Professional Psychology: Research and Practice 2015, Vol. 46, No. 5, 375–383

© 2015 American Psychological Association 0735-7028/15/$12.00 http://dx.doi.org/10.1037/pro0000039

College Students’ Perceptions of Depressed Mood: Exploring Accuracy and Associations Irene M. Geisner, Jennifer L. Kirk, Angela J. Mittmann, Jason R. Kilmer, and Mary E. Larimer

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University of Washington College is a time of high risk for depressed mood. Theories about depression (i.e., cognitive theory and depressive realism theory) are well researched, but suggest different venues of understanding the cognitive underpinnings of mood. In addition, much research is available about normative perceptions around substance use and how those perceptions relate to behaviors. However, there are no studies examining normative perceptions around depressed mood nor how these perceptions may relate to students’ own well-being. Undergraduates (N ⫽ 1,577) ages 18 –24 responded to an online survey as part of a larger study on drinking and depressed mood. The survey assessed symptoms of depression and feelings of sadness, depression, and suicidal ideation experienced in the past 2 weeks, as well as students’ perceptions of the prevalence of these feelings among other students. Rates of sadness and depression reported in the sample were relatively high; whereas rates of reported suicidal ideation were low. Most students underestimated the prevalence of sadness and depression experienced by other students; a finding that was especially true for male students. Conversely, most students overestimated the prevalence of suicidal ideation. Students who reported experiencing a given feeling in the past 2 weeks perceived greater rates of the feeling among other students. Depression symptoms were associated with both greater perceived prevalence of sadness, depression and suicidal ideation, as well as correct and overestimates of the prevalence of sadness and depression. Implications for future directions in prevention and interventions efforts are discussed. Keywords: mood disorders, alcohol use, CBT/cognitive behavior therapy, depression, child/adolescent

College students experience challenges as they navigate a potentially stressful time in emerging adulthood including depressed mood and related behaviors (Arnett, 2000, 2005; Kilmer & Bailie, 2012). In particular, depressed mood may lead to suicidality,

problematic drinking, and other drug use and can exacerbate the consequences experienced (Colder, 2001; Dawson, Grant, Stinson, & Chou, 2005; Flynn, 2000; Geisner, Larimer, & Neighbors, 2004; Gilvarry, 2000). Research has focused on understanding these

This article was published Online First July 27, 2015. IRENE M. GEISNER received her PhD in clinical psychology from the University of Washington. She is a clinical psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. Her research has focused on developing and testing the effectiveness of a personalized Web based feedback intervention for college students with high risk drinking and depressed mood and a variety of other college student health and risk behaviors. JENNIFER L. KIRK received her BA in mathematics from Smith College. She is currently a biostatistics doctoral-level student at the University of Washington and a research assistant at the Center for the Study of Health and Risk Behaviors at the University of Washington. Her areas of professional interest include analysis of longitudinal mental health data and large-scale genetic data. ANGELA J. MITTMANN received her MA in clinical psychology from the University of California, Los Angeles. She is currently a Research Coordinator with the Center for the Study of Health and Risk Behaviors at the University of Washington. Her research efforts have focused on the development of alcohol prevention efforts for young adults. JASON R. KILMER received his PhD in clinical psychology from the University of Washington. He is an Associate Professor in Psychiatry and Behavioral Sciences at the University of Washington and Assistant Director of Health and Wellness for Alcohol and Other Drug Education in the Division of Student Life. He has been an investigator on a multitude of

studies evaluating prevention and intervention efforts for alcohol and drug use by college students. MARY E. LARIMER received her PhD in clinical psychology from the University of Washington. She is a Professor and Director of the Center for the Study of Health and Risk Behaviors in the Department of Psychiatry and Behavioral Sciences at the University of Washington. Dr. Larimer’s areas of professional interest include prevention and treatment of alcohol and drug problems among adolescents and young adults; prediction of initiation of drinking and trajectories of alcohol and substance use; comorbidity of substance use with depression, suicide, trauma, PTSD, disordered eating, and gambling problems; evaluation of housing and treatment programs for chronically homeless and incarcerated individuals; and dissemination of evidence-based prevention and treatment approaches into various settings. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIAAA or the National Institutes of Health. This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA; R21AA019993) awarded to Irene M. Geisner. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Irene M. Geisner, Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th Street, Suite 300, Seattle, WA 98105. E-mail: [email protected] 375

