Depression Goes Social Media

Abstract

Looking at the hashtag #depression on Instagram, this article examines how the topic is presented and which effects this may have. As a sample shows, the hashtag is often used by people from the field of counselling/therapy, but also by micro-influencers. Posts offer information, advice and self-disclosure, aiming at affected individuals and their social surroundings. It can be assumed that the phenomenon has positive effects both for people posting through the chance of communication and networking and for affected recipients, especially as most other posts on Instagram present people very positively and provoke social comparison. Of course, the hashtag can also be misused for attention-seeking, and misinformation is also conceivable. Despite the potential of art for mental well-being, artistic works are hardly used, which may be due to the difficulty of creating such posts—but could represent interesting options in the future, especially through image generation using artificial intelligence.

Introduction

This article investigates who posts on Instagram about depression, how and why the topic is represented, and the potential effects this may have on Instagram users in general, as well as the posters themselves. Depression is a prevalent mental disorder or illness and ‘a leading cause of disease and disability in young people worldwide’ (Prizeman et al., 2024, p. 1), and young people between 18 and 34 are the biggest group of Instagram users (Statista, 2024).

At first, the high presence of the hashtag #depression may come as a surprise, as people are sharing ‘negative emotions less openly than positive ones’ (Andalibi et al., 2015, p. 231). It has been argued that the image-driven nature of Instagram encourages people to present their lives as positively as possible (Lup et al., 2015). However, self-presentation on social media also implicates identity work (Gündüz, 2017; Vincent, 2021), which suggests addressing individual vital issues. Further, depression can also be linked to social and commercial services offered by therapists or coaches, for example. Looking at how #depression is represented will also, in interaction with the people posting themselves, contribute to the public image of the disorder, to how it and those affected by it are understood and thus to their chances for healing.

Definitions

First, it is helpful to explain the basic concepts of this contribution. This is particularly necessary considering that several studies have identified negative connections between social media and psychological well-being, findings that ‘call for attention to how seemingly innocuous technological features can pose a significant threat to well-being’ (Lee-Won et al., 2020, p. 1).

Depression

Depression has been defined as ‘an emotional state typically characterised by low mood, despondency, and feelings of hopelessness. Individuals who are depressed tend to feel pessimistic about the future, unhappy, or “down in the dumps”’ (Sullivan, 2009, p. 144); however, depression does not equal ‘depressive mood’: ‘Depression is not simply feeling blue or disappointed […] it is a cluster of signs and symptoms that lasts a long time and affects a person’s everyday functioning’ (Moragne, 2011, p. 16).

The disorder is a severe problem not only on an individual but also on a political and cultural level, as it poses ‘a major health concern due to its high prevalence, early-onset, and devastating consequences’ (Vesal & Rahimi 2021, p. 2) such as ‘functional impairment, increased risk of suicide, added health care costs, and productivity losses’ (Goldman et al., 2001, p. 569). Further, there are mutual effects: sociopolitical aspects can reinforce or lead to depression (for gender, see Maji, 2018; for ‘race’ and racism, see Desai et al., 2023), which in turn influences the social environment of an affected individual and, on a larger scale, society as a whole. However, healing can also be favoured by social circumstances such as increased awareness (Goldman et al., 2001, p. 577). Among the options for treatment are classical psychotherapy with different foci and newer treatments such as deep brain stimulation (Figee et al., 2022).

Because of several treatment barriers, online therapy has proven beneficial, especially for people with moderate symptoms (Moritz et al., 2012). Further, self-help therapy is shown to be effective in the case of minor-to-moderate depression (McKendree-Smith et al., 2003). Guided self-help has been offered online, and among its benefits are ‘prompt feedback, monitoring and presentation of material on a step-by-step basis’ (Andersson et al., 2005, p. 456). Such services are also advertised on social media.

Social Media

Social media have been described as ‘highly interactive platforms’ (Kietzmann et al., 2011, p. 241) intricately linked to identity understood as a discursive process (Jakaza, 2020, p. 3). Due to their ubiquity, social media are ‘an unmatched resource for research’ (Miller, 2014, p. 1), but also a research topic in their own right. The following section will focus on Instagram, a mobile picture-sharing application. It has quickly become one of the leading social networking services since its launch in October 2010.

