Open Journal of Depression
2013. Vol.2, No.3, 35-41
Published Online August 2013 in SciRes (http://www.scirp.org/journal/ojd) http://dx.doi.org/10.4236/ojd.2013.23008
Exploring Depression Symptom References on Facebook among
College Freshmen: A Mixed Methods Approach
Megan A. Moreno1,2*, Lauren A. Jelenchick3, Rajitha Kota1
1Seattle Children’s Research Institute, Seattle, USA
2Department of Pediatrics, University of Washington, Seattle, USA
3University of Minnesota School of Medicine, Minneapolis, USA
Received March 27th, 2013; revised Ma y 1 st, 2013; accepted May 10th, 2013
Copyright © 2013 Megan A. Moreno et al. This is an open access article distributed under the Creative Com-
mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, pro-
vided the original work is properly cited.
Depression is common among older adolescents and can be challenged to identify. The purpose of this
study was to evaluate Facebook displayed depression references and their association with depression and
peer perception. First-year college students’ Facebook profiles were categorized as Depression Displayers
or Non-Displayers. Participants completed a depression screen and were interviewed regarding Facebook
displayed depression references. Analyses included logistic regression and qualitative analysis. Among
132 participants (70% response rate), the average age was 18.4 years (SD 0.49) and approximately half
were males (48.5%). Depression Displayers were twice as likely (OR 2.1, 95% CI: 1.01 - 4.5, p = 0.04) to
meet clinical criteria for depression. Qualitative analysis revealed that depression references were viewed
as support-seeking or attention-seeking. Displayed depression references were associated with depression;
these disclosures may be support-seeking efforts subject to varying interpretations by peers.
Keywords: Depression; College Student; Content Analysis; Mixed Methods; Facebook; Social Media
Introduction
Universities are important settings in which mental health
concerns such as depression must be addressed given that ap-
proximately half of emerging adults attend post-secondary edu-
cation (Statistics, 2009). Depression among college students is
common and consequential; adverse outcomes include increase-
ed rates of substance use, co-morbid psychiatric conditions and
suicide (Roa, 2006; Garlow et al., 2008; Rao & Chen, 2009;
Deas & Brown, 2006; Kessler et al., 1995; Hunt & Eisenberg,
2010; Association A.C.H., 2009; Association A.C. H., 2010). The
most common form of depression among emerging adults is
major depressive disorder, with a yearly incidence of approxi-
mately 8% (Hunt & Eisenberg, 2010; Vance, Howe, & Della-
valle, 2009; Eisenberg, Golberstein, & Gollust, 2007). Fresh-
man year of college may present increased risks for depression
as students have transitioned to an environment that brings new
experiences, stressors and uncertainties (Compas et al., 1986;
Perry, Hall, & Ruthig, 2007). The first few months of freshman
year are a particularly risky time for feelings of loneliness, de-
pression and social isolation (Cutrona, 1982).
Previous work has suggested that self-disclosure can be a
mediator among college students to reduce symptoms of mild
depression (Wei, Russell, & Zakalik, 2005). However, concerns
related to stigma regarding mental illness may impede college
students’ efforts to reach out. Concerns about stigma are asso-
ciated with less perceived need for help and decreased treat-
ment seeking behavior among college students (Eisenberg et al.,
2009). Thus, despite the frequency of depression in this age
group, college students struggling with depression symptoms
are frequently undiagnosed as many students do not perceive a
need for help or do not seek clinical services (Hunt & Eisen-
berg, 2010; Eisnberg, Golberstein, & Gollust, 2007; Zivin et al.,
2009). Other barriers to help-seeking particularly among fresh-
men students include lack of knowledge about available ser-
vices and privacy conc e rn s (Hunt & Eisenberg, 2010).
One novel approach towards improving support or resources
to college students at risk for depression may be social net-
working sites (SNSs), such as Facebook and MySpace. These
web sites are popular among and consistently used by college
students; current data suggests up to 98% of students maintain a
SNS profile and most report daily use (Leiws, Laufman, &
Christakis, 2008; Buffardi & Campbell, 2008; Ross et al., 2009).
