A techno-socio exploration of mental health communication on social media

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Abstract

Introduction

Mental illness is a serious global health challenge. Millions of people each year experience mental illness. Mental health is an integral element in overall health. Poor mental health is associated with unhealthy lifestyles and human rights violations. Thus, an environment that supports mental health is essential. Indeed, mental health has a big impact on people’s lives including behavioral, physical, work, and relationships. Notably, there are opportunities to promote mental wellbeing. Numerous studies indicate that social media platforms play a key role in mental health promotion. For example, researchers have found that social media platforms enable users to gain social support (McCosker, 2018; Phua, 2013), share and seek information to make informed decisions, and foster behavior change through online health promotion campaigns (Dewan, Luo, & Lorenzi, 2015; Moorhead et al., 2013). Current research has mainly focused on the negative and positive impact of using social media on mental wellbeing. For example, researchers have found that social media platforms could contribute to causing or exacerbating mood and anxiety disorders, cyberbullying and addiction (O’Reilly et al., 2018), informal diagnosis to each other (Giles & Newbold, 2013). On the other hand, data shows that social media platforms contribute to information sharing, engagement, and patient empowerment in health care, enabling patients to more frequently interact with their healthcare providers (Parikh, Sattigeri, & Kumar, 2014), creating safe online spaces for individuals seeking mental health help (Din, Ahmed, & Killawi, 2017), positive exchanges, connectedness, and social support (Seabrook, Kern, & Rickard, 2016).

However, limited research has examined the relationship people have with social media affordances in the meaning-making process of mental health information. Therefore, this paper aims to denaturalize the meaning-making process of mental health on social media platforms through a techno-socio perspective. This paper is part of a larger study that takes a critical discourse analytical framework to understand the representation of mental health on social media platforms. I define techno-socio meaning-making as the process of production, circulation, consumption, and reproduction of information on digitally-enabled mediums within a social-cultural context. The main question I addressed in this paper pertains to how the navigation of social media affordances shapes and is shaped by mental health information. Diverse mental health information is vital because it supports the increasingly active roles people are taking up in health care as they participate in shared decision-making and self-care practices of prevention and management. Moreover, many current health care policies require more participation in medical decision-making in addition to rising chronic disease rates.

To address this question, I drew on the affordance construct to describe the consistent ways people use the material features of social media technologies to produce and consume mental health information. Hutchby (2001) noted that affordances are “functional and relational aspects which frame, while not determining the possibilities for agentic action with an object” (p. 44). Therefore, technology such as social media platforms can result in various action opportunities because individuals have agency in how they use it (Oudshoorn & Pinch, 2003). The affordance framework facilitates analysis of the limits set for what is possible and what is not. As such, social media affordances shape the production and interpretation of information and in turn the ‘construction, mediation, and materialization of power and social relationships’(Freelon, 2015; Nagy & Neff, 2015). The analysis is based on four social media affordances proposed by (Treem & Leonardi, 2013) namely association, persistence, editability, and visibility as these were the most relevant across the social media platforms investigated in this study. Association deals with creating a visible network that can be traversed. Editability deals with how content is stored persistently. Communication is persistent if it remains accessible in the same form as the original display. Visibility enables people to see and find information easily.

