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'If I Was to Post Something, It Would Be Too Vulnerable:' University Students and Mental Health Disclosures on Instagram

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Title: 'If I Was to Post Something, It Would Be Too Vulnerable:' University Students and Mental Health Disclosures on Instagram
Language: English
Authors: Budenz, Alexandra (ORCID 0000-0001-9885-9785), Klassen, Ann, Purtle, Jonathan, Yom-Tov, Elad, Yudell, Michael, Massey, Philip
Source: Journal of American College Health. 2022 70(2):615-624.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 10
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Social Media, Mental Health, Help Seeking, Social Bias, Negative Attitudes, Barriers, School Health Services, Student Experience, Self Disclosure (Individuals), Undergraduate Students, Graduate Students
DOI: 10.1080/07448481.2020.1759608
ISSN: 0744-8481
Abstract: Objective: Assess Instagram use for mental health disclosure in university students to assess the potential for Instagram use as mental health support-seeking. Participants: Twenty-one students using mental health services while attending a private, Mid-Atlantic university between 6/2017-12/2017. Methods: Collected qualitative interview and Instagram data and analyzed them in parallel. Instagram data supplemented interview themes and were coded and analyzed quantitatively to define features of participants' Instagram use. Results: Participants displayed aversions to posting mental health disclosures on Instagram, citing public and self-stigma as barriers to disclosure. Despite this, participants reported instances in which their Instagram posts directly or indirectly reflected their lived experiences. Some also maintained second anonymous accounts for fuller disclosure. Conclusions: Given the benefits of mental health disclosures to well-being and the predilection for social media use in university students, student and university-led initiatives to promote social media environments conducive to disclosures could have widespread mental health benefits.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1335131
Database: ERIC
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  Value: <anid>AN0155633054;acl01feb.22;2022Mar10.04:40;v2.2.500</anid> <title id="AN0155633054-1">"If I was to post something, it would be too vulnerable:" University students and mental health disclosures on instagram </title> <p>Assess Instagram use for mental health disclosure in university students to assess the potential for Instagram use as mental health support-seeking. Twenty-one students using mental health services while attending a private, Mid-Atlantic university between 6/2017-12/2017. Collected qualitative interview and Instagram data and analyzed them in parallel. Instagram data supplemented interview themes and were coded and analyzed quantitatively to define features of participants' Instagram use. Participants displayed aversions to posting mental health disclosures on Instagram, citing public and self-stigma as barriers to disclosure. Despite this, participants reported instances in which their Instagram posts directly or indirectly reflected their lived experiences. Some also maintained second anonymous accounts for fuller disclosure. Given the benefits of mental health disclosures to well-being and the predilection for social media use in university students, student and university-led initiatives to promote social media environments conducive to disclosures could have widespread mental health benefits.</p> <p>Keywords: Instagram; social media; social support; undergraduate and graduate students; young adult health</p> <hd id="AN0155633054-2">Introduction</hd> <p>Onset of mental health concerns (MHCs) largely peaks during young adulthood, and approximately 75% of people living with MHCs experience their first onset by age 25.[<reflink idref="bib1" id="ref1">1</reflink>] The university experience can contribute to onset, persistence, or exacerbation of MHCs.[<reflink idref="bib2" id="ref2">2</reflink>] MHCs experienced in the university setting have educational and career implications, as well as ramifications for suicidality.[[<reflink idref="bib3" id="ref3">3</reflink>], [<reflink idref="bib5" id="ref4">5</reflink>]]</p> <p>Similarities exist between the age of onset of MHCs and the age of the majority of social media users. Of the 73% of adults online that use social media platforms, 90% are 18-29 years of age.[<reflink idref="bib6" id="ref5">6</reflink>],[<reflink idref="bib7" id="ref6">7</reflink>] Additionally, young adults living with MHCs use social media more frequently than the general population,[<reflink idref="bib8" id="ref7">8</reflink>] and some use these platforms to disclose mental health experiences and to seek social support.[<reflink idref="bib9" id="ref8">9</reflink>],[<reflink idref="bib10" id="ref9">10</reflink>] For instance, university students with higher self-reported depression scores are more likely to reference their depression on Facebook than those with lower scores.[<reflink idref="bib10" id="ref10">10</reflink>] Despite the potential for mental health support-seeking on social media, MHCs are highly stigmatized, which may hinder young adults' ability to use these platforms to seek support.[<reflink idref="bib11" id="ref11">11</reflink>] For example, as many as 21% of university students report that they feel the need to conceal their MHCs.[<reflink idref="bib12" id="ref12">12</reflink>]</p> <p>Instagram, a photo and video sharing application, is a commonly used social media platform among young adults. Research has also demonstrated that people use Instagram to disclose about MHCs such as depression and self-harm.[<reflink idref="bib10" id="ref13">10</reflink>],[<reflink idref="bib13" id="ref14">13</reflink>] Seventy percent (70%) of young adults use Instagram,[<reflink idref="bib14" id="ref15">14</reflink>] and university students report spending the most time per day on Instagram, in comparison to other popular platforms.[<reflink idref="bib15" id="ref16">15</reflink>]</p> <p>Although some individuals use Instagram to disclose about their mental health, these disclosures can be inhibited by "positivity bias," wherein users are more likely to share positive experiences on social media than negative ones, in order to receive positive responses from social media acquaintances.[<reflink idref="bib16" id="ref17">16</reflink>] Receiving positive responses on social media is contingent upon making positive disclosures.[<reflink idref="bib17" id="ref18">17</reflink>] For example, Facebook users posting about positive experiences are more likely to receive positive responses from others than users posting about negative experiences.