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concerns and designing interventions and prevention programs for depressed mood. Two relevant areas of research are social comparison and social learning theories (Bandura, 1977; Festinger, 1954). These theories have led to the understanding of how one’s own behavior is influenced by one’s normative perceptions (i.e., perceptions about the behavior of others). In particular, studies of normative perceptions of alcohol use among college students have consistently shown that students overestimate the quantity and frequency of drinking (Neighbors, LaBrie, et al., 2010; Neighbors, Lee, Lewis, Fossos, & Larimer, 2007; Neighbors, Lewis, et al., 2010b). Interventions aimed at correcting these norms have shown to reduce drinking problems (Cronce & Larimer, 2011; Larimer & Cronce, 2002, 2007). It is possible that normative perceptions of mood may serve a similar function. As with alcohol norms, telling students that not everyone feels this way, or conversely, others feel similarly to you, may provide both a change in behavior (increase help seeking) and reduce hopelessness and isolation by normalizing the experience of depression. Normative perceptions about mood (i.e., students’ perceptions of how sad, depressed, or suicidal others feel) have not been examined directly to our knowledge. There are two competing theories that underlie the examination of “depressive norms.” One theory related to depression is Beck’s cognitive theory, which suggests that depressed people’s thinking is characterized by negative thoughts about self, others, and the world (Beck, Rush, Shaw, & Emery, 1979). According to Beck’s theory, people with higher scores on a depression measure would tend to overestimate the depressed mood of others (Whitton, Larson, & Hauser, 2008). The depressive realism theory states depressed people are often more accurate in their perceptions and judgments than nondepressed people (Alloy & Abramson, 1979); however, debate surrounds this theory (Blanco, Matute, & Vadillo, 2009; Carson, Hollon, & Shelton, 2010; Kapcli & Cramer, 1999). According to depressive realism, those who are more depressed would be more accurate in estimating the mood of others. In an interpersonal context (i.e., judging perceptions of others), depressed subjects have been found to be more accurate and less distorted about people they liked/felt positively toward (Yeh & Liu, 2007). Others have concluded that depressed people distort their judgments in a negative fashion and fail to accurately predict the feelings of others (Carsone et al., 2010). Ackermann and DuRubeis (1991) conducted a meta-analytic review of 33 studies looking at the accuracy of judgments made by depressed individuals, and found that 19 studies supported the depressive realism hypothesis; however, 14 studies did not. The aim of this study was to be among the first to assess the accuracy of college students’ perceptions of others’ sadness, depression, and suicidal ideation, and to understand if and how these perceptions relate to one’s own mood. These perceptions may have a direct effect on mood (i.e., if I think others are more depressed, it makes me more depressed). Understanding whether people’s perceptions of others’ moods may impact their own mood or other aspects of their lives (i.e., their drinking) can inform intervention efforts. In addition, studies have suggested that among the barriers to seeking counseling could be the perception that others need clinical services more (Eisenberg, Golberstein, & Gollust, 2007). Consequently, if students perceive that many others are struggling (perhaps even more than they are), they may choose not to get help themselves

and, as such, this misperception could have significant public health implications. Given the known gender differences in rates of depression (American Psychological Association, 2013; Hankin et al., 1998; Hankin & Abramson, 2001), we also examine how gender influences the outcomes.