Affordances do ‘not change as the need of the observer changes. The observer may or may not perceive or attend to the affordance according to his needs, but the affordance is always there to be perceived. Although the affordance construct is relational, it does not mean that we can do anything as different environments and layouts afford different things. Affordances exist with the interaction of users’ subjective perception of utility and the qualities of technology. Consequently, technology designers are placed in a powerful position in which they enable and constrain certain action possibilities through their design choices. Focusing on affordances is a means of studying the way people use the different possibilities technologies offer (Gaver, 1991) since affordances are constructed in a dialogical relationship between people and technology (Sharma, Saha, & Sarkar, 2016). These affordances affect the production, circulation, consumption, and reproduction of information and in turn the “construction, mediation, and materialization of power and social relationships,” (Freelon, 2015, p. 4). I drew on affordance theory to generate a more nuanced and flexible theorization and understanding of the interaction between users and moderators. The affordance concept challenges the technological determinism notion which views technology as a determining force, defining the social, structural, and cultural values. The concept of affordance stresses the interplay between artifacts and users however complex it may be. Yet technologies reflect inherent values and morals, which emerge and inform their contexts. As such, Winner (1980) argues that the relationship between humans and technologies represents dynamic manifestations of power and authority. Indeed, social media platforms can provide multiple affordances, but not all affordances will be utilized with the same results in different geographical, legal, or cultural contexts. The application of the affordances concept to mental health communication on social media platforms is rare based on the literature review that I conducted. This could be attributed to the observation that most studies on mental health communication have analyzed single platforms per study. Most of the existing cross-platform analyses tend to prioritize the benefits of using social media platforms. Questioning a platform’s opportunity for action may provide key insights for more effective communication by explaining why some information emerges over the other. The affordance concept, then, helps to explain why people use the same technology differently and in similar ways (Treem & Leonardi, 2013, p. 5). Moreover, Gibson (1977) argues that the environment or context of an affordance is permanent, that it exists independently of the intentions and perceptions of the animal. In recognizing the importance of context in examining social media affordances, I have a different view from Gibson’s argument about the environment of technology. I argue that social media affordances shape and are shaped by a user’s perceptions and intention and that these intentions are important parameters for how and to what purpose communication technology is used. Therefore, the affordances of social media platforms are not permanent but instead have diverse meanings and consequences in different contexts that can strengthen or limit mental health information sharing. See figure one for the cross-cutting attributes that characterize social media affordances.

Figure 1.

Attributes of Social Media Affordances

Materials and Methods

I searched Google, Reddit, and Facebook with search terms such as ‘mental illness, ‘mental health’, ‘depression’, and ‘anxiety’ to identify social media pages focused on mental health. From the search hits, a purposive sample of relevant pages was selected. To ensure the pages explored were unique and relevant, an inclusion criterion was developed. Firstly, pages had to be active at the time of identification and data collection (with daily contributions from users up to the search date), and secondly, pages had to have gained a considerable number of ‘likes’ (over 200). This number of likes was deemed substantial to result in participation in terms of comments, posts, and likes. Facebook and website discussion forums were selected as the literature indicates that these platforms are widely used in Australia. Reddit was identified because it has not received attention from researchers despite its popularity in Australia. Additionally, although all three platforms are categorized as social networking sites, I was interested in including commercial and non-commercial sites. Due to the nature of website discussion forums and Reddit forums where any member can start up a discussion thread, I focused on depression and anxiety threads to manage the scope of the study. For Facebook pages, I analyzed mental health-related pages with more than 5,000 followers to ensure that I can mine an appropriate amount of data. The 5,000 followers threshold was deemed appropriate to ensure that the platforms analyzed had some activity such as liking, commenting for a detailed analysis.

Social media platforms included in the study targeted people living in Australia and were updated at least once a month. Data were collected from Reddit forums, website discussion forums, and Facebook pages. Data from Reddit forums were generated from various subreddits. These subreddits were identified from a search for subreddits on ‘mental health’. Reddit was selected for analysis because of its large base of daily active users and a broad range of well-defined, active communities (or subreddits) on both mental health and other topics (Barthel, Stocking, Holcomb, & Mitchell, 2016). Data from website discussion forums were generated from organization websites managed by SANE, Headspace, and Beyond Blue forums. Data from Facebook were generated from the Three Words Facebook page, Mental Health Awareness Help Facebook Page, Headspace Facebook page, and Beyond Facebook page. Data were collected between 1st January 2020 to 30th April 2020.

This paper adopted a walk-through method to engage directly with the social media interface to examine its technological mechanisms and embedded cultural references to understand how it guides users and shapes their experiences. Although this method was initially designed for apps (Light, Burgess, & Duguay, 2018), scholars have increasingly adapted it to study other technologies such as social media. The method involves a step-by-step observation and documentation of the technologies features and activity processes thereby making these aspects salient and available for critical analysis. The analyst mimics every use of the technology where possible to analyze the technical features such as number and placement of icons, symbolic elements text, and pictures. Additionally, the analyst reviews the vision, governance, and operating models. The process of analysis is three-fold. Firstly, the environment of the technology. In this part of the walkthrough, I analyzed the context and technological features of the social media platforms to understand how social media designers, developers, publishers, and owners expect users to receive and integrate it into their technology usage practices account for the socioeconomic and cultural aspects of platforms. Secondly, the operating model. This involves analyzing the business strategy and revenue resources to identify the underlying economic, commercial, cultural, and political interests. This component is important for both commercial and not-for-profit technologies. Thirdly, the governance component. I analyzed governance through an exploration of how social media platforms regulate activities to sustain and fulfill their vision and enforce norms and values.

