Self- and other-diagnosis in user-led mental health online communities

Analyzing the impact of unemployment on mental health among Chinese university graduates: a study of emotional and linguistic patterns on Weibo

Purpose

This study explores the intricate relationship between unemployment rates and emotional responses among Chinese university graduates, analyzing how these factors correlate with specific linguistic features on the popular social media platform Sina Weibo. The goal is to uncover patterns that elucidate the psychological and emotional dimensions of unemployment challenges among this demographic.

Methods

The analysis utilized a dataset of 30,540 Sina Weibo posts containing specific keywords related to unemployment and anxiety, collected from January 2019 to June 2023. The posts were pre-processed to eliminate noise and refine the data quality. Linear regression and textual analyses were employed to identify correlations between unemployment rates for individuals aged 16-24 and the linguistic characteristics of the posts.

Results

The study found significant fluctuations in urban youth unemployment rates, peaking at 21.3% in June 2023. A corresponding increase in anxiety-related expressions was noted in the social media posts, with peak expressions aligning with high unemployment rates. Linguistic analysis revealed that the category of "Affect" showed a strong positive correlation with unemployment rates, indicating increased emotional expression alongside rising unemployment. Other categories such as "Negative emotion" and "Sadness" also showed significant correlations, highlighting a robust relationship between economic challenges and emotional distress.

Conclusion

The findings underscore the profound impact of unemployment on the emotional well-being of university students, suggesting that economic hardships are closely linked to psychological stress and heightened negative emotions. This study contributes to a holistic understanding of the socio-economic challenges faced by young adults, advocating for comprehensive support systems that address both the economic and psychological facets of unemployment.

Implications of Online Self-Diagnosis in Psychiatry

Online self-diagnosis of psychiatric disorders by the general public is increasing. The reasons for the increase include the expansion of Internet technologies and the use of social media, the rapid growth of direct-to-consumer e-commerce in healthcare, and the increased emphasis on patient involvement in decision making. The publicity given to artificial intelligence (AI) has also contributed to the increased use of online screening tools by the general public. This paper aims to review factors contributing to the expansion of online self-diagnosis by the general public, and discuss both the risks and benefits of online self-diagnosis of psychiatric disorders. A narrative review was performed with examples obtained from the scientific literature and commercial articles written for the general public. Online self-diagnosis of psychiatric disorders is growing rapidly. Some people with a positive result on a screening tool will seek professional help. However, there are many potential risks for patients who self-diagnose, including an incorrect or dangerous diagnosis, increased patient anxiety about the diagnosis, obtaining unfiltered advice on social media, using the self-diagnosis to self-treat, including online purchase of medications without a prescription, and technical issues including the loss of privacy. Physicians need to be aware of the increase in self-diagnosis by the general public and the potential risks, both medical and technical. Psychiatrists must recognize that the general public is often unaware of the challenging medical and technical issues involved in the diagnosis of a mental disorder, and be ready to treat patients who have already obtained an online self-diagnosis.

Autistic discussion forums: insights into the topics that clinicians don't know about

Background

User-led autism discussion forums provide a wealth of information about autistic lived experiences, albeit oriented toward those who regularly use computers. We contend that healthcare professionals should read autism discussion forums to gain insight, be informed, and in some cases, to correct assumptions about autistic persons' lives and possibilities. But experts may be dismissive of user-led forums, believing forums to be filled with myths, misinformation, and combative postings. The questions motivating our research were: Do online forums raise issues that are educational for clinicians and other stakeholders? Are forums useful for those who do empirical research?

Method

Content analysis was conducted on 300 posts (62,000 words) from Reddit, Quora, and Wrong Planet. Forums were sampled to reflect broad topics; posts were selected sequentially from the identified forums. The authors read through posts in the Excel sheet, highlighting statements that were the main ideas of the post, to discern both broad categories of topics and more specific topics. We coded content pertinent to classic autism myths and analyzed attitudes towards myths such as 'lack emotion' and 'cannot form relationships.' To document whether forum posts discuss topics that are not widely known outside of elite experts, we compared discussion content to new material about autism contained in the March 2022 DSM 5 Text revision.

Results

Classic autism myths were discussed with examples of when elements of myths may be valid. Posters described cases where parents or therapists believed myths. Experts may believe autism myths due to rapid changes in diagnostic practices and due to their lack of knowledge regarding the characteristics of autistic people who have typical intellectual abilities. We conclude that forums contain high-value information for clinicians because all concepts in the DSM 5 text revision were discussed by posters in the years before the text revision appeared. Ideas that are only slowly becoming part of the research literature are discussed at length in forums. Reading and analyzing forums is useful for both clinicians and scientists. In addition, the relative ease of forum analysis lowers the bar for entry into the research process.

"I *know* all the things I should be doing …": accounting for mental health and illness in an online mental health discussion forum during the COVID-19 pandemic

BACKGROUND

Mental health is highly correlated with a person's social and economic circumstances, and the recent COVID-19 pandemic made this connection uniquely visible. Yet a discourse of personal responsibility for mental health often dominates in mental health promotion campaigns, media coverage and lay understandings, contributing to the stigmatisation of mental ill-health.

