Background College students’ mental health is at an all-time low. Students are increasingly disclosing their vulnerable, stigmatizing experiences on online social networking sites (SNSs). Peer support facilitated by SNSs can play a crucial role for the students in coping with mental health–related problems. Thus, it is imperative to understand how university students form perceptions, attitudes, and behaviors toward their peers who are dealing with mental health problems. Objective This study aimed to provide a better understanding of how college students recognize, perceive, and react to signs of mental health problems in their peers on SNSs. Our ultimate goal in this study was to inform the design of SNSs that can facilitate online peer support. Methods We conducted surveys with 226 students as well as semistructured interviews with 20 students at six universities in South Korea. Results Of the 226 survey respondents, 150 (66.4%) reported that they recognized signs of a mental health problem on their friends’ SNS posts. However, a considerable number of respondents (62/150, 41.3%) were reluctant to offer support, even when they had identified friends who were at risk; this reluctance was due to a lack of knowledge or confidence and their desire to maintain a distance from at-risk peers to save their identity from stigmatization and to avoid emotional contagion online. Conclusions Drawing on these results, we provide implications that could explain the construction of students’ perceptions regarding their peers’ mental health problems. We also provide design proposals for SNSs to serve as platforms that facilitate just-in-time and adaptive support exchanges among peers while mitigating stigma-related concerns.

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BACKGROUND College students are at a vulnerable age; among those with serious mental health problems, this period is frequently when the first episodes appear. As a result, college students are increasingly disclosing their vulnerable, stigmatized experiences on social networking sites (SNSs). Understanding students’ perceptions and attitudes toward their peers who are dealing with mental health problems is vital to the efforts to eliminate peer exclusion and foster social support. OBJECTIVE This work aims to provide a better understanding of how college perceive and react to their fellow students’ mental health related activities on SNSs. We investigate how students recognize, perceive, and react to peers who display mental health related challenges on SNSs. METHODS Survey with 226 students, and semi structured interviews with 20 students were conducted at six universities in South Korea. RESULTS We revealed that a considerable number of college students did not proactively provide support even when they identified at-risk peers because of stigmatized content, unusual online activities, or a gap between online and offline identities. We found that the students’ lack of knowledge, confidence, and expectations as well as their desire to maintain distance from at-risk peers hindered social support. CONCLUSIONS On the basis of this study’s finding, we discuss SNS design guideline that would help these platforms facilitate support exchanges among peers while minimizing potential risks.