SNSs allow students to create a personal web profile, commu-
nicate with online friends and build an online social network
(Ellison, Steinfield, & Lampe, 2007; Boyd, 2007). Previous
work has demonstrated that between a quarter and a third of
college students display references which are consistent with
symptoms of clinical depression on SNSs (A Pilot Evaluation
of Associations Between Displayed Depression References on
Facebook and Self-reported Depression Using a Clinical Scale,
2011; Feeling bad on Facebook: depression disclosures by col-
lege students on a social networking site, 2011). In a previous
pilot study, displayed depression symptom references were as-
sociated with self-reported depression symptoms among college
students (A Pilot Evaluation of Associations Between Display-
ed Depression References on Facebook and Self-reported De-
pression Using a Clinical Scale, 2011; Feeling bad on Facebook:
*Corresponding author.

M. A. MORENO ET AL.
depression disclosures by college students on a social net-
working site, 2011). However, the views of college students on
what these displayed depression symptoms mean to the profile
owner as well as peer viewers of that profile are not known. It
is possible that these associations between Facebook and self-
reported depression symptoms may be more salient among
freshmen, a population that may present increased risks and op-
portunities for intervention. Thus, the objectives of this mixed
methods study were twofold. The first goal was to examine the
association between Displayed Depression symptoms and clini-
cal depression screening scores within a population of freshmen
undergraduates. The second goal was to explore these partici-
pants’ views regarding displayed depression references on Face-
book.
Methods
This study was conducted between November 1, 2009 and
February 3, 2012 and received university IRB approval.
Setting and Subjects
This study was conducted using the SNS Facebook
(www.Facebook.com). This SNS was selected as it is the most
popular SNS among the target population of college students
(Buffardi & Campbell, 2008; Google, 2010). Publicly available
Facebook profiles of freshmen undergraduate students within
one large state university Facebook network were investigated.
To be included in the study, profile owners were required to
self-report their age as 18 to 19 years old and provide evidence
of Facebook profile activity in the last 30 days.
Data Collection and Recruitment
The Facebook search engine was used to search for profiles
within the selected university’s network among the freshmen
undergraduate class. At the time of this study, Facebook pro-
vided search results in lists of up to 500 profiles, not all of
which met search criteria. A single search was conducted using
the Facebook search engine and all profiles within those results
were assessed for eligibility. The majority of ineligible profiles
were due to privacy settings (N = 293), incomplete demogra-
phic information (N = 93) or were graduate students’ profiles
(N = 27). A total of 188 freshmen student profiles were eligible
for evaluation.
All eligible profiles were evaluated by three trained coders
using a research codebook. This codebook has been used in
previous work evaluating displayed depression references on
SNS profiles (A Pilot Evaluation of Associations Between Dis-
played Depression References on Facebook and Self-reported
Depression Using a Clinical Scale, 2011; Kim et al., 2010). The
coders viewed one year of status updates in order to determine
whether references to depression symptoms were present, start-
ing from the date of profile evaluation and going back to the
same date one year prior. For profiles that met inclusion criteria,
profile owners were called at their listed phone number. After
verifying identity, the study was explained and profile owners
were invited to participate in an interview.
Interview Procedures
Interviews were conducted one-on-one with a trained gra-
duate student. After explaining the study and obtaining consent,
the interviewer provided the participant access to an online
survey. After survey completion, the interviewer asked the par-
ticipant a series of open-ended questions that were audio re-
corded. Respondents who completed the interview were provi-
ded a $50 incentive.
