For adolescents, Facebook and other social media have created an irresistible forum for online sharing and oversharing, so much so that endless mood-of-the-moment updates have inspired a snickering retort on T-shirts and posters: "Face your problems, don't Facebook them."
But specialists in adolescent medicine and mental health experts say that dark postings should not be hastily dismissed, because they can serve as signs of depression and an early warning system for timely intervention. Whether therapists should engage with patients over Facebook, however, remains a matter of debate.
And parents have their own conundrum: how to distinguish a teenager's typically melodramatic mutterings - like the "worst day of my life" rants about their "frenemies," academics or even cafeteria food - from a true emerging crisis.
Last year, researchers examined Facebook profiles of 200 students at the University of Washington and the University of Wisconsin-Madison. Some 30 percent of posted updates met American Psychiatric Association criteria for a symptom of depression, reporting feelings of hopelessness or worthlessness, insomnia or sleeping too much and difficulty concentrating.
Their findings echo research that suggests depression is increasingly common among college students. Some studies have concluded that 30 percent to 40 percent of college students suffer a debilitating depressive episode each year. Yet scarcely 10 percent seek counseling.
"You can identify adolescents and young adults on Facebook who are showing signs of being at risk, who would benefit from a clinical visit for screening," said Dr. Megan Moreno, a principal investigator in the Facebook studies and an assistant professor of pediatrics at the University of Wisconsin-Madison.
Facebook started working with the National Suicide Prevention Lifeline in 2007. A reader who spots a disturbing post can alert Facebook and report the content as "suicidal." After Facebook verifies the comment, it sends a link for the prevention lifeline to both the person who may need help and the person who alerted Facebook. In December, Facebook also began sending the distressed person a link to an online counselor.
While Facebook's reporting feature has been criticized by some technology experts as unwieldy, and by some suicide prevention experts as a blunt instrument to address a volatile situation, other therapists have praised it as a positive step.
At some universities, resident advisers are using Facebook to monitor their charges. Last year, when Lilly Cao, then a junior, was a house fellow at Wisconsin-Madison, she decided to accept Facebook "friend" requests from most of the 56 freshmen on her floor.
She spotted posts about homesickness, academic despair and a menacing ex-boyfriend.
"One student clearly had an alcohol problem," Cao recalled. "I found her unconscious in front of the dorm and had to call the ambulance. I began paying more attention to her status updates."
While social media updates can offer clues that someone is overwrought, they also raise difficult questions: Who should intervene? When? How?
"Do you hire someone in the university clinic to look at Facebook all day?" Moreno said. "That's not practical and borders on creepy."
She said a student might be willing to take a concerned call from a parent or from a professor who could be trained what to look for.
But ethically, should professors or even therapists "friend" a student or patient? (Students monitored by Moreno's team gave their consent.)
Debra Corbett, a therapist in Charlotte, N.C., who treats adolescents and young adults, said some clients do "friend" her. But she limits their access to her Facebook profile. When clients post updates relevant to therapy, she feels chagrined. But she will not respond online, to maintain the confidentiality of the therapeutic relationship.
Instead, Corbett will address the posts in therapy sessions. One client, for example, is a college student who has low self-esteem. Her Facebook posts are virtual pleas for applause.
Sometimes a Facebook posting can truly be a last-resort cry for help. One recent afternoon while Jackie Wells, who lives near Dayton, Ohio, was waiting for her phone service to be fixed, she went online to check on her daughter, 18, who lives about an hour away. Just 20 minutes earlier, the girl, unable to reach her mother by phone, used her own Facebook page to post to her mother or to anyone else who might read it:
"I just did something stupid, mom. Help me."
Jackie Wells borrowed a cellphone from her parents and called relatives who lived closer to her daughter. The girl had overdosed on pills. They got her to the hospital in time.
"Facebook might be a pain in the neck to keep up with," Wells said. "But having that extra form of communication saves lives."