Teen Depression Groups on Facebook: A Content Analysis

Abstract

Major depressive disorder (MDD) is one of the most frequently diagnosed disorders in early adolescence and can lead to a multitude of negative life outcomes, highlighting the need for early and effective intervention to mitigate depressive symptoms. Recognizing the preference of youth to seek informal sources of help for mental health issues, which may include the Internet, the social networking site Facebook was investigated as a potential source of support and help for youth suffering depressive symptoms or disorder. This study examined the content of online Facebook support groups targeting adolescents with depression. A total of 508 posts from six Facebook groups were analyzed. The majority of post content on these Facebook groups consisted of self-disclosure (32.48%), feedback between posters (24.80%), and offers and recommendations of help (24.61%). Posters seem to utilize adolescent Facebook depression groups mainly to connect with those who might share a similar experience and to share information about mental health resources. Future studies should investigate the potential to use the information exchange that occurs in these groups to promote traffic to online and offline evidence-based mental health resources.

Keywords

Internet Facebook social networking depression adolescents help-seeking

Major depressive disorder (MDD) is one of the most frequently diagnosed disorders in early adolescence, and up to 9% of youth experience at least one significant episode by the age of 14 (Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993). Depressive symptoms and major depression in adolescence are associated with 2 to 7 times the odds of recurrence of symptoms in adulthood (Rutter, Kim-Cohen, & Maughan, 2006), as well as a multitude of negative interpersonal, educational, and health outcomes, and most tragically suicide (National Institute for Health Care Management Foundation, 2010), thus highlighting the importance of effective prevention and intervention. Adolescents experiencing symptoms of MDD are less likely to access mental health services than adults experiencing similar symptoms (Wang et al., 2005) and may prefer to pursue informal means of help such as family and friends (Boldero & Fallon, 1995; Wilson, Deane, & Ciarrochi, 2005). The social landscape for adolescents has expanded with the rise of social media (Goh & Huang, 2009) and adolescents seeking help for depression symptoms may look to social networking sites (SNS) such as Facebook (Lenhart, 2015) as a form of informal support and help. Examining how teens utilize Facebook for help with depression symptoms, as well as the nature of the responses they receive, may therefore have important implications for youth mental health research and practice.

Adolescents and SNS

In North America, SNS appear to be highly salient among adolescents. For instance, in a survey of 1,060 American teenagers aged 13 to 17 (and a respective parent or guardian) conducted by the Pew Research Center in 2015, it was found that 92% of teenagers report going online daily, with 76% endorsing the use of SNS (a number which rose to 89% when specific SNS names, such as Twitter or Instagram, were included in the question). Facebook emerged as a popular platform both for teenagers who endorsed use of multiple SNS (71% used Facebook, compared with ≤52% for other SNS) and for those who reported use of only one SNS (18% of the sample, of which 66% endorsed Facebook use; Lenhart, 2015). Similarly, about 93% of Canadian teenagers who go online have a Facebook account (“Marketers Must Learn,” 2009). When using SNS, adolescents are more likely than adults to disclose personal information on SNS in general (Williams & Merten, 2008) and on Facebook specifically (Christofides, Muise, & Desmarais, 2009; Nosko, Wood, & Molema, 2010). Indeed, SNS represent popular platforms for adolescents to express and share emotions, experiences, and intentions and may be replacing some aspects of face-to-face relationships (Goh & Huang, 2009).

Adolescent Help-Seeking on the Internet

Research in the United States indicates that young people commonly use the Internet as a means to obtain health information (e.g., Lenhart, Purcell, Smith, & Zickur, 2010; Rideout, 2001). Of note is that many youth use the Internet as a means to obtain information and resources about depression and other issues that may be difficult to discuss with people in their offline lives (Lenhart et al., 2010; Rideout, 2001); close to 20% of youth may search for information about these matters (Lenhart et al., 2010). Furthermore, researchers have demonstrated that youth who experience sadness, stress, and anger may be more inclined to engage in online help-seeking (Gould, Munfakh, Lubell, Kleinman, & Parker, 2002), and this percentage is comparable with that of youth seeking help from formal resources such as mental health professionals or school counselors. Gould et al. (2002) also found that youth seeking help online reported a preference for socially oriented websites with chat rooms versus informational sites, including those sanctioned by established health organizations. Additional support for the potential appeal of the Internet for youth who experience depressive symptoms comes from research by Ybarra and colleagues (2005), who found that youth with high levels of depressive symptoms might engage in more frequent Internet activity (relative to youth with low levels of symptoms), perhaps to avoid face-to-face social interaction. Not only do these youth (who experience higher levels of depressive symptoms) connect with individuals they know offline while on the Internet, they also reported connecting with individuals they do not know offline. Hence, the Internet may have general appeal for youth who struggle with depressive symptoms.

