Social media and its relationship with mood, self-esteem and paranoia in psychosis

Methodological Characteristics and Feasibility of Ecological Momentary Assessment Studies in Psychosis: a Systematic Review and Meta-Analysis

BACKGROUND

Ecological momentary assessment (EMA) involves completing multiple surveys over time in daily life, capturing in-the-moment experiences in real-world contexts. EMA use in psychosis studies has surged over several decades. To critically examine EMA use in psychosis research and assist future researchers in designing new EMA studies, this systematic review aimed to summarize the methodological approaches used for positive symptoms in psychosis populations and evaluate feasibility with a focus on completion rates.

METHODS

A systematic review of PubMed, PsycINFO, MEDLINE, Web of Science, EBSCOhost, and Embase databases using search terms related to EMA and psychosis was conducted. Excluding duplicate samples, a meta-analysis was conducted of EMA survey completion rates and meta-regression to examine predictors of completion.

RESULTS

Sixty-eight studies were included in the review. Characteristics and reporting of EMA methodologies were variable across studies. The meta-mean EMA survey completion computed from the 39 unique studies that reported a mean completion rate was 67.15% (95% CI = 62.3, 71.9), with an average of 86.25% of the sample meeting a one-third EMA completion criterion. No significant predictors of completion were found in the meta-regression. A variety of EMA items were used to measure psychotic experiences, of which few were validated.

CONCLUSIONS

EMA methods have been widely applied in psychosis studies using a range of protocols. Completion rates are high, providing clear evidence of feasibility in psychosis populations. Recommendations for reporting in future studies are provided.

Associations between digital media use and psychotic experiences in young adults of Quebec, Canada: a longitudinal study

PURPOSE

Digital media use has been associated with psychotic experiences in youth from the community, but the direction of association remains unclear. We aimed to examine between- and within-person associations of digital media use and psychotic experiences in youth.

METHODS

The sample included 425 participants aged 18-25 years (82.5% female) from the community, followed between May 2021 and January 2022 over 3 time points-of which 263 participants (61.9%) completed at least 2. Digital media use was self-reported as time spent daily on TV and streaming platforms, social media, and video games over the past 3 months. Psychotic experiences in the past 3 months were measured with the 15-item Community Assessment of Psychic Experiences. Associations between digital media use and psychotic experiences were estimated using a random-intercept cross-lagged panel model.

RESULTS

On average, individuals who reported greater digital media use also reported higher levels of psychotic experiences (r = 0.34, 95% CI 0.15, 0.53). However, a person's variation in digital media use, relative to their personal average, was not significantly associated with subsequent variations in their levels of psychotic experiences, or vice-versa. Results were similar across TV/streaming, social media and video game use, and after adjusting for age, sex, education, sleep, physical activity, and cannabis use.

CONCLUSION

Individuals with a tendency for higher levels of digital media use also had a tendency for higher levels of psychotic experiences. Understanding this association may help personalize mental health interventions for people with psychotic experiences, which may be offered digitally to promote their accessibility.

Viewing of clinical cases on social media by dentists: A cause of motivation or dissatisfaction?

Objective

To evaluate the thoughts and feelings of dentists viewing posted clinical cases (PCCs) on various social media (SM) platforms.

Methods

A questionnaire was developed, validated and its reliability was established. It was distributed (in 2022) to 355 dentists who had graduated at least 2 years prior. It had three sections consisting of 20 items pertaining to general information, SM usage, and feelings. Descriptive data were reported using percentages. The chi-squared test was used for inferential analysis. P ≤ 0.05 was considered statistically significant.

Results

The response rate was 92%. The majority of respondents were non-post-graduates (63%), and aged ≤40 years (90%) with clinical experience <5 years (41%). Dentists with the most clinical experience (>15 years) shared their clinical work significantly more than their counterparts (p < 0.05). Most of the dentists did not feel motivated after viewing the PCCs (41%), especially those aged >40 years (p = 0.037), and thought that viewing the PCCs was the reason for personal dissatisfaction (50%). They had a belief that they possess skills (36%) and knowledge (42%), but not the necessary equipment to replicate the PCCs (39%).

Conclusions

The majority of dentists felt that viewing the PCCs on SM can cause personal dissatisfaction and lack of motivation. They had a belief that they possess the skills and knowledge to replicate the PCCs, but lack equipment. Investing resources in clinical workshops, mentorship, and the procurement of modern equipment early in the career of dentists may improve their mental well-being, satisfaction, and quality of treatment delivered to patients.

Predictors of paranoia in the daily lives of people with non-affective psychosis and non-clinical controls: A systematic review of intensive longitudinal studies

BACKGROUND AND OBJECTIVES

Worrying, self-esteem, sleep problems, anomalous internal experiences, reasoning biases, and interpersonal sensitivity are associated with paranoia. However, no review has examined whether these variables function as predictors of paranoia in everyday life. The present systematic review of intensive longitudinal studies (e.g., experience sampling) examined contemporaneous and time-lagged associations between paranoia and each candidate mechanism in individuals with non-affective psychosis and controls (pre-registration: https://osf.io/uwr9d).