[<reflink idref="bib17" id="ref19">17</reflink>] Thus, people experiencing MHCs are discouraged from sharing negative experiences and are less able to make authentic, positive disclosures.[<reflink idref="bib16" id="ref20">16</reflink>] Prior studies of Instagram and mental health disclosures have intentionally examined publicly available mental health disclosure posts.[<reflink idref="bib13" id="ref21">13</reflink>],[<reflink idref="bib18" id="ref22">18</reflink>] However, users' attitudes toward disclosures and the decision-making process of disclosing on Instagram have yet to be examined. In addition, analyzing publicly available posts gives little information about user demographics, and therefore, cannot be used to make inferences about university students, a population at a pivotal phase of life for mental health outcomes.</p> <p>This study sought to understand the characteristics of Instagram use in university student mental health service users, in order to assess the potential of Instagram use for mental health support-seeking. This study addressed the following research questions:</p> <p> <emph>RQ1: How do students using university mental health services use Instagram?</emph> </p> <p> <emph>RQ2: To what extent does students' Instagram use reflect their lived mental health experiences?</emph> </p> <p> <emph>RQ3: What are the characteristics of instances during which Instagram presence reflects mental health experiences?</emph> </p> <hd id="AN0155633054-3">Method</hd> <p></p> <hd id="AN0155633054-4">Recruitment and participation</hd> <p>We recruited undergraduate and graduate students aged 18-29 from a private university in the Mid-Atlantic United States between June 20, 2017 and December 20, 2017. Because students seeking different types of services may have vastly different attitudes toward and beliefs about mental health, we recruited participants who were utilizing the university counseling center at the time of the study, for whom the counseling center was their first counseling experience since starting at the university, and who had no prior mental health-related hospitalizations. Participants were also required to be Instagram users, as study participation included both Instagram-related interview questions and an observation of Instagram presence. This study was approved by the university's Institutional Review Board (IRB).</p> <p>Participants were recruited using flyers displayed in the university counseling center, student dormitories, and areas on the campus frequented by students. We also distributed the flyers by email to academic advisors and by email and Facebook to student organizations. Students were directed to a study email and were provided a link to complete a screening and demographic form hosted by Qualtrics. We informed participants that completing the screening form automatically entered them into a $25 gift card raffle.</p> <hd id="AN0155633054-5">Qualitative interviews</hd> <p>Individual, face-to-face interviews were conducted using a semi-structured interview guide containing open-ended questions about mental health, Instagram use, exposure to Instagram content, and mental health disclosures. The interview began with questions about mental health experiences and questions about Instagram use. We then asked participants about the similarities between their Instagram presence and their lived experience. Finally, we asked students about their attitudes toward mental health disclosures, the process of making disclosures on Instagram, and other users' responses to disclosures. The interviews lasted between 40-45 minutes on average and were audio recorded. Participants gave written consent to participate and were given a $20 gift card for participating.</p> <hd id="AN0155633054-6">Instagram data collection</hd> <p>This study employed a multi-modal approach by examining participant Instagram posts in parallel to qualitative interview data. To obtain Instagram data, we created a private Instagram account with which to "follow" participants' profiles. Participants consented in writing to allow us to have access to their profiles for a week following the interview, after which point, we disconnected from their profiles. This open period was used to gather retrospective posts from participants' profiles from three months preceding their date of entry into the counseling center up until the interview date. Participants providing Instagram data received a $10 gift card for this activity.</p> <hd id="AN0155633054-7">Analysis</hd> <p></p> <hd id="AN0155633054-8">Interviews</hd> <p>Qualitative interviews were transcribed verbatim from audio recordings, and our analytic strategy was characterized by inductive coding that allowed themes to emerge throughout the process of reviewing transcripts.[<reflink idref="bib19" id="ref23">19</reflink>] We first created a global code called "Instagram basics" to illustrate features of participants' Instagram use. To understand the extent to which Instagram presence reflected lived mental health experience, we created codes for participant reports about Instagram's culture (what is acceptable to other Instagram users), prevalence of mental health disclosures on Instagram, attitudes toward making disclosures, and examples of participant disclosures. After reviewing the transcripts multiple times, we advanced to focused coding, during which global codes were narrowed to themes that described relationships between codes.[<reflink idref="bib19" id="ref24">19</reflink>] After making comparisons across participants, we selected quotes that best represented each theme. Appendix 1 outlines global codes, themes and examples of coded text from the interviews.</p> <hd id="AN0155633054-9">Instagram</hd> <p>To understand how mental health disclosures were reflected in participants' Instagram presence, Instagram data were analyzed during interview analysis. Instagram posts were grouped by respondent, and qualitative analysis of Instagram posts was conducted in parallel to interview data and in consideration of themes that emerged during interview analysis. We devised analytic memos during this process, and posts that best represented interview themes were chosen to be presented in the narrative. Photos displayed in the results section are examples of disclosures given by participants during the interviews. Additionally, we selected captions from photos that were content analyzed and determined to contain emotional disclosures, such as aspects of mental health, moods, or emotional states.