Research Questions In general, research has revealed that college students experience negative mood states at alarming rates. In the most recent American College Health Association (ACHA) survey (2014), 46% of college students (39% of men and 50% of women) endorsed feeling hopeless any time in the past 12 months, 65% felt very sad (52% of men and 67% of women), and 32.6% (27.8% of men and 34.9% of women) felt so depressed that it was difficult to function. Suicide ideation rates, although lower, were still experienced by 8.1% (7.4% of men and 8.3% of women). Drum and colleagues (Drum, Brownson, Denmark, & Smith, 2009) found that when asked whether they had “ever seriously considered attempting suicide,” 18% of undergraduates and 15% of graduate students endorsed this item. Within this group, 47% of undergraduates and 43% of graduate students reported three or more periods of this serious ideation. In addition, although ACHA (2014) found that 1.3% of students attempted suicide in the past 12 months, 8% of undergraduates and 5% of graduate students reported having attempted suicide at least once during their lives (Drum et al., 2009). We had three research questions and hypotheses: 1.

In general, will students over- or underestimate prevalence rates of sadness, depression, and suicidal ideation in others? We predicted students would overestimate prevalence of sadness, depression and suicide ideation, based on research indicating that individuals tend to overestimate the prevalence of negative behaviors: substance use (Neighbors et al., 2007), intimate partner abuse (Neighbors et al., 2010c), driving after drinking (Perkins, Linkenbach, Lewis, & Neighbors, 2010), and texting while driving (Nemme & White, 2010); while tending to underestimate prevalence of healthy behaviors such as seatbelt use (Perkins & Linkenbach, 2004) and condom use (Lewis, Litt, Cronce, Blayney, & Gilmore, 2014). For a review see Berkowitz (2004).

2.

Will students’ own depressed mood be associated with their estimates of prevalence and with over- or underestimation of the prevalence rates of others’ sadness, depression, and suicide ideation? Given the competing theories described above, this research question remains exploratory.

3.

Will gender be associated with perceptions of others’ sadness, depression, and suicidal ideation (i.e., are woman more likely to overestimate)? Based on research indicating women are more likely to experience mood problem, we predicted women’s estimates would be higher than men’s estimates.

PERCEPTIONS OF MOOD

The Survey

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Participants and Procedures A total of 3,824 randomly selected undergraduates ages 18 –24 at a large Pacific Northwest University were invited via e-mail to a larger online study. All students who participated in the present study completed a number of assessments including the Beck Depression Inventory (BDI), and a demographic profile, and data from each student was used in the current study. Specifically germane to this study, students completed a survey related to their own reported mood, and perceived mood norms which required about 15 minutes for complete. A total of 1,577 (41%) students provided responses. Demographics included 57.5% female (M age ⫽ 19.6). Ethnicity was 58.1% Caucasian, 25.1% Asian, 2% African American, 3.6% Hispanic/Latino, 8.7% Multi-Racial, .6% Native American, and 1.9% Other. Informed consent was obtained, and students received $10 for their participation. All procedures were approved by the Institutional Review Board.

Measures Own reported mood. Students were asked to report their own experience of three different feelings: “In the past 2 weeks, have you felt sad, down or ‘blue’?”; “In the past 2 weeks, have you felt depressed?”; and “In the past 2 weeks, have you felt suicidal?” All answers were coded yes ⫽ 1, no ⫽ 0. Mood prevalence rates were estimated by the percent of students who self-reported feeling sadness, depression, or suicidal ideation in the past 2 weeks. Two weeks was selected as the time frame to be comparable with one of the most wide-spread measures, the BDI-II (Beck, Steer, & Brown, 1996) which had changed from asking about the past week (in the original BDI) to the past 2 weeks. Perceived mood norms. Students were asked to estimate the percentage of undergraduates they perceived struggling with mood—for example, “What percent (%) of typical students (on this campus) do you think felt sad/depressed/suicidal in the past 2 weeks?” (range ⫽ 0 –100%). Perceived mood norms categories were calculated by comparing a student’s perceived mood norm to the actual mood prevalence rate for each emotion. Each student was categorized as overestimating, underestimating, or correctly estimating the prevalence of each feeling. See the data analysis section for details on how these classifications were determined. Depression symptoms. The BDI-II (Beck et al., 1996), a 21-item self-report measure was used. Multiple choice items were summed into a total, with 0 –13 indicating none to minimal depression; 14 –19 mild depression; 20 –28 moderate depression; and 29 – 66 severe depression. Mean total score was 8.5 (SD ⫽ 8.7).

