Depression Narratives in Blogs: A Collaborative Quest for Coherence

Coping with depression: a narrative study of an online depression community in China

PURPOSE

The goal of this study was to explore the coping strategies of depression sufferers that have worked for them based on the study of an online depression community.

METHODS

We conducted a thematic narrative analysis of 120 stories posted by the members in the largest online depression community in China. MaxQDA version 18 was used to code the data, and the analytic approach was consistent with the category-centred approach of grounded theory.

RESULTS

The study found that the coping strategies mainly include self-reconciliation (e.g., perceiving/accepting feelings, accepting the present self, and holding hope for the future), actions (recreational activities, physical exercise, and engaging in volunteer work), addressing the stressors and symptoms (e.g., staying away from stressors, seeing the doctor), and seeking interpersonal support (e.g., seeking support from family, friends, and peers).

CONCLUSION

The findings revealed the coping strategies that were helpful and examined how they functioned for the affected members, which make up for the lack of attention to the individual experiences of depression sufferers in coping research. The findings also have practical implications for the related education and consultation, providing useful insights for doctors and patients. These ways of coping are based on depression sufferer' anonymous narratives, which can be convincing to clients.

Complaining, Regret, Superiority, and Discovery: Chinese Patients' Sense Making of Depression in an Online Forum

Drawing on observations of a Chinese online depression community, this article explored the members' sense making of depression by analyzing their narrative accounts of depression. Four types of sense making were predominant among the depression sufferers: complaining, regret, superiority, and discovery. The complaining narrative is the members' telling about the pain caused by family (parental control or neglect), school bullying, stress from study or work, and social norms. The regret narrative is the members' reflection on their habit of perfectionism and lack of self-disclosure. The superiority narrative is the members' attribution of depression to their intelligence and morality that surpass the average people. The discovery narrative is the members' novel understanding of the self, significant others, and key events. The findings suggest that the social and psychological explanation of the causes of depression, instead of the medical model, is popular among the Chinese patients. Their stories of depression are also stories of marginalization, visions for the future, and realizing the normalization of identity as depression patients. The findings have implications for public policy around support for mental health.

A case study of using natural language processing to extract consumer insights from tweets in American cities for public health crises

BACKGROUND

The COVID-19 pandemic was a "wake up" call for public health agencies. Often, these agencies are ill-prepared to communicate with target audiences clearly and effectively for community-level activations and safety operations. The obstacle is a lack of data-driven approaches to obtaining insights from local community stakeholders. Thus, this study suggests a focus on listening at local levels given the abundance of geo-marked data and presents a methodological solution to extracting consumer insights from unstructured text data for health communication.

METHODS

This study demonstrates how to combine human and Natural Language Processing (NLP) machine analyses to reliably extract meaningful consumer insights from tweets about COVID and the vaccine. This case study employed Latent Dirichlet Allocation (LDA) topic modeling, Bidirectional Encoder Representations from Transformers (BERT) emotion analysis, and human textual analysis and examined 180,128 tweets scraped by Twitter Application Programming Interface's (API) keyword function from January 2020 to June 2021. The samples came from four medium-sized American cities with larger populations of people of color.

RESULTS

The NLP method discovered four topic trends: "COVID Vaccines," "Politics," "Mitigation Measures," and "Community/Local Issues," and emotion changes over time. The human textual analysis profiled the discussions in the selected four markets to add some depth to our understanding of the uniqueness of the different challenges experienced.

CONCLUSIONS

This study ultimately demonstrates that our method used here could efficiently reduce a large amount of community feedback (e.g., tweets, social media data) by NLP and ensure contextualization and richness with human interpretation. Recommendations on communicating vaccination are offered based on the findings: (1) the strategic objective should be empowering the public; (2) the message should have local relevance; and, (3) communication needs to be timely.

Personal Narratives of Mental Illness: From Hostage to Survivor

This study has delved into personal narratives extracted from online blogs to build a systematic view of mental illness trajectory through the portrayal offered by bloggers. One hundred and thirty-three blogs were reviewed and narrative analysis was used to interpret a final sample of 12 blogs. The results offer two main narratives-the hostage and the survivor-which illustrate, within the context of social and self-stigma, the need for an identity reformulation in order to reach recovery. The two narratives also led to the design of a model for mental illness trajectory (MMIT). The breaking down of mental illness trajectory into phases could be advantageous to promoting tailored interventions for specific stages of recovery. The importance of referring to lived experience when trying to understand and develop better treatments for mental illness has been well established. This study contributes to the growing body of research that includes the voice of the person with mental illness offering not only a vivid portrayal of life with mental health issues but also an understanding of the trajectory to recovery.