Ethical approval was granted by the University of Adelaide Ethics Review Committee (H-2019-149). Additionally, I drew on the ethical guidance published by the Association of Internet Researchers (www.aoir.org) when identifying the study methods to reduce the risk of distress by identifying what might be considered a reasonable degree of personal privacy. While the social sites that were analyzed are publicly accessible, sensitivity to the context and the aim of this paper was weighed. Therefore, no screenshots are included in this paper because some sites such as Facebook are not anonymous, in that case, including screenshots could comprise users’ privacy.

Results

In this section, I provide findings to show how social media affordances might enable or constrain mental health information sharing and seeking. I will show how the affordances of persistence, editability, association, and visibility shaped and were shaped by processes of production, circulation, consumption, and reproduction.

Communication is persistent if it remains accessible in the same form as the original display after the actor has finished his or her presentation. Persistence was activated through archiving, upvoting, downvoting, relevance algorithms of Facebook, and the thumbs-ups on website forums. For instance, content on website forums and Subreddits was archived by storing all posts dating back to the start of the thread. Similarly, Facebook data were archived dating back to when the page was launched. however, navigating Facebook historical posts is not straightforward as on website forums and subreddits. Additionally, the ease with which this content is accessed especially through the search widget on all the social media genres and occasional uses of hashtags on Facebook. For example, on subreddits, information is archived after six months of starting a thread. Additionally, although information, however, the content is not deleted after it has been archived however, posts and additional comments cannot be made to that thread. Similarly, information on Facebook pages and online discussion forums was archived since the start of the pages and forums. Archived information enabled other users to be part of decisions even after the original conversation has come to an end managing that information can still be useful after the discussion has ended. For instance, the data used in this study was generated from archived threads. Due to this, upvoting and downvoting contributed to some information Communication is persistent if it remains accessible in the same form as the original display after the actor has finished his or her presentation. Persistence was activated through archiving, upvoting, downvoting, relevance algorithms of Facebook, and the thumbs-ups on website forums. For instance, content on website forums and Subreddits was archived by storing all posts dating back to the start of the thread. Similarly, Facebook data were archived dating back to when the page was launched. however, navigating Facebook historical posts is not straightforward as on website forums and subreddits. Additionally, the ease with which this content is accessed especially through the search widget on all the social media genres and occasional uses of hashtags on Facebook. For example, on subreddits, information is archived after six months of starting a thread. Additionally, although information, however, the content is not deleted after it has been archived however, posts and additional comments cannot be made to that thread. Similarly, information on Facebook pages and online discussion forums was archived since the start of the pages and forums. Archived information enabled other users to be part of decisions even after the original conversation has come to an end managing that information can still be useful after the discussion has ended. For instance, the data used in this study was generated from archived threads. Due to this, upvoting and downvoting contributed to some information becoming dominant while others were suppressed. Due to the persistence of the posts, they continue to impact other users who might not have been part of the initial conversation. Therefore, it can be argued that persistence worked to foster already existing information. I observed that users tended to align their contributions to what had already been shared.

Editability was operationalized through moderation. Moderation took three forms that included automatic, collective, and assigned moderation. Users are informed of the general moderation criteria when they sign up to website forums and Reddit. Assigned moderation was conducted by assigned moderators. However, the criteria for moderation are vague and it is identified as something that is not related to the topic being discussed, something political, or something that is disrespectful to other users. Moderation also took place through automatic moderation bots that informed users that a specific message had been deleted for not following posting rules, norms, and regulations. This was evident on Reddit forums for example, although auto-moderation was not explicit on website forums, the interviews conducted with moderators showed that auto-moderation took place behind the scenes on website forums. As such collective and self-moderation worked subtly through upvoting and down-voting posts and comments as well as abiding by the rules and norms on these social media platforms. Because Facebook and Reddit provide several functions to edit content before publishing, the information on these platforms was generally more polished and complex. While website forums encouraged more raw information. Maybe this could explain why website forums generated more diverse information because the conversations mimicked face-to-face conversations and in a way, users did not feel the pressure to conform to grammatical and vocabulary standards.