[<reflink idref="bib13" id="ref25">13</reflink>]</p> <p>We also analyzed Instagram posts and profiles quantitatively, first determining the total number of posts across participants and the mean and median posts made per participant. We then quantified the mean and median number of followers per participant. We also created ranges of numbers to represent the number of likes per photo. Finally, we content analyzed photo content, which consisted of categories for photos of people, nature, objects, or text/quotes.[<reflink idref="bib20" id="ref26">20</reflink>]</p> <p>Photos containing people were coded as selfies (self-portrait taken in a mirror or with camera outstretched, turned toward the photographer), group selfies (selfie of user and others), non-selfie photos of the participant, and non-selfie photos of groups. Photos that did not contain people were categorized as nature (i.e., trees), objects (i.e., buildings), or text (photo dominated by text). We entered these codes as binary variables, and more than one option could be chosen for photo content. We limited our content analysis coding to photos and did not code videos.</p> <hd id="AN0155633054-10">Participant demographics and characteristics of instagram use</hd> <p>We described participant demographics and information about their Instagram use using the Qualtrics screening form, interview data, and Instagram data. We used the 2016 Pennsylvania State University (PSU) Center for Collegiate Mental Health Annual Report to compare participant demographics to a national sample of U.S. university students seeking mental health services.[<reflink idref="bib21" id="ref27">21</reflink>] This report described data from 400 college and university counseling centers in the U.S., which included student demographics and reasons for seeking counseling.</p> <hd id="AN0155633054-11">Results</hd> <p></p> <hd id="AN0155633054-12">Participant demographics</hd> <p>Across the recruitment period, 40 people completed the screening form, and 21 met the enrollment criteria and participated in the study. Participants in our sample were an average of 21.3 years of age. Most participants were in their sophomore (24%) or junior year (29%) at the university, which is consistent with a national sample of U.S. university mental health service users.[<reflink idref="bib21" id="ref28">21</reflink>] Approximately 19% of participants were graduate students, and participants in their freshman and senior years each represented 14.3% of the sample. The majority of participants (91%) identified as women, and only 10% identified as male. Over half of our sample (57%) identified as Asian or Asian-American, compared to 7% in the national sample.[<reflink idref="bib21" id="ref29">21</reflink>] The remainder of the sample was largely white (43%). Race/ethnicity was not a mutually exclusive category in our study, and participants could select more than one option.</p> <p>Participants spent an average of 11.3 months in university-based counseling. Most participants reported seeking counseling because of academic/work stress (52%), depression symptoms (48%), anxiety symptoms (38%), or relational stress (38%), which were also the most frequent concerns reported in the national sample.[<reflink idref="bib21" id="ref30">21</reflink>]Table 1 contains participant demographic information.</p> <p>Table 1. Participant demographics (N = 21).</p> <p> <ephtml> <table><thead><tr><td /><td>Study Sample</td><td><bold>National Sample of U.S. University Student Mental Health Service Users</bold><xref ref-type="table-fn" rid="tfn4">d</xref></td></tr><tr><td /><td><italic>N</italic></td><td><italic>%</italic></td><td><italic>%</italic></td></tr></thead><tbody valign="top"><tr><td><bold>Class Year</bold></td><td /><td /><td /></tr><tr><td><bold> Freshman</bold></td><td>3</td><td char=".">14</td><td>21</td></tr><tr><td><bold> Sophomore</bold></td><td>5</td><td char=".">24</td><td>20</td></tr><tr><td><bold> Junior</bold></td><td>6</td><td char=".">29</td><td>23</td></tr><tr><td><bold> Senior</bold></td><td>3</td><td char=".">14</td><td>21</td></tr><tr><td><bold> Graduate student</bold></td><td>4</td><td char=".">19</td><td>13</td></tr><tr><td><bold>Age</bold><xref ref-type="table-fn" rid="tfn1">a</xref></td><td /><td /><td /></tr><tr><td><bold> 18</bold></td><td>2</td><td char=".">10</td><td><italic>No data</italic></td></tr><tr><td><bold> 19</bold></td><td>2</td><td char=".">10</td><td>–</td></tr><tr><td><bold> 20</bold></td><td>5</td><td char=".">25</td><td>–</td></tr><tr><td><bold> 21</bold></td><td>2</td><td char=".">10</td><td>–</td></tr><tr><td><bold> 22</bold></td><td>4</td><td char=".">20</td><td>–</td></tr><tr><td><bold> 23</bold></td><td>2</td><td char=".">10</td><td>–</td></tr><tr><td><bold> 24</bold></td><td>2</td><td char=".">10</td><td>–</td></tr><tr><td><bold> 28</bold></td><td>1</td><td char=".">5</td><td>–</td></tr><tr><td><bold>Gender Identity</bold></td><td /><td /><td /></tr><tr><td><bold> Man</bold></td><td>2</td><td char=".">10</td><td>35</td></tr><tr><td><bold> Woman</bold></td><td>19</td><td char=".">91</td><td>63</td></tr><tr><td><bold>Race Ethnicity</bold><xref ref-type="table-fn" rid="tfn2">b</xref></td><td /><td /><td /></tr><tr><td><bold> Asian/Asian-American</bold></td><td>12</td><td char=".">57</td><td>7</td></tr><tr><td><bold> Black/African-American</bold></td><td>1</td><td char=".">5</td><td>9</td></tr><tr><td><bold> White</bold></td><td>9</td><td char=".">43</td><td>68</td></tr><tr><td><bold> Other/multiple races/ethnicities</bold></td><td>1</td><td char=".">5</td><td>5</td></tr><tr><td><bold>Time in University-Based Counseling (Months)</bold></td><td><italic>M</italic></td><td><italic>Mdn</italic></td><td>Range</td><td><italic>M</italic> (# of sessions)</td></tr><tr><td /><td>11.3</td><td>4</td><td>1-30</td><td>4.7 per person</td></tr><tr><td><bold>Reasons for Seeking Counseling</bold><xref ref-type="table-fn" rid="tfn2">b</xref></td><td /><td /><td /></tr><tr><td><bold> Academic/work stress</bold></td><td>11</td><td char=".">52</td><td>28</td></tr><tr><td><bold> Relational stress</bold></td><td>8</td><td char=".">38</td><td>27</td></tr><tr><td><bold> Grief and loss</bold></td><td>1</td><td char=".">5</td><td>11</td></tr><tr><td><bold> Depressive symptoms</bold></td><td>10</td><td char=".">48</td><td>49</td></tr><tr><td><bold> Anxiety symptoms</bold></td><td>8</td><td char=".">38</td><td>61</td></tr><tr><td><bold> Suicidal ideation</bold></td><td>2</td><td char=".">10</td><td>9</td></tr><tr><td><bold> Body image</bold></td><td>1</td><td char=".">5</td><td>14</td></tr><tr><td><bold> Obsessive Compulsive Disorder</bold><xref ref-type="table-fn" rid="tfn4">d</xref></td><td>1</td><td char=".">5</td><td>4</td></tr><tr><td><bold> Sexual harassment or assault</bold></td><td>1</td><td char=".">5</td><td>7</td></tr></tbody></table> </ephtml> </p> <p>1 Data from one participant missing.