SNS and Youth Depression

As the Internet, and in particular, social media, continues to permeate the lives of youth, questions are being raised about the effect high levels of Internet use may have on adolescent mental health. For example, researchers have examined the relation between friendship quality, Internet use, and symptoms of depression and social anxiety (Selfhout, Branje, Delsing, TerBogt, & Meeus, 2009). In this study, for those youth reporting medium to high friendship quality, no significant correlations were found between Internet use and depression or social anxiety. However, for those who reported low friendship quality, Internet use for communicative purposes (i.e., instant messaging, which is available via Facebook) was negatively correlated with depression, whereas Internet use for noncommunicative purposes (i.e., web surfing) was positively correlated with symptoms of depression and social anxiety (Selfhout et al., 2009). It is possible that there is more social gain when using the Internet for communication purposes, as opposed to simply “surfing” (Selfhout et al., 2009). Adding support to this is research demonstrating that Facebook use may contribute to a modest yet positive association with life satisfaction (Park, Kee, & Valenzuela, 2009). While this may be the case, no studies to date have established causal relations between Facebook use and mood or other indicators of well-being.

Informal, illness-specific resources and support groups are now appearing on Facebook and on other SNS (Greene, Choudhry, Kilabuk, & Shrank, 2010). For example, support groups on Facebook catering to youth have been examined for both attention deficit hyperactivity disorder (ADHD; Gajaria, Yeung, Goodale, & Charach, 2011) and nonsuicidal self-injury (NSSI; Niwa & Mandrusiak, 2012). Yet, despite the prevalence of depression symptoms and disorder among youth, to our knowledge no research has investigated the content of support youth groups for depression on Facebook.

Although youth depression groups on Facebook have not been investigated, there is evidence that Facebook has been used as a communication medium for emotional distress and depressive symptoms. In a study investigating what 200 college students disclosed on their Facebook profiles, 25% reported depressive symptoms and 2.5% reported symptoms consistent with diagnostic criteria for a major depressive episode (Moreno, Jelenchick, Egan, et al., 2011). The occurrence of depression disclosures in students’ profile status increased twofold when these disclosures were responded to positively by the students’ Facebook friends. Those who received validation from their online friends for a depression disclosure may have been more likely to discuss their depressive symptoms publicly on Facebook; likewise, depression disclosures on Facebook may elicit supportive responses from peers.

There is now a growing literature examining the potential benefits of online self-disclosure for mental and physical health difficulties. For example, numerous studies have highlighted that for individuals who self-injure there may be value in disclosing their experiences in online venues, as it may yield needed social support and acceptance which may otherwise not be available in their offline lives (see Lewis & Michal, 2014; Lewis & Seko, 2016). Similar reports have been made elsewhere for individuals who share their eating disorder experiences online (Mulveen & Hepworth, 2006) and for numerous other physical health–related concerns (Mazzoni & Cicognani, 2014; Mo & Coulson, 2010). Moreover, it has been suggested that there may be benefits to youth who share their depression and victimization experiences with their peers via social SNS (Adams & Cantin, 2012). However, the content of these youth disclosures on SNS like Facebook has not yet been thoroughly examined.

Taken together, the above findings suggest that online forums may provide insight into the nature of how adolescents utilize SNS when discussing depression. Specifically, depression groups on Facebook may be relevant for adolescents experiencing depressive symptoms in that these groups may represent a preferred venue on which to communicate about depression. To this end, it seems important to determine whether depression groups on Facebook operate in a similar manner as those dedicated to other mental health issues (e.g., NSSI, ADHD), which appear to provide individuals an informal means to connect and share experiences with similar others.