METHODS

In this study, we analysed how the concept of 'mental health' was discursively constructed in an online mental health peer-support forum in Australia during 2020, the period of the first two waves of the COVID-19 pandemic. An approach informed by Critical Discursive Psychology was employed to analyse all posts made to a discussion thread entitled "Coping during the coronavirus outbreak" in 2020, a total of 1,687 posts.

RESULTS

Two main interpretative repertoires concerning mental health were identified. Under the first repertoire, mental health was understood as resulting largely from the regular performance of a suite of self-care behaviours. Under the second repertoire, mental health was understood as resulting largely from external circumstances outside of the individual's control. The existence of two different repertoires of mental health created an ideological dilemma which posters negotiated when reporting mental ill-health. A recurring pattern of accounting for mental ill-health was noted in which posters employed a three-part concessive structure to concede Repertoire 1 amid assertions of Repertoire 2; and used disclaimers, justifications, and excuses to avoid negative typification of their identity as ignorant or irresponsible.

CONCLUSIONS

Mental ill-health was commonly oriented to by forum posters as an accountable or morally untoward state, indicating the societal pervasiveness of a discourse of personal responsibility for mental health. Such discourses are likely to contribute to the stigmatisation of those suffering from mental ill-health. There is a need therefore for future communications about mental health to be framed in a way that increases awareness of social determinants, as well as for policy responses to effect material change to social determinants of mental health.

#TreatmentResistantDepression: A qualitative content analysis of Tweets about difficult-to-treat depression

INTRODUCTION

Treatment-resistant depression (TRD) is depression unresponsive to antidepressants and affects 55% of British primary care users with depression. Current evidence is from secondary care, but long referral times mean general practitioners (GPs) manage TRD. Studies show that people with depression use Twitter to form community and document symptoms. However, Twitter remains a largely unexplored space of documented patient experience. Twitter data could provide valuable insights into learning about primary care experiences of TRD. In this study, we explored Twitter comments and conversations about TRD and produced patient-driven recommendations.

METHODS

Tweets from UK-based users were collected manually and using a browser extension in June 2021. Conventional content analysis was used to provide an overview of the Tweets, followed by interpretation to understand why Twitter may be important to people with TRD.

RESULTS

A total of 415 Tweets were organised into five clusters: self-diagnosis, symptoms, support, small wins and condition experts. These Tweets were interpreted as showing Twitter as a community for people with TRD. People had a collective sense of illness identity and were united in their experiences of TRD. However, users in the community also highlighted the absence of effective GP care, leading users to position themselves as condition experts. Users shared advice from a place of lived experience with the community but also shared potentially harmful information, including recommendations about nonevidence-based medications.

CONCLUSIONS

Findings illuminate the benefits of the TRD Twitter community and also highlight that the perception of a lack of knowledge and support from GPs may lead community members to advise nonevidenced-based medications.

PATIENT AND PUBLIC CONTRIBUTION

This study was led by a person with lived experience of TRD and bipolar. Two public contributors with mental health conditions gave feedback on our study protocol and results.

Digital community assets: Investigating the impact of online engagement with arts and peer support groups on mental health during COVID-19

The digitisation of mental health support has accelerated since the outbreak of the COVID-19 pandemic. This study investigated the impact of digital engagement with community assets on mental health during COVID-19. Digital engagement is typically not location-bound, but the restricted movement enforced during 'lockdowns' meant that people were primarily accessing digital community assets from their home environments. We report findings from a study utilising two creative workshops and semi-structured interviews to investigate how support operates in and through three digital community assets; an online peer support forum, a social enterprise running regular creative challenges nationally via social media and a local in-person creative arts support group. The concept of 'more or less digital' captures the ways that people's experiences of digital community assets extend beyond the platforms to incorporate settings of use. The analysis identifies how support is diluted through digital engagement, the value of minimal and muted forms of engagement and user-led designs for future hybrid forms of support. The article concludes by emphasising the importance of analysing digital community asset engagement in the settings of use and how such knowledge is vital for planning support in a future under continual pressure to be increasingly digital.

Integrated entitymetrics analysis for health information on bipolar disorder using social media data and scientific literature

Purpose

This study aimed to examine the mental health information entities and associations between the biomedical, psychological and social domains of bipolar disorder (BD) by analyzing social media data and scientific literature.

Design/methodology/approach

Reddit posts and full-text papers from PubMed Central (PMC) were collected. The text analysis was used to create a psychological dictionary. The text mining tools were applied to extract BD entities and their relationships in the datasets using a dictionary- and rule-based approach. Lastly, social network analysis and visualization were employed to view the associations.

Findings

Mental health information on the drug side effects entity was detected frequently in both datasets. In the affective category, the most frequent entities were “depressed” and “severe” in the social media and PMC data, respectively. The social and personal concerns entities that related to friends, family, self-attitude and economy were found repeatedly in the Reddit data. The relationships between the biomedical and psychological processes, “afraid” and “Lithium” and “schizophrenia” and “suicidal,” were identified often in the social media and PMC data, respectively.