</p> <ulist> <item>2 Not mutually exclusive.</item> <item>3 Sample drawn from the Pennsylvania State University Center for Collegiate Mental Health (2016).</item> <item>4 No data on Obsessive Compulsive Disorder in national sample- percentage represents "other" concerns reported.</item> </ulist> <hd id="AN0155633054-13">Characteristics of instagram use</hd> <p>All interview participants provided Instagram posts, with 933 posts across all participants and an average of 44.4 posts and 10.8 months of posts per person. More than half (57%) of participants reported that they used Instagram more than once per day. Approximately 57% of participants kept private profiles, while the rest kept public profiles. Participants had an average of 462 followers per user (median = 432), and photos most often received 21 to 60 likes (46%). One participant's file was corrupted, so likes and comments on select posts (7% of total posts) were missing. Participants were most likely to post photos of objects (27%) or non-selfie group photos (26%). Table 2 outlines characteristics of participants' Instagram activity.</p> <p>Table 2. Participant Instagram activity features from self-reports and Instagram analysis.</p> <p> <ephtml> <table><thead><tr><td /><td><italic>N</italic></td><td><italic>%</italic></td><td><italic>M</italic></td><td><italic>Mdn</italic></td><td>Range</td></tr></thead><tbody valign="top"><tr><td><bold>Self-Reported Frequency of Instagram Use</bold></td><td /><td /><td /><td /><td /></tr><tr><td><bold />One time/week</td><td char=".">2</td><td>10</td><td /><td /><td /></tr><tr><td><bold />2-3 times/ week</td><td char=".">2</td><td>10</td><td /><td /><td /></tr><tr><td><bold />4-5 times/week</td><td char=".">1</td><td>5</td><td /><td /><td /></tr><tr><td><bold />Once/day</td><td char=".">4</td><td>19</td><td /><td /><td /></tr><tr><td><bold />More than once/day</td><td char=".">12</td><td>57</td><td /><td /><td /></tr><tr><td><bold>Profile Status</bold></td><td /><td /><td /><td /><td /></tr><tr><td><bold />Public profile</td><td char=".">9</td><td>43</td><td /><td /><td /></tr><tr><td><bold />Private profile</td><td char=".">12</td><td>57</td><td /><td /><td /></tr><tr><td><bold>Followers per Participant</bold></td><td /><td /><td>462</td><td>432</td><td char=".">88-1098</td></tr><tr><td><bold>Posts per Participant</bold></td><td /><td /><td>45.7</td><td>16</td><td char=".">1-243</td></tr><tr><td><bold>Months of Instagram Data Contributed</bold></td><td /><td /><td>10.8</td><td>7</td><td char=".">2-33</td></tr><tr><td><bold>Types of Photos Posted</bold><xref ref-type="table-fn" rid="tfn5">a</xref></td><td /><td /><td /><td /><td /></tr><tr><td><bold />Selfie</td><td char=".">137</td><td>14.7</td><td /><td /><td /></tr><tr><td><bold />Group selfie</td><td char=".">89</td><td>9.6</td><td /><td /><td /></tr><tr><td><bold />Non-selfie individual</td><td char=".">145</td><td>15.6</td><td /><td /><td /></tr><tr><td><bold />Non-selfie others/group</td><td char=".">243</td><td>26.1</td><td /><td /><td /></tr><tr><td><bold />Nature</td><td char=".">138</td><td>14.8</td><td /><td /><td /></tr><tr><td><bold />Objects</td><td char=".">247</td><td>26.5</td><td /><td /><td /></tr><tr><td><bold />Text</td><td char=".">45</td><td>4.8</td><td /><td /><td /></tr><tr><td><bold>Likes per Photo</bold></td><td /><td /><td /><td /><td /></tr><tr><td><bold />0-20</td><td char=".">169</td><td>18.1</td><td /><td /><td /></tr><tr><td><bold />21-40</td><td char=".">225</td><td>24.1</td><td /><td /><td /></tr><tr><td><bold />41-60</td><td char=".">205</td><td>22.0</td><td /><td /><td /></tr><tr><td><bold />61-80</td><td char=".">96</td><td>10.3</td><td /><td /><td /></tr><tr><td><bold />81-100</td><td char=".">42</td><td>4.5</td><td /><td /><td /></tr><tr><td><bold />101-120</td><td char=".">20</td><td>2.1</td><td /><td /><td /></tr><tr><td><bold />121-140</td><td char=".">18</td><td>1.9</td><td /><td /><td /></tr><tr><td><bold />141-160</td><td char=".">27</td><td>2.9</td><td /><td /><td /></tr><tr><td><bold />161+</td><td char=".">60</td><td>6.4</td><td /><td /><td /></tr><tr><td><bold />NONE (corrupted file)</td><td char=".">68</td><td>7.3</td><td /><td /><td /></tr></tbody></table> </ephtml> </p> <p>5 Not mutually exclusive.</p> <p>Participants reported in the interviews that they were more likely to use Instagram for browsing than for posting. Browsing included consuming news, viewing celebrity or commercial accounts, and exploring interests, such as art or sports. Several participants also reported that they "stalked" or viewed peers' profiles in detail to learn about them. Some participants reported using their Instagram profiles as a "scrapbook" to document moments that they wished to remember later in life.</p> <p>Participants reported that they mainly posted photos of themselves, travel or scenery, or family, friends, and partners. This was reflected in the Instagram analysis, but we also found that many participants posted photos of objects. Some reported that they were particularly likely to post pictures of special occasions and novel experiences. Many participants said that they posted photos to elicit positive responses ("likes") from other users, and some said that they only posted photos that would receive likes. A junior year participant reported that his anxiety about others' responses kept him from posting frequently.</p> <p> <emph>"I usually don't like posting on Instagram...I always get...anxious...that I'm gonna like post like a bad story...people will watch and like 'that was weird...why did he post that?'"</emph> </p> <p>Three woman participants said that they could anticipate which kinds of photos would receive the most likes: photos of oneself and photos with other people. Several participants reported that they ruminated on the number of likes and experienced negative feelings when they did not receive the number anticipated. A junior year participant expressed shameful feelings about her preoccupation with likes.</p> <p> <emph>"Sometimes, there is...this part of me where it goes like...'why this picture not get as many likes?'...I used to find it very disgusting, that mental thought, but it has been happening for quite some time"</emph> </p> <hd id="AN0155633054-14">Participant experiences of instagram use</hd> <p></p> <hd id="AN0155633054-15">Positivity bias</hd> <p>Participants reported experiencing positivity bias on Instagram, as well as posting content that conformed to this bias. Many reported seeing an overrepresentation of posts that suggested that the user was "having a good time" or "living a good life." Several participants called this practice "fake" or "curated." One participant in her junior year stated that positivity bias results from users' desires to receive positive interactions.