Lastly, no research to date has explored the nature of help-seeking or help offering within the context of depression groups on Facebook. Specifically, information about how adolescents utilize this resource and the nature of help and information they receive is not well understood. It may be that youth who struggle with mood difficulties connect with other, similar youth via Facebook, and these interactions may help or hinder in various ways. For example, youth may find comfort in connecting with peers experiencing similar mood difficulties; however, this may also dissuade offline help-seeking, especially if the youth in these groups do not encourage professional help for mood difficulties (though in contrast, if professional help is encouraged through these groups, this may persuade some youth to seek help and work toward improving their mood symptoms). Considering how widely the nature of online mental health information can vary (Griffiths & Christensen, 2000), and the potential salience of Facebook as a means to connect youth suffering depressive symptoms, understanding the type(s) of the content on such sites may have important implications for understanding how to optimize adolescents’ access to established depression resources and interventions. This may be especially the case if established, evidence-based interventions are not mentioned within these groups. Examining the nature of posts within teen depression groups on Facebook may represent an important first step in better understanding the extent to which these groups might be helpful to youth who struggle with mood difficulties.

Current Study

The current study has the following goals:

To provide a preliminary examination of the nature of all posts and replies within six active Facebook groups for teen depression. With previous research suggesting that youth use online sites for support that may mirror peer-to-peer interaction, we hypothesized that youth posting to these groups would use Facebook as a means to obtain informal help and advice (instead of receiving suggestions about professional help).

To understand the nature of posts specifically about the provision of help and resources within Facebook groups for teen depression. In particular, we were interested in the type of help adolescent Facebook users are seeking and the nature of exchanges offered in this regard. Given that this is the first study, to our knowledge, to examine the content of these particular posts, no particular hypotheses were associated with this goal.

Method

The data used in this study¹ were collected from Facebook groups for adolescent depression. A Facebook account was created for the purposes of obtaining these data, which comprised content posted by Facebook users to an open or public group. To maintain anonymity of group members, no usernames were recorded and any identifying information within posts was omitted from data collection. Due to the more recent increase in privacy of profile information, demographic variables (e.g., age, sex) were not consistently available and were excluded from consideration in this study. Although participant ages could not be known for certain, data were collected from depression groups targeting youth, as described in the following section.

Data Collection

Data were collected on March 9, 2012. The initial search was attenuated to all publicly accessible groups and pages (labeled as “open” and “public,” respectively) that included 100 or more members and contained the terms “teen” and “depression” in either the title or description of the group. From here, the search was filtered further by removing groups that did not have five or more individual members posting within the last 12 months; this yielded a total of six groups for the current investigation. All six groups were considered “active” as they contained content posted within the month prior to data collection. Specifically, four groups had new content posted during the month of data extraction (March 2012), and the remaining two had new content posted in the month prior (February 2012).

Data

Data consisted of “wall posts” within each group. This term describes comments made by members on the main page of the group; in the current study, all wall posts within a particular group were used, provided they were posted within the last year as noted below. All data were extracted and collated in a data spreadsheet. A maximum of 100 of the most recent posts were extracted per group to avoid biasing results toward groups with more content. Posts older than 12 months at the time of collection and posts in discussion boards or other areas of the Facebook group were not included. This resulted in a total of 508 posts for analysis, with four groups contributing 100 posts each, and two groups contributing 72 posts and 36 posts, respectively.

Coding Rubric and Procedures

A coding rubric was developed based on previous research examining the discourse of health support groups on Facebook (Greene et al., 2010) and the manner by which youth and emerging adults discuss other mental health issues when online (Gajaria et al., 2011; Lewis, Heath, Sornberger, & Arbuthnott, 2012; Lewis, Heath, St Denis, & Noble, 2011). The rubric was also informed using an inductive approach in which four coders reviewed a selection of posts from five adolescent depression, self-harm, or suicide support groups on Facebook with more than 100 members for salient themes. This allowed for other possibly salient codes (not based on past research) to emerge and be used in the rubric. Following this, all potential codes identified (from both past research and the review of Facebook groups) were discussed among the researchers, in order for specific codes to be operationalized and clarified prior to being integrated with the coding rubric. The resultant coding rubric comprised binary (present-absent) codes covering 14 broad categories; within each were subcategories referring to more specific elements of that code (see the appendix). Each individual Facebook post could receive a score on one or more of the coding categories.

