Back of the net

Abstract

People use social media such as Twitter and Facebook to define and present their identity. In turn, networks formed and feedback received might impact a person's sense of self, their mood and outlook, and their sense of belonging within a group. Anecdotal reports abound of the benefits of social networks—for example, in facilitating supportive companionship with others experiencing mental illness. So, unfortunately, do accounts of the darker side of social media: from unhealthy feelings generated by comparing oneself with the seemingly picture-perfect lives of others, to active abuse and threats sent via social media that generate fear, anxiety, and depression. In some cases, as outlined in Stephen Fry's recent film The Not So Secret Life of the Manic Depressive, social media use by the public risks a return to the days of mental illness as spectacle: the story of Alika, whose manic behaviour on the London Underground was recorded and uploaded by a stranger for the derision of others, was particularly troubling.Could these effects—good and bad—be sufficient to have an effect at a population level, and change the mental health landscape of a generation? And how might parents, teachers, and health professionals advise young people to use digital technology and social networks in a healthy manner? Observational studies might identify broad associations between patterns of use and specific social problems and mental illnesses; but the rapidity of smartphone and social media uptake that has occurred, the wide range of possible confounders, and the problems of clearly identifying causality are among the factors that will inevitably limit their value. There is perhaps a role for qualitative analysis, as well as relatively novel techniques such as sentiment analysis of social media content. As for the guidance professionals can give, while it is hard as yet to define what precisely this should be, it is rather more straightforward to say what it should not consist of. Advice that is based on an imperfect or outdated understanding of how social media platforms work is likely to be ignored. Similarly, attempts to turn back the clock to a supposed golden pre-digital age are as unrealistic as they are useless.Social media use also opens up new areas for clinicians and researchers, albeit in a landscape that is fraught with both possibility and peril. Analysis of online postings might provide insights into the psychological response of populations in the aftermath of disasters (as documented by Oliver Gruebner and colleagues in The Lancet); could it also facilitate effective mental health interventions, both online and in the physical world? Meanwhile, the use of social media by service users has the potential to level the historic power imbalance between patient and practitioner, and to bring transparency to such processes as inpatient admission and care. However, there are numerous ethical pitfalls of which all parties need to be aware. One problem is the confidentiality of individuals and their families, and the extent to which monitoring a patient's social media output is a justifiable activity for professionals: the letter of the law might be that anything posted rests in the public domain, but the spirit in which individuals post, and their expectations of who might use this information and how, could be completely different.Additionally, there is the use of social media for communication by and between scientists, clinicians, and the public to consider. Social media might have clear advantages in the rapid, targeted dissemination of important information and debate, including to usually hard-to-access geographical areas in both high-income and low-income countries. However, care is needed to prevent free discussion from becoming a free-for-all conflict that leaves nobody the wiser. In April, 2016 the Center for Mobile Communication Studies at Boston University—in collaboration with Elsevier, The Lancet Psychiatry's publishing company—held a workshop about social media effects on scientific controversies. While acknowledging the benefits of social media in making discussion rapid and accessible, several pitfalls were identified: the spread of misinformation, oversimplified “scienceploitation” of click-bait articles, and a rancorous, uncivil tone to online discourse. Health professionals—clinicians and researchers—should not fool themselves that they are any less prone to the problems that have already been identified as affecting online discourse in other areas, such as politics. Nor should they presume that the fact that they are standing for something good—improved health and wellbeing—gives them carte blanche to behave badly on social media. If we are going to use digital technology's potential to its best advantage, we need to be responsible social network users ourselves. People use social media such as Twitter and Facebook to define and present their identity. In turn, networks formed and feedback received might impact a person's sense of self, their mood and outlook, and their sense of belonging within a group. Anecdotal reports abound of the benefits of social networks—for example, in facilitating supportive companionship with others experiencing mental illness. So, unfortunately, do accounts of the darker side of social media: from unhealthy feelings generated by comparing oneself with the seemingly picture-perfect lives of others, to active abuse and threats sent via social media that generate fear, anxiety, and depression. In some cases, as outlined in Stephen Fry's recent film The Not So Secret Life of the Manic Depressive, social media use by the public risks a return to the days of mental illness as spectacle: the story of Alika, whose manic behaviour on the London Underground was recorded and uploaded by a stranger for the derision of others, was particularly troubling. Could these effects—good and bad—be sufficient to have an effect at a population level, and change the mental health landscape of a generation? And how might parents, teachers, and health professionals advise young people to use digital technology and social networks in a healthy manner? Observational studies might identify broad associations between patterns of use and specific social problems and mental illnesses; but the rapidity of smartphone and social media uptake that has occurred, the wide range of possible confounders, and the problems of clearly identifying causality are among the factors that will inevitably limit their value. There is perhaps a role for qualitative analysis, as well as relatively novel techniques such as sentiment analysis of social media content. As for the guidance professionals can give, while it is hard as yet to define what precisely this should be, it is rather more straightforward to say what it should not consist of. Advice that is based on an imperfect or outdated understanding of how social media platforms work is likely to be ignored. Similarly, attempts to turn back the clock to a supposed golden pre-digital age are as unrealistic as they are useless. Social media use also opens up new areas for clinicians and researchers, albeit in a landscape that is fraught with both possibility and peril. Analysis of online postings might provide insights into the psychological response of populations in the aftermath of disasters (as documented by Oliver Gruebner and colleagues in The Lancet); could it also facilitate effective mental health interventions, both online and in the physical world? Meanwhile, the use of social media by service users has the potential to level the historic power imbalance between patient and practitioner, and to bring transparency to such processes as inpatient admission and care. However, there are numerous ethical pitfalls of which all parties need to be aware. One problem is the confidentiality of individuals and their families, and the extent to which monitoring a patient's social media output is a justifiable activity for professionals: the letter of the law might be that anything posted rests in the public domain, but the spirit in which individuals post, and their expectations of who might use this information and how, could be completely different. Additionally, there is the use of social media for communication by and between scientists, clinicians, and the public to consider. Social media might have clear advantages in the rapid, targeted dissemination of important information and debate, including to usually hard-to-access geographical areas in both high-income and low-income countries. However, care is needed to prevent free discussion from becoming a free-for-all conflict that leaves nobody the wiser. In April, 2016 the Center for Mobile Communication Studies at Boston University—in collaboration with Elsevier, The Lancet Psychiatry's publishing company—held a workshop about social media effects on scientific controversies. While acknowledging the benefits of social media in making discussion rapid and accessible, several pitfalls were identified: the spread of misinformation, oversimplified “scienceploitation” of click-bait articles, and a rancorous, uncivil tone to online discourse. Health professionals—clinicians and researchers—should not fool themselves that they are any less prone to the problems that have already been identified as affecting online discourse in other areas, such as politics. Nor should they presume that the fact that they are standing for something good—improved health and wellbeing—gives them carte blanche to behave badly on social media. If we are going to use digital technology's potential to its best advantage, we need to be responsible social network users ourselves. Mental health surveillance after the terrorist attacks in ParisThe terror events in Paris in November, 2015, and elsewhere remind us of the substantial consequences that violent events can have for a population's mental health.1 Although effective approaches exist for treating these consequences,1 no systematic attempts have been made to identify populations at risk early on to expeditiously mitigate them. Social media could help identify populations in need during and after disasters.2 Specifically, automated sentiment analysis can extract emotional reactions from these data,3 and space–time syndromic surveillance can effectively detect disease outbreaks. Full-Text PDF