第99期之《十三个原因》研究：自杀的“传染性”复杂

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Suicide’s “contagiousness” is complicated—studies on 13 Reasons Why prove it
自杀的“传染性”非常复杂——由《十三个原因》相关研究证实

                               
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Researchers found a small increase in teen suicide before and after the show's release.
研究发现在这部剧播出前后，青少年的自杀率都有小幅提升
BETH MOLE - 5/2/2019, 9:44 PM

Enlarge / Katherine Langford, Derek Luke, Dylan Minnette, Alisha Boe, Miles Heizer, and Brian Yorkey attend #NETFLIXFYSEE Event For "13 Reasons Why" Season 2 - Inside at Netflix FYSEE At Raleigh Studios on June 1, 2018 in Los Angeles, Calif.
6月1日，加州洛杉矶罗利工作室，凯瑟琳·朗福德、德里克·卢克、迪伦·明内特、阿丽莎·波伊、迈尔斯·海泽和布莱恩·约克为《十三个原因》第二季出席了网飞的年度“供您决定”活动。
图源：Getty | Presley, Ann

A study out this week suggests that the release of the first season of Netflix's 13 Reasons Why series in 2017 led to a small but notable uptick in teen suicides. The finding seems to confirm widespread apprehensions among mental health experts and advocates that a suicide "contagion" could spread from the teen drama, which centers around a 17-year-old girl's suicide and includes graphic details. But the study contains significant caveats, and the findings should be interpreted cautiously.
本周公布的一个研究表明，网飞2017年上映的《十三个原因》第一季导致青少年自杀率有了小幅度但显著的上涨。该发现似乎证实了心理学家的普遍担忧，即这部青少年剧可能会“传染”自杀，因为该剧的故事围绕一个17岁少女自杀展开，其中包含了细致逼真的场景。但是该研究有一些值得注意的地方，研究结果也应该谨慎解读。
The study was published online by the Journal of the American Academy of Child & Adolescent Psychiatry and conducted by a research team led by epidemiologist Jeff Bridge at Nationwide Children's Hospital in Columbus, Ohio. The researchers analyzed monthly suicide rates in the four years prior to the show's March 31, 2017 release, plus post-release suicide rates through December 31, 2017.
这个研究是由《美国儿童与青少年精神病学会杂志》在线发布，是俄亥俄州哥伦布市国家儿童医院流行病学家杰夫·布里奇带领的研究团队进行的。研究者分析了2017年3月31日该剧开播前四年、以及开播后截止到2017年12月31日的月度自杀率。
The researchers concluded that in the month following the show's initial release in April 2017, there was a 28.9 percent increase in suicides among 10- to 17-year-olds that would not have otherwise been predicted. They also found elevated rates in June and December of 2017, which they attributed to the show as well.
研究者总结，在2017年4月该剧首次开播后的一个月内，10岁至17岁的儿童和青少年的自杀率增长了28.9%，这种增长在预料之外。他们还把自杀率在2017年6月和12月的提高归因于该剧。
"In conclusion, we found a significant increase in suicide rates among US children and adolescents in the month after the release of 13 Reasons Why," the researchers wrote. "Suicide rates in two subsequent months remained elevated over forecasted rates, resulting in 195 additional deaths."
研究人员写道：“总的来说，我们发现《十三个原因》这部剧开播后的一个月内，美国儿童和青少年的自杀率明显上升。随后2个月的自杀率也比预测的要高，死亡人数额外增加了195例。”
In a press statement, co-author Lisa Horowitz, a clinical scientist at the National Institute of Mental Health, said that the finding "should raise awareness that young people are particularly vulnerable to the media. All disciplines, including the media, need to take good care to be constructive and thoughtful about topics that intersect with public health crises."
报告的共著作者，美国国家心理健康研究所的临床科学家丽莎·霍洛维茨在媒体声明中提到，这一发现“应当让人们更加意识到年轻人特别容易受到媒体的影响。包括媒体在内的各行各业在面对与公共卫生危机相关的主题上，应当小心谨慎，并发挥建设性作用。”
While the point that care should be taken with regard to suicide should be duly noted, it's still unclear just how vulnerable young people are to the show's content. The study has significant caveats and limitations. And the overall field of research into the epidemiology of suicide is a bit murky.
自杀的问题应该谨慎对待，尽管这一点应当受关注，但是目前尚不清楚年轻人有多容易受这部剧的影响。这个研究有非常值得注意的地方和明显的局限性。而且整个自杀传染病学的研究领域还有些模糊不清。