METHODS

We searched electronic databases, PsyArXiv, and reference lists for studies published since 1994.

RESULTS

Of n = 5,918 results, n = 54 fulfilled inclusion criteria (n = 43 datasets). Most studies examined individuals with non-affective psychosis (n = 34). Strong evidence emerged for negative affect (subsumed under 'anomalous internal experiences') and sleep problems. For self-esteem, results suggest contemporaneous and lagged effects on paranoia but associations are likely driven by between-person variance. The low number of studies (n = 2 studies each) allowed no conclusions regarding worrying and reasoning biases. Findings on interpersonal sensitivity, which should be interpreted with caution because of the predictor's conceptual overlap with paranoia, indicate contemporaneous effects whereas time-lagged and within-person associations could not be judged due to insufficient data.

LIMITATIONS

The present review used a narrative data-synthetization and it did not cover outcomes such as hallucinations.

CONCLUSIONS

Despite convincing evidence for affect and sleep problems, it remains unclear whether affective states are precursors or also consequences of paranoia (vicious circle), and which of the actigraphy measures (sleep time, -efficiency, -fragmentation, etc.) best predicts paranoia.

Digital tools to support mental health: a survey study in psychosis

BACKGROUND

There is a notable a gap between promising research findings and implementation of digital health tools. Understanding and addressing barriers to use is key to widespread implementation.

METHODS

A survey was administered to a self-selecting sample in-person (n = 157) or online (n = 58), with questions examining: i) ownership and usage rates of digital devices among people with psychosis; ii) interest in using technology to engage with mental health services; and iii) facilitators of and barriers to using digital tools in a mental healthcare context.

RESULTS

Device ownership: Virtually all participants owned a mobile phone (95%) or smartphone (90%), with Android phones slightly more prevalent than iPhones. Only a minority owned a fitness tracker (15%) or smartwatch (13%). Device ownership was significantly lower in unemployed people and those without secondary education. Device cost and paranoid ideation were barriers to ownership. Technology and mental health services: Most participants (88%) said they would willingly try a mental health app. Symptom monitoring apps were most popular, then appointment reminders and medication reminders. Half the sample would prefer an app alongside face-to-face support; the other half preferred remote support or no other mental health support. Facilitators: Participants thought using a mental health app could increase their understanding of psychosis generally, and of their own symptoms. They valued the flexibility of digital tools in enabling access to support anywhere, anytime. Barriers: Prominent barriers to using mental health apps were forgetting, lack of motivation, security concerns, and concerns it would replace face-to-face care. Overall participants reported no substantial effects of technology on their mental health, although a quarter said using a phone worsened paranoid ideation. A third used technology more when psychotic symptoms were higher, whereas a third used it less. Around half used technology more when experiencing low mood.

CONCLUSIONS

Our findings suggest rapidly increasing device ownership among people with psychosis, mirroring patterns in the general population. Smartphones appear appropriate for delivering internet-enabled support for psychosis. However, for a sub-group of people with psychosis, the sometimes complex interaction between technology and mental health may act as a barrier to engagement, alongside more prosaic factors such as forgetting.

Associations between older adults' social media use behaviors and psychosocial well-being

BACKGROUND

Research examining associations between social media use behaviors and psychosocial well-being among older adults are limited.

AIMS

To explore associations between older adults' social media (social networking services and instant messaging applications) use behaviors and psychosocial well-being.

METHODS

This was a secondary data analysis. All data were retrieved from the Taiwan Communication Survey database, an annual survey that examines trends in Taiwanese residents' communication behaviors and social media use. The original investigation was conducted in Taiwan from September to December 2019. Data from 647 older adults aged over 60 years were extracted for the analyses. Social media use behaviors (users/non-users and time spent using), positive psychosocial outcomes (life satisfaction, self-determination, subjective well-being, and happiness), negative psychosocial outcomes (loneliness, depression, and anxiety), and demographic variables were included.

RESULTS

Social media users had significantly higher levels of subjective well-being and lower levels of depression, anxiety, and loneliness compared with non-users. Time spent on social networking services was significantly and positively correlated with negative psychosocial outcomes (β = 0.103, p = 0.044, f2 = 0.011), and it was significantly and inversely correlated with positive psychosocial outcomes (β = - 0.063, p = 0.049, f2 = 0.004). Time spent using an instant messaging application was significantly positively associated with positive psychosocial outcomes (β = 0.068, p = 0.031, f2 = 0.005). The proposed path model had an acceptable model fit.

DISCUSSION

Study results indicated that older adults' social media use behaviors were associated with their psychosocial well-being.