Blogging with dementia: Writing about lived experience of dementia in the public domain

Public narratives around dementia have historically been negative, and have not been shaped by people with dementia themselves, but stories of living with dementia are becoming more common in the public domain. This qualitative study explored the motivations and experiences of bloggers by conducting interviews with six bloggers with dementia in the UK. Thematic analysis suggested that the asynchronous nature of blogging offered a valuable, personalised space for people with dementia to tell their own stories in their own way. Blogging as a format posed some practical challenges, but bloggers developed strategies to overcome these. Motivations for blogging were on three levels: the personal (as a journal, and as a 'room of one's own'); community (as solidarity for other people with dementia, and as comfort for families and friends) and society (as an educational and campaigning tool). Whilst the study is small, and there are many voices of people with dementia missing from the blogging community, this research demonstrates the potential for blogging by people with dementia to change public narratives and perceptions of dementia.

Impact of Medical Blog Reading and Information Presentation on Readers' Preventative Health Intentions: Mixed Methods, Multistudy Investigation

Background

Medical blogs have become valuable information sources for patients and caregivers. Most research has focused on patients’ creation of blogs as therapy. But we know less about how these blogs affect their readers and what format of information influences readers to take preventative health actions.

Objective

This study aimed to identify how reading patient medical blogs influences readers’ perceived health risk and their intentions to engage in preventative health actions. Further, we aimed to examine the format of the medical blog and the reader’s response.

Methods

We surveyed 99 university participants and a general-population, online panel of 167 participants. Both studies randomly assigned participants to conditions and measured blog evaluation, intentions for preventative health action, and evaluation of health risk and beliefs, and allowed open-ended comments. The second study used a different sample and added a control condition. A third study used a convenience sample of blog readers to evaluate the link between reading medical blogs and taking preventative health action.

Results

Across 3 studies, participants indicated a desire to take future preventative health action after reading patient blogs. Studies 1 and 2 used experimental scenario-based designs, while Study 3 employed a qualitative design with real blog readers. The 2 experimental studies showed that the type of blog impacted intentions to engage in future preventative health actions (Study 1: F_2,96=6.08, P=.003; Study 2: F_3,166=2.59, P=.06), with a statistical blog being most effective in both studies and a personal narrative blog showing similar effectiveness in Study 2, contrary to some prior research. The readers’ perceptions of their own health risk did not impact the relationship between the blog type and health intentions. In contrast, in one study, participants’ judgments about the barriers they might face to accessing care improved the fit of the model (F_2,95=13.57, P<.001). In Study 3’s sample of medical blog readers, 53% (24/45) reported taking preventative health action after reading a health blog, including performing a self-check, asking a doctor about their health risk, or requesting a screening test. Additionally, these readers expressed that they read the blogs to follow the author (patient) and to learn general health information. All studies demonstrated the blogs were somewhat sad and emotional but also informative and well-written. They noted that the blogs made them appreciate life more and motivated them to consider taking some action regarding their health. 

Conclusions

Reading patient blogs influences intentions to take future health actions. However, blog formats show different efficacy, and the readers’ disease risk perceptions do not. Physicians, medical practitioners, and health organizations may find it useful to curate or promote selected medical blogs to influence patient behavior.

Topic modelling online depression forums: beyond narratives of self-objectification and self-blaming

BACKGROUND

Depression raises a double challenge: besides the negative mood and the intrusive thoughts, the relation to the self also becomes difficult. Online forums are analysed as communicative platforms enabling the interactive reconstruction of the self.

AIMS

The discourses of online depression forums are explored. Firstly, narrative patterns are identified according to their thematic focus (e.g. dysfunctional body, challenges of intimacy) and discursive logic (e.g. information exchange, support). Secondly, narratives are analysed in order to describe various ways of grounding a depressed self.

METHODS

∼70.000 depression-related posts from the biggest English-speaking online forums (e.g. www.reddit.com/r/depression, www.healthunlocked.com) were analysed. Quantitative (LDA topic modelling) and qualitative (deep reading) approaches were used simultaneously to determine the optimal number of topics and their interpretation.

RESULTS

13 topics were identified and interpreted according to their content and communicative function. Based on the inter-topic distances four clusters were identified (medicalized, intimacy-oriented, critical and uninhabitable self-narratives).

