“My depression is causing me physical pain … I don’t know how to stop it.”
“I’m afraid if I ask for help … I’ll get called dramatic.”
“Would any of you have any idea of what to do? Because I definitely don’t.”
On the social media platform Reddit, teens and young adults detail their mental health struggles in candid, vulnerable posts that speak volumes about how stigma still deters many from seeking help.
It was a sobering takeaway for University of Alberta researchers who conducted one of the first investigations of youth mental health experiences by manually extracting and analyzing Reddit data.
“There’s been so much focus on mental health literacy, mental health campaigns and trying to increase awareness,” says Lisa Hartling, professor in the Department of Pediatrics and director of the Alberta Research Centre for Health Evidence (ARCHE).
“But people still feel stigmatized about disclosing. That really came out in the Reddit analysis. They feel ashamed or uncomfortable with it internally, and then worried about what others will think if they disclose.”
Conducted by undergraduate student Meghan Sit and overseen by Hartling, nursing professor Shannon Scott and ARCHE assistant director Sarah Elliott, the study was a unique way to understand youth discourse about mental health and barriers to seeking help, within an anonymous platform.
The researchers started by examining 3,000 messages posted on two “subreddits” over the first half of 2021; of those, they selected 98 written by people whose stated age was 13 to 24 and whose message focused on help-seeking behaviour or information needs. Researchers then analyzed the posts to identify themes.
“There’s lots of discourse in the social media space. We see it go by, but to analyze it in depth is certainly a different undertaking,” says Hartling.
The analysis wasn’t easy for the front-line researchers, either, she adds.
“I think it was taxing for them (Sit and Elliott) to be reading these things — in particular, reading without an opportunity to provide support.”
In addition to the damaging influence of stigma, researchers found many posts suggested that a low level of mental health literacy discourages young people from talking about their struggles or seeking help.
Many Reddit posters asked about symptoms, what is “normal,” effectiveness of medications, and even basic questions about cost, wait lists and how to access services.
The researchers note that this lack of knowledge seemed to create additional challenges for people trying to cope with their own struggles or difficulties others were experiencing.
“My girlfriend … is struggling with self-harm,” says one poster. “I must stop her and I’ve been trying my best for last 3 months. I need advice.”
Many experiences captured in the study highlighted feelings of embarrassment, shame and fear of not being taken seriously — all growing out of stigma — that caused young people to hide what they were going through.
One message shared uncertainty over a parent’s potential reaction: “I don’t really know how she feels about therapy. (I don’t know if she considers it shameful / embarrassing / only for really crazy people.)”
Among those who had previously sought help, some posted unfavourably about the experience, noting the side-effects of medication and feelings of being dismissed or ignored by doctors.
“I’m so scared to seek therapy again in case I get told it’s just anxiety again,” wrote one. “I just feel like there is something much more going on.”
The researchers caution that these negative experiences would likely reinforce the worries of youth who are already battling a range of stigma-related emotions.
The project builds on previous research by Hartling and Scott, both Canada Research Chairs, whose work involves connecting health information to parents and families.
In 2021, the team published a study listing the top 10 health priorities for parents and youth. The youth identified issues related to anxiety and depression — signs, symptoms and when to seek help — as a main concern. That led to a series of projects, including a review of existing online resources on the topic, as well as a graduate student project on how youth search for mental health information online, and the Reddit study.
Hartling says the new study shows a diversity of issues affecting young people and their struggles with mental health, meaning solutions must be equally diverse.
She also wonders whether the vast amount of available information about mental health is not available in formats or in places that are easily accessible to youth.
“Some of those questions seem pretty straightforward,” she says. “It would be good to figure out how we get the answers out to youth where they're going to find them,” she says.
“I think this is just demonstrating that unique discourse youth have and how we really need to involve youth in developing the knowledge tools and disseminating them.”
Lisa Hartling and Shannon Scott are members of the Women and Children’s Health Research Institute and Stollery Science Lab Distinguished Researchers.
The study was funded by the Stollery Children’s Hospital Foundation and the Alberta Women’s Health Foundation through WCHRI.