

situation over and over again for different individuals.

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No parent should have to live with the worry and fear that their children could be a

danger to themselves. That much is clear. So why shouldn’t we care about this issue? Some see

suicide as a taboo topic, but in actuality, it’s quite the opposite. The more people that involve

themselves, in small or large ways, the more that can be done to hold back this contagion.
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Works Cited

Daly, Mary, et al. “Relative Status and Well-Being: Evidence from U.S. Suicide Deaths”

Federal Reserve Bank of San Fransisco, July 2010,

https://www.frbsf.org/economic-research/files/wp07-12bk.pdf​.

Gilbert, Sophie. “Did ​13 Reasons Why​ Spark a Contagion Effect”, August 1, 2017,

https://www.theatlantic.com/entertainment/archive/2017/08/13-reasons-why-dem

onstrates-cultures-power/535518/​.

“Global Burden of Disease Study 2017 (GBD 2017) Data Resources,” Global Health

Data Exchange, ​http://ghdx.healthdata.org/gbd-2017

Hedegaard, Holly. “Suicide Rates in the United States Continue to Increase”, Centers for

Disease Control and Prevention, June 2018,

https://www.cdc.gov/nchs/products/databriefs/db309.htm​.

Jacobson, Sansea. “Thirteen Reasons to be Concerned About ​13 Reason Why”​ ,

ebscohost.com/ehost/pdfviewer/pdfviewer?vid=1&sid=081d5907-6c5c-4349-bf50

-9a1f1c404520%40pdc-v-sessmgr03​.
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Krans, Brian. “Being Successful Doesn’t Make You Immune From Suicide”, June 11,

2018,

https://www.healthline.com/health-news/being-successful-doesnt-make-you-imm

une-from-suicide#5​.

Mock, Mary. “Fact or Fiction: You Can Be Prosecuted for Encouraging or Causing

Someone’s Suicide,” February 3, 2017,

https://www.robertreeveslaw.com/blog/causing-suicide/

Railton, David. “How High Altitudes Could Raise Risk of Depression, Suicide”, March

16, 2018, ​https://www.medicalnewstoday.com/articles/321219.php​.

“Suicide”, May 2018, ​https://www.nimh.nih.gov/health/statistics/suicide.shtml

“Suicide Statistics”, ​https://afsp.org/about-suicide/suicide-statistics/

“The Relationship Between Bullying and Suicide: What We Know and What It Means

For Schools”, Centers for Disease Control and Prevention,

https://www.cdc.gov/violenceprevention/pdf/bullying-suicide-translation-final-a.p

df