As mentioned, much research suggests a connection between psychological problems and the (heavy) use of social media: the photos posted on social media tend to stress physical aspects (Lippl & Wohler, 2011), which may lead to the conclusion that their superficiality cannot fill an inner emptiness (Geiger, 2008, p. 22), matching the finding that adolescents who derive more of their self-worth from social media feedback are more depressed (Schreurs et al., 2024). Depression influenced by social comparison on social media has frequently been addressed (Hwang, 2019; Lup et al., 2015): although ‘comparisons can be motivating and have a positive effect on well-being’ (Meier & Schäfer, 2018, p. 411), it is more likely a harmful effect—even if the audience is aware of the underlying connections: ‘neither an authoritative disclaimer nor educating users about cognitive biases or mindsets significantly reduced the negative consequences of social comparisons’ (Weber et al., 2021, p. 411).

In addition, filter bubbles that arise due to algorithms (Pariser, 2011) not only help to find topics which are attractive for individuals but also lead to pathological self-reinforcement so that people suffering from a disorder like anorexia may get further incentives to foster their unhealthy body ideal (Lee-Won et al., 2020). Isolation, loneliness (Hu, 2009; Dror & Gershon, 2012; Primack et al., 2017) and cyberbullying (Katzer, 2013) have been further topics analysed in research on social media.

This should not deny the fact that studies have also shown that ‘different individuals apply their strengths and virtues differently on SNS to adapt to different life situations, feel satisfied with their life experiences, and not be trapped by depressive conditions’ and that ‘it helps them […] to create positive emotions, be happy about their life and be optimistic about their future based on the affordances provided by social media’ (Kasmani et al. 2022, referring to adolescents). As the prevalence of the hashtag #depression may suggest, it can also be beneficial to post about this topic.

In addition, it is worth mentioning that social media have been used frequently as tools for research, for example, in the question of how to identify markers of depression from photos posted by people (Andalibi et al., 2015; Kim et al., 2021; Reece & Danforth, 2017). Thus, social media helps recognise and understand disorders through its accessibility.

Content Analysis of Instagram Posts

The analysis was based on a search for the hashtag #depression. A new account was created so that it did not already have certain tendencies, as the logarithms get matched to a specific person and their preferences. As of April 2024, Instagram found the hashtag 24.4 million times. For the analysis, the first 100 posts made under the hashtag were taken into account, assuming that the number reflects an adequate picture and, at the same time, remains manageable for content analysis. Of course, a considerably larger sample could underpin the analysis, and it would also be interesting to see how and if the use of the hashtag has changed over time, which could be subject to further studies.

The algorithmic composition of the posts shown depends on various factors, including attention and timeliness. The cell phone’s location was Western Europe.

Only publicly visible accounts were displayed in the search. This avoids ethical concerns, as the people behind the accounts do not want privacy and, as evidenced by their hashtag use, are hoping for public attention. However, this means that those who do not use the hashtag for whatever reason and/or have set their account to ‘private’ fall through the cracks. There could be account holders who do not find hashtags important, forget to include the hashtag, or use words such as #sadness, #grief, #pain or #melancholy, for example. On the other hand, posts are included that may refer instead to the condition of ‘depressed mood’ or ‘being upset’ but not really to ‘depression’ or at least do not use the clinical term ‘depression’ adequately.

As the hashtag is based on a linguistic input, it is necessary to consider the language. The word ‘depression’, deriving from the Latin term ‘depresses = pressed down’, is spelt the same in English, German, French (the accent used in French is often omitted on social media) and several more languages. In Italian and Spanish, on the other hand, the spelling is slightly different. However, it is not unusual for accounts that want to reach a larger audience to use English in addition to hashtags in their language. Consequently, most of the contributions from the sample are in English, but the account holders’ origin is often unclear. Therefore, reflecting on how the topic is dealt with from different countries and/or cultural backgrounds is impossible.

