Background: Depression is common and frequently undiagnosed among college students. Social networking sites are popular among college students and can include displayed depression references. The purpose of this study was to evaluate college students' Facebook disclosures that met DSM criteria for a depression symptom or a major depressive episode (MDE). Methods: We selected public Facebook profiles from sophomore and junior undergraduates and evaluated personally written text: “status updates.” We applied DSM criteria to 1‐year status updates from each profile to determine prevalence of displayed depression symptoms and MDE criteria. Negative binomial regression analysis was used to model the association between depression disclosures and demographics or Facebook use characteristics. Results: Two hundred profiles were evaluated, and profile owners were 43.5% female with a mean age of 20 years. Overall, 25% of profiles displayed depressive symptoms and 2.5% met criteria for MDE. Profile owners were more likely to reference depression, if they averaged at least one online response from their friends to a status update disclosing depressive symptoms (exp(B) = 2.1, P<.001), or if they used Facebook more frequently (P<.001). Conclusion: College students commonly display symptoms consistent with depression on Facebook. Our findings suggest that those who receive online reinforcement from their friends are more likely to discuss their depressive symptoms publicly on Facebook. Given the frequency of depression symptom displays on public profiles, social networking sites could be an innovative avenue for combating stigma surrounding mental health conditions or for identifying students at risk for depression. Depression and Anxiety, 2011.

ObjectiveTo examine the associations between displayed alcohol use and intoxication/problem drinking (I/PD) references on Facebook and self-reported problem drinking using a clinical scale.DesignContent analysis and cross-sectional survey.SettingFacebook Web site (http://www.facebook.com/).ParticipantsThe study included undergraduate students (age range, 18-20 years) at 2 state universities with public Facebook profiles.Main ExposuresThe profiles were categorized into 1 of 3 distinct categories: Nondisplayers, Alcohol Displayers, and I/PD Displayers.Outcome MeasuresAn online survey measured problem drinking using the Alcohol Use Disorders Identification Test (AUDIT) scale. Analyses examined associations between alcohol display category and (1) AUDIT problem drinking category using logistic regression, (2) AUDIT score using negative binomial regression, and (3) alcohol-related injury using the Fisher exact test.ResultsAmong 307 profiles identified, 224 participants completed the survey (73% response rate). The average age was 18.8 years; 122 (54%) were female; 152 (68%) were white; and approximately 50% were from each university. Profile owners who displayed I/PD were more likely (odds ratio, 4.4; 95% CI, 2.0-9.4) to score in the problem drinking category of the AUDIT scale, had 64.0% (incidence rate ratio, 1.64; 95% CI, 1.27-11.0) higher AUDIT scores overall, and were more likely to report an alcohol-related injury in the past year (P = .002).ConclusionsDisplayed references to I/PD were positively associated with AUDIT scores suggesting problem drinking as well as alcohol-related injury. Results suggest that clinical criteria for problem drinking can be applied to Facebook alcohol references.

Perceived peer alcohol use is a predictor of consumption in college males; frequent references to alcohol on Facebook may encourage alcohol consumption. Content analysis of college males’ Facebook profiles identified references to alcohol. The average age of 225 identified profiles was 19.9 years. Alcohol references were present on 85.3% of the profiles; the prevalence of alcohol was similar across each undergraduate grade. The average number of alcohol references per profile was 8.5 but increased with undergraduate year (p = .003; confidence interval = 1.5, 7.5). Students who were of legal drinking age referenced alcohol 4.5 times more than underage students, and an increase in number of Facebook friends was associated with an increase in displayed alcohol references (p < .001; confidence interval = 0.009, 0.02). Facebook is widely used in the college population; widespread alcohol displays on Facebook may influence social norms and cause increases in male college students’ alcohol use.

The objective of this study was to determine associations between displayed depression symptoms on Facebook and self-reported depression symptoms using a clinical screen. Public Facebook profiles of undergraduates from two universities were examined for displayed depression references. Profiles were categorized as depression symptom displayers or non-displayers. Participants completed an online PHQ-9 depression scale. Analyses examined associations between PHQ-9 score and depression symptom displayers versus non-displayers. The mean PHQ-9 score for non-displayers was 4.7 (SD = 4.0), the mean PHQ-9 score for depression symptom displayers was 6.4 (SD = 5.1; p = 0.018). A trend approaching significance was noted that participants who scored into a depression category by their PHQ-9 score were more likely to display depression symptom references. Displayed references to depression symptoms were associated with self-reported depression symptoms.

Stress is common among college students and associated with adverse health outcomes. This study used the social networking Web site Facebook to identify self-reported stress and associated conditions among college students. Public Facebook profiles of undergraduate freshman at a large Midwestern State University (n = 300) were identified using a Facebook search. Content analysis of Facebook profiles included demographic information and displayed references to stress, weight concerns, depressive symptoms, and alcohol. The mean reported age was 18.4 years, and the majority of profile owners were female (62%). Stress references were displayed on 37% of the profiles, weight concerns on 6%, depressive symptoms on 24%, and alcohol on 73%. The display of stress references was associated with female sex (odds ratio [OR], 2.81; confidence interval [CI], 1.7-4.7), weight concerns (OR, 5.36; CI, 1.87-15.34), and depressive symptoms (OR, 2.7; CI, 1.57-4.63). No associations were found between stress and alcohol references. College freshmen frequently display references to stress on Facebook profiles with prevalence rates similar to self-reported national survey data. Findings suggest a positive association between referencing stress and both weight concerns and depressive symptoms. Facebook may be a useful venue to identify students at risk for stress-related conditions and to disseminate information about campus resources to these students.

Internet use is nearly ubiquitous among US youth; risks to internet use include cyberbullying, privacy violations and unwanted solicitation. Internet safety education may prevent these negative consequences; however, it is unclear at what age this education should begin and what group is responsible for teaching this topic. Surveys were distributed to key stakeholders in youth safety education including public school teachers, clinicians, parents and adolescents. Surveys assessed age at which internet safety education should begin, as well as experiences teaching and learning internet safety. Surveys of adults assessed willingness to teach internet safety. Finally, participants were asked to identify a group whose primary responsibility it should be to teach internet safety. A total of 356 participants completed the survey (93.4% response rate), including 77 teachers, 111 clinicians, 72 parents and 96 adolescents. Stakeholders felt the optimal mean age to begin teaching internet safety was 7.2 years (SD = 2.5), range 2-15. Internet safety was regularly taught by some teachers (20.8%), few clinicians (2.6%) and many parents (40.3%). The majority of teachers, clinicians and parents were willing to teach internet safety, but all groups surveyed identified parents as having primary responsibility for teaching this topic. Findings suggest agreement among key stakeholders for teaching internet safety at a young age, and for identifying parents as primary teachers of this topic. Clinicians have a unique opportunity to support parents by providing resources, guidance and support.