Pursuant to finalizing the coding rubric, three separate practice-coding sessions were conducted, each spaced a month apart. The goals of these practice-coding sessions were to (a) work toward obtaining interrater agreement of at least 80%² across all variables and (b) verify whether additional changes had to be made to the coding rubric prior to final coding. The four coders noted above conducted all coding during these practice-coding sessions. Specifically, practice coding involved the use of 75 posts randomly selected from two of the five groups used to create the Rubric (noted above). Following the first two practice sessions, meetings were held to discuss any coding issues and resolve any coding disputes; amendments to the coding approach were integrated in the rubric for subsequent practice coding. After the final practice session, the interrater reliability across all variables was 97% (with the lowest individual item reliability being 84%).

For final coding, data consisted of 508 total posts, all meeting the above inclusion criteria. These were randomly split between the four coders. A subsample of 15% of the data (n = 76 posts) was evaluated by all coders to measure interrater reliability in the final data set. Overall reliability was 98% across all variables; the lowest coded variable had an interrater reliability of 90%.

Results

Of the six Facebook groups meeting inclusion criteria, 508 posts were extracted and coded.³ Of these, the three most common codes were as follows: Posts coded for Self-disclosure represented 32.48% (n = 165) of the sample, posts coded for Feedback Directed to Other Posters represented 24.80% (n = 126) of the sample and posts coded for Offering/Referring Help represented 24.61% (n = 125) of the sample. Several posts (10.83%; n = 55) were coded as indecipherable or spam (e.g., “Get 10% off final price of parties all through the month of March”) and several posts (18.50%; n = 94) did not fit into the coding scheme. These chiefly comprised comments that were irrelevant to all other categories, in that they did not seem to meaningfully cohere as a standalone category and appeared random in nature. As such, these were marked as “uncategorized” (e.g., “Look at my lovely fishes! :D”) The remainder of the codes occurred much less frequently (Table 1). Subcategories subsumed within these superordinate categories are reported below in more detail.

Table 1.

Frequency and Percentage Data for the 14 Major Categories Coded and High-Lighted Subcategories Within the Teen Depression Facebook Groups.

Categories	Subcategories	N = 508	%
Youth Post Evident		30	5.91
Self-Disclosure		165	32.48
	Contextual Detail Given	45	27.27
	Disclosed Mood	38	23.03
	Current Struggle With Mood	19	50.00
	Explicit Diagnosis of a Mood Disorder	4	10.53
Recovery		20	3.94
Feedback to Group		35	6.89
Feedback to Poster		126	24.80
	General Words of Encouragement	60	47.62
	Thanks	36	28.57
	Personal Validation	31	24.60
	Shared Experience	17	13.49
	Hostile/Negative Feedback	6	4.76
Offering/Referring to Help		125	24.61
	Offers to Help	25	20.00
	Offers to Help (Facebook)	11	8.80
	Offers to Help (External Contact)	8	6.40
	Formal Therapy	4	3.20
	Speak to Someone	11	8.80
	Self-Coping Techniques	16	12.80
	Encouraging Mental Health Literacy	81	64.80
Asking for/Receiving Help		36	7.09
Factual		23	4.53
Offers to Participate in Research		0	0.00
Evidence of Nonsuicidal self-Injury		6	0.00
Evidence of Suicidal Ideation/Behavior		1	0.00
Evidence of Alcohol Use		0	0.00
Evidence of Drug Use		0	0.00
Indecipherable/Spam		55	10.83
Uncategorized		94	18.50

Note. Individual posts could be coded using more than one coding category. Thus, the total percentages for each coding category exceed 100% in some cases, and the frequencies may not align with the total number of posts.

Self-Disclosure

Self-disclosure posts referred to any personal statement or message related to the individual poster with respect to personal information, including mood (e.g., “I am too sad to function”). Of the 165 posts being coded as self-disclosure, 27.27% (n = 45) were coded as providing contextual detail (i.e., the individual shared more detailed information about their daily life, background, or experiences). An example of a post containing contextual detail would be: “My mom recently moved from BC to Ontario and since then I’ve lived with my dad. Things have gone fairly well, but I’ve been suspended from school a couple times now.” The remaining subcategories within the self-disclosure posts pertained to explicit disclosures of mood. In total, 23.03% (n = 38) of posts entailed individuals making a disclosure about past or current mood (e.g., “Lately . . . I’ve been depressed . . . I don’t know why.”); of those 38, 50% (n = 19) made indications that the individual making the post was currently struggling with depressed mood (e.g., “I’ve been crying myself to sleep, not sleeping, etc., . . . I don’t know what to do anymore . . .”) and 10.53% (n = 4) explicitly indicated the poster had a diagnosis of major depression (e.g., “I have major depression and it’s hard to see a reason to live when you feel like that!”).