Data Sources and Variables
Facebook Profiles
From each SNS profile that met inclusion criteria, demo-
graphic data and displayed depression symptom reference data
were recorded , including verba tim text from profil es. If presen t,
identifiable information was removed from text references. Re-
ferences to depression symptoms were defined using the DSM-
IV symptom criteria for a major depressive episode (MDE)
(Association, A.P, 2000). The criteria for MDE included de-
pressed mood, loss of interest/pleasure in activities, appetite
changes, sleep problems, psychomotor agitation or retardation,
energy loss, feeling worthless or guilty, decreased concentra-
tion or suicidal ideation (Association, A.P, 2000). Status up-
dates were considered a depression symptom reference if they
fit one of the described depression criteria by keyword or a sy-
nonym. For example, one symptom keyword of major depres-
sion is “hopeless,” therefore a status update stating “I feel hope-
less” would be coded as a reference to depression. The term
“giving up” is a synonym of “hopeless,” therefore, a status up-
date disclosing “I feel like giving up” would be coded as a re-
ference to depression. Status updates that clearly referenced a
person other than the profile owner (i.e. “Matt is sitting next to
me in class and he looks sad”), or references to the common si-
tuational experience of having a bad day (i.e. “I’m having a
bummer of a day”) were not considered depression references.
Profiles were categorized into one of two groups. Profiles
with one or more references to depression symptoms were con-
sidered “Depression Displayers.” Profiles without any depress-
ion symptom references were considered “Non-Displayers.” A
20% random subsample of profiles was evaluated by all three
coders to test interrater reliability. Fleiss’ Kappa statistic was
used to evaluate the extent to which there was overall agree-
ment in the coding of the presence or absence of depression re-
ferences on a profile, as well as overall agreement among co-
ders for the categorization of the depression references. Fleiss’
kappa was 0.79 for the presence or absence of depression re-
ferences present on profiles.
Interviews
Participants completed an online version of the Patient
Health Questionnaire (PHQ-9) clinical screen for depression.
This screen is based on Diagnostic and Statistical Manual of
Depressive Disorders version four (DSM-IV) criteria for a
MDE and has been validated in both adult and adolescent
populations (Vance, Howe & Dellavalle, 2009; Peppard, Austin
&Brown 2007). The PHQ-9 scale inquires about frequency of
depression symptoms experienced in the last two weeks, such
as depressed mood and hopelessness. Response categories in-
clude: not at all, several days, nearly half the days, and nearly
every day. PHQ-9 scores range from 0 to 27; a score of less
than 5 suggests no depression, a score of 5 or greater suggests
depression. Depression diagnostic categories within the PHQ-9
are differentiated as follows: a total score of 5 - 9 suggests mild
depression; a score of 10 - 14 suggests moderate depression and
over 15 suggests moderately severe depression.
36

M. A. MORENO ET AL.
Participants were then asked the following open-ended ques-
tions: “In some of our research studies, we’ve found that many
college students display references to depression on Face-book.
What do you think those references mean? What do you think
might motivate a college student to display a reference to men-
tal health on their Facebook profile? Do you think there are
differences in how females display these references compared
to males?”
Analysis
Categorical outcome measures were summarized as frequen-
cies and percentages. Outcome variables measured on a con-
tinuous scale were summarized in terms of means, standard de-
viations, m e d i a ns and ranges. Chi-square tests were used to eva-
luate Depression Displayers and Non-Displayers and the asso-
ciation with categorical demographic variables. The nonpara-
metric Wilcoxon Rank Sum test was used to compare the PHQ-9
total scores between various subgroups.
The association between displayed depression symptom refe-
rences on Fa ceboo k and depre ssion meas ured by t he PHQ-9 w as
evaluated in three steps. First, the PHQ-9 total scores were
dichotomized into a no risk for depression category (total score
<5) and an “at risk” for depression category (total score five or
greater). A chi-square test was used to compare the proportions
of participants at risk for depression between Non-Displayers
and Depression Displayers. Second, the ass ociation betw een dis-
played depre ssion s ymptom re f eren ces o n Fac ebo ok and all four
PHQ-9 depression categories (none, mild depression, moderate
depression, moderately severe depression) was evaluated using
the Cochran-Armitage trend test. In the final step, we evaluated
whether being a Depression Displayer was an independent pre-
dictor for any PHQ-9 depression category using multivariate
logistic regression. Demographic variables and two-way inte-
raction terms between c ategoric al vari ables w ere inc luded as co-
variates in the initial non-parsimonious model. Backward se-
lection was used to identify a final parsimonious model. Data
analyses were conducted using SAS software version 9.2 (SAS
Institute, Cary, NC). All P values were 2-sided, and P < 0.05
was used to indicate statistical significance.