</p> <p> <emph>"I think the natural, normal goal right now for social media...is not to share what is ...your life but to...share the good things of your life, and unfortunately...a little side effect goal is to get likes or...good interactions"</emph> </p> <p>During our Instagram analysis, we found that a sophomore participant displayed an awareness of this phenomenon in a photo of herself on the beach captioned,</p> <p> <emph>"Tried...working out today. Felt great til I made the mistake of looking on Instagram people are so pretty, toned, thic, worldly, successful...then there's me"</emph> </p> <hd id="AN0155633054-16">Instagram culture and mental health content</hd> <p>Instagram culture also included an absence of mental health content. Four participants said that they "rarely" or "never" saw mental health content on Instagram. Two said they saw users post about situational issues (i.e., breakups) but not explicitly about mental health. Some said that they saw mental health content on Twitter but not on Instagram. Another said that mental health disclosures are "self-branding" to "solicit [a] response" from one's audience [woman, senior]. Even when participants saw mental health disclosures on Instagram, some said that these also contained positivity bias. A graduate student participant described characteristics of mental health disclosures on Instagram.</p> <p> <emph>"It's always...presented as...on the other side...people I went to high school with have drug problems, and they like post like 'x number days clean...' it's always like [a] positive spin."</emph> [woman participant]</p> <hd id="AN0155633054-17">The idealized self</hd> <p>Participants reported that they conformed their posts to meet the "standard" of Instagram culture, which included putting a great deal of effort into each post and presenting an idealized version of the self. This entailed taking multiple photos, extensively editing them, and soliciting others' opinions about the photos before posting. A senior year participant described her tendency to present an idealized image of herself on Instagram.</p> <p> <emph>"I've definitely projected this girl that is carefree...My thought process at the time that I'm taking these pictures is different, but when I post them, people get a positive image of me."</emph> </p> <p>Positivity bias also caused some participants to post positive content to conceal their MHCs. Many reported that they only posted when they were feeling happy, which contributed to this seemingly positive presence. For example, a freshman participant said that she only posted older photos from when she was "feeling better." A senior year participant said that her Instagram presence contained exciting experiences and portrayed a person who did not have "any mental health issues." A freshman participant said that she presented this content because she did not want people to "know what [she] was thinking," but "there's always more behind the picture." Another freshman participant described her desire to create the impression that she was not struggling with MHCs.</p> <p> <emph>"I...wanna like keep my personal account...one dimensional...I'm a...sane human being...not dealing with depression...tryin' to put out like the '...I'm doing great right now' vibe."</emph> </p> <hd id="AN0155633054-18">Instagram and mental health disclosures</hd> <p>Most participants reported being hesitant to make mental health disclosures on Instagram. In many cases, the interviewer had to rephrase questions about mental health disclosures to "moods," or "what you are going through" to elicit answers about disclosures. Participants reported fears about both public and self-stigma related to posting mental health disclosures.</p> <hd id="AN0155633054-19">Public stigma</hd> <p>Several participants held preconceptions about the ways in which others might stigmatize them if they disclosed about mental health. They said that others would perceive them as "attention-seeking" or that they would receive no response because people "don't care." Some participants also worried that they would receive unsolicited attention for their disclosures. Some cited fears of being perceived as "crazy," and others thought that these disclosures would "scare" people or cause others to ostracize them. A sophomore participant described her reticence to post about her panic attacks on Instagram.</p> <p> <emph>"The panic attack...I wouldn't...put that on social media...because it's too personal... there are a lot of people on my social media who are never going to understand it, like for them it's still a stigma."</emph> </p> <hd id="AN0155633054-20">Self-stigma</hd> <p>Participants also cited self-stigma as a barrier to disclosure. Some said that making mental health disclosures would make them feel "weak" or "vulnerable." Two said that they would be "embarrassed" for others to know that they had MHCs. A senior year participant said that these feelings of embarrassment stem from the culture of Instagram.</p> <p> <emph>"A lot of people don't want...to show that...side...being vulnerable...projecting whatever issues...out into like this space where it's usually all for show..."</emph> </p> <hd id="AN0155633054-21">Second profiles or "finstas."</hd> <p>In response to the pressure conform to Instagram culture, five participants reported that they created secondary accounts only shared with their closest friends. Three participants called these profiles "Finstas" (fake Instagrams). Four participants gave consent for these profiles to be analyzed along with their primary profiles. Participants reported that they were more active on these accounts than on their "main" profiles. Two participants reported that they used these profiles to browse discretely, and one said that she used it to view "depression memes." A junior year participant said that her Finsta allowed her to post about her sexuality without revealing it to her wider social network. A sophomore participant described the difference between her Finsta and her main account.</p> <p> <emph>"...You just post whatever...how you're feeling...On...my real Instagram, I really can't post everything that I want...Everyone has...things they wanna hide...Instagram is...all about image, you know?"