Data Analytic Plan As previously described, for each feeling (sadness, depression, and suicide ideation) we used the percent of students who reported experiencing the feeling in the past two weeks as the actual prevalence rate. The Agresti-Coull approximation to the binomial confidence interval was used to calculate a 95% confidence interval for the estimate of the actual prevalence rates (Brown, Cai, & DasGupta, 2001). Students’ perceived mood norms were classified as “correct” if they fell within the following intervals—sadness,

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60 –70%; depressed, 22–33%; and suicidal ideation, 2–4.5%. Perceived mood norms that fell below these intervals were classified as underestimates, and those that fell above these intervals were classified as overestimates. We used intervals wider than the 95% confidence intervals to classify a correct estimate, as the confidence intervals represented a stricter definition of accuracy than could reasonably be expected. Associations for perceived mood norms. For the feelings of depression and sadness, we used linear regression with robust standard errors to examine the associations of perceived mood norms with BDI score and own mood reports. Each of the covariates was analyzed in separate models adjusted for gender. For suicidal ideation, most reported perceived mood norms were close to zero, so linear regression was not appropriate. Instead, we calculated the Spearman’s rank correlation coefficient (Spearman’s rho) to assess the association of perceived mood norms with BDI score and own mood, for males and females separately. The Wilcoxon’s rank sum test assessed differences in perceived mood norms for suicidal ideation between students who reported their own feeling of suicidal ideation and those who did not by gender. Associations of perceived mood norms categories. Perceived mood norms were grouped into three categories: overestimation, underestimation, and correct estimation. To assess the association of these categories with BDI score and own mood report, we used multinomial (polytomous) logistic regression. For each model, the underestimation category was the reference; odds ratios (ORs) represent the relative odds of correct- and overestimation compared to underestimation associated with a 1-unit increase in the covariate. To assess the association between perceived mood norms categories and gender, multinomial logistic regression models were again used and adjusted for BDI score and own mood reports separately.

Findings Research Question 1: In general, will students over- or underestimate the prevalence rates of sadness, depression, and suicidal ideation?

Table 1 shows the prevalence estimates and 95% confidence interval for sadness, depression, and suicidal ideation and the percentage of students who correctly estimated, overestimated, and underestimate the actual prevalence rates. Most students incorrectly estimated the prevalence of each feeling. For feelings of sadness and depression, most students underestimated the prevalence; however, for feeling suicidal, most students overestimated the prevalence (perhaps due to the low base rate of the phenomenon). Research Question 2: Will students’ own depressed mood be associated with their estimates of prevalence and with over- or underestimation of the prevalence rates of others’ sadness, depression, and suicidal ideation?

Sadness and depression perceived norms. After adjusting for gender, students with higher BDI scores perceived a higher rate of sadness among other students (␤ ⫽ 0.43; p ⬍ .001) than did students with lower BDI scores (see Table 2). Further, the perceived sadness norm was, on average, 22.5 points higher among students who endorsed feeling sadness in the past 2 weeks compared to those who did not endorse feeling sad (p ⬍ .001). The

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Table 1 Actual Prevalence Rates and Frequency and Percent of Correct, Over- and Underestimation of Perceived Mood Norms in the Past 2 Weeks by Undergraduate Students Perceived mood norm categories

Mood

Actual prevalence % (95% CI)

Correct estimate n (%)

Overestimate n (%)

Underestimate n (%)

Sad Depressed Suicidal

65.3 (62.7, 67.6) 27.8 (25.6, 30.0) 3.3 (2.5, 4.3)

203 (12.9) 301 (19.1) 288 (18.3)

385 (24.4) 571 (36.2) 987 (62.7)

967 (61.3) 683 (43.3) 290 (18.4)

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Note. n ⫽ 1,560. CI ⫽ confidence interval; Actual prevalence ⫽ the percentage of the sample that reported feeling the emotion/mood in the past two weeks. Students’ perceived mood norms were classified as correct if the norms were within the interval specified for actual prevalence.