Qualitative analysis of interview data was conducted in an
iterative approach (Creswell, 1998). Three investigators indivi-
dually evaluated transcripts to develop preliminary themes and
representative quotations. These reviewers then met to discuss
themes using the Constant Comparative method (Glasser &
Strauss, 2011). The group discussed until consensus on themes
was reached and representative quotations were selected.
Results
A total of 132 participants completed the interview (70% re-
sponse rate). Participants had an average age of 18.4 years (SD
0.49) and included 64 males (48.5%). Table 1 summarizes de-
mographic data.
Displayed Depression on Facebook
Among Facebook profiles, 33.6% displayed references to
one or more depression symptoms (Depression Displayers) and
66.4% had no depression symptom references displayed on the
profile (Non-Displayers). The mean number of references to
depression symptoms per profile was 1.2 (SD = 2.1), while the
Table 1.
Participant demographic information (N = 132).
Gender Number (%)
Male 64 (48.5%)
Female 68 (51.2%)
Age (years)
18 75 (56.8%)
19 57 (43.2%)
Ethnicity
Caucasian 120 (91.6%)
Asian American 5 (2.8%)
African American 1 (0.8%)
Hispanic/Latino 1 (0.8%)
Mixed/Other 4 (3.2%)
Missing 1 (0.8%)
Facebook Depression D i splay Categ ory
Non-Displayer 88 (66.4%)
Depressio n Displayer 44 (33.6%)
PHQ-9 Depression Category
None 81 (61.4%)
Mild 40 (30.3%)
Moderate 9 (6.8%)
Moderately Severe 2 (1.5%)
median number of references was 0 with a range of 0 to 11 re-
ferences.
Females were more likely to be Depression Displayers (41%
Displayers) compared to males (24% Displayers) (p = 0.02).
Among females who were Depression Displayers, the mean
number of depression displays was 2 (SD 1.62), the median
was 1 and the range was 1 to 7. Among males who were De-
pression Displayers, the mean number of depression symptom
displays was 3.2 (SD 3.2), the median was 2 and the range was
1 to 11. Thus males were less likely to display references to
depression symptoms, but among those who displayed such
depression references they did so more frequently compared to
females (p = 0.003). Though there were few non-white parti-
cipants, they were also more likely to display depression symp-
tom references compared to white participants (p = 0.009),
though there were not statistically significant differences in fre-
quency of display. See Table 2.
Displayed Depression on Facebook
Among Facebook profiles, 33.6% displayed references to
one or more depression symptoms (Depression Displayers) and
66.4% had no depression symptom references displayed on the
profile (Non-Displayers). The mean number of references to
depression symptoms per profile was 1.2 (SD = 2.1), while the
median number of references was 0 with a range of 0 to 11 re-
ferences.
Females were more likely to be Depression Displayers (41%
Displayers) compared to males (24% Displayers) (p = 0.02).
Among females who were Depression Displayers, the mean
number of depression displays was 2 (SD = 1.62), the median
was 1 and the range was 1 to 7. Among males who were De-
pression Displayers, the mean number of depression symptom
displays was 3.2 (SD 3.2), the median was 2 and the range was
1 to 11. Thus males were less likely to display references to

M. A. MORENO ET AL.
38
Table 2.
Descriptive information for gender and race by facebook de pr e ss io n d is pl a y category and phq-9 depression screening results.