Originality/value

Mental health information has been increasingly sought-after, and BD is a mental illness with complicated factors in the clinical picture. This paper has made an original contribution to comprehending the biological, psychological and social factors of BD. Importantly, these results have highlighted the benefit of mental health informatics that can be analyzed in the laboratory and social media domains.

Misinformation in Italian Online Mental Health Communities During the COVID-19 Pandemic: Protocol for a Content Analysis Study

Background

Social media platforms are widely used by people suffering from mental illnesses to cope with their conditions. One modality of coping with these conditions is navigating online communities where people can receive emotional support and informational advice. Benefits have been documented in terms of impact on health outcomes. However, the pitfalls are still unknown, as not all content is necessarily helpful or correct. Furthermore, the advent of the COVID-19 pandemic and related problems, such as worsening mental health symptoms, the dissemination of conspiracy narratives, and medical distrust, may have impacted these online communities. The situation in Italy is of particular interest, being the first Western country to experience a nationwide lockdown. Particularly during this challenging time, the beneficial role of community moderators with professional mental health expertise needs to be investigated in terms of uncovering misleading information and regulating communities.

Objective

The aim of the proposed study is to investigate the potentially harmful content found in online communities for mental health symptoms in the Italian language. Besides descriptive information about the content that posts and comments address, this study aims to analyze the content from two viewpoints. The first one compares expert-led and peer-led communities, focusing on differences in misinformation. The second one unravels the impact of the COVID-19 pandemic, not by merely investigating differences in topics but also by investigating the needs expressed by community members.

Methods

A codebook for the content analysis of Facebook communities has been developed, and a content analysis will be conducted on bundles of posts. Among 14 Facebook groups that were interested in participating in this study, two groups were selected for analysis: one was being moderated by a health professional (n=12,058 members) and one was led by peers (n=5598 members). Utterances from 3 consecutive calendar years will be studied by comparing the months from before the pandemic, the months during the height of the pandemic, and the months during the postpandemic phase (2019-2021). This method permits the identification of different types of misinformation and the context in which they emerge. Ethical approval was obtained by the Università della Svizzera italiana ethics committee.

Results

The usability of the codebook was demonstrated with a pretest. Subsequently, 144 threads (1534 utterances) were coded by the two coders. Intercoder reliability was calculated on 293 units (19.10% of the total sample; Krippendorff α=.94, range .72-1). Aside from a few analyses comparing bundles, individual utterances will constitute the unit of analysis in most cases.

Conclusions

This content analysis will identify deleterious content found in online mental health support groups, the potential role of moderators in uncovering misleading information, and the impact of COVID-19 on the content.

International Registered Report Identifier (IRRID)

PRR1-10.2196/35347

What are people's experiences of orthorexia nervosa? A qualitative study of online blogs

PURPOSE

Orthorexia nervosa (ON) is a proposed new eating disorder, used to describe a pathological obsession with healthy or 'clean' eating. Although some quantitative research has been carried out in ON, very little qualitative work has been published to date to explore individual experiences of ON. Thus, this study aimed to explore individuals' personal experiences of ON, as described in online blogs.

METHODS

Fifteen women bloggers, who self-identified as having ON, consented for their blog entries to be analysed in this study. Forty pre-existing blog entries describing the first-person experiences of ON were analysed using thematic analysis.

RESULTS

Three key themes were discussed: (1) initial motivations for a healthier lifestyle, (2) fuelling the problem-social influences, and: (3) when healthy becomes unhealthy. Bloggers described the role of social messages, comparison with others around ideas of 'healthiness', as well as confusion around diagnosis as factors influencing their disordered eating. They also described the exacerbating impact of perfectionism and perceived control, as well as a confirmatory cycle of fear and avoidance. For some bloggers, increased physical symptoms in response to feared foods provided confirmation for these fears, further exacerbating food avoidance.

CONCLUSION

Whilst the debate around the diagnosis of ON continues, these bloggers' accounts suggest that ON is experienced as a legitimate, debilitating disorder, worthy of clinical and research investigation. This study provides evidence of some of the potential triggers and maintaining factors for this disordered eating style.

LEVEL OF EVIDENCE

Level V, qualitative descriptive study.

A deep learning model for detecting mental illness from user content on social media

Users of social media often share their feelings or emotional states through their posts. In this study, we developed a deep learning model to identify a user’s mental state based on his/her posting information. To this end, we collected posts from mental health communities in Reddit. By analyzing and learning posting information written by users, our proposed model could accurately identify whether a user’s post belongs to a specific mental disorder, including depression, anxiety, bipolar, borderline personality disorder, schizophrenia, and autism. We believe our model can help identify potential sufferers with mental illness based on their posts. This study further discusses the implication of our proposed model, which can serve as a supplementary tool for monitoring mental health states of individuals who frequently use social media.

A Critical Perspective on Mental Health News in Six European Countries: How Are "Mental Health/Illness" and "Mental Health Literacy" Rhetorically Constructed?