Feedback to Poster

The second most common post-type referred to responses to a previous post and were thus coded as Feedback to Poster. An example of this post would be: “Oh my God, this post is . . . Just amazing, words can’t explain it, thank you so much.” Of the 126 posts, the most frequently coded subcategory was general words of encouragement (47.62%; n = 60), which referred to posts that provided support to an individual poster (e.g., “atta girl haha, good luck though”). This was followed by posts which gave thanks toward individual posters for sharing their experiences (e.g., “thank you [name] it really was an inspiration and I look up to you for being so open”; 28.57%, n = 36) and those which offered validation toward posters (e.g., “[name] it’s actually you who is amazing”; 24.60%, n = 31). Less frequent codes included those posts in which individuals shared their own experiences or emotions in response to another post (e.g., “hey everyone, sorry but I couldn’t help but read the comments above and I’m so glad that you are all so open. It really helps me to be open with my depression”; 13.49%, n = 17) and those which were hostile toward an individual poster (e.g., “You suburban kids are depressed as hell”; 4.76%, n = 6).

Offering/Referring to Help

The Offering/Referring to Help superordinate category encompassed all posts with the intent to help others (e.g., offers to talk, encouragement of seeking professional help, and posting links to helpful websites and videos). An example is as follows: “Just saying if anyone ever needs to talk don’t hesitate.” Within this category (n = 125), the most frequent subcategory was Encouraging Mental Health Literacy (64.8%; n = 81), defined as providing information or links to online mental health resources. As a goal of the current study was to understand the nature of the help offered, we further coded Encouraging Mental Health Literacy into the types of content being suggested. Results indicated that the most frequent suggestion (44.44%; n = 36) was a website related to mental health (e.g., “Go to beyond blue. It’s a website and it has a checklist for teens who might think they have depression ♥ good luck”), followed by a YouTube video (e.g., one video had the title “Some of you should give meditation a try, you’ll find true happiness from within]”) or research article (e.g., “Teen Depression Article from Los Angeles Times ”) (both 16.05% and both with n = 13). Other mental health–related suggestions were less common and are reported in Table 2. The quality of each individual resource suggested was not investigated in the scope of this study.

Table 2.

Frequencies of Suggested Resources in the Subcategory of Encouraging Mental Health Literacy.

Subcategory	Description	n = 81	%
Website	Links to websites related to mental health (e.g., blogs)	36	44.44
YouTube	Links to videos hosted on the website YouTube	13	16.05
Research articles	Links to/citations of research articles from journals or from a verified news source	13	16.05
Other	Referrals to a general resource (e.g., “use the web!”) or to resources not located online (e.g., live presentations)	8	9.88
Facebook pages	Links to pages or other support groups hosted on the website Facebook	5	6.17
Books	Links to online books or reference to helpful books and other literary sources	4	4.94
TMovies	Links to online movies or reference to helpful movies	2	2.47

Following posts related to mental health literacy, the second most frequent subcategory was posts in which individuals made general offers to help without mention of how this would occur (e.g., “I’m here to talk”; 20%, n = 25). Reported less often than this were posts which provided self-help techniques, such as ways to cope on one’s own (e.g., “I have put up 2 images of sheets where you can write down what you’ve done and how it makes you feel after if that’s your thing :)”; 12.8%, n = 16). Others made offers to help using Facebook, such as suggesting the individual add the poster as a Facebook friend, or suggestions that individuals talk to someone to obtain support (e.g., a parent or friend; both 8.80% and both with n = 11). Following this were comments in which individuals provided contact information to communicate in ways other than Facebook (e.g., providing an email address; 6.40%, n = 8) and those in which formal therapy was suggested (e.g., “Yea it’s sometimes awkward to talk about your feelings in person, but the social worker might really help. It may be worth it to give her a shot”; 3.20%, n = 4).