CONCLUSIONS

The clusters of the 13 topics highlight various ways of narrating depression and the depressed self. Based on a comparison with a systematic review of mental illness recovery narratives, depression forums cover most narrative genres and emotional tones, thus create a unique opportunity for integrating the depressing experiences in the self.

The asymmetries of the biopsychosocial model of depression in lay discourses - Topic modelling online depression forums

BACKGROUND

One of the most comprehensive approaches to depression is the biopsychosocial model. From this wider perspective, social sciences have criticized the reductionist biomedical discourse, which has been dominating expert discourses for a long time. As these discourses determine the horizon of attributions and interventions, their lay interpretation plays a central role in the coping with depression.

METHODS

In order to map these patterns, online depression forums are analyzed with natural language processing methods, where computational tools are complemented with a qualitative approach. Latent Dirichlet Allocation topic model of depression-related posts from the most popular English-speaking online health discussion forums (N = ~70 000) reveals the monolog (attributions and self-disclosures) and interactive (consultations and quasi-therapeutic interactions) patterns.

RESULTS

Following the evaluation of various models 18 topics were differentiated: attributions referring to health, family, partnership and work issues; self-disclosures referring to contemplations, introducing the experience of suffering and well-being, along with diaries of everyday activities and hardships; consultations about psychotherapies, classifications, drugs and the experience; and quasi-therapeutic interactions relying on unconditional positive regards, recovery helpers experience or spirituality. These topics were evaluated from the perspective of the biopsychosocial model: the weight of each dimension was measured along with the discursive function.

CONCLUSIONS

Biomedical discourse is underrepresented in lay discussions, while psychological discourse plays an overall dominant role. Even if actors are initially aware of the social mechanisms contributing to depression, they neglect these factors when it comes to considering the countermeasures.

From Lay Depression Narratives to Secular Ritual Healing: An Online Ethnography of Mental Health Forums

The article aims at analysing online depression forums enabling lay reinterpretation and criticism of expert biomedical discourses. Firstly, two contrasting interpretations of depression are reconstructed: expert psy-discourses are confronted with the phenomenological descriptions of lay experiences, with a special emphasis on online forums as empirical platforms hosting such debates. After clarifying the general theoretical stakes concerning contested 'depression narratives', the results of an online ethnography are introduced: the main topics appearing in online discussions are summarised (analysing how the abstract tensions between lay and expert discourses appear in the actual discussions), along with the idealtypical discursive logics (analysing pragmatic advises, attempts of reframing self-narratives and expressions of unconditional recognition). Finally, based on these analyses an attempt is made to explore the latent functionality of online depression forums by referring to a secular 'ritual healing' existing as an unreflected, contingent potential.

Health as Experience: Exploring Health in Daily Life Drawing From the Work of Aaron Antonovsky and John Dewey

Research has pursued salutogenic and narrative approaches to deal with questions about how everyday settings are constitutive for different health practices. Healthy behavior is not a distinguishable action, but a chain of activities, often embedded in other social practices. In this article, we have endeavored to describe such a chain of activities guided by the salutogenic claim of exploring the good living argued by McCuaig and Quennerstedt. We use biographical material written by Karl Ove Knausgaard who has created a life story entitled My Struggle. The novel is selected upon an approach influenced by Brinkmann who stresses that literature can be seen as a qualitative social inquiry in which the novelist is an expert in transforming personal life experiences into common human expressions of life. The study illustrates how research with a broader notion of health can convey experiences of health, thereby complementing (and sometimes challenging) public health evidence.

Exploring Mental Health Issues through the Use of Blogs: A Scoping Review of the Research Evidence

The aim of this scoping review of the available research evidence was to explore the experiences and perceptions of people with mental health difficulties through the use of blogs. A search of relevant electronic databases was undertaken from January 2009 to February 2019. Selected studies included people who blog about their mental health difficulties online. The PRISMA system was used to present the results of the searches. Following the application of specific inclusion and exclusion criteria, the final number of included studies was eleven. Following data analysis, the subordinate categories in the public category were moderation, confidentiality and boundaries. The subordinate categories in the private sphere included catharsis, enhanced coping strategies and social connectedness. The implications for mental health practice developments and research, are presented and discussed.