In this study, we aim to contribute to the field of critical health communication research by examining how notions of mental health and illness are discursively constructed in newspapers and magazines in six European countries and how these constructions relate to specific understandings of mental health literacy. Using the method of cluster-agon analysis, we identified four terminological clusters in our data, in which mental health/illness is conceptualized as "dangerous," "a matter of lifestyle," "a unique story and experience," and "socially situated." We furthermore found that we cannot unambiguously assume that biopsychiatric discourses or discourses aimed at empathy and understanding are either exclusively stigmatizing or exclusively empowering and normalizing. We consequently call for a critical conception of mental health literacy arguing that all mental health news socializes its audience in specific understandings of and attitudes toward mental health (knowledge) and that discourses on mental health/illness can work differently in varying contexts.

Adherence of the #Here4U App - Military Version to Criteria for the Development of Rigorous Mental Health Apps

Background

Over the past several years, the emergence of mobile mental health apps has increased as a potential solution for populations who may face logistical and social barriers to traditional service delivery, including individuals connected to the military.

Objective

The goal of the #Here4U App – Military Version is to provide evidence-informed mental health support to members of Canada’s military community, leveraging artificial intelligence in the form of IBM Canada’s Watson Assistant to carry on unique text-based conversations with users, identify presenting mental health concerns, and refer users to self-help resources or recommend professional health care where appropriate.

Methods

As the availability and use of mental health apps has increased, so too has the list of recommendations and guidelines for efficacious development. We describe the development and testing conducted between 2018 and 2020 and assess the quality of the #Here4U App against 16 criteria for rigorous mental health app development, as identified by Bakker and colleagues in 2016.

Results

The #Here4U App – Military Version met the majority of Bakker and colleagues’ criteria, with those unmet considered not applicable to this particular product or out of scope for research conducted to date. Notably, a formal evaluation of the efficacy of the app is a major priority moving forward.

Conclusions

The #Here4U App – Military Version is a promising new mental health e-solution for members of the Canadian Armed Forces community, filling many of the gaps left by traditional service delivery.

Responding to depression-related Imgur posts: A content analysis of social support and non-bona fide features in user-generated comments

Objectives

A growing body of health communication scholarship has explored the utility of social media platforms for eliciting social support, although much of this scholarship has focused on Facebook and Twitter. This study contributes to this body of research by identifying support in comments submitted to depression-related Imgur posts. Furthermore, the use of non-bona fide linguistic features (e.g. humor, sarcasm, and irony) is documented for comparison with supportive elements.

Methods

A content analysis was performed of 1530 comments submitted in response to 20 popular Imgur posts about depression, including the emergence of four social support types outlined by the Multi-Dimensional Support Scale—reassuring, empathic, informational, and tangible support—as well as non-bona fide features.

Results

Findings suggest a supportive discourse, with nearly 60% of comments containing some supportive element. Reassuring and informational support emerged most prominently (26.3% and 26.2% of comments, respectively), followed by empathic (22.9%) and tangible (0.3%) support types. Non-bona fide features manifested in 28.8% of comments. Results indicate significant covariation between non-bona fide features and support, as these infrequently co-occurred.

Conclusions

This study’s findings suggest that depression-related messages frequently receive support from Imgur commenters, especially reassuring and informational support. Additionally, this study provides a conceptual framework for future analyses of online social support by integrating non-bona fide communication with established support types. The results of this study could have implications for health professionals and scholars interested in the use of social media platforms such as Imgur, which serves a predominantly young male demographic, for support provision.

The critical reception of the DSM-5: Towards a typology of audiences

Since its initial publication, the Diagnostic and Statistical Manual of Mental Disorders has been the object of criticism which has led to regular revisions by the American Psychiatric Association. This article analyses the debates that surrounded the publication of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Building on the concepts of public arenas and reception theory, it explores the meaning encoded in the manual by audiences. Our results, which draw from a thematic analysis of traditional and digital media sources, identify eight audiences that react to the American Psychiatric Association's narrative of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.): conformist, reformist, humanist, culturalist, naturalist, conflictual, constructivist and utilitarian. While some of their claims present argumentative polarities, others overlap, thus challenging the idea, often presented in academic publications, of a fixed debate. In order to further discuss on the Diagnostic and Statistical Manual of Mental Disorders, we draw attention to claims that 'travel' across different communities of audiences.

Women's obstetric and reproductive health care discourse in online forums: Perceived access and quality pre- and post-Affordable Care Act

This corpus-based study examines women's framing of health issues in online forums (MedHelp.org, AphroditeWomensHealth.com, and Connect.MayoClinic.org) prior to, during, and after implementation of the Affordable Care Act (ACA). Since worldviews affect how women describe health issues, their discourse is both a way to see ideology indexed in the forums, as well as how that discourse has been shaped by policy. Posts were collected December 2016-April 2017 and annotated using the UAM (Universidad Autónoma de Madrid) Corpus Tool to examine emergent categories and compare them to three time periods: pre-, during, and post-ACA. Data within posts were coded as to the linguistic moves being made. Three frequent categories of linguistic function in the data were identified: experience-sharing, advice-requesting and offering, and rationale-offering (N = 1268). These linguistic moves were sub-divided into further categories (e.g., under advice requesting, a request for diagnosis), and a discourse-analytical perspective provides insight into the values indexed in each. Before ACA, forum participants cited access, fear, and a history of unhelpful medical visits as obstacles to seeking care. After implementation, obstacles cited were prior unhelpful visits, followed by access, and uncertainty regarding care-seeking appropriateness. While ACA implementation reduced lack of insurance as an obstacle to obtaining healthcare, online forums indicate that patients continue to find doctors' visits unhelpful, instead choosing to seek medical advice from the lay public. Patients' distrust of the medical profession persisted following ACA implementation. There is a need for public health initiatives to improve this relationship in order to augment health care outcomes.