results for perceived depression are similar; students with higher BDI scores perceived a higher rate of depression among other students (␤ ⫽ 0.52; p ⬍ .001) than did students with lower BDI scores (see Table 2). The perceived depression norm was, on average, 12.9 points higher among students who endorsed feeling depressed compared to those who did not (p ⬍ .001). Sadness and depression perceived norms categories. In multinomial logistic regression models, after adjusting for gender, a higher BDI score was associated with higher odds of correct (OR ⫽ 1.02; p ⫽ .02) and overestimation (OR ⫽ 1.03; p ⬍ .001) of the prevalence of sadness relative to underestimation (see Table 3). Own reported sadness was also associated with a higher likelihood of correct (OR ⫽ 2.62; p ⬍ .001) and overestimation of sadness prevalence (OR ⫽ 11.78; p ⬍ .001) relative to underestimation. Similar patterns were observed when examining perceptions of depression as the outcome. A higher BDI score was associated with higher odds of correct (OR ⫽ 1.03; p ⫽ .001) and overestimation (OR ⫽ 1.05; p ⬍ .001) of depression relative to underestimation. Own reported depressed mood in the past 2 weeks was also associated with increased odds of correct- and overestimation of depression prevalence (correct: OR ⫽ 1.94, p ⬍ .001; overestimation: OR ⫽ 3.25, p ⬍ .001). Suicidal ideation perceived norm. Among male and female students, own report of feeling suicidal was associated with higher perceived suicidal ideation in others; the median perceived suicidal ideation for both males and females was 5% for students who did not report feeling suicidal in the past 2 weeks and 10% for those who reported feeling suicidal (Wilcoxon’s rank sum p value for each gender ⬍0.001). Similarly, for both males and females, BDI

Sad Depressed

Research Question 3: Will gender be associated with perceptions of others’ sadness, depression, and suicidal ideation (i.e., are women more likely to overestimate)?

As depicted in Figure 1, males perceived less sadness and depression than did females (␤ ⫽ ⫺.04; p ⬍ .0001). Males were also more likely than females to underestimate rather than correctly estimate sadness and depression norms, after adjusting for own BDI score and reported mood (see Table 4). Males were less likely than females to overestimate the prevalence of sadness and depression, although the effect for perceived sadness was not significant after adjusting for own reported sad mood. There were no observable gender differences in perceptions of others’ suicidal ideation; however, again, this could be due to the low prevalence of suicidal ideation.

Implications The purpose of the present study was to determine if college students tend to over- or underestimate the prevalence rates of sadness, depression, and suicidal ideation, in general, and whether depressed mood and/or gender were associated with these normative perceptions.

Table 2 Estimated Linear Regression Coefficients (95% Confidence Interval) for the Difference in Perceived Mood Norms for Feeling Sad and Feeling Depressed According to BDI Score and Own Sad and Depressed Mood Perceived mood norm

score was positively associated with perceived suicidal ideation (males: Spearman’s ␳ ⫽ 0.24, p ⬍ .001; females: Spearman’s ␳ ⫽ 0.22, p ⬍ .001). Suicidal ideation perceived norms categories. Because of the extremely low prevalence of feeling suicidal, we were not able to create a meaningful category for underestimation, while still allowing a reasonable range of correct estimates. This led to very small ranges for underestimates and correct estimates and very few subjects who underestimated or correctly estimated the prevalence. With so few underestimates and correct estimates, comparisons between these categories are not meaningful.

Research Question 1

Self-report measure

␤

95% CI

p

BDI score Own sadness BDI score Own depression

0.43 22.50 0.52 12.90

0.27, 0.59 20.1, 24.9 0.38, 0.63 10.7, 15.1

⬍.001 ⬍.001 ⬍.001 ⬍.001

Note. n ⫽ 1,560. CI ⫽ confidence interval; BDI ⫽ Beck Depression Inventory-II.

