Investigating mental health service user views of stigma on Twitter during COVID-19: a mixed-methods study

Abstract

Background: Mental health stigma on social media is well studied, but not from the perspective of mental health service users. Coronavirus disease-19 (COVID-19) increased mental health discussions and may have impacted stigma. Objectives: (1) to understand how service users perceive and define mental health stigma on social media; (2) how COVID-19 shaped mental health conversations and social media use. Methods: We collected 2,700 tweets related to seven mental health conditions: schizophrenia, depression, anxiety, autism, eating disorders, OCD, and addiction. Twenty-seven service users rated them as stigmatising or neutral, followed by focus group discussions. Focus group transcripts were thematically analysed. Results: Participants rated 1,101 tweets (40.8%) as stigmatising. Tweets related to schizophrenia were most frequently classed as stigmatising (411/534, 77%). Tweets related to depression or anxiety were least stigmatising (139/634, 21.9%). A stigmatising tweet depended on perceived intention and context but some words (e.g. “psycho”) felt stigmatising irrespective of context. Discussion: The anonymity of social media seemingly increased stigma, but COVID-19 lockdowns improved mental health literacy. This is the first study to qualitatively investigate service users' views of stigma towards various mental health conditions on Twitter and we show stigma is common, particularly towards schizophrenia. Service user involvement is vital when designing solutions to stigma.

Social networks use in the context of Schizophrenia: a review of the literature

“…Education has a positive effect on reducing public stigma towards adults with mental illness. Early identification and intervention in people with psychosis can be achieved through widespread information campaigns and easily accessible services (46,48).…”

“…Studies show that there are many users disseminating beneficial information on social networks, increasing public education about schizophrenia and disease management, but also connecting people through organized events focused on this debilitating disorder (35,39,41,48). It is therefore necessary to integrate therapeutic functions using social networks (18) as an aspect of social functioning in psychosis, allowing for the establishment of a more reliable and valid dimension (54,55).…”

“…Many people with schizophrenia are active users of social networks (18,48), which may have a positive effect on their subjective well-being, as they develop extensive social networks, communicate frequently with other users, and share personal experiences of living with a mental illness and learning from others (51). Acceptance and usability of the reviewed platforms by patients with schizophrenia were generally high, as were perceptions of usefulness and safety (51,53,54).…”

The Power of Social Media: Stigmatizing Content Affects Perceptions of Mental Health Care

“…Social media may serve a particularly important role in shaping individuals' mental health stigma, perceptions of stigma, and attitudes toward help-seeking, given its synchronicity and users' ability to comment, read, and respond to others' comments (Pavlova & Berkers, 2020). For example, a sample of Twitter users rated 1,101 posts that were "scraped" from Twitter related to seven commonly stigmatized disorders (schizophrenia, depression/anxiety, autism, eating disorders, obsessive-compulsive disorder, and addiction) for stigmatizing content (Jansli et al, 2022). A large proportion of the posts were rated as stigmatizing, with some conditions more often stigmatized (schizophrenia) than others (depression/anxiety).…”

Analyzing Twitter Data to Understand Stigmatization of Schizophrenia Before and After Elon Musk

“…Often, social media is a floor for discussions, sharing opinions, and obtaining information about mental illness (Passerello et al, 2019). However, social media also allows for the promotion of stigmatizing attitudes towards mental health and those with mental health issues (Jansli et al, 2022). One such social media site is Twitter, a popular microblogging platform where users create short posts that are less than 280 characters.…”