Making expertise fit: On the use of certified versus experiential knowledge in becoming an informed patient

This article reports a discursive psychological study of online conversations among patients with ADHD, diabetes, or ALS on what constitutes an “informed patient.” Being informed means different things for different patient groups. Whether patients prioritize experiential or certified expert knowledge is not indicative of patients’ preferences per se but depends on how they give meaning to the responsibilities particular to their disease. ADHD patients hold each other accountable for demonstrating the seriousness of their disease. ALS patients use expert information to orient to a norm of thinking positive. Diabetes patients challenge experts to carve out independence from the diabetes regimen.

Informal caregiving experiences in posttraumatic stress disorder: A content analysis of an online community

This study explored the experiences of individuals who self-identify as providing support to a friend, family member, or significant other with posttraumatic stress disorder (PTSD). We analyzed and coded a total of 345 posts from an online support forum, with reference to 13 categories (finances, life interference, venting/emotional expression, maltreatment, sexual behavior, distress, prevented expression, physical health, communication, no personal space, isolation, and compassion fatigue). Categories for coding were established a priori and based on previous literature about caregiving and supporting. Results suggested that informal PTSD caregivers experience concerns involving interpersonal relations, emotional turmoil, and barriers to care for themselves and the individual they are caring for. This study provides a preliminary examination of the experiences and concerns of PTSD caregivers. Implications and suggestions for future research are discussed.

'You must know what you mean when you say that': the morality of knowledge claims about ADHD in radio phone-ins

Drawing on a corpus of radio phone-ins, we present a discursive psychological analysis of how mothers carefully tailor their knowledge claims regarding their children with Attention Deficit Hyperactivity Disorder (ADHD). Mothers typically claim knowledge about their children's good intentions, but not about the 'ADHD-ness' of their conduct. Whereas the former is seen as appropriate knowledge for a concerned parent, the latter is treated as a matter of expert knowledge. We show that as soon as problematic behaviour is treated as observable from the outside and describable by mothers and other lay persons, it becomes vulnerable to being formulated as 'normal disobedience', rather than symptomatic of a professionally administered, doctorable condition. We argue that it is important to be aware of the moralities hidden in knowledge claims, as they help sustain an unproductive perspective in which either the child's brain or his mother is blamed for behaviour perceived as problematic.

Consumer-led health-related online sources and their impact on consumers: An integrative review of the literature

The aim of the review was to describe consumer-led health-related online sources and their impact on consumers. The review was carried out as an integrative literature review. Quantisation and qualitative content analysis were used as the analysis method. The most common method used by the included studies was qualitative content analysis. This review identified the consumer-led health-related online sources used between 2009 and 2016 as health-related online communities, health-related social networking sites and health-related rating websites. These sources had an impact on peer support; empowerment; health literacy; physical, mental and emotional wellbeing; illness management; and relationships between healthcare organisations and consumers. The knowledge of the existence of the health-related online sources provides healthcare organisations with an opportunity to listen to their consumers' 'voice'. The sources make healthcare consumers more competent actors in relation to healthcare, and the knowledge of them is a valuable resource for healthcare organisations. Additionally, these health-related online sources might create an opportunity to reduce the need for drifting among the healthcare services. Healthcare policymakers and organisations could benefit from having a strategy of increasing their health-related online sources.

"Listen to your body": Participants' alternative to science in online health discussions

We present a discursive psychological analysis of how the idiomatic expression “Listen to Your Body” is deployed in online forum discussions about ADHD medication and aspartame. The Listen to Your Body device allows participants to demonstrate to others that they take their health seriously and for that reason avoid scientific knowledge. They contrast Listen to Your Body with “blindly following science,” presenting Listen to Your Body as the more critical and, therefore, more rational behavior. Instead of treating the idiomatic expression as “anyone’s knowledge,” speakers and recipients compete for the right to own it. It is discussed what these results mean for the role of and relation between experiential knowledge (“lay expertise”) and scientific expertise in online discussions about health issues.

Ethical perspectives on recommending digital technology for patients with mental illness

The digital revolution in medicine not only offers exciting new directions for the treatment of mental illness, but also presents challenges to patient privacy and security. Changes in medicine are part of the complex digital economy based on creating value from analysis of behavioral data acquired by the tracking of daily digital activities. Without an understanding of the digital economy, recommending the use of technology to patients with mental illness can inadvertently lead to harm. Behavioral data are sold in the secondary data market, combined with other data from many sources, and used in algorithms that automatically classify people. These classifications are used in commerce and government, may be discriminatory, and result in non-medical harm to patients with mental illness. There is also potential for medical harm related to poor quality online information, self-diagnosis and self-treatment, passive monitoring, and the use of unvalidated smartphone apps. The goal of this paper is to increase awareness and foster discussion of the new ethical issues. To maximize the potential of technology to help patients with mental illness, physicians need education about the digital economy, and patients need help understanding the appropriate use and limitations of online websites and smartphone apps.