Visibility deals with how information becomes available and accessible. Visibility was operationalized through various ways namely, hyper textuality, multimodality, recommender bots, private/public nature, and various subreddits for Reddit and various threads on discussion forums. Hyperlinks allow users to navigate social media spaces by moving from one site to another by clicking on a related or more detailed text in form of a signifier usually a word underlined and, in another font, color and style. Landow (1997, p. 80) notes, hypertext ‘‘creates an open, open-bordered text, a text that cannot shut out other texts’’ it ‘‘blurs the distinction between what is ‘inside’ and what is ‘outside’ a text’’, making ‘‘all the texts connected to a block of text collaborate with that text’’ (1997, p. 83). Social media platforms present no beginning and no end, only specific encounters with the text. As Bolter (2001) observes: ‘‘………hypertext is multiple and associative…. a hypertext responds to the reader’s touch’’ (p. 42). In terms of multimodality, the findings show that users mainly engaged with text and links and the use of videos and images. To an extent, the recommender bot plays part in invisibility. From a user’s profile page, one gets recommendations of the threads they could engage in based on their past engagements and interests were limited to Facebook. By drawing on these different modes of communication, users and moderators drew on different information although in some instances these worked to sustain already existing knowledge. Users can follow these recommendations, or they can choose not to. Reddit allows users to operate various subreddits even on the same topic. This allows users to discuss a given topic from different angles with similar or different people.

The threads that were analyzed were not necessarily about similar topics, but users discussed mental health and mental illness from different angles, which contributed to diverse information. Information can be produced cheaply, easily, and in a fast approach. However, the more important aspect is how people become aware of the information on the internet and use it in meaningful ways. In this case, dominant social media organizations control the amount of information on social media platforms because of the resources that have such as money, influence, reputation, the power to mention but a few that gives them advantages over ordinary citizens who produce and consume information within their means. Certainly, although everyone can to a great extent produce and circulate information quite easily because of the decentralized nature of internet communication, the information does not attain the same attention. Visibility, then, is the reward for interaction on social media (Bucher, 2012, p. 1174). Additionally, drawing on Foucault’s notion of spectacle and surveillance, Bucher (2012, p. 1165) argues that ‘becoming visible, or being granted visibility, is a highly contested game of power in which the media play a crucial role’. Social media managers are gatekeepers for the information that circulates on social media platforms.

Association affordance was operationalized through one-to-many features, unlimited characters, anonymity/semi/non-anonymity, multidirectional as well as heterosynchronicity. The affordance of association enabled users to interact and connect allowing users to provide as much detail as they were willing to share and as many times as they were willing to share. In this way, this limited one person dominated the discussion and contributed to the free flow of ideas from the face value of it. The multi-directionality and heterosynchronicity aspect also allowed users to switch the agenda to different directions that emerged from the discussion while remaining focused on the main issue being discussed; this allowed various views about the topic to be discussed. On the other hand, however, the multi-directional structure brings about the issue of context-collapse, which could act as a hindrance to participation and action. Additionally, the heterosynchronicity and multidirectional nature of subreddits, website discussion forums, and Facebook facilitated diverse and alternative information. Asynchronous communication affords users temporal and spatial independence by allowing access to information at their convenience regardless of time and location. However, the downside of this is the lack of immediacy can frustrate participants when they are communicating with others. Reddit and website forums operate under anonymity.

