Participants characterized multiple perspectives of depression, wondering in particular about the condition’s permanence and the utility of seeking help, either for symptom resolution or temporizing management. If one's depression is real, what responsibility exists to mitigate it? For some, depression is a core identity, influenced by genetic inheritance or other happenstance, modifiable but not entirely eradicable: “It's a chemical malfunction in your brain and… it's not something you can control or change about yourself. And there's nothing wrong with you—it just means you need help” [P8]. For others, depression is a temporary response to individual choices or circumstances that make people “not themselves,” and it can be resolved with enough support and effort: “It's something that's gonna be there, but you're gonna be able to get away from it… You might just become back to your normal self” [P12]. Both narratives impacted perceived stigma (in this case, predominantly self-stigma), casting depression as either as an inherent malfunction or a temporary weakness, as well as help-seeking behavior, influencing one's perceived urgency for seeking support. For those who viewed depression as temporary, seeking help was beneficial in resolving the symptoms, but not always necessary: “Depression might die off you” [P12], because it's “a passing cloud that can be dealt with” [P19]. When considering the impact of peer narratives of depression, participants wanted to feel congruence between their own and their peers’ perspectives of depression.

Reflecting the judgments of others, participants emphasized shame and fear as significant barriers to seeking care, demonstrating the power of interpersonal stigma: “Like, oh, you're just lazy… or you're dark and can't be interacted with, like it's contagious” [P5]. The stigma contributed to intense privacy concerns: Confidentiality was paramount for adolescents and an oft-mentioned consideration for seeking help, for fear of judgment from others; adolescents expressed particular concern about having private information shared with their parents by other adults. Participants also cited specific stigmas from parents, including the idea that children should not be depressed because their parents worked to make their lives easier, revealing a burden of responsibility and guilt among participants: “They don't feel like mental issues should be something, because we have a much better life” [P10]. Participants also felt judged by their parents for having trivial concerns, despite feeling like “the things that I'm experiencing right now are like the biggest problems that I've experienced in my life so far” [P9]. Whether actual or anticipated, parental stigma was a significant element of participants’ responses, and one that spoke uniquely to the experience of adolescence.

From peers, participants noted differential stigma based on public vs. private engagement in conversations about mental illness, with a suspicion that peers “laugh at” mental health due to discomfort with public vulnerability: “It's vulnerable… so instead of choosing to talk about it, people just call it stupid” [P7]. Simultaneously, increased public discussion about mental health caught participants in a paradox: Reduced stigma leads to the normalization of depression, but also increased scrutiny of whether one truly fits the label, creating an additional stigma of perceived inauthenticity: “It's a time for everyone to have mental illness and to just like brag about having depression or ADHD, so like the people who are really suffering… may shy away from seeking help because they don't want people to think they're just doing it for attention or joining a trend” [P9]. When considering possible peer interventions for stigma reduction, such as through the videos discussed in interviews, participants therefore carefully weighed the pros and cons of sharing such a personal story with a wider audience, with some preferring the use of fictional accounts told by actors rather than true lived experience told by peers. Participants also suggested that negative perceptions of depression originate from a lack of understanding or insufficient mental health literacy; this may reflect the consequences of reluctance to discuss depression publicly as described above.

Participants hypothesized that limited mental health literacy in the general public results in deprioritization of mental health support, creating structural barriers to help-seeking. Because others misunderstand depression, necessary resources are inaccessible or nonexistent: “[People] just think, oh, you're sad. Okay. What am I supposed to do about that? But if people knew that it's like, more than that, like the other symptoms and all that stuff, I think it would be more helpful” [P1]. Specifically, participants noted that getting help sometimes necessitates going beyond the usual recommendations to speak up and reach out, naming structural supports as a solution. For example, adolescents desired access to mental healthcare independently of one's parents: “I don't know if you can get like a therapist as, like, being under 18 without your family's consent” [P7]. Others named financial support and academic accommodations as resolving stressors contributing to depression. Students willing to use school-based resources noted the barrier of insufficient support staff: “There's also a school counselor. but sometimes I just feel like they're overworked or overwhelmed and sometimes they won't even remember you or like your specific stories because they're dealing with, like, the entire student body” [P9]. These barriers reflect participants’ recognition of structural stigma, and participants hoped for future interventions, such as social media videos targeted in this study, to include more concrete resources or recommendations for adolescents to access mental healthcare.