Exploring the Experience of Self-Diagnosis of Autism Spectrum Disorder in Adults

One in 68 Americans has autism spectrum disorder (ASD), and diagnosis is often delayed into adulthood in individuals without comorbid intellectual disability. Many undiagnosed adults resort to self-diagnosis. The purpose of this descriptive phenomenology was to explore the experience of realizing a self-diagnosis of ASD among 37 individuals who were not formally diagnosed. Results revealed five themes: feeling "othered," managing self doubt, sense of belonging, understanding myself, and questioning the need for formal diagnosis. Healthcare professionals must have an understanding of self-diagnosis to help individuals transition to formal diagnosis and to adequately educate, support, and screen this population for comorbidities.

Stepping Back From Crisis Points: The Provision and Acknowledgment of Support in an Online Suicide Discussion Forum

Suicide is a global health concern, though little is known about the social practices that might support those who are contemplating suicide. Online forums provide a unique insight into the anonymous discussion of suicide, including sociocultural norms about suicide and the delicate management of online interaction. In this article, we examine the provision and acknowledgment of support in an online discussion forum about suicide, using discursive psychology to analyze the textual interaction. The analysis illustrates how forum threads function as case studies and enable members to gain support on numerous occasions. In this way, members can gain help at crisis points as and when these occur, while still maintaining authenticity as a valid forum member. The analysis also provides additional evidence for models of suicide which highlight the fluid nature of suicidality and contributes to the preventative work on suicide by demonstrating how support can be provided at crisis points.

"You get to know the people and whether they're talking sense or not": Negotiating trust on health-related forums

The internet is increasingly being used as a source of health advice and information by individuals with long term conditions (LTCs). Specifically, online forums allow people to interact with others with similar conditions. However, it is not clear how online health information is assessed by those with LTCs. This study aims to address this gap by exploring how individuals with contested and uncontested LTCs utilise internet forums. Semi-structured interviews were conducted with 20 participants with ME/CFS and 21 participants with type 1 and 2 diabetes and analysed using thematic analysis. Participants were recruited via online and offline routes, namely forums, email lists, newsletters, and face-to-face support groups. The findings indicate that the use of online forums was a complex and nuanced process and was influenced by a number of individual and illness-specific factors. Participants trusted those with similar experiences and perspectives as themselves, while also valuing conventional biomedical information and advice. By accessing support online, forum users were able to draw on a personalised form of support based on the lived experiences of their peers. However, the role of digital literacy in developing and maintaining online relationships must be acknowledged.

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The use of online forums by individuals with LTCs is a complex and nuanced process.

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Participants trust those with similar experiences and perspectives as themselves.

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Users can access a personalised form of support based on the experiences of peers.

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Role of digital literacy in developing online relationships must be acknowledged.

Diagnoses, Relational Processes and Resourceful Dialogs: Tensions for Families and Family Therapy

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), given its psychiatric focus on mental disorders in individuals, presents families and family therapists with challenges. Despite considerable controversies over its adoption, the DSM-5 extends a process of standardizing a language for human and relational concerns. No longer a diagnostic language of professionals alone, its use is medicalizing how mental health funders and administrators, as well as clients, respond to human concerns. For family therapists who practice systemically, particularly from poststructuralist and strengths-based orientations, many tensions can follow when use of the DSM-5 is expected by mental health administrators and funders, or by clients who present concerns about themselves or a diagnosed family member. In this paper, I explore how such DSM-5 related tensions might be recognized, navigated, and negotiated in the practice of family therapy with clients, and with administrators and funders.

Substance use disorder in Asperger syndrome: An investigation into the development and maintenance of substance use disorder by individuals with a diagnosis of Asperger syndrome

BACKGROUND

Recent research has suggested that the prevalence of problematic substance use within the Asperger syndrome population has previously been underestimated. Furthermore, there is some indication that problematic substance use might take place to manage the traits of Asperger syndrome; however this possibility has yet to be examined in detail. This study aimed to address this omission by exploring individuals' perceptions of their substance use in relation to their diagnosis of Asperger syndrome.

METHODS

Eight participants were recruited from either a specialist Asperger syndrome service or a drug and alcohol service. Participants were interviewed regarding their views of which factors led to their development and maintenance of problematic substance use, specifically in relation to their experience of having been diagnosed with Asperger syndrome. Thematic analysis was conducted on the interview transcripts.

RESULTS

Six main themes were identified: self-medication; social facilitation; discrepancy between need and support; defining problematic substance use; substance use of peers, and recreational use of substances. The two themes of social facilitation and self-medication are focused on within this paper as they most closely reflect the more prominent bodies of literature in relation to the research aim.