Study caveats 研究中值得注意的地方

First and foremost, the new study is correlational; it cannot prove that any statistically significant changes in suicide rate found in the post-release time frame of the study were caused by the show. And speaking of statistical significance, the study used a quasi-experimental forecasting model to make predictions about what suicide rates should have been after the show's release. This method tried to account for seasonal patterns and other underlying trends. But the initial analysis indicated that the data was too variable for other statistical models (a problem called as overdispersion), which is a known sticking point when looking at such small numbers of suicides.
首先，这个新研究是相关性研究，并不能证明在播出后的研究时间范围内，是这部剧导致了自杀率在统计学上的显著变化。从统计显著性上来说，这个研究用了一个准实验预测模型估测了该剧开播后的自杀率。该模型试图去解释自杀率的季节变化模式和其他潜在趋势。但是初始分析表明，研究数据对于统计模型来说变量太多（数据过于离散的问题），对于研究如此少量的自杀事件是个已知的难点。
As Harvard psychologist Matthew K. Nock noted in an interview with The New York Times, "Suicide rates bounce around a lot more when the cell sizes are low, as they are with kids aged 10 to 17 years. So, this new paper suggests there may be an association between 13 Reasons Why and the suicide rate. However, we must always be cautious when trying to draw causal conclusions from correlational data."
正如哈佛大学心理学家马修·K·诺克在接受《纽约时报》的采访时指出：“如果研究范围很小，自杀率就会更加起伏波动，因为研究的是10-17岁年龄段的儿童。因此这个新研究指明了《十三个原因》这部剧和自杀率之间可能会有一定的关联。但在根据相关数据得出因果结论时，我们始终都要谨慎一些。”
In terms of bouncing around, the authors reported finding a significant uptick in suicides in April—the month after the show's release—but they also found them in June and December. It's unclear how the show is linked to changes in those specific months. Moreover, the authors found a statistically significant increase in suicides in a fourth month—the month of March, which would be prior to the show's release on March 31. The authors say this finding "raises questions about effects of pre-release media promotion of the series premiere." However, it also raises questions about whether factors or events unrelated to the show may explain or contribute to the reported increase in suicide rates.
说到自杀率的波动性，作者报告说发现自杀率在该剧开播后的4月份有明显的上升，但是他们发现在同年的6月份和12月份也有这种变化。这些特定月份自杀率的变化与该剧有何关联尚不清楚。此外，作者还发现第四个自杀率明显增长的月份是2017年的3月，早于该剧播出的时间3月31日。作者谈到这个发现“引发了对该剧开播前的媒体预告宣传影响的质疑。”但这也引发了其他疑问如与该剧无关的一些因素或者事件是否也有可能导致了自杀率的上升。
All in all, the researchers estimated that between April 1 and December 31 of 2017, there were 195 additional suicide deaths that would not otherwise have been predicted following the release of 13 Reasons Why. Of those 195 deaths, 58 were linked to April and the other 137 were from June and December.
总之，研究人员认为，《十三个原因》开播后，2017年4月1日至12月21日共有195起预料之外的自杀事件，其中58起发生在4月，另外137起发生在6月和12月。
Another odd wrinkle emerged from the data when the authors looked at the sex breakdown of those deaths. The statistically significant increase in suicides was entirely due to suicides in boys, not girls, as the researchers had hypothesized. This was surprising to the researchers because the main character who commits suicide in 13 Reasons Why is a 17-year-old girl. As such, they expected the suicide to resonate most with female viewers in that age range. However, there was no statistically significant change in the suicide rates of 10- to 17-year-old girls in the study's time frame, and there was no change in older age groups, regardless of sex.
而研究者看到这些自杀事件的性别分类结果后，发现了另一件很奇怪的事。在统计上显著增加的这部分自杀事件全都发生于男性，而非研究人员所假设的女性自杀。这个结果令研究人员感到很惊讶，因为在《13个原因》中自杀的主角是一个17岁女生。他们还由此预估受剧影响而自杀的应该主要是17岁前后的女性观众。然而，在他们研究的时间范围内，10到17岁女生的自杀率在统计学上并没有明显变化。且不论性别，自杀率在年岁更长的范围内也没有明显变化。