Many participants named school as a key site for intervention, alongside the Internet, social media, and hearing from peers first-hand. Students named existing school strategies to bolster student mental health and increase awareness, including displaying informational posters, discussing mental health in health class, and staffing school therapists, social workers, and guidance counselors. Regular contact was positively received: “There's a mindful Monday, a weekly and monthly check in where they ask, how are you doing? Do you need support with school or home? The guidance counselors check in on you pretty frequently” [P11]. Simultaneously, many wished that schools could do more to both educate and support, which was viewed as part of school's responsibility: “A school's total responsibility [is] to support them mentally, not educationally alone” [P13]. Suggestions included peer support programs, joint awareness programs for kids and parents, mental health syllabi, and mental health-related elective or seminars. Peer interventions were particularly desirable, because they increase a sense of belonging and reduce the age or experience differential between the adolescent and their supporter: “When you talk to your peers, like the way you talk to your best friend, you're just open… like you feel understood” [P10]. The beneficial aspects of school environments, such as being able to disseminate better mental health information and connecting participants with an understanding peer community, echoed participants’ commentary on the value of potential social media video interventions, which we analyzed as targeting similar goals. Consequently, when considering potential next steps for de-stigmatizing depression and increase help-seeking behavior, adolescents identified concordant opportunities across in-person and virtual environments (i.e., school and social media, respectively).

Adolescents viewed school as a good place to accomplish these goals because they perceived school as somewhat of a parental surrogate based on hours of supervision: “We spend so many hours in school and then a few with our parents before we go to bed or come back to school. So, I think they have a bigger chance… because we spend more time with them” [P10]. Although academics did contribute to some participants’ distress, school itself was not a primary stressor. but rather a safe haven, particularly from students with limited support from home. Part of school's perception as a safe haven lay in the presence of peers, who were perceived to hold more generationally-congruent attitudes towards mental illness compared to adults.

Attitudes towards family and school's shared responsibilities revealed a wish to be taken care of, alongside the independence participants desired in order to access formal mental health resources without their parents: “It's up to other people to help you and you shouldn’t have that responsibility to make yourself better,” noted one participant, who added that “it's been really helpful when [adults] take the reins… and help guide me through it” [P8]. Consequently, school figured as a nurturing environment in which to learn, grow, and be cared for. Simultaneously, participants recognized the limitations of schools’ psychosocial role, acknowledging that not every staff member has the sufficient training or time given the academic demands. Participants acknowledged that mental healthcare is a “collective responsibility” shared between parents, school staff, and other community adults: “It's the job of the whole community” [P14].

Together, these findings represent tensions in participants’ attitudes towards sources of support. Peers can be acutely judgmental, yet a valued source of validation instead of adults’ misunderstandings of their struggles. School can create additional psychological demands, but also offer belonging and respite from home. Parents can seem unsympathetic, yet simultaneously offer consistency, safety, and access to care. Per some participants, school itself could provide a path to ease these tensions by engaging all parties in psychoeducation:

To inform future video interventions, we identified that perceived validation of one’s depression experience by peer narratives in videos helped ease acceptance of seeking help in the future, making legitimization or validation a key component to consider for future interventions. Reflecting earlier commentary about stigma and identity, adolescents painted a complex picture of belonging, paradoxically casting a stigmatized label as a sometimes-exclusionary in-group with implicit qualifying criteria. Participants struggled to reconcile the idea that depression has prerequisites [“Some people might feel that if they don't have that family background, then the depression doesn't make sense for them” (P18)] with an open acceptance of the diversity of illness [“Mental illness can look like anything. It can look like a person like me, or… like my little brother, or like my grandmother…” (P11)]. The possibility of “faking it” or “just doing it for attention” was a particularly sensitive accusation, suggesting a deep emphasis on authenticity: “It’s kind of become like a trend. I guess a lot of people—I wouldn't say romanticize… but, like make it seem like something that it's not” [P3]. To reduce this discomfort, participants were adamant about the difference between sadness and depression: “People are like, I'm depressed, when they're trying to say they're sad. And I'm like, those are two very different things” [P4]. Hearing externally-accepted narratives of depression that resonated with their own helped to “legitimize” participants’ experiences, validating that their struggles also merited seeking help: “This person got help, so… so can I, you know?” [P2]. For participants who sense trivialization or dismissal from parents, feeling validated by peer narratives also offered a way to elevate their voices and concers: “I would love my parents to know that depression is not just about money and bills” [P9].

To find these validating stories, adolescents appreciated video narratives from peers. “If they're talking about an experience with mental health that I've experienced similar to, I am going to connect to that,” shared one participant [P4]. Participants requested tailoring the video script or protagonist to increase authenticity, especially for participants who self-reported lived experience with depression, who felt the protagonist was sugarcoating her experience. When elaborating on what could increase authenticity, participants emphasized maintaining a realistic tone and avoiding listing symptoms in a stereotypical way: “The tone of the voice sounded a little bit condescending… like a little bit overly peppy… It should sound like it's coming from a teenager” [P5]. In fact, perceived authenticity and relatability was the predominant concern in participants’ reflections on social media videos. Participants felt very strongly that future videos should strike the right balance of emotion, with video protagonists being neither overly stoic nor overly caricatured: “It doesn't seem like she's talking from her heart. Like, it feels kind of like… put on, like an act” [P3]. Participants also sought relatability in the amount and type of information provided by videos, requesting either more or less detail depending on their satisfaction with the protagonist's portrayal. Above all, participants reported that video narratives should feel realistically detailed rather than generic: “I feel like every video I've seen about depression has been that stereotypical, like, if you went through and googled depression and you read all the symptoms, and then you had a person say that's how they felt” [P4]. In order to feel a sense of trust or efficacy in future video stimuli, participants therefore requested careful stimulus design to take affective and informational authenticity into account.

Multiple participants also offered commentary on how their race, gender, or other identities intersected with experiences of stigma and help-seeking. Some felt that gender-specific concerns created unique stressors during adolescence, noting that “I don't think… a boy… would understand what a teenage girl would go through in high school” [P9]. Male participants commented on the intersection of stigma and masculinity: “Society believes… that as a man, you should always be strong [P16]. Black participants noted that while their personal experiences were not monolithic and they had very supportive families, the stereotypes about Black communities were prominent: “Those notions of—Black people are tough and do anything… They create the barriers of them getting help when they're really—actually they're really in need” [P19]. Therefore, when brainstorming new video narratives, participants suggested that protagonists match the target audience’s demographics: “There's other different problems that I may experience as a Black teenager in high school that maybe I would only relate to with another Black teenager” [P9]. Culturally-specific representations therefore offered a meaningful way to increase a sense of belonging for adolescents’ depression experiences, thereby informing their perceptions about who should seek help for mental illness.

Across this desire for relatability, participants broadly wanted a clear blueprint on the practicalities of seeking help and reassurance. Participants recommended including more experiential details, specific steps for seeking help, or resources available for adolescents, casting the video interventions as a vehicle not just for legitimacy but also for explicit instructions on next steps. The intervention's format was accessible: Participants responded positively to the study's one-minute video, noting that it was an appropriate length for their attention spans, but still sufficiently empowering. Many found the concept of sharing one's struggle as admirable and believed that hearing how peers received help is encouraging for others experiencing depression: “It also gave me the courage to ask for help whenever I need it because, you know, a young person telling the world that they need help and they asked for it… It's very encouraging for other teens too” [P19]. Consequently, with adjustments for authenticity and instructiveness, participants viewed videos as an accessible, motivating intervention.