Contrary to predictions, most students underestimated the prevalence of sadness (61%) and depression (43%); however, most students (63%) did overestimate the prevalence of suicidal ideation. It is noteworthy that in this sample, a surprisingly large percent of students indicated being sad (65%) and/or depressed (28%) over the past 2 weeks, although the suicidal ideation rate was low (3%). This likely contributed to the contradictory findings

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Table 3 Odds of Correct and Overestimation of Perceived Mood Norm Relative to Underestimation for Feeling Sad and Feeling Depressed Associated With BDI Score and Own Sad and Depressed Mood With 95% Confidence Interval (CI) and p Value After Adjusting for Gender Perceived mood norm Sad

Self-report measure BDI score Own sadness

Depressed

BDI score

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Own Depression

Estimation

OR

95% CI

p

Correct Over Correct Over Correct Over Correct Over

1.02 1.03 2.62 11.78 1.03 1.05 1.94 3.25

1.00, 1.04 1.02, 1.04 1.86, 3.66 7.85, 17.7 1.01, 1.05 1.03, 1.06 1.40, 2.68 2.49, 4.24

.016 ⬍.001 ⬍.001 ⬍.001 .001 ⬍.001 ⬍.001 ⬍.001

Note. n ⫽ 1,560. OR ⫽ odds ratio; CI ⫽ confidence interval; BDI ⫽ Beck Depression Inventory-II. Odds ratios were estimated for the relative odds of correct and overestimation compared to under-estimation.

regarding over- versus underestimation. College students may not frequently get the chance to see their peers responding with sadness to a situation, perhaps because such expressions may be subtle or purposely hidden. Alternatively, students’ increasing communication via social networking sites with friends only known virtually and not through face-to-face interactions, as well as use of abbreviations or emoticons to express what one is feeling rather than actually expressing what one is feeling, could set the stage for less comfort with (and experience in) responding with sadness to a situation (Kilmer, Cronce, & Logan, 2014). In fact, Vander Ven (2012) alluded to “eroding” in-person/face-to-face communication skills. Students may also be less likely to feel or express feelings of sadness at times when they are around others, as they may be distracted by academic and social pursuits. In contrast, incidents of suicides are widely reported so students may be led to believe that suicide ideation is more common among their peers than it is. This

is a case where media reports of “trends” could contribute to a misperceived norm (Hassan, 1995; Martin, 1998).

Research Question 2 Depression affected students’ estimates of others’ sadness, depression, and suicidal ideation. Those who reported feeling depressed (28% of the sample) in the past two weeks tended to estimate significantly higher rates of sadness and depression among other students. Consistent with depressive realism theory, depressed students were more likely to be accurate in their estimates of the prevalence of sadness and depression than were nondepressed students; and, consistent with Beck’s cognitive theory, depressed students were also more likely to overestimate the prevalence of sadness and depression and suicide ideation than were nondepressed students. Students who reported feeling sad

Figure 1. Boxplots of observed perceived mood norms by emotion/mood type and gender with the actual prevalence reported among students (true norm).

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Table 4 Odds of Correct- and Over-Estimation Relative To Under-Estimation of Descriptive Norms Comparing Males To Females For Feeling Sad or Blue and Feeling Depressed After Adjusting For BDI Score and Own Depressive Symptom With 95% Confidence Interval (CI) and p-Value Perceived mood norm Sad

Self-report measure (adjusted for) BDI score Own sadness

Depressed

BDI score

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Own depression

Estimation

OR

95% CI

p

Correct Over Correct Over Correct Over Correct Over

0.63 0.76 0.68 0.87 0.73 0.62 0.72 0.61

0.46, 0.87 0.60, 0.98 0.49, 0.93 0.67, 1.13 0.55, 0.96 0.49, 0.78 0.54, 0.95 0.48, 0.77

.005 .031 .018 .238 .022 ⬍.001 .019 ⬍.001

Note. n ⫽ 1,560. Gender was contrast coded (Men ⫽ 1, Women ⫽ 0). OR ⫽ odds ratio; CI ⫽ confidence interval; BDI ⫽ Beck Depression Inventory-II. Odds ratios were estimated for the relative odds of correct and overestimation compared to underestimation.