Furthermore, it should also be mentioned that Instagram first displays a counselling offer in the hashtag search to refer vulnerable people to professional counselling. In addition, Instagram blocks some hashtags, for example, those connected to harmful body ideals, such as #thinspiration (Marcus, 2016).

Social Actors Posting

Who are the persons posting about depression on social media? One can usually get a glimpse of who is behind the posts by looking at the names of the account holders and their profiles. Sometimes, there are names of institutions, and sometimes, there are programmatic names such as ‘the self space’, which can be used by both institutions and individuals. Whenever individuals can be identified as account holders, the topic ‘depression’ is usually related to their professions, as with therapists, coaches, social workers, authors or other (micro-) influencers. In the case of (micro-)influencers, the question is to what extent their self-presentation revolves around the topic or if it is just one aspect among many.

The majority of social actors using the hashtag #depression on Instagram are professionals from the therapeutic or social field (around 60%), commercial or social institutions dealing with the topic (around 20%), or media with a public service mission (less than 5%, e.g., German public service media). For around 15%, it does not seem easy to assess whether a person or an association of people is behind the account. A somewhat smaller but partly overlapping proportion of up to 35% consists of individuals who have been or are suffering from depression or are related to individuals suffering from depression. Their individual experience has made some of them take up an occupation in counselling.

Thus, it can be concluded that the hashtag is used mainly by professionals, which brings financial interest to the fore. However, there is not necessarily a direct connection between economic interest and Instagram posts; for example, when a social organisation or a therapist makes an educational contribution, it may not directly lead to new clients. Therefore, it is difficult to tell how vital the monetary incentive may be for the people posting.

Addressed Issues and Advice

In terms of content, the posts can be roughly divided into two categories: information on the addressed issues and advice, using both neutrally presented facts and personal stories (as will be discussed under ‘modes of addressing’).

Some posts define (aspects of) depression, for example, differentiate it from ‘depressive mood’, mention demographics or symptoms. Further, comorbidities and problems associated with depression are also treated. In this context, one can find, for example, posts on fear, panic attacks and anger: ‘F’ck everything and run – face everything and recover’ (James Sebastiano, December 2023) or ‘There is a tremendous amount of repressed anger behind depression.’ (the.trauma.educator, April 2023). Psychosomatic issues are dealt with as well: ‘I wish people knew that mental health is physical too. Headaches. Dizziness. Heart Palpitations […]’ (anxiety_fightermum, December 2023).

Besides rather descriptive posts, advice is a significant topic. Of course, giving customised tips or real psychotherapy via a public social medium is difficult—accordingly, the tips are relatively general. Also, the contact points mentioned are spatially dispersed, but many services relate to online counselling.

Among the coping strategies, self-care or self-love is a particularly recurring topic. Appearing already in the Bible (Timothy 3:1-2) and in the second commandment, but also present in many other spiritual sources from all over the world (Maharaj & April, 2013, p. 120), self-love has been increasingly discussed in popular and scientific debate within the last 30 years (Faulconer, 1993, p. 2). In this context, self-love has to be understood as more than a (biological) ‘self-interest necessary for survival, one that is easily prone to overindulgence’ (Makujina, 1997, p. 211). Instead, it should be seen as a source of holistic love and, in the tradition of Erich Fromm, of psychological well-being. There are several posts in the sample that aim to promote self-love, such as the tips for mantras: ‘My emotions are valid. I am important. I value myself and everything I am’ (actual depression project, June 2023) or ‘Learn to love yourself through your sadness, mistakes, confusion […]’ (andrea_evgeniou, December 2022).

Another very recurring topic is self-disclosure. ‘Self-disclosure is a process whereby a person verbally reveals private feelings, thoughts, beliefs, or attitudes to another person’ (Vogel & Wester, 2003, p. 351). Examples are given by your.anxiety.bible, an account of an individual who set up a community. The videos often start, for example, with ‘I broke down today when my therapist asked me: […]’ (your.anxiety.bible, March 2024). It has been shown that social support, made possible by self-disclosure, can increase positive interactions and create a supportive social environment (Feeney & Collins, 2015). It has been related to the ability to solve problems (Bani Melhem & Al-Twalbeh, 2020), even though there are also reasons not to disclose (Vogel & Wester, 2003).

