From the Editor
“I know all about antidepressants,” the young patient told me in the ED. “I’ve seen TikTok videos.” Social media isn’t just a source of great cat videos, many individuals – especially younger patients – turn to it for health information.
But how reliable is the mental-health information? In a new Digital Health paper, Roxanne Turuba (of the University of British Columbia) and her co-authors report on a summative content analysis of the 1 000 most popular mental health TikTok videos. They found that many featured personal stories and confessionals; less than 4% referenced scientific evidence; about a third offering advice was misleading. “Healthcare practitioners and researchers may consider increasing their presence on the platform to promote the dissemination of evidence-based information to a wider and more youth-targeted population.” We examine the paper and its implications.
Social media: more than cat videos?
In the second selection, Harriet Battle (of the South London and Maudsley NHS Foundation Trust) and her co-authors consider attitudes toward mental health providers in social media. In a new British Journal of Psychiatry study, they analyzed more than 300 000 tweets spanning over a 16-year period, finding: “positive perceptions of mental health and mental health professionals increased over time. However, ‘psychiatrist’ had a consistently higher proportion of negative perceptions.”
And in the third selection, Dr. Vivek H. Murthy (the former US Surgeon General) writes about social media and adolescents in a New York Times essay. He notes the potential harms of social media for youth. He advocates changes, including warning labels. “We have the expertise, resources and tools to make social media safe for our kids. Now is the time to summon the will to act.”
DG
Selection 1: “Do you have depression? A summative content analysis of mental health-related content on TikTok”
Roxanne Turuba, Marco Zenone, Raman Srivastava, et al.
Digital Health, 17 January 2025 Online First
TikTok is a global social media platform that allows users to create and share short-form videos. During the COVID-19 pandemic and the new reality of physical distancing and public health measures, over 1.1 billion people worldwide reported using TikTok each month as an important platform to communicate, learn, and connect with others, with 80% of users being 12–30 years of age…
In the last few years, #mentalhealth and derivations of this term (e.g., #mentalhealthawareness, #mentalillness, #mentalhealthmatters) have been accessed tens of billions of times on TikTok. The use of social media platforms and mobile phone-based apps in identifying and monitoring mental health symptoms and disorders is increasing each month, especially among youth. Young people view mental health-related content organically, through self-directed searches, or via direction from complex algorithms that learn and predict a user’s interest in specific content types, such as mental health advice and information…
While the use of social media for youth mental health awareness is promising, there are ethical and contextual considerations to be noted, such as how to best connect youth to developmentally- and age-appropriate services when problems are identified, and how to best address the proliferation of health-related misinformation online. A recent content analysis found that TikTok proliferated negative content about cognitive behavioral therapy (CBT), despite the empirical evidence on CBT as an effective treatment for post-traumatic stress disorder (PTSD)…
So begins a paper by Turuba et al.
Here’s what they did:
- They collected the top 1 000 videos with the most views on TikTok with the hashtag #mentalhealth from October 12 to October 16, 2021.
- They performed a summative content analysis – “This type of analysis involves developing a list of codes (also referred to as a coding frame) to categorize or theme the data. The codes are then quantified, described, and interpreted.”
- Six content themes were developed to code the data: “(1) a personal story, perspective, or confessional, (2) advice and information, (3) emoting, (4) references to death, (5) references to science or research, and (6) a product or service for sale. Advice and information were further assessed by clinical experts.”
- Reviewers coded the videos, and they also considered their accuracy and quality.
Here’s what they found:
- A total of 970 mental health-related videos were pulled for the analysis; 30 were removed because of non-English content.
- Themes. The most prevalent content themes included a personal story, perspective, or confessional (59.1%), advice and information (39.2%), emoting (20.4%), references to death (13.2%).
- Misleading. “Advice and information were considered misleading in 33.0% of videos…”
- Scientific evidence. Very few videos included references to scientific evidence or research (3.8%).
