A Qualitative Analysis of Youth Responses to Depression Education Delivered on Social Media

Depression is a common mental disorder among adolescents, with increased rates during the COVID-19 pandemic. Despite its high burden, few young people seek professional help due to, among other things, low mental health literacy and fear of stigma. Since most adolescents often seek health information online and use social media daily, the "ich bin alles" (English: "I am everything"; www.ich-bin-alles.de) project was launched to provide accessible, age-appropriate information about depression via a website and social media channels (e.g., Instagram). This study aims to understand how participants perceive and evaluate the social media channel "ich bin alles" (English: "I am everything"; https://www.instagram.com/ich.bin.alles/).

Depression is one of the most common mental disorders worldwide, with a prevalence of approx. 7.5% in youth. In connection with the COVID-19 pandemic, a meta-analysis found an increase in clinically relevant depressive symptoms to 25.2% in children and adolescents. At the same time, adolescents who experience mental health crises are reluctant to seek help and only 12% of adolescents with clinically relevant depressive symptoms seek professional treatment. The main barriers for young people to seek professional help include low knowledge of mental disorders/low mental health literacy and social factors such as the fear of stigmatization. Mental health literacy (MHL) is defined as "knowledge of how to prevent mental disorders, recognition of when a disorder is developing, knowledge of help-seeking options and treatment available, knowledge of effective self-help strategies for milder problems, and first aid skills to support others who are affected by mental health problems". It has been found that increased depression literacy can reduce depressive symptoms in adults and improve help-seeking for depression. Stigma in the context of mental health is a multidimensional concept that encompasses several domains. For many people living with mental illness, stigma is a significant contributor to a wide range of negative outcomes, including delayed help-seeking, hopelessness, diminished self-esteem, reduced quality of life and poorer clinical outcomes. Many of these negative effects have also been found in young people with mental health problems. Therefore, improving MHL and reducing the stigmatization of mental illness are two important starting points that can serve as targets for interventions. Improved MHL goes hand in hand with better knowledge about seeking help and less stigmatization of mental illness. The vast majority of adolescents in western countries, such as the United States and Germany, have access to digital devices, such as smartphones. 97% of young people in the United States (13-17 years) state that they use social media and 45% say that they are online almost all the time. Along with this, young people are more likely to ask health questions, including mental health questions, online than through other channels. However, to date, few digital psychoeducational interventions for depression in adolescents have been developed and evaluated. In order to meet this need for action in a contemporary manner that attracts youth, the web-based project "ich bin alles" (English: "I am everything"; www.ich-bin-alles.de) was launched in September 2021 with an associated social media presence. The "ich bin alles" project provides comprehensive evidence-based and age-appropriate information on depression and mental health in youth via social media (such as Instagram). This strategy of providing information via social media is to be scientifically evaluated in this study. The aim of this qualitative study is to evaluate the spontaneous thoughts and feelings that young people express while viewing "ich bin alles" Instagram content and to understand how the participants perceive and evaluate it. This will be investigated using the "Thinking Aloud Protocol"- method in 10-20 healthy adolescents and adolescents with current or remitted depression aged 13-18 years. The results of the study can help to gain insight into the perception and acceptance of the content.