Researching Experiences of Cancer Risk Through Online Blogs: A Reflexive Account of Working Toward Ethical Practice

By providing space to document personal narratives and hold virtual discussions, the Internet represents a fruitful resource for sociologists of health and illness. However, the use of social media content for research entails complex ethical considerations. Due to the fluidity of online material, existing ethical guidelines advise a deliberative approach. However, this has led to disparity in the use of social media resources within the social sciences. I share an account of "doing ethics" for qualitative research with blogs focused on hereditary cancer risk. Blogging emerged not only as cathartic for authors, but also a means of accessing support. Blogs may thus be construed as constitutive and not only representative of cancer (risk) experience. Ethical questions surround anonymity and the appropriation of authors' accounts beyond the context in which they are composed. By sharing reflections on working with hereditary cancer risk blogs, I contribute to the continued reflexivity of social media researchers.

Supporting Self-Management in Bipolar Disorder: Mixed-Methods Knowledge Translation Study

BACKGROUND

Self-management is increasingly recognized as an important method through which individuals with bipolar disorder (BD) may cope with symptoms and improve quality of life. Digital health technologies have strong potential as a method to support the application of evidence-informed self-management strategies in BD. Little is known, however, about how to most effectively maximize user engagement with digital platforms.

OBJECTIVE

The aims of this study were (1) to create an innovative Web-based Bipolar Wellness Centre, (2) to conduct a mixed-methods (ie, quantitative and qualitative) evaluation to assess the impact of different sorts of engagement (ie, knowledge translation [KT]), and (3) to support engagement with the self-management information in the Bipolar Wellness Centre.

METHODS

The project was implemented in 2 phases. In phase 1, community-based participatory research and user-centered design methods were used to develop a website (Bipolar Wellness Centre) housing evidence-informed tools and strategies for self-management of BD. In phase 2, a mixed-methods evaluation was conducted to explore the potential impact of 4 KT strategies (Web-based webinars, Web-based videos, Web-based one-to-one Living Library peer support, and in-person workshops). Quantitative assessments occurred at 2 time points-preintervention and 3 weeks postintervention. Purposive sampling was used to recruit a subsample of participants for the qualitative interviews, ensuring each KT modality was represented, and interviews occurred approximately 3 weeks postintervention.

RESULTS

A total of 94 participants were included in the quantitative analysis. Responses to evaluative questions about engagement were broadly positive. When averaged across the 4 KT strategies, significant improvements were observed on the Bipolar Recovery Questionnaire (F_1,77=5.887; P=.02) and Quality of Life in Bipolar Disorder (F_1,77=8.212; P=.005). Nonsignificant improvements in positive affect and negative affect were also observed. The sole difference that emerged between KT strategies related to the Chronic Disease Self-Efficacy measure, which decreased after participation in the webinar and video arms but increased after the Living Library and workshop arms. A subsample of 43 participants was included in the qualitative analyses, with the majority of participants describing positive experiences with the 4 KT strategies; peer contact was emphasized as a benefit across all strategies. Infrequent negative experiences were reported in relation to the webinar and video strategies, and included technical difficulties, the academic tone of webinars, and feeling unable to relate to the actor in the videos.

CONCLUSIONS

This study adds incremental evidence to a growing literature that suggests digital health technologies can provide effective support for self-management for people with BD. The finding that KT strategies could differentially impact chronic disease self-efficacy (hypothesized as being a product of differences in degree of peer contact) warrants further exploration. Implications of the findings for the development of evidence-informed apps for BD are discussed in this paper.

"I can do more than I thought I could": exploring the online blogs from the Sailing Sclerosis Oceans of Hope journey

Background: Diagnosis of a chronic, unpredictable, and incurable disease such as multiple sclerosis can have profound effects on emotional wellbeing. The Sailing Sclerosis Foundation provided an opportunity for 94 individuals living with multiple sclerosis from 16 countries to challenge themselves by sailing aboard the Oceans of Hope yacht, as it circumnavigated the globe over a 17-month period in 2014 and 2015. We explored the psychosocial outcomes of this unique journey.Methods: Deductive thematic analysis was used to analyze 206 blogs posted online by participants to the Sailing Sclerosis website during and after their journey.Results: Four major themes were identified: (1) the challenges of the journey; (2) teamwork and camaraderie that arose from sharing a diagnosis in common; (3) reframing mindsets as people acknowledged and adjusted to their diagnosis; and (4) empowerment and personal growth with hope rediscovered. The blogs suggested psychosocial outcomes of the journey included lower levels of depression, better quality of life, more positive well-being, an increase in self-esteem, reduced anxiety, lower stress levels, and better life satisfaction, as well as increased social support and empowerment.Conclusion: Numerous psychosocial benefits are achievable when individuals with multiple sclerosis are provided with opportunities and support to challenge themselves.Implications for RehabilitationA diagnosis of multiple sclerosis does not necessarily have to mean a sedentary lifestyle and social isolation.Psychological adjustment to a diagnosis of multiple sclerosis, changes in mindset, and rediscovering hope and optimism can be achieved by adventurous means outside clinical settings.We encourage clinicians, policy makers, and funding bodies to think 'outside the box' when developing and supporting programs for individuals living with chronic illnesses.