CONCLUSIONS

Older adults are recommended to use social media for appropriate time periods as an important way to promote social engagement for their psychosocial well-being.

Social Media Use, Fake News and Mental Health during the Uncertain Times of the COVID-19 Pandemic in Ukraine

A sample of 351 adults (women/men 4:1) aged 18 to 60 participated in an online survey administered during the first two waves (15 March-25 April and 10 October-25 November 2020) of the COVID-19 pandemic in Ukraine. The user ethnography profile was Generation Z (born in the 1990s), female (81.2%), Instagrammer (60.3%), unmarried (56.9%) and student (42.9%). An increased time spent on social media (3.18 h/day), searching for COVID-19-related information (1.01 h/day) after the first COVID-19 case and the observation of fake news that went viral (58.8%) decreased in the second wave. Alterations (increase or reduction) in sleep patterns (46.7%) and changes (increase or loss) in appetite (32.7%) affected participants' well-being, but only sleep ameliorated in the second wave. Mental health reports unveiled moderate perceived stress (PSS-10: 20.61 ± 1.13) and mild anxiety (GAD-7: 14.17 ± 0.22), which improved in the second wave. A higher prevalence of severe anxiety (8.5%) was found among individuals in the first survey (8.5%) than those in the second (3.3%). Social media counteracted physical distance policies and played as an immediate source of (mis)information for users, but also anticipated the impact of the most uncertain times of this COVID-19 physical health crisis on well-being and mental health.

Media Production on Smartphones: Analysis of the Timing, Content, and Context of Message Production Using Real-World Smartphone Use Data

Although media production is a critical concept in communication theory, we know surprisingly little about the timing, content, and context of individuals' production behavior. Intensive observation and analysis of 94 American adults' smartphone use over 1 week showed that although time spent in producing content was on average only about 6 percent of the amount of time spent on smartphones, the production content was more purposeful, expressive, articulate, condensed, confident, personal, and emotionally charged than consumption content. Analysis of the temporal dynamics of production suggests that the content consumed in the minute before individuals' production began to resemble the subsequently produced content. Other results suggest that content production on smartphones was fragmented, idiosyncratic, and purposeful, highlighting the impact of individuals' quick interactions with media, and the need to develop user-centric theories about how, when, and why individuals produce digital content.

[Self-administration of a "mole removal pen"]

A 31-year-old woman used a "mole removal pen" purchased from the internet for cosmetic reasons to remove numerous pigmentary moles. After self-application there was multiple scarring. Sequential videodermatoscopic documentation was performed. The purchase of medical-cosmetic products, their use, and the possible risks are discussed.

Problematic Smartphone Use Mediates the Pathway from Suicidal Ideation to Positive Psychotic Experiences: a Large Cross-Sectional, Population-Based Study

The present study followed the newly hypothesized "suicidal drive for psychosis" suggesting that psychosis may be consequential to suicidal ideation (SI) and behavior and attempted to explain parts of the pathway between these variables. To this end, we aimed to test whether problematic smartphone use (PSU) has an indirect mediating effect in the cross-sectional relationship between SI and positive psychotic experiences (PEs). Lebanese community young adults (N=4158; 64.4% females; mean age 21.91±3.79) have been invited to participate to a cross-sectional, web-based study in the period from June to September 2022. After adjusting for potential confounders (i.e., the living situation, marital status, household crowding index, economic pressure, cannabis use, other drugs use, and past history of mental illness other than psychosis), we found that higher levels of suicidal ideation was significantly associated with greater PSU, which was also positively and significantly associated with more positive PEs. Finally, greater suicidal ideation was significantly and directly associated with more positive PEs. Our findings suggest that SPU may be regarded as a potential target for prevention and intervention in psychosis. Clinicians, educators, and school administrators ought to give greater attention to PSU among vulnerable young people who present with SI.

Time to Think "Meta": A Critical Viewpoint on the Risks and Benefits of Virtual Worlds for Mental Health

The metaverse is gaining traction in the general population and has become a priority of the technological industry. Defined as persistent virtual worlds that exist in virtual or augmented reality, the metaverse proposes to afford a range of activities of daily life, from socializing and relaxing to gaming, shopping, and working. Because of its scope, its projected popularity, and its immersivity, the metaverse may pose unique opportunities and risks for mental health. In this viewpoint article, we integrate existing evidence on the mental health impacts of video games, social media, and virtual reality to anticipate how the metaverse could influence mental health. We outline 2 categories of mechanisms related to mental health: experiences or behaviors afforded by the metaverse and experiences or behaviors displaced by it. The metaverse may benefit mental health by affording control (over an avatar and its virtual environment), cognitive activation, physical activity, social connections, and a sense of autonomy and competence. However, repetitive rewarding experiences may lead to addiction-like behaviors, and high engagement in virtual worlds may facilitate and perpetuate the avoidance of challenges in the offline environment. Further, time spent in virtual worlds may displace (reduce) other determinants of mental health, such as sleep rhythms and offline social capital. Importantly, individuals will differ in their uses of and psychological responses to the metaverse, resulting in heterogeneous impacts on their mental health. Their technological motivations, developmental stage, sociodemographic context, and prior mental health problems are some of the factors that may modify and frame the positive and negative effects of the metaverse on their mental health. In conclusion, as the metaverse is being scaffolded by the industry and by its users, there is a window of opportunity for researchers, clinicians, and people with lived experience to coproduce knowledge on its possible impacts on mental health and illness, with the hope of influencing policy-making, technological development, and counseling of patients.