</emph> </p> <hd id="AN0155633054-22">The art of disclosure</hd> <p>Despite an overall reticence to make mental health disclosures on Instagram, participants identified instances in which they disclosed. From participant reports, two types of disclosures emerged, which we described as "direct" and "indirect." Participant reports shaped the definition of direct disclosures, which were posts that intentionally revealed details about mental health, moods, or feelings. We also included posts that emerged in our Instagram analysis that were forthright about these topics. Indirect disclosures were defined as posts that participants reported to be about mental health, moods, or feelings but did not discuss these outright.</p> <hd id="AN0155633054-23">Direct disclosures</hd> <p>Participants categorized a variety of posts as direct disclosures, ranging from situational issues to explicit posts about mental health. A junior year participant defined a direct disclosure as a post about her grandmother who passed away. Three reported that their direct disclosures included political views. One participant that had a Finsta said that she would "never" disclose on her "main" profile but would post "pictures of [herself] crying" on her Finsta [sophomore]. A junior year participant provided the direct disclosure post shown in Figure 1, describing it as "pretty personal."</p> <p>PHOTO (COLOR): Figure 1. Junior year participant direct disclosure instagram post and caption.</p> <p>Three participants posted direct disclosures that emerged in our Instagram analysis. A graduate student participant posted a photo of herself frowning captioned, "accurate depiction of current mental state," and a junior year participant posted a photo of herself with friends captioned, "finding friends with the same mental disorder...priceless." Additionally, the participant that reported disclosing on her Finsta account posted two identical pictures on both accounts, one on her "main" account that did not contain a disclosure and one on her Finsta account captioned, "crying while trying to put on mascara is probably one of the most tragic and stressful things..."</p> <hd id="AN0155633054-24">Indirect disclosures</hd> <p>Indirect disclosures were more common amongst participants, and 11 reported making these disclosures. Many said that they used song lyrics or quotes to indirectly discuss their feelings or mental health. A freshman participant called it "vaguing" or "being honest but not too honest." Some reported topics of these disclosures were depression, anxiety, and bullying. A freshman participant described a post that alluded to her depression.</p> <p> <emph>"I posted this one picture where...I looked really happy...and my caption was like 'don't be fooled,' but like some people can...not understand what I mean"</emph> </p> <p>A sophomore participant reported that she used song lyrics in her captions that would suggest that she was "feeling down" but that she did not publicize her "mental status." She provided Figure 2 as an example of an Instagram post in which she indirectly referred to MHCs.</p> <p>PHOTO (COLOR): Figure 2. Sophomore year participant indirect disclosure instagram post and participant description of post.</p> <p>A junior year participant said that she created a Photoshop project for Instagram, intended to be a direct disclosure about her struggle with social comparison and mental health. However, instead of posting a caption in which she disclosed directly, she censored it because she felt that it was too "out there." Figure 3 illustrates this post with a quote from the participant about her experience making the post.</p> <p>PHOTO (COLOR): Figure 3. Junior year participant indirect disclosure instagram post and participant description of post (participant's face removed).</p> <hd id="AN0155633054-25">Responses to disclosures</hd> <p>Most participants reported that they typically received no response to their disclosures or received likes rather than messages or comments. A sophomore participant reported that when she received comments on an indirect disclosure, the comments were not appropriate for the feelings conveyed in her post. She said she felt that people were "scared to say something" or "ask what's wrong."</p> <p> <emph>"...I posted like a selfie...with...a sad lyric as my caption, and my sister commented...'you look so sad,' and then she has the emoji that was like laughing crying...I was like, 'I am sad, like that's why I posted it...' Then one of my friends commented like 'you're so cute!' I was like 'thanks, but that's not what I'm trying to say.'"</emph> </p> <p>Some participants reported that they intentionally posted disclosures to elicit responses from others. For example, a junior year participant reported that she posted "a really sad quote" on her Finsta account after a breakup, so that her ex-girlfriend would see it and respond. Another junior year participant said she felt that this practice was typical of her generation of social media users.</p> <p> <emph>"...Our generation does that a lot on social media. Like we'll post stuff that we like wanna get a specific response about, but we're very like implicit in it..."</emph> </p> <p>Three participants reported that they would have appreciated a response to their disclosures. A junior year participant described her disappointment in others' lack of responses.</p> <p> <emph>"Usually, what I hope for [after disclosing] doesn't happen... I will hope like the person that I am trying to reach out to...would actually...drop me a text to say 'hey, like saw this post, like, are you okay?'...That just makes me feel like I am...worth something...because of my negative emotions, I just wanted to fill that hole with like love and acceptance..."</emph> </p> <p>Two participants reported that they received positive responses to disclosures through messages or comments. A sophomore participant stated that, when others responded to disclosures on her Finsta, it made her feel as if they "cared" and "took [her] seriously." The other participant (junior) said that users thanked her for her suicide awareness post and responded positively to her "body positivity" post.</p> <p>Although most participants were hesitant to disclose on Instagram, some said that they were beginning to disclose or wished to disclose in the future. Two junior year participants reported that they had recently begun posting about mental health, which they described as more "authentic" or "personal." Two other participants expressed that they had not disclosed but were considering doing so. One said that it was "something [she] believe[d] in" (junior), and the other (senior) called it "brave" to make mental health disclosures.</p> <hd id="AN0155633054-26">Discussion</hd> <p>Students utilizing university mental health services internalize Instagram content in ways that may inhibit their use of the platform for mental health disclosures and support-seeking. Many participants reported using Instagram to receive positive responses from others, which required them to conform their content to reflect Instagram's culture of positivity bias.