COLUMBUS, Ohio - When college students post about feelings of depression on Facebook, their friends are unlikely to encourage them to seek help, a small study suggests.

In fact, in this study, none of the 33 participating students said their friends told them they should reach out to a mental health professional to discuss their problems.

Instead, most friends simply sent supportive or motivating messages.

But that may not be good enough for people who are truly depressed - as some of the people in this study probably were, said Scottye Cash, lead author of the study and professor of social work at The Ohio State University.

"It makes me concerned that none of the Facebook friends of students in this study were proactive in helping their friend get help," Cash said.

"We need to figure out why."

The research, published online recently in the journal JMIR Research Protocols, is part of a larger online study of health outcomes of 287 students at four universities in the Midwest and West. This study included the 33 students in the larger study who reported that they had "reached out on Facebook for help when depressed."

The students reported what type of post they made and how their friends responded. They also completed a measure of depression.

Results showed that nearly half of the participants reported symptoms consistent with moderate or severe depression and 33 percent indicated they had had suicidal thoughts several days in the previous few weeks.

"There's no doubt that many of the students in our study needed mental health help," Cash said.

The two most common themes in the participants' Facebook posts were negative emotions ("I just said I felt so alone," one student reported) or having a bad day ("Terrible day. Things couldn't get any worse," one wrote). Together, those themes appeared in about 45 percent of the posts the students reported on.

But only one of the students directly asked for help and only three mentioned "depression" or related words, Cash said.

Many participants found ways to hint at how they were feeling without being explicit: 15 percent used sad song lyrics, 5 percent used an emoji or emotion to indicate their depressed feelings and another 5 percent used a quote to express sadness.

"They didn't use words like 'depressed' in their Facebook posts," Cash said.

"It may be because of the stigma around mental illness. Or maybe they didn't know that their symptoms indicated that they were depressed."

Students reported that the most common responses from their friends to their posts about depression (about 35 percent of responses) were simply supportive gestures. "All my close friends were there to encourage me and letting me know that everything will be okay," one student wrote.

The next most common response (19 percent of posts) was to ask what was wrong, which participants didn't always take positively. "It is hard to tell who cares or who's (just) curious this way, though," one participant wrote.

The other three most common responses (all occurring 11 percent of the time) were contacting the depressed friend outside of Facebook, sending a private message within the app, or simply "liking" the post.

Although participants reported that none of their friends suggested they get help, Cash said she is sympathetic to the plight of these friends.

"For the friends reading these posts, they often have to read between the lines since few people came right out and said they were depressed," Cash said.

"Many people used quotes and song lyrics to talk about how they're feeling, so their friends really had to decode what they were saying."

Cash said the findings point to the need for more mental health literacy among college students and others so they know how to recognize the signs of depression and how to respond.

"Both Facebook and colleges and universities could do more to give these students information about resources, mental health support and how to recognize the signs of depression and anxiety," she said.

"We need to increase mental health literacy and decrease mental health stigma."

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Co-authors of the study were Laura Marie Schwab-Reese of Purdue University; Erin Zipfel, a former graduate student at Ohio State; and Megan Wilt and Megan Moreno of the University of Wisconsin.

Contact: Scottye Cash, Cash.33@osu.edu

Written by Jeff Grabmeier, 614-292-8457; Grabmeier.1@osu.edu