A few thoughts:
1. This is an interesting, practical study, published in a good journal.
2. The main finding in a sentence: the videos were widely viewed but often misleading and largely free of reference to scientific evidence and research.
3. It’s amazing how many views these videos received. Those categorized as “story, confessional or perspective” had more than two billion views. “Advice and information” videos: more than 1.1 billion.
4. Let’s focus on that second group of videos. The authors note: “This included advice on managing difficult feelings, dealing with trauma and symptoms of mental health disorders, and identifying signs of a mental health disorder… Some videos broke down mental health myths, encouraged individuals to seek help to address their mental health concerns, and provided information about psychiatric wards and crisis lines. Meanwhile, a few content creators shared their views on mental health medication, with some suggesting that medications are not necessary to treat certain mental health conditions, with statements such as ‘ADHD is a trait; meds are for profit only.’”
5. Is the problem with TikTok itself? “The algorithm is more likely to promote shorter videos that tend to receive full views and higher engagement metrics. This makes it challenging to discuss nuanced topics like mental health and limits the quality of the content shared on the platform.”
6. On the positive side, many videos discussed personal experiences and stories. “Common narratives observed included testimonials of survival, struggle, journey, and inspiration. In some cases, videos were an outlet to share a difficult journey and reflect on recovery or living with illness.” Pulling this together: TikTok may not be a bastion of scientific information, but is it helping to reduce stigma?
7. Like all studies, there are limitations. The authors note several, including: “The sample was retrieved from the top-listed TikTok videos with the hashtag #mentalhealth, which does not necessarily include all of the top videos related to mental health.”
The full Digit Health paper can be found here:
https://journals.sagepub.com/doi/10.1177/20552076241297062
Selection 2: “Attitudes towards mental health professionals in social media: infodemiology study”
Harriet Battle, Miguel Ángel Álvarez-Mon, Francisco J. Lara-Abelenda, et al.
The British Journal of Psychiatry, 7 January 2025 Online First
In 2010, the World Psychiatric Association published a review reporting that the general depiction of psychiatry in the news and entertainment media was predominantly negative. Since then, various public campaigns and strategies have been implemented to address and reduce this stigma. In England, ‘Time to Change’, which began in 2007, was the largest programme aimed at reducing stigma and discrimination against people with mental health conditions. National surveys on attitudes towards mental illness surveys examined a decade of trends, from 2003 to 2013, in public attitudes in England. These surveys reported a significant increase in positive attitudes related to prejudice and exclusion following the launch of the Time to Change anti-stigma campaign. However, there was no notable improvement in tolerance or support for community care…
A literature review of attitudes towards psychiatry and psychiatrists in 2009 found that among patients who did not comply with a referral to a psychiatrist, the most frequently mentioned reason was the fear of mental illness stigma, rather than negative expectations about the treatment and its quality… Stigma and discrimination are well-known barriers that prevent individuals from seeking treatment for mental health conditions. These factors can also prevent people from accepting help when offered or continuing with ongoing treatments.
So begins a paper by Battle et al.
Here’s what they did:
- They conducted a retrospective study where they “collected and analysed all tweets posted in English between 2007 and 2023 that included any of the following keywords: psychiatry, psychology, neurology, mental health, psychiatrist, psychologist or neurologist.”
- “Each tweet was assessed on whether the content was classifiable or not.” Those that were not considered classifiable: they weren’t written in English or if the content was not complete enough to understand the meaning of the tweet.
- They also used “semi-supervised machine learning to categorise a large data-set.”
- Statistical analyses were done.
Here’s what they found:
- Tweets. Tweets containing “mental health” were the largest in number (n = 45 892) and had the greatest engagement, with 29.4% classified as viral tweets. Among the other key terms (“psychiatry,” “psychiatrist,” etc.), there was a smaller range of retweets, with a median between 170 and 255 among tweets classified as viral.
- Perception. “Tweets containing the key terms ‘mental health’, ‘psychology’, ‘psychologist’, ‘neurology’, ‘neurologist’ and ‘psychiatry’ had a higher percentage with a positive perception compared with a negative perception, both before and after 2020.” (!)