The Relationship between Social Media and the Increase in Mental Health Problems

Social media has become an indispensable aspect of young people's digital interactions, as they use it mostly for entertainment and communication purposes. Consequently, it has the potential to have both positive and negative effects on them. Deterioration in mental health is one of the side effects stemming from social media overuse. This study investigates the relationship between social media and the increase in mental health problems in Saudi Arabia. The population considered for analysis includes young people from Saudi Arabia, with a sample size of 385. A closed-ended survey questionnaire was used to collect data on different social media features and criteria. Using the Analytical Hierarchical Process (AHP), the researcher analyzed data to compare the effect of different social media features on mental health. The social media features included in this paper are private chats and calls, group chats and calls, browsing posts, games, media sharing, adverts, likes/comments/followers, and pages. The researcher adopted entertainment, information, social interaction, privacy, esteem, and communication as the criteria in the AHP process. Among these criteria, the study found that entertainment was the most significant, while privacy was the least significant. Findings suggested that likes, comments, and followers were the biggest contributors to poor mental health (total utility = 56.24). The least effective feature was 'games' (total utility = 2.56). The researcher recommends that social media users be cautious when interacting with social media features, especially likes, comments, followers, media, and posts, because of their significant effect on mental health.

Identifying accurate pro-choice and pro-life identity labels in Spanish: Social media insights and implications for comparative survey research

INTRODUCTION

Although debate remains about the saliency and relevance of pro-choice and pro-life labels (as abortion belief indicators), they have been consistently used for decades to broadly designate abortion identity. However, clear labels are less apparent in other languages (e.g., Spanish). Social media, as an exploratory data science tool, can be leveraged to identify the presence and popularity of online abortion identity labels and how they are contextualized online.

PURPOSE

This study aims to determine how popularly used Spanish-language pro-choice and pro-life identity labels are contextualized online.

METHOD

We used Latent Dirichlet Allocation (LDA) topic models, an unsupervised natural language processing (NLP) application, to generate themes about Spanish language tweets categorized by Spanish abortion identity labels: (1) proelección (pro-choice); (2) derecho a decidir (right to choose); (3) proaborto (pro-abortion); (4) provida (pro-life); (5) antiaborto (anti-abortion); and (6) derecho a vivir (right to life). We manually reviewed themes for each identity label to assess scope.

RESULTS

All six identity labels included in our analysis contained some references to abortion. However, several labels were not exclusive to abortion. Proelección (pro-choice), for example, contained several themes related to ongoing presidential elections.

DISCUSSION AND CONCLUSION

No singular Spanish abortion identity label encapsulates abortion beliefs; however, there are several viable options. Just as the debate remains ongoing about pro-choice and pro-life as accurate indicators of abortion beliefs in English, we must also consider that identity is more complex than binary labels in Spanish.

Internet addiction is associated with psychological distress in highly schizotypal students

BACKGROUND

There is some limited evidence of an association between technology addictions and emergence of pre-psychotic symptoms, high psychoticism, psychotic like experiences and high schizotypy among young non-clinical adults. These addictions and their subsequent distress are likely to contribute to transition to psychosis in individuals at risk. We aimed to compare smartphone, Internet and Facebook addictions between low and high schizotypal individuals; and to explore the association between these addictions and distress in the high schizotypy group.

METHODS

From a pool of 700 students, the final sample consisted of 74 low schizotypal and 70 high schizotypal students. The Schizotypal Personality Questionnaire, the Bergen Facebook Addiction Scale, the Internet Addiction Test, the Smartphone Addiction Scale-Short Version and the Depression, Anxiety and Stress Scales.

RESULTS

Students of the high schizotypy group displayed significantly greater scores on smartphone (p < .001), Internet (p < .001) and Facebook (p = .001) addictions scales, as compared to those of the low schizotypy group. After controlling for potential confounders, Internet addiction predicted psychological distress in the high schizotypy group (R²  = 0.380, F_(13,55)  = 2.597, p < .001) and explained an additional 19.7% of variation in Depression, Anxiety and Stress Scales total scores in the final model.