Missing data 缺失的数据

The sex finding flies in the face of some ideas of a "suicide contagion," a term used by the authors of the new study and used generally by researchers to discuss the hypothetical contagiousness of suicide from events or media. Often (not always), when epidemiologists toss around the term, they do so with the idea that those who are vulnerable to suicide after being exposed (directly or indirectly) to a suicide or suicide attempt are those who strongly identify somehow with the person or character who committed suicide or attempted to do so. Based on the data in the study, that does not appear to be the case here.
研究结果在自杀性别上的差异发现与“自杀传染”的一些想法截然相反。“自杀传染”是这个新研究的作者使用的一个术语，也是其他事件或媒体的研究人员用来指代关于自杀的传染设想。流行病学家把这个术语翻来覆去，并经常（但非通常）认为，若有人在（直接或间接）遇到他人自杀或者自杀未遂的事件后容易受到影响随之行动，是因为他们对所遇到的自杀或自杀未遂对象有强烈共情。但此说法似乎不能直接套用到这个研究中的数据中去。
But that discrepancy may simply be due to the fact that we only have data on suicides, not non-fatal suicide attempts. Researchers have established that males tend to have higher rates of suicide, and females have higher rates of suicide attempts. Thus, it could be that a jump in suicide attempts in girls and teens following the show was simply not captured in the data. We don't know. The study authors report that monthly data on suicide attempts was not available.
但这种差异可能只是因为我们只有成功自杀的数据，缺少那些企图自杀却未成功的数据。研究人员确信男性的自杀率更高，而女性企图自杀的几率更高。因此，在该剧播出后，企图自杀的女性人数和青少年人数都有急剧增加，但这种增加并未在研究的数据中反映出来。该研究的作者写道他们并没有关于自杀未遂案件的月度数据。
There's also no data on the methods of suicides, which would be helpful in assessing another idea linked to "suicide contagion," one that deals with imitation or copycat suicides—a phenomenon known as the Werther Effect. Some researchers would hypothesize that if viewing 13 Reasons Why encouraged vulnerable viewers to act on suicidal impulses, they may do so using the same suicide method. The idea stems from the 1770s, when some readers of the German novel The Sorrows of Young Werther committed suicide in the same manner of the main character.
同样，研究者也没有关于自杀方式的数据。这方面的数据有助于评估关于“自杀传染”的另一设想，即是否为模仿自杀，这种现象也叫维特效应。有研究人员假定，若是观众容易受到《十三个原因》影响而冲动自杀，他们可能会采取和剧中人物一样的自杀方式。这个假定设想源于17世纪70年代，当时有人看过德国小说《少年维特之烦恼》后和小说主角相同的方式自杀。