In addition to giving advice and suggesting coping strategies to individuals suffering from depression, there are also posts addressing their social surroundings, which can play a vital role in healing, for example, ‘If you know someone living with depression or anxiety, please do not make them feel like they have to prove how unwell they are’ (actual depression project, November 2022). Of course, people are unlikely to come across such a post randomly. Still, it is perceivable that relatives, friends or colleagues of people suffering from depression may look for information.

Furthermore, there are very few somewhat sarcastic posts, for example, ‘I asked my therapist who their therapist was and went to see them. I asked them the same thing until I got to the final boss therapist and defeated them with my trainwreck of a life’ (the.mr.impulsive, January 2024), which could be seen as a creative way to illustrate emotions and consequently as a coping strategy.

The informative aspects on depression, as well as the posts on possible therapy options and coping strategies, are entirely redundant overall but well-researched, and some of them even document scientific sources.

Use of Visuals

Although Instagram is usually described as a photo-based medium, photographs rarely appear in this study. More than half of the posts only contain text. Of course, these can also be perceived as images, as they are based on font selection, colour, layout and others. However, it can be noted that most of the text posts in the sample choose relatively standard, well-readable fonts and muted colours. Frequently, there is simple black text on a white background or vice versa, stressing the topic’s seriousness. It is also noticeable that many images contain much text, often on several pictures to swipe through.

A smaller proportion, about 15%, uses visual elements such as comic figures and another 15% symbolic images or videos such as a staircase or a broken fence. Nature is viral, whether dark and hostile-looking or in warm colours. Nature as a mirror of human emotions is common, at least since the era of Romanticism (Milani, 2009, p. 14). By offering an emotionally touching picture but not connecting the feeling to a particular individual, it may convey a more profound emotional understanding of a condition.

In another 15%, one can see a person, men and women, about equally distributed, non-binary or transgender people were probably not in the sample, just as no people of colour could be seen, which could be due to the location of the cell phone used. The pictures and videos that show people appear less made up compared to other Instagram content, even though people are said to post beautiful and flattering images of themselves habitually and just occasionally interspersing an intentionally awkward picture, for example, a grimace (Brad, 2011) to convey authenticity or social media expertise. Posting rather unstaged and unretouched pictures may add to the realness and honesty of the people behind the accounts.

However, because of the importance of art therapy (Malchiodi, 2003, p. ix), artistically motivated picture posts appear rare. Further, the sample contains only one artificial intelligence (AI)-generated image posted by artist Andrea Costantini (March 2024). This meagre number may be due to the novelty of AI image generation that this possibility has so far been little recognised by individuals and organisations or—because of the very few staged photographs—that artistic reflections play a subordinate role, at least for the time being.

Modes of Addressing the Audience

The mode of addressing the audience can establish specific relationships with the readers, which is particularly interesting when dealing with a sensitive topic such as depression.

Third-person formulations are the most common when posting information or advice, making the information appear neutral. Some posts offer background explanations, for example, ‘Sadness & Depression. What the real difference is’ (the self space, July 2023) or ‘What is the difference? Anxiety vs depression’ (with two overlapping Venn diagrams, time4changesorg, August 2023), usually with more than one picture to swipe through and, compared to the majority of Instagram posts, much text.

Slightly fewer posts give information by directly addressing the viewer, for example, ‘Lies depression tells you and how to fight them back’ (happiness project, Nov 2022), ‘Doing imaginary arguments in your head all day has the same impact on your mood as arguing all day’ (mark freeman, May 2023), or ‘If you listen to your mental health when it whispers, you will not have to hear it scream’ (Dr. Christina, November 2022). Compared to third-person formulations, second-person formulations help to establish a closer relationship with the reader. Furthermore, there is a smaller category that advises relatives and friends, such as ‘5 positive things to say to a depressed person […]’ (mypositiveoutlooks, July 2023) or can use third or, in a few cases, second person.