estimated a 23% higher prevalence of sadness and students who reported feeling depressed estimated a 13% higher prevalence of depression than students who did not report feeling sad/depressed. As BDI scores increased, estimates of the prevalence of sadness, depression, and suicide ideation increased, similar to Fu and colleagues who found that severely depressed people evidence cognitive distortions consistent with Beck’s cognitive rather than depressive realism theory (Fu, Koutstaal, Poon, & Cleare, 2012). In addition to sadness and depression, students’ own report of suicidal ideation was also related to higher estimated prevalence of suicidal ideation in others. These findings parallel findings from other research areas, such as drinking studies, which consistently find normative perceptions to be associated with students’ own drinking (Larimer & Cronce, 2002, 2007). Correcting students’ perceptions about how much other students actually drink has been found to lead to decreases in students’ own drinking (Hingson, 2010; Larimer & Cronce, 2002, 2007). As such, findings from the current study offer an interesting avenue for future depression interventions. Inclusion of a normative perception component in a cognitive-behavioral based intervention designed to improve mood, delivered in an individual counseling setting or through group discussions in residence halls, or elsewhere, could allow for discussions that challenge individuals’ negative world view, with the goal of stemming the depressed mood while being careful not to stigmatize the individual.

Research Question 3 Even after adjusting for BDI score and own experience of sadness and depression, female students tended to estimate significantly higher rates of sadness and depression than male students. There were no gender differences in perceived rate of suicidal ideation. Females were also less likely than males to underestimate (relative to correctly estimating) the prevalence of sadness and depression; however, it was still the case that a majority of both females and males underestimated the actual prevalence of both sadness and depression (as reported above). There was no significant difference in the odds of overestimation for males compared to females.

Limitations The current study had several limitations. First, the crosssectional design of the study prevents knowledge of the causal relationship between normative perceptions of the prevalence of mood experiences in the student population and reports of own experiences. That is, we do not know whether students’ own reports of past 2-week mood predict their normative perceptions or, conversely, whether normative perceptions predict students’ own reports of experiences. Also, it is possible that the two are reciprocally related, which may offer an area for intervention. In addition, using a 2-week period limits our understanding of these issues across longer time spans. Another limitation regarding timing of assessments of this sample, is that while selection was random, we did not account for differences in time of year/quarter (e.g., beginning, midterm, end of quarter), year in school, or other contextual factors in our analysis. Another limitation is that, although questions about feeling sad/blue, depressed, and suicidal were asked individually and in that order, these terms were not defined for students and were open to each student’s interpretation. Understanding of these terms may have differed across students. It is also likely that most students did not treat the terms as mutually exclusive when responding. Students may have included depression and suicidal ideation, when responding about feeling sad/blue, and may have included suicide ideation when responding about feelings of depression. Although this may have inflated the responses regarding prevalence/experience of feeling sadness and depression, this pattern of responses has external validity, as most people would consider feeling sad to be a necessary condition for feeling depressed or suicidal. Finally, this study was conducted on one campus, limiting generalizability. The categories that emerged to rate accuracy were not compared to prevalence rates found in other large-scale studies, so the findings are limited in terms of over-, accurate, and underestimation. Without the broader context, the measurement of estimation is sample dependent and validity questions remain requiring broader testing on multiple campuses. Furthermore, the ethnicity of the sample was not considered in the analysis, per se. Rates of depression among Asian (25% of the sample) students may be different than Caucasian students, though the findings in

PERCEPTIONS OF MOOD

the literature are mixed (Lam, Pepper, & Ryabchenko, 2004; Rosenthal & Schreiner, 2000). The rates of substance use is likewise different among students with different ethnicities (Grant et al., 2004; Shih, Miles, Tucker, Zhou, & D’amico, 2010). Further comparisons and explorations of ethnicity variables should be conducted with studies constructed to ensure equal sample sizes across ethnicities.