CONCLUSION

Although preliminary, our findings shed light on relatively new avenues for prevention and early intervention in psychosis. It is recommended to raise awareness about Internet addiction risks, particularly among vulnerable young adults; and to find ways to turn Internet into a protective rather than stressor factor, by utilizing it as a resource in the care pathway.

The window to the world for individuals with mental disorders: A qualitative study about social media

This study aimed to determine the views of individuals with mental disorders on the experience of social media. This was a qualitative study conducted using the content analysis method. Using purposive sampling, 12 individuals with mental disorders were selected and interviewed. Data were collected using semi-structured interviews and were analyzed using the content analysis method. Four main themes and 10 subthemes were identified. The themes included the window opening to the world (source of information, facilitating life), from invisibility to visibility (feeling good, liberation and socialization), negative experiences (feeling lost, envy, and privacy), and the rejection of society (escape and stigmatization). Individuals with mental disorders stated that social media had both positive as well as negative effects on their lives. The results of the study highlight the various aspects of social media use and its effects on individuals with mental disorders. These results can be used in planning and implementing mental health services for individuals with mental disorders. ACCESSIBLE SUMMARY: What is known about the subject? What does the paper add to existing knowledge? What are the implications for the practice?

Research to Clinical Practice-Youth seeking mental health information online and its impact on the first steps in the patient journey

BACKGROUND

Online searches about anxiety and depression are recorded every 3-5 s. As such, information and communication technologies (ICT) have enormous potential to enable or impair help-seeking and patient-professional interactions. Youth studies indicate that ICT searches are undertaken before initial mental health consultations, but no publications have considered how this online activity affects the first steps of the patient journey in youth mental health settings.

METHODS

State-of-the-art review using an iterative, evidence mapping approach to identify key literature and expert consensus to synthesize and prioritise clinical and research issues.

RESULTS

Adolescents and young adults are more likely to seek health advice via online search engines or social media platforms than from a health professional. Young people not only search user-generated content and social media to obtain advice and support from online communities but increasingly contribute personal information online.

CONCLUSIONS

A major clinical challenge is to raise professional awareness of the likely impact of this activity on mental health consultations. Potential strategies range from modifying the structure of clinical consultations to ensure young people are able to disclose ICT activities related to mental health, through to the development and implementation of 'internet prescriptions' and a youth-focused 'toolkit'.

Real-time cognitive performance and positive symptom expression in schizophrenia

Deficits in cognitive functions are frequent in schizophrenia and are often conceptualized as stable characteristics of this disorder. However, cognitive capacities may fluctuate over the course of a day and it is unknown if such variation may be linked to the dynamic expression of psychotic symptoms. This investigation used Ecological Momentary Assessment (EMA) to provide mobile tests of cognitive functions and positive symptoms in real time. Thirty-three individuals with schizophrenia completed five EMA assessments per day for a one-week period that included real-time assessments of cognitive performance and psychotic symptoms. A subsample of patients and 31 healthy controls also completed a functional MRI examination. Relative to each individual's average score, moments of worsened cognitive performance on the mobile tests were associated with an increased probability of positive symptom occurrence over subsequent hours of the day (coef = 0.06, p < 0.05), adjusting for the presence of psychotic symptoms at the moment of mobile test administration. These prospective associations varied as a function of graph theory indices in MRI analyses. These findings demonstrate that cognitive performance is prospectively linked to psychotic symptom expression in daily life, and that underlying brain markers may be observed in the Executive Control Network. While the potential causal nature of this association remains to be investigated, our results offer promising prospects for a better understanding of the underlying mechanisms of symptom expression in schizophrenia.

The Role of Envy in Linking Active and Passive Social Media use to Memory Functioning

Social media use has previously been shown to have negative implications for cognition. Scarce research has examined underlying pathways through which social media use may influence cognition. One potential pathway involves the consequences of social comparison, such that those who use social media more frequently may feel worse about themselves and more envious toward others. In turn, these negative socioemotional states could compromise memory. Further, whether an individual uses social media actively or passively may moderate these associations. Using an online adult lifespan sample (n=592), the current cross-sectional study examined whether socioemotional consequences of social comparison (self-esteem and envy) mediated relationships between social media use and memory (everyday memory failures and episodic memory) and whether active/passive use moderated these associations. Mediation models revealed that higher envy, but not lower self-esteem, partially explained the relationship between higher social media use and more self-reported everyday memory failures. Neither envy nor self-esteem mediated the relationship between higher social media use and lower objective episodic memory performance. Additionally, higher social media use was associated with higher envy to a greater extent for active users compared to passive users. These findings may suggest that high social media use has negative ramifications for both subjective and objective memory and that increased feelings of envy may partially explain these effects for subjective, but not objective, memory.

