Helen Christensen was the 2013 recipient of the APS Distinguished Contribution to Psychological Science Award for her longstanding and exceptional contribution in the area of e-mental health.
Social media, big data and the next generation of e-health interventions
The Internet is a place where we, as psychologists, can quickly learn about new developments in our area, source research papers, publish research, connect with our colleagues and clients, undertake online training, manage accounts, and keep records. For those who use our services, we can also learn about useful apps or websites that offer online assessments, psychoeducation, self-help and supplementary therapies. However, as ordinary people in everyday life, we use the Internet far more frequently. We make social connections, keep in touch with our families, pay bills, upload our exercise data from our Jawbones and Fitbits, send out invitations, make appointments, read the news, text our family members, look at television programs we missed over the past week and even check the rain radar before we walk to work. Internet enabled activities are ubiquitous in Australia, as they are in almost all countries, and we can’t get enough of them.
The number of Internet users in 2012 was more than a third of the world’s population. Today, the number of text messages received in one day exceeds the total population of the planet (7.1 billion). There are over one billion people on Facebook. If Facebook were a country it would be third largest behind China and India (Facebook, 2013). Twitter is currently broadcasting 58 million tweets a day. Lady Gaga, Justin Bieber and Katy Perry have more Twitter followers than the entire populations of Germany, Turkey, South Africa, Canada, Argentina, Egypt, and Australia (Twitter Courier, 2014). This level of interpersonal and global interactivity is changing everything we do, and in ways that are not yet predictable. Indeed the global pace of these changes is quite staggering!
The last 20 years have seen the rapid development of e-health therapies for the treatment and prevention of anxiety, depression, bipolar disorder and behavioural disorders (see Beacon, https://beacon.anu.edu.au/; Christensen et al., 2010). In the 1980s and 1990s, e-therapies were originally offered via computer (see Selmi, Klein, Greist, Johnson, & Harris, 1982; Proudfoot et al., 2003; Proudfoot et al., 2004). In the 2000s, interactive websites were developed and evaluated, (for example, MoodGYM; Christensen, Griffiths, & Korten, 2002) and more recently, web programs for mobile phones have been developed, where the material can be accessed via mobile phones from a website (see Proudfoot et al., 2013). Apps which are standalone applications operating on mobile phones (see Donker et al., 2013) are now common, but still very few have been evaluated. As these interventions are developed, the unintended consequences and the usefulness of the intervention in connection with the technology have surprised even the inventors. However, the biggest development in the last decade has been the rise of social media, the impact and usefulness of which have hardly been touched by e-mental health.
This very brief article defines social media, illustrates its potential use, and briefly describes some current research projects in this rapidly expanding area. If we understand what technology can do, and how the community uses it, we can harness it to solve certain types of mental health issues, and indeed to speed up the ‘translation’ process of bringing evidence-based activities into practice.
According to Wikipedia (2014), social media is:
the interaction among people in which they create, share or exchange information and ideas in virtual communities and networks. Furthermore, social media depend on mobile and web-based technologies to create highly interactive platforms through which individuals and communities share, co-create, discuss, and modify user-generated content. They introduce substantial and pervasive changes to communication between organizations, communities, and individuals (Kietzmann, Hermkens, McCarthy, & Silvestre, 2011).
Well known examples of social media platforms are Facebook, Twitter, Instagram and Tumblr, but social media also includes forums, interactive bulletin boards and blogs. Consumers use social media through sites such as Patients Like Me (www.patientslikeme.com) and LiveJournal (www.livejournal.com). Platforms like the Big White Wall (www.bigwhitewall.com) provide peer support (and online therapy) to communities throughout the UK.
Business and marketing have known for five years that social media is critical to promote products. A whole industry has developed to help organisations manage their social media. Business uses sophisticated software applications such as Salesforce to help co-ordinate the connections that are needed to deliver business solutions (www.salesforce.com/au/crm/customer-service-support/social-networking/). Amazon is now releasing a software package called Amazon Kinesis which processes millions of bits of social media data and streams in real time (https://aws.amazon.com/kinesis/) to assist business to know their customers and understand their connections. All marketing departments use social media to promote sales, engagement and connection.