[<reflink idref="bib16" id="ref31">16</reflink>] Positivity bias was also characterized by an absence of mental health content, which can provide helpful models for future disclosures among young adults. Overall, participants tended to internalize Instagram's culture and present versions of themselves that were incongruent to their mental health experiences.</p> <p>Participants were averse to posting mental health disclosures on Instagram and cited perceived public stigma and self-stigma as barriers to disclosure. However, participants reported instances in which their posts reflected their lived experiences. Several participants defined disclosures as situational (i.e., break-ups), rather than explicit mental health posts. The aversion to mental health disclosures may be compounded by the fact that many participants kept public profiles and averaged over 400 followers per person, which implies that their profiles had a large audience.</p> <p>Some participants made direct disclosures, but these were not as common as indirect disclosures, which consisted of posts intended to communicate aspects of mental health without being forthright about those experiences. Some participants created secondary accounts, which presented confidential disclosure spaces. This finding reflects research showing that users posting about sensitive topics on Yahoo! Answers created secondary accounts to post questions confidentially.[<reflink idref="bib22" id="ref32">22</reflink>] Finally, although many participants reported that they would like others to respond to their disclosures, responses were uncommon or perceived as unhelpful.</p> <hd id="AN0155633054-27">Proposed model</hd> <p>Our findings provide a framework through which to understand young adults' decision-making process of making mental health disclosures on social media (Figure 4). Our findings suggested that MH disclosures on social media, which can elicit social support, were influenced by four factors: internalizing social media culture, stigma (public and self-stigma), seeking positive responses from other users on social media posts, and perceived confidentiality of social media posts. Internalizing social media culture (positivity bias, lack of mental health content) reportedly contributed to perceived public stigma and internalized self-stigma,[<reflink idref="bib23" id="ref33">23</reflink>] which seemed to discourage disclosures. Participants also reported that the desire to receive positive responses on their posts discouraged disclosure. Finally, perceived confidentiality (i.e., anonymous or Finsta accounts) reportedly encouraged disclosures, which may be especially salient to those with high levels of self-stigma. Although this model was developed through Instagram-related findings, it can be useful in understanding mental health disclosures across platforms. Future research can test this model empirically, using quantitative methodologies such as surveys to test associations between the proposed factors and willingness to make mental health disclosures on social media. Future studies may also expand these findings by using this model to examine predictors of disclosures across multiple platforms. University counseling center clinicians can reference this framework to explore issues of social media positivity bias and approval-seeking with students. Finally, student- or university-led advocacy for support-seeking on social media can use this model to inform efforts to reduce barriers to disclosures on these platforms.</p> <p>PHOTO (COLOR): Figure 4. Proposed model of factors influencing young adults' mental health disclosures on social media.</p> <hd id="AN0155633054-28">Limitations</hd> <p>One limitation of this study was that participation was limited to participants who were seeking university-based mental health services during the study period and had no prior mental health-related hospitalizations. This is not representative of the entire student population living with MHCs, because students requiring a higher level of care were likely excluded from the study. Over half of our sample identified as Asian or Asian-American, and the remainder was largely white, which may limit the generalizability of our findings. However, according to PSU Center for Collegiate Mental Health, Asian and Asian-American populations are underrepresented in university counseling centers.[<reflink idref="bib21" id="ref34">21</reflink>] Therefore, these students' perspectives may be missing from other studies of university student mental health. A majority of our sample also identified as women, meaning that our findings may not generalize to male student experiences. Female are almost twice as likely to utilize university counseling centers as male[<reflink idref="bib21" id="ref35">21</reflink>] and are also more likely to use Instagram,[<reflink idref="bib24" id="ref36">24</reflink>] but the proportion of women in our sample exceeded what would be expected.</p> <p>Some participants had been utilizing the counseling center longer than others and thus, we had access to a longer period of Instagram activity, potentially weighting Instagram data toward older students and those with longer involvement in counseling. However, those accessing the counseling center longer did not always post on Instagram as frequently as those that sought services soon before the study period. In addition, one participant's Instagram data was corrupted, which removed information from some of the posts.</p> <p>Instagram posts and interviews were gathered independently, and participants were not required to engage with their Instagram posts during the interview. Some participants voluntarily opened their accounts during the interview, but this was optional. Future studies should explore participants' insight into their Instagram presence during the interview process. We also did not examine posts temporally relative to counseling initiation, and future studies should be conducted on potential differences in posts prior to and following counseling initiation using longitudinal Instagram data. Finally, this study did not address the direct effects of disclosure on mental health outcomes.