Facebook
Non-Displayers
Facebook
Depression
Displayer PHQ-9 Score Indicates
No Depression PHQ-9 Score Indicates Depression
Variable Value N (%) N (%) P Value1 P Value1
Female (N = 68) 38 (44.2%) 30 (66.7%) 39 (57.4%) 29 (42.6%) 0.37
Gender Male (N = 63) 48 (55.8%) 15 (33.3%) 0.02 42 (66.7%) 22 (34.9%)
White (N = 119) 82 (96.5%) 37 (82.2%) 75 (63%) 45 (37.8%) 0.22
Race Non-White (N = 11) 3 (3.5%) 8 (17.8%) 0.01 6 (54.5%) 6 (54.5%)
1Fisher’s exact Test.
depression symptoms, but among those who displayed such
depression references they did so more frequently compared to
females (p = 0.003). Though there were few non-white par-
ticipants, they were also more likely to display depression sym-
ptom references compared to white participants (p = 0.009),
though there were not statistically significant differences in fre-
quency of display. See Table 2.
PHQ-9 Scores
The mean PHQ-9 total score was 4.1 (SD = 3.3) and the me-
dian was 3 (range 0 to 16). A total of 81 participants had total
scores which indicated no risk for depression (61.4%). Table 2
illustrates the proportion of participants who met each of the
depression criteria on the PHQ-9. Among participants whose
total scores indicated depression, 40 participants met criteria for
mild depression (30.3%), 9 participants met criteria for moder-
ate depression (6.8%) and 2 participants met criteria for moder-
ately severe depression (1.5%). The mean PHQ-9 score for
females was 4.5 (SD = 3.7) compared to 3.5 (SD = 2.7) for
males (p = 0.07).
Association between Facebook Display and PHQ-9
Scores
The PHQ-9 score was significantly higher among Depression
Displayers when compared to Non-Displayers. The median
total PHQ-9 score for Depression Displayers was 5 (range 0 to
15), compared to a median total score of 3 for Non-Displayers
(range 0 to 16) (p = 0.04).
Our initial analytic approach examined the relationship be-
tween PHQ-9 scores that indicated any category of depression
(PHQ-9 total score >4) compared to no risk for depression. We
found that among Depression Displayers, 51.1% had PHQ-9
scores that met criteria for Depression compared to 32.6% of
Non-Displayers (p = 0.04).
Our second analysis examined the relationship between dis-
played depression references on Facebook and all four de-
pression categories (None, Mild, Moderate, Moderately severe).
A significant negative trend was detected for the proportions of
Depression Displayers across the depression categories. (p =
0.033.) Specifically, the proportions of Depression Displayers
were 48.9% (None), 37.8% (Mild), 11.1% (Moderate), and
2.2% (Moderately severe). Table 3 illustrates these findings.
Our third approach was to conduct a multivariate analysis in
order to evaluate whether depression reference display on Face-
book was an independent predictor for a total PHQ-9 score
indicating depression. Gender, ethnicity (white vs. non-white),
number of Facebook friends and two-way interaction terms
Table 3.
Association between Facebook displayed depression category and
PHQ-9 depression category.
Non-Displayers Depression
Displayers P Value
N (%) N (%)
No Risk 58 (67.4%) 22 (48.9%)
Depression
Risk by PHQ-9
Score At Risk 28 (32.6%) 23 (51.1%) 0.041
None 58 (67.4%) 22 (48.9%)
Mild 23 (26.7%) 17 (37.8%)
Moderate 4 (4.7%) 5 (11.1%)
Depression
Category b y
PHQ-9 ScoreModerately
Severe 1 (1.2%) 1 (2.2%)
0.032
1Chi-square test. 2Cochran-armitage trend test.
were included as covariates in the initial non-parsimonious
model. Backward selection with a 0.1 significance level for
removing effects was used to identify a parsimonious model.
Depression reference display was identified as an independent
predictor for PHQ-9 depression in the multivariate analysis.
Specifically, participants who displayed Depression references
on Facebook were twice as likely (OR 2.1, 95% CI: 1.01 - 4.5,
p = 0.04) to score into one of the depression categories on the
PHQ-9.
A marginally significant interaction between depression re-
ference display and gender was detected in the multivariate
analysis (p = 0.08). Hence, subgroup analyses were conducted
for males and females separately. Among females, the odds
ratio for PHQ-9 depression was 3.7 (95% CI: 1.4 - 10.1) when
comparing Depression Displayers to Non-Displayers. There was
no significant association between depression reference dis-
play and PHQ-9 depression among males.