Discussion

Results from the current study suggest that adolescent depression Facebook groups are used as safe spaces by youth to disclose personal experiences. This appears to involve connecting with others who share similar experiences, including depressive symptoms. These findings are consistent with other research pointing to the utility of teen groups on Facebook for youth who struggle with mental health difficulties (Gajaria et al., 2011; Niwa & Mandrusiak, 2012). Regarding the first study objective, the nature of posts and replies within the Facebook groups was examined and the majority of the posted content pertained to the categories of self-disclosure, feedback to posters, and offering/referring to help. The nature of messages within each of these general coding categories is outlined next.

In line with previous research demonstrating that adolescents are more likely to disclose personal information online than adults (Christofides et al., 2009; Nosko et al., 2010), self-disclosure emerged as the most prominent coding category in the current study. Members of the sampled Facebook depression support groups appeared to use group forums mainly to divulge personal experiences. Interestingly, most self-disclosure messages had no direct reference to mood or a struggle with mood, nor did they indicate a direct request for support. Rather, group members used Facebook groups to share personal statements, and day-to-day personal events and experiences (evidenced by “posts containing contextual detail” being the most frequently coded subcategory). Findings from previous research examining other forms of online communication for mental health difficulties (e.g., Lewis, Heath, Michal, & Duggan, 2012; Lewis & Michal, 2014) have found similar patterns regarding the disclosure of personal information without directly requesting support, such as that observed by Niwa and Mandrusiak (2012) in their study of self-harm and NSSI groups on Facebook (spanning adolescents, young adults, and middle-aged adults). It is conceivable that rather than using these groups as a direct means to obtain help for depression (or related mood difficulties), youth instead use these groups as a “safe space” to share personal experiences with those who (implied by virtue of joining the group) have similar experiences with, or an understanding of, depression. Indeed, this seemed to reflect at least some of the posts coded within this category (e.g., “after what happened today I’m not sure if I can trust anyone =/ I know this has nothing to do with the group but I didn’t know where else to post this”).

The notion of these Facebook groups being utilized as safe spaces is further supported by the positive environment that was observed in the nature of responses within the category of Feedback to Posters. Words of encouragement were the most frequently coded subcategory, with the second and third most frequently coded subcategories comprising posts which thanked other posters for sharing their story, or expressed acceptance, admiration, and personal validation. Posts expressing positive support far outnumbered those containing hostile or angry feedback. Indeed, a paucity of hostile posts (e.g., trolling, hateful/flaming comments as recorded in the subcategory Hostile/Negative Feedback) was observed overall. These findings are similar to those of a study examining Facebook support groups for youth with ADHD (Gajaria et al., 2011). Here, researchers found that youth utilized the Facebook groups to create a social environment in which they felt accepted and understood and in which ADHD had positive valuation. Taken together, the findings of the categories of Self-disclosure and Feedback to Poster support the notion that youth may use the seemingly positive environment within these groups as a means to obtain indirect social support; if this is the case, it would parallel the preference of many youth for informal support from friends and family over professional help reported by others (Boldero & Fallon, 1995; Wilson et al., 2005). It should be noted, however, that while this may be the case, the extent to which this directly affects mood or depressive symptoms was not examined in this study and should be considered in future work.

While a majority of the content within the examined Facebook groups appeared positive in nature, this is not always the case for groups on Facebook. Niwa and Mandrusiak (2012) found that the category of Trolling and Flaming (hateful and inciting comments) was the second most frequently category coded for NSSI support groups. The nature of the different subjects associated with Facebook groups (i.e., ADHD vs. NSSI vs. Depression) may account for the frequency of these negative comments, in that certain topics (e.g., NSSI) may be more stigmatized and thus may receive more negative comments from individual posters. Indeed, more recent research examining the nature of comments made to online content concerning NSSI have found that posts can at times be hostile (Lewis, Rosenrot, & Messner, 2012), and this may be attributed to the stigma associated with NSSI (e.g., Lewis & Heath, 2013). Of course, there are other explanations for this discrepancy, such as the presence or absence of group moderators; future work would be needed to confirm the exact factors influencing the environments found within these support groups.