</p> <hd id="AN0155633054-29">Conclusions</hd> <p>To encourage mental health disclosures on Instagram, the culture of this platform must shift from curated, idealized portrayals of the self and toward a setting in which young adults can receive supportive responses to disclosures. Given that the majority of social media users are young adults, university students are well positioned to advocate for social media communities that are supportive to mental health disclosures. Those providing university student services, such as counseling centers or student life offices, can aid in this effort by designing workshops on supportive responses to social media-based mental health disclosures or by facilitating student-led efforts of this kind. Considering the benefits of social support to well-being and the predilection for social media use in university students, student- and university-led initiatives to promote social media environments conducive to mental health disclosures could have widespread benefits for university student mental health.</p> <hd id="AN0155633054-30">Acknowledgments</hd> <p>Incentives provided by Drexel University Dornsife School of Public Health dissertation funding scholarship. Thank you to Dr. Paul Furtaw for facilitating study recruitment.</p> <hd id="AN0155633054-31">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States of America and received approval from the Institutional Review Board of Drexel University.</p> <hd id="AN0155633054-32">Funding</hd> <p>Incentives provided by Drexel University Dornsife School of Public Health dissertation funding scholarship.</p> <ref id="AN0155633054-33"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2020.1759608.</bibtext> </blist> </ref> <ref id="AN0155633054-34"> <title> References </title> <blist> <bibtext> Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. 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  Data: 'If I Was to Post Something, It Would Be Too Vulnerable:' University Students and Mental Health Disclosures on Instagram
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  Data: <searchLink fieldCode="AR" term="%22Budenz%2C+Alexandra%22">Budenz, Alexandra</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-9885-9785">0000-0001-9885-9785</externalLink>)<br /><searchLink fieldCode="AR" term="%22Klassen%2C+Ann%22">Klassen, Ann</searchLink><br /><searchLink fieldCode="AR" term="%22Purtle%2C+Jonathan%22">Purtle, Jonathan</searchLink><br /><searchLink fieldCode="AR" term="%22Yom-Tov%2C+Elad%22">Yom-Tov, Elad</searchLink><br /><searchLink fieldCode="AR" term="%22Yudell%2C+Michael%22">Yudell, Michael</searchLink><br /><searchLink fieldCode="AR" term="%22Massey%2C+Philip%22">Massey, Philip</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2022 70(2):615-624.
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  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: 2022
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Social+Media%22">Social Media</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Help+Seeking%22">Help Seeking</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Bias%22">Social Bias</searchLink><br /><searchLink fieldCode="DE" term="%22Negative+Attitudes%22">Negative Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22School+Health+Services%22">School Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Experience%22">Student Experience</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Disclosure+%28Individuals%29%22">Self Disclosure (Individuals)</searchLink><br /><searchLink fieldCode="DE" term="%22Undergraduate+Students%22">Undergraduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Graduate+Students%22">Graduate Students</searchLink>
– Name: DOI
  Label: DOI
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  Data: 10.1080/07448481.2020.1759608
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  Group: ISSN
  Data: 0744-8481
– Name: Abstract
  Label: Abstract
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  Data: Objective: Assess Instagram use for mental health disclosure in university students to assess the potential for Instagram use as mental health support-seeking. Participants: Twenty-one students using mental health services while attending a private, Mid-Atlantic university between 6/2017-12/2017. Methods: Collected qualitative interview and Instagram data and analyzed them in parallel. Instagram data supplemented interview themes and were coded and analyzed quantitatively to define features of participants' Instagram use. Results: Participants displayed aversions to posting mental health disclosures on Instagram, citing public and self-stigma as barriers to disclosure. Despite this, participants reported instances in which their Instagram posts directly or indirectly reflected their lived experiences. Some also maintained second anonymous accounts for fuller disclosure. Conclusions: Given the benefits of mental health disclosures to well-being and the predilection for social media use in university students, student and university-led initiatives to promote social media environments conducive to disclosures could have widespread mental health benefits.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2022
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1335131
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1335131
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07448481.2020.1759608
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 615
    Subjects:
      – SubjectFull: Social Media
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Help Seeking
        Type: general
      – SubjectFull: Social Bias
        Type: general
      – SubjectFull: Negative Attitudes
        Type: general
      – SubjectFull: Barriers
        Type: general
      – SubjectFull: School Health Services
        Type: general
      – SubjectFull: Student Experience
        Type: general
      – SubjectFull: Self Disclosure (Individuals)
        Type: general
      – SubjectFull: Undergraduate Students
        Type: general
      – SubjectFull: Graduate Students
        Type: general
    Titles:
      – TitleFull: 'If I Was to Post Something, It Would Be Too Vulnerable:' University Students and Mental Health Disclosures on Instagram
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Budenz, Alexandra
      – PersonEntity:
          Name:
            NameFull: Klassen, Ann
      – PersonEntity:
          Name:
            NameFull: Purtle, Jonathan
      – PersonEntity:
          Name:
            NameFull: Yom-Tov, Elad
      – PersonEntity:
          Name:
            NameFull: Yudell, Michael
      – PersonEntity:
          Name:
            NameFull: Massey, Philip
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2022
          Identifiers:
            – Type: issn-print
              Value: 0744-8481
          Numbering:
            – Type: volume
              Value: 70
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Journal of American College Health
              Type: main
ResultId 1