Research has found that the flexibility of not dealing with responses from other people facilitates self-disclosure. For instance, Suler (2004) notes, this makes “users feel safe putting their message out there in the cyberspace where they can be left behind,” (p. 323). Additionally, many people tend to make sensitive self-disclosures and share personal difficulties with others in cyberspace (Barak & Gluck-Ofri, 2007). On these platforms, users use pseudonyms as part of their profiles. Through anonymity, users do not know exactly who they are interacting with and further, the gender of users is equally anonymous. The findings suggest that users who shared very personal information that could probably otherwise have not shared if the platform were not anonymous. For instance, users discussed suicidal attempts, personal and work-related challenges, as well as financial challenges. All three platforms supported text and images, but they placed different constraints on the way the media were used. As such, the types of multimedia the platform supports, and the limitations placed on them, directly affect the content campaigns can communicate. Reddit operates karma points that a user gets for participating in the discussion through commenting, through starting a discussion thread, or through voting the comments and posts of other users. Additionally, anonymity seemed to play a key role in opening space for some information to emerge while silencing others. Website forums and subreddits offer anonymity while Facebook does not. Anonymity enables users to remain invisible to other users. On the one hand, this alleviates negative experiences such as stigma. Notably, the lack of nonverbal social cues can create the potential for hostile messages and make it difficult to contact people for additional information, support, or develop -term relationships beyond social media platforms (Wright & Bell, 2003). Anonymity and the lack of anonymity could explain why anonymous platforms exhibited diverse information on subreddits and website forums while information on Facebook was mainly unchallenged.

In addition to sustaining and challenging information, social media platforms worked to preserve and, in some instances, disrupt power relations. I view power as constituted by discursive formations created and reproduced throughout the communication processes. I draw this perspective from a critical view which argues that powerful actors can develop narratives about what mental health communication is critical to shaping what can and cannot be said. For example, the multidirectional nature of social media platforms extended power to laypeople away from professionals. Power by laypeople was exercised through challenging dominant information through commenting on original posts as well as changing topics within the same thread or creating new threads. However, through moderation, managers of these social media platforms retain/reclaim their power by limiting what is said, how it is said, and by whom. Moderation also took place collectively through abiding by social media platform social norms. Social norms were more explicit on Reddit and website forums as opposed to Facebook taking a more general nature. Additionally, multidirectional and heterosynchronicity extend power to control the temporal and spatial aspects of producing, consuming, and distributing mental health content. These findings show that power relations are unstable what I will define as power relations volatility, a combination of and a direct or subtle shift in expert-based or top-down information production and dissemination through the vertical, transmission of information, and peer-led horizontal information curation and dissemination.

Furthermore, in addition to the hard code or technological codes of social media platforms, soft codes the social norms or rules of engagement on these platforms that are employed to manage these social media platforms similarly shaped the production, circulation, consumption, and reproduction of information on social media platforms in similar ways like the codes through limiting what is said and positioning users and moderators in different subject positions. Social norms show a threat of exclusion if users do not abide by the set rules of engagement. On the other hand, these social norms worked to encourage people to publicize their thoughts, activities, and emotions. This inclusion and exclusion work in a subtle way to privilege ways of meaning-making. The written social norms were similar across Reddit and website forums. I did not find written social norms for Facebook. Social media platforms are characterized by multiple power dynamics such as users, moderators, community managers, and social media corporations. Unlike website forums and subreddits, passive reception was more evident on Facebook with limited critical engagement. This was exemplified through users mainly liking and sharing posts with minimum comments. Comments were more noticeable on professionally managed pages. Social media platforms are filled with paradoxical tensions such as highly networked individuals who occupy different roles of user, producer, consumer, and moderator as well as culturally and socially contingent constraints. The findings above have highlighted that the power relations between individuals and sociotechnical systems in social media are volatile. This was activated in various hard codes and soft codes. Notably, the hard and soft codes hinge on the social media logic, in particular, the programmability of social media platforms which (Van Dijck & Poell, 2013) argue that influences users’ experiences on consuming and creating information, how people connect with others and what information is prioritized or popularised. Indeed, the techno-socio perspective of mental health information production and consumption on social media is three-pronged involving varying interests and practices among people who use the platforms, social media corporations, and mental health organizations. The overarching aim of this study was to expose the fault lines and opportunities for mental health communication through a techno-socio perspective. In the next section, I highlight implications for practices and propose strategies and tactics to harness social media for diverse mental health information on social media.