Identity, community and care in online accounts of hereditary colorectal cancer syndrome

Sociological literature has explored how shifts in the point at which individuals may be designated as diseased impact upon experiences of ill health. Research has shown that experiences of being genetically "at risk" are shaped by and shape familial relations, coping strategies, and new forms of biosociality. Less is known about how living with genetic risk is negotiated in the everyday and over time, and the wider forms of identity, communities and care this involves. This article explores these arrangements drawing on online bloggers' accounts of Familial Adenomatous Polyposis (FAP). We show how accounts of genetic risk co-exist with more palpable experiences of FAP in everyday life, notably the consequences of prophylactic surgeries. We consider how the act of blogging represents but also constitutes everyday experiences of hereditary cancer syndrome as simultaneously ordinary and exceptional, and reflect on the implications of our analysis for understanding experiences of genetic cancer risk.

“Hopefully This Will All Make Sense at Some Point”: Meaning and Performance in Illness Blogs

Aims: To analyze the narratives of illness blogs created by parents of children with cancer. Background: The profound effects of the childhood cancer experience on family members and the turn to the Internet by parents for help in the process are gaining research attention. Design: The qualitative study design involved secondary narrative analysis of 14 illness blogs: 9 by the parents of children with neuroblastoma and 5 by the parents of children with leukemia. Daily blog entries were analyzed as individual units of illness experience expression and in relation to one another to identify thematic and linguistic similarities. Methods: The initial analysis of these illness blogs resulted in identification of the quest for balance as a primary theme. Narratives in parents’ childhood cancer illness blogs illustrated themes of performance. During this initial analysis, however, the author repeatedly asked, “Why are they writing this? And why publish this?” A second analysis of the data answered these questions of why parents blog about the experience. Results: Narrative analysis resulted in the discovery of 6 main reasons that parents wrote and published the childhood cancer experience online: to report, explain, express, reflect, archive, and advocate. Conclusion: The analysis suggests that incorporation of parent writing may improve family-–provider communication, enhance the family-health care professional relationship, enhance safety by preventing medical errors, improve reporting of clinical trial data such as adverse events, and improve satisfaction.

"Being Bipolar": A Qualitative Analysis of the Experience of Bipolar Disorder as Described in Internet Blogs

In the light of debates about the nature of bipolar disorder (BD), the current article presents a thematic analysis of Internet "blogs" by self-identified bipolar sufferers. Extreme and frequent fluctuation of mood was considered the principal feature of BD, along with a broad range of other problems. BD was often invoked as an explanation for life difficulties or lack of achievement, and was mostly regarded as a brain disease. Most bloggers emphasized the importance of drug treatment, along with the self-management techniques. The blogs present a "bipolar identity," which is much broader than traditional definitions, are based on a medicalized model of the disorder, and are connected to the moral function of enabling people to externalize unwanted aspects of the self.

Public discourse on mental health and psychiatry: Representations in Swedish newspapers

Mass media plays a central role in shaping public discourse on health and illness. In order to examine media representations of mental health and expert knowledge in this field, two major Swedish daily newspapers from the year 2009 were qualitatively analysed. Drawing on the theory of social representations, the analysis focused on how issues concerning mental health and different perspectives are represented. The results show how the concept of mental illness is used in different and often taken-for-granted ways and how the distinction between normal and pathological is a central underlying question. Laypersons' perspectives are supplemented by views of professionals in the newspapers, where signs of confidence and dependence on expert knowledge are juxtaposed with critique and expressions of distrust. The newspaper discourse thus has salient argumentative features and the way that conflicts are made explicit and issues concerning authoritative knowledge are addressed indicates ambivalence towards the authoritative role of expert knowledge concerning mental health. In this way, the newspapers provide a complex epistemic context for everyday sense-making that can be assumed to have implications for relations between laypersons and professionals in the field of mental health.