Social media's role in support networks among LGBTQ adolescents: a qualitative study

Background Adolescents use social media more frequently than other age groups. Social media has been described as a safe environment for lesbian, gay, bisexual, transgender and queer and/or questioning (LGBTQ) adolescents. As part of mixed-methods research investigating the association between social networks and sexual agency, we present qualitative findings on how LGBTQ adolescents connect online to form support networks. Methods We recruited 30 adolescents aged 14-17years who identified as LGBTQ in terms of their gender or attraction in the longitudinal Social Networks and Agency Project. Semi-structured interviews were conducted online or face-to-face across Australia. Thematic analysis was used to explore perceptions and experiences of participants in relation to social media use and relationships. Results Two overarching themes were identified: LGBTQ adolescents use social media for identity, relationships and wellbeing support. Social media is not always free of discrimination for LGBTQ adolescents. Many LGBTQ participants joined Facebook groups to connect with LGBTQ peers. Facebook was considered a vital support for those with mental health concerns including suicidal ideation. Participants gave and received support from group members, which was considered useful for those feeling isolated or victimised. LGBTQ adolescents formed friendships, romantic relationships and gained information on sex, relationships, and sexual health from these groups. Participants described negative experiences including discrimination within Facebook groups, mismanaged groups and exposure to anti-LGBTQ sentiments. Conclusion Social media is an environment where LGBTQ adolescents can connect, educate and support each other, which may have beneficial effects for this marginalised group. There remain issues with social media including discrimination against and within LGBTQ communities.

Improving social functioning in people with schizophrenia-spectrum disorders via mobile experimental interventions: Results from the CLIMB pilot trial

Background

Patients with Schizophrenia Spectrum Disorders (SSD) demonstrate poor social functioning. While group-based approaches show long-term improvements, access to treatments is limited. Digital platforms hold promise to overcome barriers to treatment delivery and improve outcomes.

Objective

In a parallel arm, double-blind RCT, we tested CLIMB, a clinician-assisted, adjunct to treatment that includes computerized social cognition training (SCT), ecological momentary assessments (EMAs), group tele-therapy, and moderated messaging. CLIMB was compared to an active control that includes computerized general cognitive training (GCT), unstructured support groups, and unmoderated messaging.

Methods

The primary outcome was social functioning. Secondary outcomes were negative symptoms and quality of life (QoL). Given the sample size, Propensity Score Models were used to ensure balanced baseline covariates. Mixed-effects models examined change over time.

Results

24 participants completed the study (12 per arm). No significant between-group differences emerged in engagement. CLIMB participants engaged in a median of 8 sessions (IQR = 2), 2.8 h of SCT (IQR = 7.5), and 2710 EMAs; control participants engaged in a median of 9 sessions (IQR = 3) and 2.2 h of GCT (IQR = 7.9). As a group, participants showed significant improvements in social functioning (p = .046), with no between-group differences. Intent-to-treat analyses indicated greater improvements in QoL (p = .025) for the active control.

Conclusions

Delivering group-based mobile interventions to individuals with SSD is feasible. EMAs allow clinicians to maintain inter-session engagement, build participant self-awareness, and tailor treatment delivery. In this treatment model, whether SCT or GCT is more effective remains unclear. Further research will evaluate group-based mobile interventions to improve outcomes in SSD.

Use of social media and online dating among individuals with a history of affective disorder

OBJECTIVES

To investigate how individuals with a history of affective disorder use and perceive their use of social media and online dating.

METHODS

A questionnaire focusing on affective disorders and the use of social media and online dating was handed out to outpatients from unipolar depression and bipolar disorder clinics and general practice patients with or without a history of affective disorders (latter as controls). The association between affective disorders and use of social media and online dating was analysed using linear/logistic regression.

RESULTS

A total of 194 individuals with a history of unipolar depression, 124 individuals with a history of bipolar disorder and 196 controls were included in the analysis. Having a history of unipolar depression or bipolar disorder was not associated with the time spent on social media compared with controls. Using the controls as reference, having a history bipolar disorder was associated with use of online dating (adjusted odds ratio: 2.2 (95% CI: 1.3; 3.7)). The use of social media and online dating had a mood-congruent pattern with decreased and more passive use during depressive episodes, and increased and more active use during hypomanic/manic episodes. Among the respondents with a history of affective disorder, 51% reported that social media use had an aggravating effect on symptoms during mood episodes, while 10% reported a beneficial effect. For online dating, the equivalent proportions were 49% (aggravation) and 20% (benefit), respectively.

CONCLUSION

The use of social media and online dating seems related to symptom deterioration among individuals with affective disorder.

Social Media Insights Into US Mental Health During the COVID-19 Pandemic: Longitudinal Analysis of Twitter Data

BACKGROUND

The COVID-19 pandemic led to unprecedented mitigation efforts that disrupted the daily lives of millions. Beyond the general health repercussions of the pandemic itself, these measures also present a challenge to the world's mental health and health care systems. Considering that traditional survey methods are time-consuming and expensive, we need timely and proactive data sources to respond to the rapidly evolving effects of health policy on our population's mental health. Many people in the United States now use social media platforms such as Twitter to express the most minute details of their daily lives and social relations. This behavior is expected to increase during the COVID-19 pandemic, rendering social media data a rich field to understand personal well-being.