Less than one-third of the posts comprise personal stories usually told in the first person. Among them, there are often persons active as coaches who contribute their experiences in a self-reflective manner, for example, ‘This is the point I massage for grief, depression + sadness’ (amandanovawellness, November 2023). Some of these individuals seem to have overcome depression, such as ‘I have unearthed the invaluable significance of self-care […] I have become intimately acquainted with the ethereal realm of introspection, seeking solace in the soliloquies of my thoughts’ (existential. reflections, May 2023). In contrast, some still struggle with the condition ‘My self-destructive thoughts are coming back. I do not think I’ll be able to handle them this time.’- ‘We have already been through this. We overcame these demons many times before […]’’ (recovering. overthinker, February 2024). People show their faces in several cases, such as the post ‘Healing is not linear’ (Chiara. Mercedes, January 2024). Through their disclosure, such posts establish a personal relationship and encourage others to discuss their problems. As several comments show, the bravery is highly appreciated, which may also add to the self-esteem of the people posting.

Another relatively small subcategory uses a descriptive mode in first, second or third person but differs from the others in that it does not provide information or advice but rather makes demotivating or sarcastic statements, for example: ‘When does depression end? when it ends you’. (set in tiny white lettering on a black slightly torn background, sadbits, November 2018). This category helps to experience an emic perspective and may address individuals who wish to understand depression or who (have) experienced (d) it and thus feel less alone. In addition, a coping strategy is expressed here, namely a verbal-artistic confrontation.

Meta-level: Disclosure, Community and Attention Seeking

On a more general level, as Kim and Lee (2011) have shown, social media can promote life satisfaction due to their social support and empowerment (for a critical reflection of the term, see Sastre, 2016, 125f.).

As mentioned above, in general, ‘people feel more positive sharing positive emotional disclosure and more negative sharing negative disclosure […] because it increases the salience and significance of the events, and allows people to rearrange their memories about the event during expression. In addition, given the ‘positivity-norm’ of Internet culture, positive disclosure often occurs more frequently. It predicts positive feedback and more social support’ (Luo & Hancock, 2020, p. 112). However, the IESD (Internet-enhanced self-disclosure) hypothesis assumes that online self-disclosure, including or especially about negative aspects, is a key factor ‘for the positive relationship between online communication and social connectedness’ (Valkenburg & Peter, 2016, p. 4) and thus can enhance well-being. This may be particularly the case when posting about depression on social media: people can feel connected, openly show their emotions, and, because of the way social media works, still stay anonymous. In addition, they can get advice and gain a deeper understanding of their condition. However, it has to be noted that ‘the same liberating or disinhibiting mechanisms of online communication that have led to the positive outcomes … can also have negative consequences …’ for example, flaming (hostile and insulting interactions between Internet users), online harassment and cyberbullying (Valkenburg & Peter, 2016, p. 4). Although this was not observed in the sample, it cannot be ruled out and would be all the more problematic if it is a susceptible topic anyway.

Programmes such as HOP [Honest, Open, Proud] have shown that self-disclosure aids persons in ‘facing stigma stress, showing positive effects, whether helping to diminish stress or to improve self-conscience, both of which have indirect effects on self-stigma’ (Modelli et al., 2021, p. 1). Contrary to Luo and Hancock’s (2020, p. 113) assumption of a ‘positivity norm’, here, people may be honest about their disclosures, and as comments and likes show, the posts receive positive feedback. In this context, further contributing factors in reducing stigma, such as people’s living circumstances (Oudejans et al., 2021, p. 1547), should not be neglected.

In summary, from the point of view of the people posting about their depression, self-disclosure diminishes stress and helps overcome (self-)stigma and increase self-esteem (Andalibi, 2020, p. 1). Thus, for the account holders, the engagement is advantageous: ‘People can benefit from disclosing negative emotions or stigmatised facets of their identities’ (Andalibi, 2020, p. 1485). The interactive component—liking, commenting, sharing—can reinforce the positive effect, as it increases visibility and the feeling of being not alone, understood, appreciated and ‘liked’. For people who suffer from depression but do not post themselves but rather follow other people’s accounts, this has similar positive consequences: the posts convey the feeling that their emotions are not uncommon and understood.