Interview
Qualitative analysis of transcripts revealed several consistent
findings across interviews. First, participants described several
perceived meanings behind displayed depression symptoms.
These meanings mostly centered on displaying depression refe-
rences as a way to express feelings or seek support. Some par-
ticipants described their perception that depression displays re-
present a cry for help:
“I feel that that’s like a cry for help, like they want people to
see it and they want people to ask about it and they want people
to like comfort them in some way.” (Female, Displayer).
Another commonly described motivation for depression dis-
plays was to seek feedback, empathy or support:

M. A. MORENO ET AL.
“I think that at the moment in time they posted it, they were
feeling incredibly depressed and were trying to use the internet
to take a poll and see if anyone else is feeling that way. Then
people can comment.” (Female, Non-Displayer ).
A final commonly described motivation was to relieve stress
or vent feelings: “when they’re stressed out, or sometimes
you’re just tense, like you have homework, you have work to do,
like work, you might be sick, and just everything’s going wrong.
You need a break and you feel like you’re ready to explode.”
(Female, Displayer).
While some variety exists in these perceived meanings for
depression disclosures, all related to a core motivation of trying
to feel better. Participants also discussed the importance of the
pattern of display, that displays are more common around
stressful times such as exams or relationship breakups. Partici-
pants also commented that a pattern of depression symptoms
displays was more meaningful compared to a single disclosure:
“Um, I would say some people kind of do it for attention.
They’ll put something like ‘school is so frustrating and so de-
pressing’ because people will comfort them. I may have done
that, I definitely put up something about how school is really
hard and I couldn’t handle it and that kind of thing. And then
my friends are like, ‘it’s ok, it’ll get better, you can do it,’ and
it’s kind of a self-confidence boost. But unless there’s, like if I
see status updates, unless there’s a lot of depressing ones in a
row, I’m not too worried about those people” (Female, Dis-
player).
These common meanings were discussed by both Depression
Displayers and Non-Displayers. However, there were subtle
differences noted in how some Non-Displayers described their
perception of displayed depression references. Non-Displayers
were more likely to describe the feeling that the displayed de-
pression sympt oms were motivated by a desire for attention:
“maybe it’s for attention, or to have someone help them fi-
gure out what’s going on, or even to relieve stress, sometimes
just saying something is a way or relieving it, and you’re re-
lieving it to a lot of people which may be helping.” (Female,
Non-Displayer).
Some Non-Displayers went as far as to criticize the practice
of displaying depression symptoms on Facebook:
“Um, I don’t know, sometimes I’ve seen people that are emo-
tional or post status updates and I just don’t think that’s really
the right place to put it. You should actually talk to someone
about your mental health, you shouldn’t be like posting it on
Facebook, you should be talking to your friends or a profes-
sional, not using a status update or bumper sticker.” (Female,
Non-Displayer).
Non-Displayers also mentioned not being sure whether the
displayed depression symptom was meant as a joke:
“I think sometimes it could be seen as a joke, and other times
they could actually be true and it’s someone’s way of asking for
the attention that they want.” (Female, Non-Displayer).
“Yeah, probably just exaggerated, um, not like serious. If
some kid had some mental health problem, I don’t think they’d
post it there.” (Male, Non-Displayer).
Interviews also elicited feedback from participants regarding
whether gender differences were present among displayed de-
pression symptoms on Facebook. Many participants described
differences in social or gender norms and expectations for pub-
licly displaying emotions or feelings. Representative quotes
from gender differences are in Table 4.
Table 4.
Gender differences in display of depress io n sy mptoms on facebook.
“I think girls are more likely to [display depression symptoms]. I feel
like I don’t really see that th ing with boys. It’s more common with girls,
I think maybe more acceptable I guess. Whatever stereotypes go with
it.” (Female, Displayer).
“Um, well, I think girls are more open to what they’re feeling and guys
just want to be seen as like they’re more laid back an d they have t hi ngs
under control and are n o t stressed are. So I think girls are just more
willing to sha re their feel ing s.” (Female, N on -Displayer).