OBJECTIVE

This study aims to answer three research questions: (1) What themes emerge from a corpus of US tweets about COVID-19? (2) To what extent did social media use increase during the onset of the COVID-19 pandemic? and (3) Does sentiment change in response to the COVID-19 pandemic?

METHODS

We analyzed 86,581,237 public domain English language US tweets collected from an open-access public repository in three steps. First, we characterized the evolution of hashtags over time using latent Dirichlet allocation (LDA) topic modeling. Second, we increased the granularity of this analysis by downloading Twitter timelines of a large cohort of individuals (n=354,738) in 20 major US cities to assess changes in social media use. Finally, using this timeline data, we examined collective shifts in public mood in relation to evolving pandemic news cycles by analyzing the average daily sentiment of all timeline tweets with the Valence Aware Dictionary and Sentiment Reasoner (VADER) tool.

RESULTS

LDA topics generated in the early months of the data set corresponded to major COVID-19-specific events. However, as state and municipal governments began issuing stay-at-home orders, latent themes shifted toward US-related lifestyle changes rather than global pandemic-related events. Social media volume also increased significantly, peaking during stay-at-home mandates. Finally, VADER sentiment analysis scores of user timelines were initially high and stable but decreased significantly, and continuously, by late March.

CONCLUSIONS

Our findings underscore the negative effects of the pandemic on overall population sentiment. Increased use rates suggest that, for some, social media may be a coping mechanism to combat feelings of isolation related to long-term social distancing. However, in light of the documented negative effect of heavy social media use on mental health, social media may further exacerbate negative feelings in the long-term for many individuals. Thus, considering the overburdened US mental health care structure, these findings have important implications for ongoing mitigation efforts.

Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice

Social media platforms are popular venues for sharing personal experiences, seeking information, and offering peer-to-peer support among individuals living with mental illness. With significant shortfalls in the availability, quality, and reach of evidence-based mental health services across the United States and globally, social media platforms may afford new opportunities to bridge this gap. However, caution is warranted, as numerous studies highlight risks of social media use for mental health. In this commentary, we consider the role of social media as a potentially viable intervention platform for offering support to persons with mental disorders, promoting engagement and retention in care, and enhancing existing mental health services. Specifically, we summarize current research on the use of social media among mental health service users, and early efforts using social media for the delivery of evidence-based programs. We also review the risks, potential harms, and necessary safety precautions with using social media for mental health. To conclude, we explore opportunities using data science and machine learning, for example by leveraging social media for detecting mental disorders and developing predictive models aimed at characterizing the aetiology and progression of mental disorders. These various efforts using social media, as summarized in this commentary, hold promise for improving the lives of individuals living with mental disorders.

Is cesarean section a cause of affective disorders?-A national cohort study using sibling designs

BACKGROUND

The gut microbiota of children delivered by cesarean section differs from that of children delivered vaginally. In light of the gut-brain axis hypothesis, cesarean section may influence risk of affective disorders.

METHODS

Population based prospective cohort study included Danish children born 1982 through 2001, with follow-up until 2015. The effect of delivery mode on the risk of affective disorders was assessed using a standard Cox model and two types of Cox sibling models. Diagnostic codes or prescriptions for antidepressants and lithium were used to define cases of affective disorders.

RESULTS

1,009,444 children were followed for 8,880,794 person-years from the age of 13 years, with relevant covariates available from birth. There are strong calendar time trends in the occurrence of affective disorders with an increasingly younger age at first diagnosis and with a hotspot between the years 2007-2012. Fully adjusted standard Cox models showed an increased risk of affective disorders for both pre-labor (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.08-1.15) and intrapartum (HR, 1.07; 95% CI, 1.05-1.10) cesarean section, compared to vaginal delivery. This effect disappeared in the between-within sibling model for pre-labor (HR, 1.00; 95% CI, 0.94-1.07) but not intrapartum (HR, 1.05; 95% CI, 1.00-1.12) cesarean section.

LIMITATIONS

Interpretation of results from sibling models may not be relevant to children without siblings.

CONCLUSIONS

These results do not support the hypothesis that a delivery-mode dependent change in gut microbiota is a cause of subsequent affective disorders, despite an apparent association with delivery mode.

Ecological momentary assessment of everyday social experiences of people with schizophrenia: A systematic review

INTRODUCTION

Our goal in the current review was to summarize the existing literature on the utility of ecological momentary assessment (EMA) in assessing the social experiences of people with schizophrenia (SZ). We were further interested in examining the associations between EMA-reported social outcomes and traditional assessments of social functioning.