Contagiousness? 传染性？

Another critical bit of data missing from the study is viewership. We don't know if those who committed suicide even watched the show—let alone if they watched all or just some of it, which may be most telling. In a study published late last month, an international team of researchers found that people who watched just part of the second season of 13 Reasons Why were at greater risk of suicide than those who stuck through and watched the whole season (all based on self-reported survey data). The authors speculated that the findings suggest that there are self-selecting groups of people who are interested and begin watching. Some viewers are perhaps distressed by the content and stop watching, while others continue on and may benefit, such as by increasing compassion for those who are suicidal or learning from the show how to identify and help a suicidal person.
该研究缺失的另一个关键数据是该剧的收看情况。我们甚至都不知道那些自杀的人是否看过这部剧，更别说是看了整部剧还是其中的一部分，而这可能是最具有说服力的数据。在上月末发表的另一项研究中，一个国际研究小组发现那些只看了部分《十三个原因》第二季的人比那些坚持看完一整季的人更有可能自杀（研究数据皆来自于受试者的自述报告）。作者推断，这些发现表明有观众是基于兴趣挑选内容并且观看。一些观众可能对剧情感到不适就停止观看；其他人则继续观看并可能从中受益，例如对自杀者抱有更多的同情心，或者从剧中学到如何鉴别并且帮助一个有自杀倾向的人。
"Apparently, there is no one-size-fits-all solution to suicide prevention in fictional suicide depictions," write the authors of the study, which was published in the journal Social Science and Medicine. "It appears that audiences relate differently to such content depending on their backgrounds and viewing patterns."
这项研究发表在《社会科学与医学》期刊上，报告中作者写道，“虚构作品的自杀情节显然也没有预防自杀的万全之策。观众如何看待这些内容似乎因个人背景和观看方式的不同而有所差异。”
Overall, the research into 13 Reasons Why serves to highlight the complexity of suicide and suicide prevention—and also the murkiness of the research field that surrounds it.
总的来说，关于《十三个原因》的研究有助于强调自杀及自杀预防的复杂性，也突出了有关自杀的研究领域的模糊不清。
In a 2014 review of how social scientists discuss and study the spread of suicide in populations, experts in suicide prevention came up flummoxed. They found a "remarkable lack of clarity and inconsistent definition of 'contagion,'" which allowed researchers "to cite one another to support their arguments without having to delve into the differences that separate them."
2014年一篇文章回顾了关于社会科学家如何研讨自杀在人群中的传播，文中自杀预防领域的专家们很挫败。他们发现了“‘传染性’一词的定义十分不明确并且前后矛盾”，这导致了研究者“互相引用彼此的话来支持自己的论点，却没有深入研究各论点之间的差异。”
They conclude:
他们总结道①：
Many authors have adopted the term as an analogy, with complex implications regarding shared characteristics and presumed mechanisms of spread that have scant scientific support. Once adopted, contagion has been oft-repeated without critical scrutiny of its uncertain meanings, or implied mechanisms, and the presumed clarity of what authors have intended to say has only served to mask or mute rigorous inquiry.
许多作者采用（传染性）这一术语都是作为类比来使用，除去共同的特征及缺少科学依据的假定传播机制，该术语的含义非常复杂。一旦采用，该术语就会反复套用，含义中不明确之处及术语隐含机制就被忽略，得不到反复推敲，结果就是使用者试图表达的所谓明确含义只会掩盖或者削弱调查的严谨性。
Based on current data and appreciating the substantial limitations in published studies that we have described, it is problematic to draw any conclusion whether suicide truly is contagious–that is, passed from one person to another, either directly or indirectly. Undoubtedly, clusters are apparent and well described, and population-level fluctuations have been demonstrated after key events. These do not prove contagion! Our review suggests that the concept of suicide contagion requires further investigation, and its use (along with terms such as epidemic) should be defined cautiously and thoughtfully.
基于目前的数据和已发表的研究中存在的许多局限性，要得出自杀是否真的具有传染性（即自杀是否会直接或间接地从一个人传染给另一个人）的结论是很困难的。毫无疑问，自杀的群体现象很明显并且得到了详细的说明，而且关键事件过后，数据也证明了自杀人数的波动。但这些都无法证明自杀有传染性！我们的审查表明需要进一步研究自杀传染的概念，并且应当谨慎周密地定义这种术语（诸如传染病之类的术语）的用法。

If you or someone you know is feeling suicidal or in distress, please call the Suicide Prevention Lifeline number, 1-800-273-TALK (8255), which will put you in touch with a local crisis center.
如果您或者您认识的人想自杀或深度抑郁，请致电中国境内的自杀预防热线 010-82951332（全国24小时免费热线），并与当地的危机干预中心保持联系。

注解：
①此处的“总结”是引用期刊文章Suicide Contagion: A Systematic Review of Definitions and Research Utility的部分结论内容。引文地址：https://journals.plos.org/ploson ... nal.pone.0108724#s5

原文链接：https://arstechnica.com/science/ ... sons-why-proves-it/

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