CONCLUSIONS

Participants reported that substances were used to act as a social facilitator to compensate for social deficits by increasing confidence in social settings and increasing participants' ease with which they communicate. The self-medication of psychological distress was reported and was associated with depression, anxiety and sleep difficulties. The study ends with a reflection on the method of data collection, the implications for clinical practice and suggestions for future research.

"Please Know That You Are Not Alone with Your Pain": Responses to Newcomer Posts in an Online Grief Support Forum

In an effort to better understand how the Internet can provide support to bereaved individuals, this discourse analysis study examined the responses to 107 initial posts in an online grief support group to understand how newcomers' bids for group membership were taken up by current members. Discursive features included validation and empathy through second stories, constructing grief through descriptions, and accepting bids for membership through advice giving and invitations to return to the group. These features illustrate how grief and being a griever are constructed in an online context and how they deviate from the "normal" grief expectations in the offline world.

Online anonymous discussion between service users and health professionals to ascertain stakeholder concerns in using e-health services in mental health

Implementation of e-health in mental health services requires that we are aware of stakeholders' concerns. We ascertained the views of mental health professionals and mental health service users through the (1) development of 12 topics based on the research literature, (2) presentation to 31 participants (19 mental health professionals and 12 mental health service users) and discussion in three 1-week programmes, (3) thematic analysis of transcripts, and (4) comparison with the literature to identify areas requiring attention in e-health implementation. This method of engaging mental health service users and mental health professionals was effective. We identified areas that (1) should be the first to implement (e.g. discussion forums, email, and Skype), (2) where further education and engagement are necessary before e-health methods could be used (e.g. unsupported computerised cognitive behavioural therapy, computer-patient interviewing, and patient access to online medical records), and (3) for further research (e.g. the impact of bad online experiences).

A unified conceptual model for diagnostic errors: underdiagnosis, overdiagnosis, and misdiagnosis

Progress in diagnostic error research has been hampered by a lack of unified terminology and definitions. This article proposes a novel framework for considering diagnostic errors, offering a unified conceptual model for underdiagnosis, overdiagnosis, and misdiagnosis. The model clarifies the critical separation between 'diagnostic process failures' (incorrect workups) and 'diagnosis label failures' (incorrect diagnoses). By dividing processes into those that are substandard, suboptimal, or optimal, important distinctions are drawn between 'preventable', 'reducible,' and 'unavoidable' diagnostic errors. The new model emphasizes the importance of mitigating diagnosis-related harms, regardless of whether the solutions require traditional safety strategies (preventable errors), more effective evidence dissemination (reducible errors; harms from overtesting and overdiagnosis), or new scientific discovery (currently unavoidable errors). Doing so maximizes our ability to prioritize solving various diagnosis-related problems from a societal value perspective. This model should serve as a foundation for developing consensus terminology and operationalized definitions for relevant diagnostic-error categories.

‘DSM-V is taking away our identity’: The reaction of the online community to the proposed changes in the diagnosis of Asperger’s disorder

This article considers the fate of Asperger’s disorder in the light of proposals for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) to collapse Asperger’s disorder along with other pervasive developmental disorders into a general spectrum of autism. It is argued that a powerful lay and scientific culture has evolved around the concept of Asperger’s disorder, which has found a particularly compelling voice over the last decade in the online Asperger community, with websites such as Wrong Planet recruiting tens of thousands of members. In order to assess the impact of these proposed changes on the online Asperger community, 19 threads on the topic of Diagnostic and Statistical Manual of Mental Disorders (5th ed.) are analysed according to the arguments that community members put forward in favour of, or in opposition to, the proposals. Many members embrace the notion of the spectrum and have already coined a new identity – ‘spectrumite’ – to adapt to the diagnostic shift. Others, however, are suspicious of the motives behind the absorption of Asperger’s disorder, and potential threats to the provision of services as well as the strong ‘aspie’ identity that reflects the large literature and the online public sphere around Asperger’s disorder. To what extent this culture poses a challenge to the authority of the Diagnostic and Statistical Manual of Mental Disorders is uncertain at present.

Furthering the reliable and valid measurement of mental health screening, diagnoses, treatment and outcomes through health information technology

INTRODUCTION

Measurement of mental health is challenging; however, many solutions may be found through the use of health information technology.

METHOD

This article reviews current approaches to measuring mental health, focusing on screening, diagnosis, treatment, and outcomes. It then identifies several key areas in which health information technology may advance the field and provide reliable and valid measurements that are readily available to and manageable for providers, as well as acceptable, feasible, and sustainable for selected populations.

RESULT AND CONCLUSIONS

Although new technologies must overcome many challenges, including privacy, efficiency, cost, and scalability, it is an exciting and fast-growing field with many potential applications and clinical benefit.

Immobility, battles, and the journey of feeling alive: women's metaphors of self-transformation through depression and recovery

Australian mental health services have responded to the problem of depression by adopting an early intervention and recovery orientation. Using qualitative research conducted in Australia with 80 women aged 20 to 75 years, we examine how participants invoked particular metaphors to construct meaning about the gendered experience of depression and recovery. We argue that women's stories of recovery provide a rich source of interpretive material to consider the everyday metaphors of recovery beyond clinical notions and linear models of personal change. We identified key metaphors women drew on to articulate the struggle of self-transformation through depression and recovery: the immobilizing effect of depression, recovery as a battle to control depression, and recovery as a journey of self-knowledge. Our findings might be useful for mental health professionals in a range of clinical contexts to reflect on the power of language for shaping how women interpret their experiences of recovery from depression.