The second major objective of the study was to understand the nature of help individual posters received from others. In this regard, posts coded as Offering/Referring to Help represented the third most frequent type of post. These included posts offering support to fellow posters and recommending resources to help others. Members’ interactions contained many links to websites and videos related to mental health, but very few offers of direct help or recommendations to seek professional help. The intent to help is present; this is reflected in the nature of coded posts within the Offering/Referring to Help category as well as in the Feedback to Poster category, wherein “Words of Encouragement” was coded as the most frequent subcategory. However, youth do not by and large recommend accessing professional mental health support (e.g., via family physicians, school counselors, psychologists), a resource which might be most helpful for youth experiencing moderate to severe depression. That we found very few indications of youth discussing or mentioning being diagnosed with depression may help to explain why there were a small number of posts suggesting group members obtain professional help. We also found that the forums were populated with posts containing links to websites and videos related to mental health. The source of information varied substantially (e.g., links to blog posts, YouTube videos, or news articles), and it may be that youth prefer sharing various types of media (e.g., videos or blogs, exemplified by posts such as “This song helps me, might help you [YouTube link]”) instead of what some professionals would view as helpful for youth who struggle with depression (e.g., recommendations to seek professional help, or an established but static mental health website). If this is the case, our findings would cohere with those in another study reporting that adolescents may be more likely than adults to share media, such as videos, through SNS (e.g., Pfeil, Arjan, & Zaphiris, 2009). Future research ought to consider examining the quality of the types of resources youth do share via SNS for depression and other mental health difficulties. For example, these resources could be examined for the quality of health information as well as their perceived helpfulness from the vantage point of young people.

Although posts directly requesting help were not as numerous as those offering help, the act of seeking out these youth support groups may in some respects imply a search for help or at least a need to connect with similar others. Researchers examining reasons for depressive Facebook disclosures among college-aged students (Moreno, Jelenchick, Grant, Pumper, & Richardson, 2011) reported that the primary factor motivating such posts was to reach out and ask for help. Participants frequently stated that this need might be met by peers responding to such comments publicly on Facebook to demonstrate support. Thus, considering the positive environment and validation found in these groups, simply participating in them may provide an innate form of help. Research has reported that online support can be emotionally beneficial to those who receive it (e.g., Lewis & Michal, 2014; Lewis & Seko, 2016; Whitlock, Powers, & Eckenrode, 2006). As well, given the propensity of youth to share links to online depression-related resources within these groups (as evidenced in the Encouraging Mental Health Literacy subcategory), there may also be merit in identifying ways to provide these groups with evidence-based treatment information alongside the resources they already provide. This may help to augment the benefits that may already be associated with involvement in these groups.

Limitations

Due to the online environment from which data were extracted, demographic information could not be verified. Though efforts were made to limit groups to those that would involve youth (e.g., searches were conducted with the term “teen”), the age of the sample group could not be confirmed. We were likewise unable to determine whether participants in these groups knew each other offline. If individual group members were peers offline, the nature of what they discussed (and the posts made within the group) could differ from groups in which members are largely composed of individuals who do not know each other offline. We also surmised that the groups were primarily developed by youth; however, as we were unable to contact group members (and developers), this cannot be confirmed. We were also unable to determine the extent to which groups were moderated. Thus, it remains unclear whether the low number of hostile posts is an artifact of the group itself or of the group being vetted for negative posts (which would be subsequently removed).

The data retrieved from Facebook were also characterized by a wide number of posts with very little depth of content (i.e., the content shared was not rich in detail). Although Facebook is a promising venue for researching online mental health support and communication, inclusion of other SNS may broaden the understanding of this issue as the nature of e-communication about depression and other mental health issues may vary by SNS. In addition, our data were limited to public (open) Facebook groups. There are also private (“closed”) Facebook groups, in which Facebook users cannot see posts without first requesting an invitation or being invited to join by current members. It is possible that the increased privacy of these groups may lead to different types of comments and discourse, but we were unable to access these groups due to pragmatic and ethical reasons. Also, we did not examine content about depression disclosure, help-seeking, or offering to help that might be present more generally within Facebook (i.e., outside the context of a teen depression groups, such as disclosures on one‘s Facebook profile). Thus, care must be taken to generalizing our findings to different types of Facebook groups or Facebook use more generally, which may have different levels of perceived privacy.

Finally, our coding approach was informed by and likely reflects a scientist-practitioner perspective of the nature of posts on the Facebook groups analyzed; youth involved in these groups may hold different views regarding their posts.