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Clinical Implications A large percentage of college students are struggling with symptoms of depressed mood and mental health issues. To reduce the likelihood of students deteriorating and suffering, universities should consider routine screening for depression in college health and counseling centers (regardless of presenting issues). Efforts to do this have successfully identified students and connected them with outcomes-based treatment for depression (Chung, Klein, & Greenberg, 2009). However, it is still the case that only 21% of suicides reported by counseling center directors were current or former clients, suggesting that most students who commit suicide never got connected with campus resources (Gallagher, 2013). Drum and colleagues (2009) asked students who seriously considered attempting suicide in the past 12 months if they told anyone about their suicidal thoughts: 46% of undergraduate and 47% graduate students chose not to tell anyone. However, they found that even for those who disclosed their ideation, only 58% of undergraduates and 50% of graduate students were advised to seek professional help (Drum et al., 2009). An additional strategy may include implementing proactive, targeted outreach to students “on the radar” of student life administrators following an upsetting event, a trauma, or feedback from concerned others (Kilmer & Bailie, 2012). Once such offices “reach out” to students, students can get connected with counseling, support, or other treatment as indicated and when needed. Other attempts to reach students could mirror established alcohol prevention programs (after being screened for depression through broad-based prevention efforts using social norms aimed at depression) and could include bystander intervention programs and interventions targeting norm misperception. Much like Stony Brook University’s bystander program to increase skills related to responding to alcohol emergencies and University of Kentucky’s bystander program to prevent power-based violence, students could be educated about the high prevalence rates of sadness and depressed mood symptoms and taught how to support their friends, how to recognize challenges they may be experiencing, and how to keep those who are sad from escalating. QPR (Question, Persuade, Refer) Gate Keeper Training efforts, which seek to educate professors, families, friends, administrators, and others in positions to notice when students are struggling with suicidal ideation, have also been shown to be successful in both in person, and Web-based formats (Lancaster et al., 2014). Social norms campaigns and/or individualized feedback can be used to correct students’ misperceptions of others, clarify “normal” sadness versus clinical depression, and encourage students to seek social support. Results from this study indicate experiencing depressed mood is related to increased normative perceptions of the prevalence of sadness and depression among other students. Research has found depressed individuals are less likely to detect expressions of happiness in others (Csukly, Czobor, Szily, Takács, & Simon, 2009;

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Loi, Vaidya, & Paradiso, 2013; Surguladze et al., 2004), and more likely to interpret neutral faces as sad and happy faces as neutral (Gur et al., 1992). These findings shed light on the current study, which may be an avenue for future depression interventions targeting negative thoughts characterized by Beck’s cognitive theory. Such interventions could be applied either campus wide through social norms campaigns around mood issues, or individually/as indicated by identifying those with misperceived norms about depression and sadness in others. Correcting these misperceptions may serve to decrease students’ own sadness and/or depression. Finally gender differences found in the study may be useful in considering when working with men/women in regards to depressed mood. Males were more likely than females to underestimate sadness and depression in others. Raising male students’ awareness and mental health prevalence may increase their own willingness to seek help as well as help others who may be impacted.

Future Directions Additional research is needed to explore the underestimates surrounding feeling sad. It is possible that much like other normative perceptions, students perceive excessive or extreme behaviors to be more prevalent than they actually are (e.g., heavy episodic drinking), yet underestimate behaviors that might be more common (e.g., abstinence or moderate drinking). It is also possible that for people experiencing upsetting feelings or thoughts (particularly ones incongruent with how they see themselves), perceiving these feelings as widespread could make their own experiences of these feelings and thoughts seem less troublesome. Thus, future studies could explore what role cognitive dissonance plays (if any) in these perceptions, as well as additional factors (cultural, ethnic, socioeconomic, etc.) contributing to beliefs about issues like depression or suicidal ideation. Future studies could examine how normative perceptions of depression relate to mood changes over time which would also be important in designing interventions.

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Received December 8, 2014 Revision received June 11, 2015 Accepted June 12, 2015 䡲