- Psychiatrist tweets. Tweets containing the key term “psychiatrist,” in contrast, had a higher proportion with a negative perception.
- Over time. “Before 2020, there was a higher proportion of tweets about psychiatrists with a negative perception (39.52%), compared with a positive perception (15.99%). Although this gap narrowed after 2020, negative perceptions still prevailed (36.10% negative v. 22.77% positive).” The increase in positive perceptions and decrease in negative perceptions over time was statistically significant.
A few thoughts:
1. This is an interesting study, with a robust dataset, published in an important journal.
2. The main finding in a sentence: the social media posts (tweets) had more positive perceptions of mental health and mental health professionals – except for psychiatrists. Ouch.
3. As an aside, this is a cool application of AI.
4. Do psychiatrists need to be more engaged with social media?
5. Like all studies, there are limitations. Among them: the focus on one social media platform.
The full BJP paper can be found here:
Selection 3: “Why I’m Calling for a Warning Label on Social Media Platforms”
Vivek H. Murthy
The New York Times, 17 June 2024
One of the most important lessons I learned in medical school was that in an emergency, you don’t have the luxury to wait for perfect information. You assess the available facts, you use your best judgment, and you act quickly.
The mental health crisis among young people is an emergency – and social media has emerged as an important contributor. Adolescents who spend more than three hours a day on social media face double the risk of anxiety and depression symptoms, and the average daily use in this age group, as of the summer of 2023, was 4.8 hours. Additionally, nearly half of adolescents say social media makes them feel worse about their bodies.
It is time to require a surgeon general’s warning label on social media platforms, stating that social media is associated with significant mental health harms for adolescents. A surgeon general’s warning label, which requires congressional action, would regularly remind parents and adolescents that social media has not been proved safe.
So begins an essay by Dr. Murthy.
“Evidence from tobacco studies show that warning labels can increase awareness and change behavior. When asked if a warning from the surgeon general would prompt them to limit or monitor their children’s social media use, 76 percent of people in one recent survey of Latino parents said yes.”
He advocates other changes:
- Congress. “Legislation from Congress should shield young people from online harassment, abuse and exploitation and from exposure to extreme violence and sexual content that too often appears in algorithm-driven feeds. The measures should prevent platforms from collecting sensitive data from children and should restrict the use of features like push notifications, autoplay and infinite scroll, which prey on developing brains and contribute to excessive use.”
- School. Schools should ensure that classroom learning and social time are phone-free experiences.
- Home. “Parents, too, should create phone-free zones around bedtime, meals and social gatherings to safeguard their kids’ sleep and real-life connections — both of which have direct effects on mental health.
He writes about the toxic content of social media based on his conversations with youth. “They spoke about their experiences with social media: the endless comparison with other people that shredded their self-esteem, the feeling of being addicted and unable to set limits and the difficulty having real conversations on platforms that too often fostered outrage and bullying.”
He notes changes in other industries. “Faced with high levels of car-accident-related deaths in the mid- to late 20th century, lawmakers successfully demanded seatbelts, airbags, crash testing and a host of other measures that ultimately made cars safer. This January the F.A.A. grounded about 170 planes when a door plug came off one Boeing 737 Max 9 while the plane was in the air. And the following month, a massive recall of dairy products was conducted because of a listeria contamination that claimed two lives. Why is it that we have failed to respond to the harms of social media when they are no less urgent or widespread than those posed by unsafe cars, planes or food?”
A few thoughts:
1. This is a well-argued and important essay. It was published back in June 2024 and much has changed (note: Dr. Murthyis no longer the US Surgeon General). Yet the essay is as relevant as ever.
2. Perhaps we can all agree that this is an area in urgent need of further study and research.
3. Would warning labels achieve much? On the other hand, would they be so harmful? As always, readers can draw their own conclusions.
The full NYT essay can be found here:
https://www.nytimes.com/2024/06/17/opinion/social-media-health-warning.html
Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.
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