Conclusions and Future Directions

This study demonstrates that youth depression groups on Facebook may generally provide a positive, safe, and nonjudgmental environment to allow for self-disclosure and connections between like-minded youth. This aligns with other research examining how youth connect about mental health difficulties online (Lewis, Heath, Sornberger, & Arbuthnott, 2012; Lewis & Michal, 2014; Niwa & Mandrusiak, 2012; Whitlock et al., 2006), and points toward an overall beneficial use of youth depression groups for adolescents. Specifically, youth may gain social support and an outlet for safe disclosure by virtue of their involvement in these Facebook groups. Following this, at least based on our preliminary findings, youth involvement in these Facebook groups may not warrant concern from practitioners or caregivers, though future research ought to verify this. In particular, it would be important to examine both the short and long-term effects of involvement in these SNS groups. For example, it would be useful to know how involvement in these groups impacts mood, perceived social support, and attitudes toward help-seeking. Use of experimental or longitudinal studies may be fruitful in these cases, as well as speaking directly with the youth currently utilizing Facebook and other SNS for these purposes. This line of research is especially important in light of research indicating that at least for some online activities associated with mental health difficulties (e.g., self-injury, eating disorders), there may be risks (e.g., normalization and reinforcement, impeded help-seeking) to those involved (e.g., Lewis & Baker, 2011; Lewis et al., 2011; Rouleau & von Ranson, 2011).

Although the intent to help was evidenced in these Facebook groups, and there seems to be a clear benefit to providing youth an online platform to safely disclose their experiences and potentially obtain social support, the type of exchanges between youth may be limited in their effectiveness as they chiefly focused on informal rather than professional support. Professional help may be necessary to alleviate depressive symptoms in more severe cases of depression among young people. Thus, researchers may need to identify ways to better reach out to adolescents in an effort to provide accessible and relevant evidence-based information and resources; doing so may augment the benefits we identified above. Given the nature of what youth tend to share with each other through the Facebook groups examined in this study, it will be important that these resources are appealing to youth (e.g., videos, interactive websites). Previous studies have investigated the current success of youth-based websites for mental health support (Nicholas, 2010; Oh, Jorm, & Wright, 2009; Santor, Poulin, LeBlanc, & Kusumakar, 2007) and the potential successes of online interventions for youth (Ryan, Shochet, & Stallman, 2010; Shandley, Austin, Klein, & Kyrios, 2010). As youth have demonstrated that they are more than willing to utilize the Internet as a resource for emotional and social support, enhanced development and positioning of evidence-based online resources to identify and combat youth depression is a strong future priority.

Footnotes

Appendix

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

Author Biographies

Bethany I. Lerman completed a BA (Honors) degree in psychology at the University of Guelph. She currently works as a research coordinator at the Sunnybrook Research Institute. Her research interests focus on investigating mechanisms of resilience in the mood and anxiety disorders, and isolating underlying cognitive risk factors.

Stephen P. Lewis, PhD, is an associate professor in the Department of Psychology at the University of Guelph. His research has been funded by the Canadian Institute of Health Research and Canada Foundation for Innovation. Central to his research approach is the use of the Internet as a research platform and outreach tool to study self-injury and the mental health of youth and emerging adults. His research has been featured in national and international media outlets, including The New York Times, Time, USA Today, ABC, CBS, The Globe and Mail, and the BBC. He is also an invited member of the International Society for the Study of Self-Injury (ISSS), where he currently sits on the Executive Board. His work in the area of self-injury led to him cofounding Self-injury Outreach and Support (SiOS: ).

Margaret Lumley, PhD, is an associate professor in the child clinical psychology program at the University of Guelph. She is a board member of the Canadian Positive Psychology Association and a registered clinical psychologist practicing with children and adolescents. Her research has been funded by the Ontario Mental Health Foundation, Canada Foundation for Innovation, and Ministry of Education. Her career ambition is to significantly contribute to positive mental health for youth by researching cognitive, emotional, and interpersonal factors that support resilience and well-being.

Greg J. Grogan completed a BA (Honors) degree in psychology at the University of Guelph. His research interests include youth mental health, resilience, and mood disorders.

Chloe C. Hudson is a PhD student in clinical psychology at Queen’s University. Her research focuses on understanding the social and cognitive factors that lead to the development and maintenance of major depression in adolescence and early adulthood.

Erin Johnson completed a BA (Honors) degree in psychology at the University of Guelph. Her research interests include youth mental health, depression, self-injury, and the role of the Internet on youth well-being.

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