The capacity to connect, engage and disseminate through social media has driven many mental health non-government organisations to establish active social media programs. Two years ago, the Black Dog Institute employed its first ‘digital marketing expert’. The number of Institute Facebook fans rose from about 5,000 to now 25,000 members. Reachout has 25,000 likes, while beyondblue has 180,000. Social media facilitates the dissemination of information via its networks and is a powerful mechanism for promoting mental health information to relevant communities.
However, this is just the beginning. A new big idea is emerging that if we can understand the science of social media and how it works, we may be able to improve the mental health of nations. This idea requires that we understand the science of human behaviour and also the capability of technology. A number of current research projects outlined below demonstrate how this synergy has the potential to bring about improvements in mental health.
Social media as a means of changing mental health stigma
How does this work? Stigma for mental illness is believed to be reduced through social connections – where messages between people are targeted, local, credible and continuous (see Corrigan, 2011). Evidence is emerging as to the conditions that will reduce stigma. The principles of Corrigan’s theory (2011) of strategic stigma change are defined by the acronym ‘TLC’: Targeted, Local, Credible and Continuous contact. However, implementing stigma reduction at a population level is likely to be a challenge. Social media (Facebook, Twitter, etc.) provide the platform for exactly the sort of communication which breaks down stigma – local, targeted, trusted and continuous. Moreover, social media is an ideal medium to experimentally test models of how messaging and networking can reduce stigma, such as through Mechanical Turk (www.mturk.com/mturk/welcome). Once these messages are determined, then social media may become the platform for lowering stigma in communities.
We need to be able to answer these sorts of questions: Which messages using social media will lead to attitude and behavioural change? Which network connections will lead to greatest influence? Who is best to transmit it? Which research designs are required/possible to establish this knowledge? From other areas, we know that an innovative program using social media can work. For example, voting behaviour can be influenced by social messages on Facebook (see Bond et al., 2012). Once established, the program’s impact will be enormous because the platform is the means of dissemination. Remember, one person (Lady Gaga) can influence millions of people.
Social media as a means of changing help seeking
How does this work? A large proportion of people with mental health problems do not seek help. Help seeking will increase if stigma is lowered (Link & Phelan, 2006). However, changing actual help-seeking behaviour is difficult. Nevertheless, we do know that social networks can influence personal behaviours such as eating tendencies (Christakis & Fowler, 2007). Understanding both offline and online social connections may prove to be an effective strategy to influence help seeking.
Social media as a means of identifying suicide risk
How does this work? If we understand how Twitter messages around suicide are transmitted, the context that determines which tweets represent suicide risk, and the way in which people respond to tweets, then we have the potential to develop more innovative ways to respond to individuals at risk of suicide who post online. We could further determine whether tweets influence attitudes and behaviour, and whether Twitter can become a monitoring system for certain sorts of tweets. A project the Black Dog Institute is currently undertaking with CSIRO uses a tool that can capture, code and interpret tweets related to suicide ideation and depression.
Social media as a means of indicating the mental health of nations
How does this work? If we can measure the mental health and wellbeing of the planet through Twitter, we may be able to detect deviations quickly. The Black Dog Institute is currently undertaking a project with CSIRO and Amazon to determine the emotional health of the world in real-time. Ultimately this research may lead to proactive interventions in areas of health need.
Conclusion
Because current research at the Black Dog Institute is examining social networks and behavioural change, a key conclusion of this brief article is that the expertise of psychologists is critical to this new endeavour. Psychological knowledge is the core component of any public health program that aims to bring about behavioural change. However, it is just one element, and multidisciplinary approaches need to be combined. This type of research involves computer scientists, sociologists, software and industrial engineers, and human performance experts. Our focus is currently on developing the answers to the question: Which research designs are required/possible to establish this knowledge? At this stage, we cannot predict the extent to which we will be successful in investigating this new area. The next decade of research will be incredibly exciting.
The author can be contacted at [email protected]
Acknowledgements
Dr Phil Batterham (ANU), Dr Cecile Paris, Dr Dave Milne (CSIRO), Professor Svetha Venkatesh (Deakin University), and Mr Neil Jackson (Amazon) among others are investigating these technologies in association with Bridi O’Dea and Helen Christensen at the Black Dog Institute.