The feeling of connectedness also explains the small number of demotivating posts: such posts can help because people see that they are not alone with similar feelings. Here, a similar situation as in peer-to-peer online groups is apparent: for such groups, some benefits for individuals suffering from depression have been shown, for example, normalisation of depression and stigma reduction, even if the engagement was generally low (Breuer & Barker, 2015). The reported barriers, such as being harmed or judged by others, may be considerably less in the case of Instagram groups, as anonymity is offered to the point that the recipients can just read and not actively contribute by liking or commenting.

However, attention-seeking may also play a role, especially when people have accounts that are not exclusively about depression. A prominent and much-discussed case was Kathy Hummels, a German influencer who, in 2022, combined a post about depression with advertising for a wellness hotel and was heavily criticised for it (Zimmermann, 2022)—first because she downplayed the disorder as if some wellness could help sufficiently and second because she instrumentalised depression for advertising purposes that even went beyond self-promotion. The sample did not show such behaviour, perhaps because society has become more sensitive and sanctions such behaviour by cancelling the person.

Evaluation of Social Media Posts about Depression

When evaluating posts using the hashtag #depression, it is important to consider the possible motivations of the people who post and who follow and whether and how the posts may benefit individuals and/or society.

An essential benefit of the posts is that they offer a feeling of connection, of not being alone with the condition. This can apply to account holders, who are affected themselves, and recipients. In addition, getting information and advice on social media is an effortless and low-barrier way to help the people affected and their surroundings (Muriungi & Ndetei, 2013). Then, the chance of complete anonymity makes dealing with such a sensitive topic easier. If a person dares to self-disclose, this usually leads to recognition and social support, as the posts in the sample show.

The content of social media, in general, tends to lead to unfavourable social comparisons. In such an environment that is even accused of causing or enhancing the disorder, it is specifically vital to also address depression and show posts contrary to the usual. Seeing that other people also suffer from depression makes affected recipients not only feel less alone and more understood but also ensures that they do not feel shallow in social comparison. This is, of course, not to downplay the importance of real-life contact and therapy.

For therapists, coaches or institutions, posting on depression is not just a way to spread information but also to acquire customers. This way, therapists show their presence and competence and reflect their perspectives on problems to find not just any clients but clients who fit their approach. To a certain extent, however, there is probably also an instrumentalisation of the topic to generate attention for one’s business and oneself.

Furthermore, it has to be mentioned that not all posts appear to come from psychotherapists or appropriately trained people, which makes misinformation conceivable. Abbreviated or incorrect information and the misuse of the hashtag for advertising purposes cannot be ruled out, although the posts were quite adequate in the sample. In addition, looking at social media dynamics, free riders may be exposed and cancelled.

Of course, people who do not specifically search for the hashtag are less likely to come into contact with the topic. Despite this, they could still come across such posts online, which then provide socially significant psycho-education or learn more about depression through indirect effects, such as people learning to talk more openly about the issue.

The soberly designed posts in the sample stress that the topic is taken seriously and is not being instrumentalised for attention-seeking purposes. However, it is surprising that the contributions largely refrain from artistic realisations, although on the one hand, the medium ‘Instagram’ is considered to be very visual. On the other hand, art is also used in various ways in therapy: ‘Art therapy can help people express themselves more freely, improve their mental health, and improve interpersonal relationships’ (Shukla et al., 2022, p.1). Further, art serves as a means of communication that helps people grow and intensify their social networks (Stuckey & Nobel, 2010, p. 257). Especially on social media, self-staging and ‘the perception of the own body as part of creative processes’ (Jerrentrup, 2021, p. 1149) could be beneficial.

The lack of artistic interpretations may be because they are often time- and money-consuming. However, there may be new possibilities here, such as using AI to create works in a far less complicated way. Engaging visuals would also have the advantage of appealing to groups that are not consciously looking for depression-related content, thereby spreading awareness-raising work to a broader audience. In addition, through their emotional appeal, artistic representations could also make depression more understandable for non-affected people.