Developing an online learning community for mental health professionals and service users: a discursive analysis

BACKGROUND

There is increasing interest in online collaborative learning tools in health education, to reduce costs, and to offer alternative communication opportunities. Patients and students often have extensive experience of using the Internet for health information and support, and many health organisations are increasingly trying out online tools, while many healthcare professionals are unused to, and have reservations about, online interaction.

METHODS

We ran three week-long collaborative learning courses, in which 19 mental health professionals (MHPs) and 12 mental health service users (MHSUs) participated. Data were analysed using a discursive approach to consider the ways in which participants interacted, and how this contributed to the goal of online learning about using Internet technologies for mental health practice.

RESULTS

MHSUs and MHPs were able to discuss issues together, listening to the views of the other stakeholders. Discussions on synchronous format encouraged participation by service users while the MHPs showed a preference for an asynchronous format with longer, reasoned postings. Although participants regularly drew on their MHP or MHSU status in discussions, and participants typically drew on either a medical expert discourse or a "lived experience" discourse, there was a blurred boundary as participants shifted between these positions.

CONCLUSIONS

The anonymous format was successful in that it produced a "co-constructed asymmetry" which permitted the MHPs and MHSUs to discuss issues online, listening to the views of other stakeholders. Although anonymity was essential for this course to 'work' at all, the recourse to expert or lay discourses demonstrates that it did not eliminate the hierarchies between teacher and learner, or MHP and MHSU. The mix of synchronous and asynchronous formats helped MHSUs to contribute. Moderators might best facilitate service user experience by responding within an experiential discourse rather than an academic one.

Developing an online learning community for mental health professionals and service users: a discursive analysis

BACKGROUND

There is increasing interest in online collaborative learning tools in health education, to reduce costs, and to offer alternative communication opportunities. Patients and students often have extensive experience of using the Internet for health information and support, and many health organisations are increasingly trying out online tools, while many healthcare professionals are unused to, and have reservations about, online interaction.

METHODS

We ran three week-long collaborative learning courses, in which 19 mental health professionals (MHPs) and 12 mental health service users (MHSUs) participated. Data were analysed using a discursive approach to consider the ways in which participants interacted, and how this contributed to the goal of online learning about using Internet technologies for mental health practice.

RESULTS

MHSUs and MHPs were able to discuss issues together, listening to the views of the other stakeholders. Discussions on synchronous format encouraged participation by service users while the MHPs showed a preference for an asynchronous format with longer, reasoned postings. Although participants regularly drew on their MHP or MHSU status in discussions, and participants typically drew on either a medical expert discourse or a "lived experience" discourse, there was a blurred boundary as participants shifted between these positions.

CONCLUSIONS

The anonymous format was successful in that it produced a "co-constructed asymmetry" which permitted the MHPs and MHSUs to discuss issues online, listening to the views of other stakeholders. Although anonymity was essential for this course to 'work' at all, the recourse to expert or lay discourses demonstrates that it did not eliminate the hierarchies between teacher and learner, or MHP and MHSU. The mix of synchronous and asynchronous formats helped MHSUs to contribute. Moderators might best facilitate service user experience by responding within an experiential discourse rather than an academic one.

Unsolicited written narratives as a methodological genre in terminal illness: challenges and limitations

Stories about illness have proven invaluable in helping health professionals understand illness experiences. Such narratives have traditionally been solicited by researchers through interviews and the collection of personal writings, including diaries. These approaches are, however, researcher driven; the impetus for the creation of the story comes from the researcher and not the narrator. In recent years there has been exponential growth in illness narratives created by individuals, of their own volition, and made available for others to read in print or as Internet accounts. We sought to determine whether it was possible to identify such material for use as research data to explore the subject of living with the terminal illness amyotrophic lateral sclerosis/motor neuron disease--the contention being that these accounts are narrator driven and therefore focus on issues of greatest importance to the affected person. We encountered and sought to overcome a number of methodological and ethical challenges, which is our focus here.

Membership and boundary maintenance on an online self-harm forum

In this article we explore how young adults became members and sustained membership in an online self-harm support forum, SharpTalk. We take a discursive approach to consider resources young people used to establish themselves, how others responded to their attempts, and how membership categories were developed and applied. Participants displayed expectations about appropriate ways of discussing self-harm, and about responses and advice. New posters made reference to other self-harm sites, provided biomedicalized narratives of their "story," and asked for help in particular ways. Participants were active in shaping interactions on the forum, requesting input from site moderators, and challenging each other both on perceived infringements of posting content, and on style of posting pertinent to membership. On the SharpTalk site, perceived deviance in posting behavior, and also the giving of health care advice, were most commonly addressed by other young people who self-harmed, rather than by the site moderators. We consider implications for creating sites that enable young people who self-harm to become members and sustain membership, and therefore access support.