There was a 28.9% spike in suicides of children 10 to 17 following the release of Netflix’s controversial drama series 13 Reasons Why, according to a new study.

The study, which was funded by the National Institutes of Health, can’t prove the show was directly linked to the suicides. But, it said that given historical and seasonal suicide trends, there were almost 200 more youth suicides than expected in the nine months following the March 2017 release of 13 Reasons Why.

Published Monday in the Journal of the American Academy of Child and Adolescent Psychiatry, it stated that during April 2017 alone, 190 U.S. youth had taken their own lives. In an additional analysis, Jeff Bridge, a suicide researcher at Nationwide Children’s Hospital in Columbus, Ohio, also found that the April suicide rate had been the highest its ever been in the last 19 years. 

“The results of this study should raise awareness that young people are particularly vulnerable to the media,” Lisa Horowitz, a co-author of the study, said in a statement. “All disciplines, including the media, need to take good care to be constructive and thoughtful about topics that intersect with public health crises.”

Horowitz also noted that suicide is the second leading cause of death for U.S. teens.

“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, Bridge told The Associated Press.

Bridge acknowledged that the study’s limitation includes not knowing whether those who died by taking their own lives had even watched the Netflix series. Researchers also advise caution with this study because they were not able to account for other factors and reasons that may have influenced suicides, like the former New England Patriots tight end Aaron Hernandez taking his own life on April 19, 2017. But before coming to this conclusion, researchers took seasonal differences into account and identified recent trends, according to The New York Times.

“Females of all ages are three times more likely to attempt suicide, but males are four times more likely to complete it,” Horowitz told The New York Times. “Any increase among girls may have come in attempts.”

13 Reasons Why which focuses on the female main character Hannah Baker who takes her own life at the end of the first season by slitting her wrists while sitting in a bathtub is based on a book of the same title by Jay Asher. 

50 CELEBRITIES WHO DIED IN 2018 – TRIBUTE SLIDESHOW

After receiving backlash following the release of the series, Netflix warned viewers of its sensitive content and added warning messages before episodes and created a website with crisis hotlines and other resources. The release of the second season of the show also came under scrutiny for its graphic sexual assault scene. 

“We’ve just seen this study and are looking into the research, which conflicts with last week’s study from the University of Pennsylvania. This is a critically important topic and we have worked hard to ensure that we handle this sensitive issue responsibly,” Netflix, which is slated to release the third season of 13 Reason Why this year, said in a statement.