Youth suicide rates in the United States reached a 19-year high in the month after Netflix released a series about a girl ending her life, a new study shows.

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It found that in the nine months after “13 Reasons Why” was released in March 2017, there were 195 more suicides among youth aged 10 to 17 than would have been expected, the Associated Press reported Monday.

In April 2017 alone, there were 190 suicides in that age group, for a rate of 0.57 per 100,000 people. That rate was higher than in the previous 19 years.

“The creators of the series intentionally portrayed the suicide of the main character. It was a very graphic depiction of the suicide death,” which can trigger suicidal behavior, study lead author Jeff Bridge, a suicide researcher at Nationwide Children’s Hospital in Columbus, Ohio, told the AP.

Suicide rates among people aged 18 and older did not change after the show was released, according to the study in the Journal of the American Academy of Child and Adolescent Psychiatry.

The researchers did not have information on whether anyone who died by suicide had watched the show, the AP reported.

A University of Pennsylvania study published last week found that young adults who watched the entire second season of “13 Reasons” had fewer suicidal thoughts than non-viewers, a Netflix spokesman noted.

“We’ve just seen the [new] study and are looking into the research,” he told the AP. “This is a critically important topic and we have worked hard to ensure that we handle this sensitive issue responsibly.”

Some of the episodes included warning messages, and Netflix created a website with crisis hotlines and other resources. The series’ third season will be released later this year.

The new study adds to evidence that compelling media depictions of suicide can have a negative influence on young people, University of Chicago sociologist Anna Mueller told the AP. She was not involved in the study.

Teen suicide rates in the United States have increased in recent years. Other studies have suggested that bullying and heavy use of social media may contribute to suicide risk, the AP reported.

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