“Yeah, I feel like females are more open about it and basically what I’ve
learned it tends to be more, me n ta l h ealth things, I mean they tend to be
“Oh I’m sad be cause of…” or they do a song lyric or something, where
guys for the most part guys don’t really post a lot of things involving
emotions. Again that is kind of like the social norms playing like part o r
also just physiology.” (Male, Displayer).
Gender differences in how Facebook itself is used
“Um yeah, I don’t know um certain the girls I know tend to be more
emotional than guys I know. And it comes out more, especially because
that my girlfriends are much more active on Facebook so I see it m uch
more from them.” (Male, Displayer).
“It seems like guys are less likely to call out for things like that, try to
get attention on Facebook, and a lot of girl s are. But at the same time
girls seem lik e just make more status update s in general, about the good
things and the bad. Guys make less comment in general and when they
do they’re l ess attached to a personal issue.” (Male, Non-Displayer).
“I don’t think there are that many differences, I think guys generally
don’t get a response to what they display on a Facebook page. Girls do,
and they get it from girls. Girls are the ones who re ally go on Facebook
and browse around for a long time. I don’t know, I think the reason is
all the same, anything you do over Facebook you’re wanting to get
attention, that’s just my opinio n (Female, Displayer).
Discussion
This study presents findings from both quantitative and qua-
litative data to explore displayed depression symptom referen-
ces on Facebook. Findings suggest a positive association be-
tween displayed depression symptoms on Facebook and self-
reported depression symptoms using a clinical screen among
freshmen undergraduates. Freshmen generally viewed diplayed
depression references as a way to seek support or attention;
however, Non-Displayers more often described feelings of ne-
gativity or attention-seeking associated with these references.
The finding that approximately a third of college students
referenced depression symptoms on Facebook is consistent
with previous work (Feeling bad on Facebook, 2011; A Pilot
Evaluation of Associations Between Displayed Depression Re-
ferences on Facebook and Self-reported Depression Using a
Clinical Scale, 2011). Similarly, the majority of Depression
Displayers had clinical scores in the mild depression category
(A Pilot Evaluation of Associations between Displayed Depres-
sion References on Facebook and Self-reported Depression Us-
ing a Clinical Scale, 2011). However, the current findings focus
on freshmen college students and found a heightened associ-
ation between Facebook displayed depression symptoms and
depression identified by a clinical screen, with Depression Dis-
players over twice as likely to be at risk for depression. Fresh-
men also represent a group at risk for depression and less likely
to be proactive in seeking care for depression (Cutrona, 1982).
Placing these findings in the context of related work, Wei,
Russell and Zakalik (2005). investigated the role of emotional
disclosures among college students. Their study found that

M. A. MORENO ET AL.
among freshmen students, emotional self-disclosure was a me-
diator to decrease mild depression. However, emotional com-
fort with self-disclosure did not play a role as a mediator when
more severe depression was present. This work provides in-
sights to the current findings in two ways. First, Facebook de-
pression symptom references may represent an innovative form
of emotional self-disclosure. Students who choose to disclose
depression symptoms, even via Facebook, may experience an
emotional benefit from their actions. It is worth considering
whether displaying depression symptoms on Facebook and re-
ceiving social support may allow an adolescent with depression
to maintain a symptom level in the “mild” category during times
of stress when that adolescent is at risk for heightened symp-
toms. Second, findings suggest that the association between
Facebook displayed depression references and self-reported
depression symptoms is most clearly seen among those with
mild depression symptoms. It is possible that students with
more severe depression do not benefit from, and thus are less
likely to engage in, displayed depression disclosures.
If it is the case that displayed depression references on Face-
book represent college students who may have mild depression,
and if these Facebook disclosures represent emotional self-
disclosure and support-seeking, then it is worth considering
how to support or improve what is currently taking place in this
naturalistic environment. One consideration is to provide edu-
cation to college students (the majority of whom are Non-Dis-
players) regarding the positive association between Facebook
displayed depression references and likelihood of depression.