Implications for Practice

By no means do I attempt to provide an exhaustive exposition of how social media affordances shape and are shaped by communication processes, nor do I claim that these are the only constructs that explain mental health information sharing and production processes. Rather, I used this paper to show the usefulness of the affordance construct for integrating social media research into mental health communication concerns. Empowering people with mental illness to take charge of their wellbeing is a central endeavor for mental health communication. Mental health communicators work in user-centered ways, respecting their rights to be involved in decision-making. Practitioners need to be well-informed of the perceived and actual social media affordances, so they can effectively engage and educate society. Extending the affordance construct in this paper creates a nuanced approach towards perspective about communicating mental health in the social media era by bringing to bear taken-for-granted opportunities and challenges. By focusing on the techno-socio perspectives we can begin to make sense of the broader issues at stake to better appreciate the relationship between social media and mental health communication. Of note, this paper does not propose a fully open flow of information without controls because mental health is a sensitive topic thereby inherently limiting some discussions for instance some discussion on self-harm. However, due to the enabling and constraining nature of social media affordances, mental health communicators need to make constant and deliberate balancing acts to give mental health information the spotlight it deserves. Additionally, the affordance contrast highlights the need for continuous reflexivity among health communicators through the awareness of the enabling and constraining tensions in the communication process on social media. This ever-changing awareness could mean that health communication projects broadly and mental health communication projects specifically can be tailored to circumnavigate the social media constraints while building on the affordances.

The findings have shown that the relationship between social media and mental health is complex and multidimensional. Drawing on my commitment to theory, praxis, and a keen desire to add value to social media-based mental health interventions, I highlight the three key health communication strategies namely, community building, awareness, and engagement that could foster more equal power relations to reap the benefits of social media for mental health communication and, promoting diverse mental health information. These strategies are proposed based on the tension between social media constraints and affordances. Creating awareness of the existing and emerging health threats is a key component in facilitating meaningful and beneficial conversations. It appears from the analysis that maximizing opportunities for information sharing, experience sharing, information about risks information about services. Community building is another key aspect that could enhance alternative information to emerge. This entails clear social media norms to allow individuals to feel a sense of belonging which could, in turn, facilitate support and disclosure. Users are experts on their experiences, while health professionals can be seen more as people with technical skills. Community building is mutually beneficial in that it enables health professionals to learn more about the unique experiences, on the other hand, it empowers communities to take ownership over their health experiences and outcomes. Interactivity can be defined in three ways. Firstly, interactivity can be viewed as being embedded in social media structures that facilitate multi-way communication. Secondly, interactivity takes on a sociological orientation derived from the view that users adapt their actions to a particular situation. Thirdly interactivity manifests through psychosocial orientations. This relates to the perceptions that arise from the terms audience and user. Depending on the context in which these definitions are used, they highlight passive or active, levels of participation. Boler (2008) notes that “the web has always been about voice and conversation” and it was never intended to be about delivering content to passive audiences, but to be about “shared creativity” (p. 39). Critical mental health communicators should strive for active levels of participation as a way of circumnavigating social media constraints that serve to prioritize already existing and dominant mental health information. See table one for a more detailed analysis of the communication strategies and tactics.

Table 1.

Attributes of Social Media Affordances

Conclusion

I have shown that social media affordances shape and are shaped by the practices and processes of production and consumption of mental health information through three main aspects namely, sustaining, and challenging knowledge as well as shaping the relations of power. Thereby limiting what has been shared on these platforms as well as limiting who can share. Therefore, largely then, it can be argued that by design social media platforms as less emancipatory and more related to fuelling growth and consolidation of power and commodification of power by social media corporations who benefit from people publicizing their thoughts. At the same time, the findings show that users are not passive but resist unequal power relations through circumventing some of the constraints. Therefore, this study adds to existing knowledge, which notes that people who used to simply consume content have become content producers, which to an extent democratizes information consumption and production. Likewise, the findings show on the other hand that while social media platforms give users to access a certain degree of power, indeed, this power is not absolute because social media platforms are built on already existing hierarchical structures as discussed above. More empirical studies are needed to better understand the role those social media affordances play in mental health communication processes if research is to remain important, timely, and applicable.

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