METHODS

We conducted a systematic review of EMA studies published between January 1, 1990 and October 31, 2018 from PubMed and PsycINFO electronic databases. We included EMA studies that assessed social experiences (proportion of time spent alone/with others, affective experiences when with others, social stress, factors related to social experiences) in people with SZ. We included studies that examined associations between laboratory-based, self-report, or clinical assessments of functioning with EMA-reported social experiences.

RESULTS

We identified 22 EMA studies for inclusion in this review. Though heterogeneous in aspects of social experiences assessed, the current literature suggests that people with SZ report more social stress and a preference to be alone when they are with others (nine out of 10 studies). People with SZ report more positive affect when they are with others compared to being alone, and equivalent amounts of positive affect during social experiences as healthy controls (all four studies assessed). Five studies assessed the coherence between functioning assessments and momentary social experiences, with mixed results.

CONCLUSION

We discuss limitations of the literature and future directions. EMA shows promise in assessing more granular aspects of social experience (including social stress and social pleasure) in people with SZ compared to other methods.

Risks to Privacy With Use of Social Media: Understanding the Views of Social Media Users With Serious Mental Illness

OBJECTIVE

Social media may afford new opportunities to enhance mental health services; however, privacy risks have received less attention. This study explored privacy risks of using social media for reasons related to mental health from the perspectives of social media users with serious mental illness.

METHODS

Twitter users who self-identified in their profile as having a serious mental illness participated in an online survey inquiring whether they were ever concerned about risks to their privacy when using social media for anything related to their mental illness. User characteristics were compared between those who were concerned about risks and those who were not. Participants' responses to an open-ended question about privacy risks were analyzed thematically.

RESULTS

Among 90 respondents who self-identified as having schizophrenia spectrum disorders (40%), bipolar disorder (37%), or major depressive disorder (23%), more than one-third (36%) expressed concerns about privacy risks with using social media. Risks were more frequently reported among respondents with a college degree, compared with those without a college degree, and among respondents who were currently working or in school, compared with those who were not currently working. Thematic analysis of participants' responses to the open-ended question yielded four categories of risk: threats to employment, fear of stigma and being judged, impact on personal relationships, and facing hostility or being hurt.

CONCLUSIONS

These findings offer preliminary insights about the types of privacy risks that individuals with serious mental illness are concerned about when using social media for their mental health. The findings can inform the safety of future social media interventions.

The digital revolution and its impact on mental health care

The digital revolution is evolving at an unstoppable pace. Alongside the unprecedented explosion of digital technology facilities and systems, mental health care is under greater pressure than ever before. With its emphasis on big data, computing power, mobile technology, and network information, digital technology is set to transform health care delivery. This article reviews the field of digital health technology assessment and intervention primarily in secondary service mental health care, including the barriers and facilitators to adopting and implementing digitally mediated interventions in service delivery. We consider the impact of digitally mediated communication on human interaction and its potential impact on various mental states such as those linked to mood, anxiety but also well-being. These developments point to a need for both theory- and data-driven approaches to digital health care. We argue that, as developments in digital technology are outpacing the evaluation of rigorous digital health interventions, more advanced methodologies are needed to keep up with the pace of digital technology development. The need for co-production of digital tools with and for people with chronic and mental health difficulties, and implications of digital technology for psychotherapy practice, will be central to this development. PRACTITIONER POINTS: Mental health problems are one of the main causes of global and societal burden and are a growing public health. People with mental health problems around the world have limited, if any, chance of accessing psychological help at all. Technological innovations and solutions are being considered in an attempt to address the size and scale of the mental health crisis worldwide. Digital platforms allow people to self-monitor and self-manage in a way that face-to-face/paper-based methods of assessment have up until now not allowed. We provide examples of digital tools that are being developed and used in the secondary setting and identify a number of challenges in the digital health field that require careful consideration.

Social media and its relationship with mood, self-esteem and paranoia in psychosis

OBJECTIVE

An evidence-base is emerging indicating detrimental and beneficial effects of social media. Little is known about the impact of social media use on people who experience psychosis.

METHOD

Forty-four participants with and without psychosis completed 1084 assessments of social media use, perceived social rank, mood, self-esteem and paranoia over a 6-day period using an experience sampling method (ESM).

RESULTS

Social media use predicted low mood, but did not predict self-esteem and paranoia. Posting about feelings and venting on social media predicted low mood and self-esteem and high paranoia, whilst posting about daily activities predicted increases in positive affect and self-esteem and viewing social media newsfeeds predicted reductions in negative affect and paranoia. Perceptions of low social rank when using social media predicted low mood and self-esteem and high paranoia. The impact of social media use did not differ between participants with and without psychosis; although, experiencing psychosis moderated the relationship between venting and negative affect. Social media use frequency was lower in people with psychosis.

CONCLUSION

Findings show the potential detrimental impact of social media use for people with and without psychosis. Despite few between-group differences, overall negative psychological consequences highlight the need to consider use in clinical practice.