Social media users with major depression are more likely to seek treatment, report unmet treatment needs, and have a higher risk of suicide than individuals with minor depression, according to study results published in Depression and Anxiety. Attitudinal barriers, such as the wish to handle the problem alone, were highest in individuals with major depression, while individuals with mild depression experienced more structural barriers, such as financial concerns.

Hannah Szlyk, PhD, from the George Warren Brown School, Washington University in St. Louis, Missouri, and colleagues recruited individuals 15 years or older who posted about or followed groups involving depression-related topics. They examined online depression forums or social media platforms, including Instagram, Facebook, Twitter, Reddit, and Tumblr, between October 2016 and August 2018. The researchers assessed depression with the Patient Health Questionnaire-9, as well as sociodemographic factors and treatment barriers via survey items.

A total of 348 participants (median age, 22 years; 70% men) met criteria for depression (major, n=179; mild, n=169). Compared with patients who had mild depression, patients with major depression were more likely to seek treatment (84% vs 71%; P =.029), report an unmet need for treatment (86% vs 75%; P =.044), be an adolescent (32% vs 15%; P =.014), and have a higher risk for suicide (87% vs 64%; P <.001).

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Overall, 95% of participants not linked to treatment who perceived an unmet treatment need reported at least 1 type of barrier to treatment. Individuals with major depression were more likely to experience attitudinal barriers toward treatment (76% vs. 51%; P =.001) and stigma (67% vs. 40%; P =.001) compared with patients with mild depression. Patients with minor depression were more likely to have structural barriers than patients with major depression (59% vs 41%, respectively; P =.024). In fully adjusted logistic regression models, attitudinal barriers toward stigma were significantly associated with major depression (OR, 3.42; 95% CI, 1.34-8.70), age (OR, 0.96; 95% CI, 0.92-1.01), and treatment history (OR, 0.26; 95% CI, 0.11-0.63), while financial and structural barriers were associated with high income (OR, 0.11; 95% CI, 0.03-0.44) and treatment history (OR, 0.34; 95% CI, 0.15-0.73), respectively.

The study may be limited by the self-selection of patients. “The findings of this study have implications for how social media can be used to help minimize barriers to treatment for depression through mental health literacy. Specifically, engagement strategies may take into account how barriers to treatment vary by severity of depression symptoms,” the investigators concluded.


Szlyk H, Deng J, Xu C, Krauss MJ, Cavazos-Rehg PA. Leveraging social media to explore the barriers to treatment among individuals with depressive symptoms [published online Jan 13, 2020]. Depress Anxiety. doi:10.1002/da.22990