Colleges could consider awareness campaigns to provide stu-
dents information that depression references may represent
mild depression, and education about resources available to stu-
dents. As both peer support interventions and online support
interventions have been found to be effective in treating de-
pression, educating students about how to respond to peers’ dis-
played depression symptom references may have a meaningful
impact (Pfieffer et al., 2011; Houston, Cooper, & Ford, 2002).
Given the high prevalence of depression in this population, and
the low frequency of help-seeking behavior, it is exciting to
consider Facebook depression disclosures as a potential means
for impacting mild depression.
Similar to previous work, females were more likely to be De-
pression Displayers as well as to score into a depression cate-
gory of the PHQ-9 (Feeling bad on Facebook, 2011; A Pilot
Evaluation of Associations Between Displayed Depression Re-
ferences on Facebook and Self-reported Depression Using a
Clinical Scale, 2011) The association between displayed de-
pression references and PHQ-9 reported depression was strong
among females, suggesting this may be an ideal group to target
for future interventions using Facebook. Findings regarding
males are less clear. While males were less likely to display de-
pression references, male Depression Displayers displayed as
frequently or more frequently compared to female Displayers.
Qualitative findings provide insights that depression displays
by males we re conside re d less so cially appropriate by peers and
more likely to be viewed as a joke. It is possible that males who
display depression references are less likely to receive sup-
portive comments or feedback, though this may be the purpose
of their disclosure. Future studies among male college students
who display depression references on SNSs may yield further
insights into the meaning of these references and the pattern of
their display, as well as possible opportunities for targeting in-
terventions to this subgroup.
Study findings are limited in that we only examined publicly
available profiles on one SNS. Therefore we cannot generalize
our findings to profiles that were set to private, or to profiles on
other SNSs. This study took place during a transition time for
Facebook, profile security settings were trending towards in-
creased security settings. Thus, many of the profiles we screen-
ed for eligibility were excluded due to privacy settings. In the
present time, this study method would be unlikely to succeed
given that private security settings are now the norm. It is im-
portant to note that SNS profile privacy settings are not per-
manent; profile owners may change their privacy settings at any
time or to reflect what security upgrades are offered by Face-
book. It is unclear whether profile owners who maintained a
private profile at the time of this study would be more likely, or
less likely, to display depression references. Further, genera-
lization to other universities or upperclassmen is not warranted.
Finally, among older adolescents who have been diagnosed
with depression, their Facebook usage patterns are not well un-
derstood.
Despite these limitations, our study represents a unique por-
trait of displayed depression symptoms on Facebook during a
time in which Facebook security settings frequently allowed
public glimpses of their content. In the present time, security
settings have changed, leading to an increased likelihood that
profiles are private. However, today’s college students are also
likely to friend adults in their lives, such as parents or college
professors. Thus, while these profiles may not be publicly
available, they may be accessible by caring adults who may see
displayed depression references and wonder what they mean.
Our study findings demonstrate that displayed depression symp-
toms on Facebook likely have meaning to those who choose to
display them.
There are several ways in which these findings could be used
to enhance screening or intervention efforts towards reducing
depression among college students. Attention to both privacy
concerns and ethics are paramount to the success of any future
research or clinical efforts involving SNSs (Correa, Hinsley, &
de Zuniga, 2010; Moreno, Fost & Christakis, 2008). A first op-
tion is considering raising awareness of the common meanings
and motivations for displayed depression symptoms on Face-
book among incoming college students. This may allow stu-
dents who are Non-Displayers to recognize if a peer is using
Facebook to seek support or in need of resources. A second
option is to consider targeted messaging based on the displayed
content on a SNS profile. Advertisements on Facebook are trig-
gered by keywords displayed on the profile and can be tailored
to depression keywords. It is possible that universities could
choose to place messages or educational materials, such as a
link to the university health services, targeted to keywords re-
garding depression symptoms such as “depression” or “hope-
less.” Future study should evaluate how these options could en-
hance and complement current screening efforts on college
campuses.
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