Online searches about suicide and suicide methods spiked in the weeks following the release of Netflix’s 13 Reasons Why, a show that dramatizes the suicide of a teenage girl, according to a U.S. study released Monday.

Google searches about suicide were 19 percent higher than average in the 19 days following the show’s release on March 31, translating into 900,000 to 1,500,000 more searches, researchers reported in the Journal of American Medical Association (JAMA) Internal Medicine. 

The study did not examine whether the actual number of suicides increased following the series’ release, but researchers said the internet search trend is troubling.

Google search volumes for things like “how to commit suicide,” “commit suicide” and “how to kill yourself” all decisively spiked during the 19-day window after the show’s release. A 2009 study suggested “suicide search trends are correlated with actual suicides,” according to a letter accompanying the study in JAMA.

Many mental health experts concluded that Netflix acted unethically by releasing the series. In it, a high school girl leaves behind 13 cassette tapes that explain the decision to take her own life. The series, which some argue glamorizes suicide, has been renewed for a second season.

The San Diego State University researcher who led the study, John Ayers, called on Netflix to reconsider the show and the effects it is having on its teenage-skewing audience.

“Psychiatrists have expressed grave concerns because the show ignores the World Health Organization’s validated media guidelines for preventing suicide,” Ayers told VOA in an email. “Tragically, it is unsurprising then that we find the show has increased suicidal thoughts.

“The show’s makers must swiftly change their course of action, including removing the show and postponing a second season. If not, subscribers should consider canceling their subscriptions so not to support programming that can cause premature death. I am no longer a subscriber.”

Currently, the most violent episodes are prefaced with warnings. Netflix has also created a website equipped with suicide hotlines for each of the countries in which it can be streamed. In a statement, Netflix defended 13 Reasons Why, saying that the show has spurred an important conversation.

“We always believed this show would increase discussions around this tough subject matter,” Netflix said. “This is an interesting quasi-experimental study that confirms this. We are looking forward to more research and taking everything we learn to heart as we prepare for season two.”

The study analyzed Google trends between March 31, 2017, and April 18. They halted their research on that date because former National Football League player Aaron Hernandez committed suicide on April 19, a development that might have skewed the data.

Researchers used the period between January and March 2017 as a control to determine the expected volume of suicide-related Google search queries.

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