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Online support groups vary widely in both goals and structures owing to the rapid development of social networking services. Several studies have shown the potential effectiveness of online support groups, such as reducing psychological distress (eg, depression) among individuals with mental health problems. However, online support groups often do not aim at effectiveness regarding distress relief–related outcomes.
This study aims to examine whether the use frequency of online support group platform functions (U2plus) is associated with lower stigma and higher consumer activation.
A total of 350 U2plus users participated in a web-based survey. They were asked what therapy they had received in the past and how often they logged on to it, used each of its functions, and completed the following questionnaires: the Patient Health Questionnaire-9, the Devaluation-Discrimination Scale, and the General Help-Seeking Questionnaire.
Regarding the therapy received, 88% (308/350) of participants had taken medication for mental health problems, and 66.6% (233/350) had received psychotherapy or mental health counseling. Regarding use frequency, 21.7% (74/341) of the participants signed in to U2plus and used its functions more than once a week. The use frequency of U2plus functions was not correlated with perceived stigma, but the use frequency of some functions was weakly correlated with help-seeking intentions from formal sources (eg, doctors and psychologists). However, multiple regression analyses revealed that the use frequency of those functions did not uniquely predict help-seeking intentions.
It was suggested that online support groups may serve as an alternative treatment option for those who are already undergoing pharmacological treatment and are willing to seek help from whatever source they deem helpful.
Andersson [
After conducting a comprehensive review, Barak et al [
People with mental illness are often interested in and willing to form connections with others through social media; specifically, young adults with mental illness were more likely to express their personal views through blogging, form friendships via social media, and connect with people via the web who share the same interests [
After this initial phase of social networking development and group establishment (ie, people getting in touch with others and entering groups), online support groups can take on different forms. First, they have different functions; they can provide emotional, informational, and instrumental support or even (and often) a combination of all three. In particular, support groups (online) may decrease isolation, increase health information sharing, and provide role modeling [
Some studies have analyzed the benefits of online support groups in depth; one remarks that writing about one’s feelings and experiences associated with life challenges decreases one’s negative emotions, writing about neutral events has no such effect, and sharing one’s bad feelings with others has a tremendous relieving effect [
However, the effectiveness of online support group outcomes (eg, improvements in people’s mental health) remains largely unknown. One systematic review aimed to examine the effectiveness of online peer-to-peer support for young people with mental health problems; it identified six relevant studies to be reviewed: 3 randomized controlled trials, 2 pre-post studies, and one randomized trial [
Importantly, online support groups do not always aim at effectiveness regarding distress relief outcomes [
Owing to the rapid development of social networking services, online support groups take on different forms [
After signing up, the users gain access to the psychoeducation page, from which they can learn what depression is and what keeps depression going. By applying the information that they have learned from this page, users should be able to develop a simple formulation based on a cognitive model for depression on the U2Cycle page (
Screenshot of the U2Cycle function.
Screenshot of the FunCan function.
This study aims to examine whether the use frequency of these U2plus functions is associated with decreased stigma, increased consumer activation, and depression levels.
This section reports the nature of this web-based survey in accordance with the Checklist for Reporting Results of Internet E-Surveys [
In total, we had 350 participants (350/23,864, response rate 1.46%) willing to participate, including 219 women, 118 men, and 13 who did not disclose their gender, with a mean age of 38.36 (SD 10.095) years. Regarding the therapy they received, 88.0% (308/350) had been on medication for mental health problems and 66.6% (233/350) had received psychotherapy or mental health counseling.
In addition to the standardized measures mentioned later, participants were asked about how long they had been using U2plus, to which they responded by choosing one of the five options: (1) less than 1 month, (2) 1 month to 6 months, (3) 6 months to 1 year, (4) 1 year to 3 years, and (5) over 3 years. Then they were asked how often they used each function of U2plus (ie, signing in, reacting to other users’ activities, reading U2Friend [other users’ profile and story], U2Cycle, FunCan, and Column), to which they responded by choosing 1 of 5 options: (1) never, (2) once a year, (3) once a month, (4) once a week, (5) a few times a week, and (6) almost every day.
Patient Health Questionnaire-9 (PHQ-9) [
The Discrimination-Devaluation (D-D) scale [
The General Help-Seeking Questionnaire (GHSQ) [
We first calculated the frequency distributions of how long the participants had used U2plus and how often they used each U2plus function. After computing the means and SDs of PHQ-9, D-D scale, help-seeking intentions from formal sources, and help-seeking intentions from informal sources, we performed bilateral correlation analyses between these scales and the use frequency of U2plus functions. Subsequently, multiple regression analyses were conducted to test if the frequency use of each U2plus function uniquely predicted the D-D scale and GHSQ
The ratios of use frequency for the U2plus platform were: 10.3% (36/350) for less than 1 month, 10.9% (38/350) for 1 month to 6 months, 16.9% (59/350) for 6 months to 1 year, 33.4% (117/350) for 1 year to 3 years, and 28.6% (100/350) for over 3 years.
Participants’ use frequency for each of the U2plus functions.
Use frequency | Participant, n (%) | |||||
|
Never | Once a year | Once a month | Once a week | A few times a week | Almost every day |
Signing in (n=341) | 26 (7.6) | 146 (42.8) | 95 (27.9) | 23 (6.7) | 20 (5.9) | 31 (9.1) |
Reactiona (n=334) | 134 (40.1) | 62 (18.6) | 69 (20.7) | 23 (6.9) | 21 (6.3) | 25 (7.5) |
U2Friendb (n=334) | 118 (35.3) | 99 (29.6) | 72 (21.6) | 15 (4.5) | 21 (6.3) | 9 (2.7) |
U2Cyclec (n=333) | 177 (53.2) | 83 (24.9) | 59 (17.7) | 11 (3.3) | 2 (0.6) | 1 (0.3) |
FunCand (n=335) | 130 (38.8) | 67 (20) | 72 (21.5) | 23 (6.9) | 20 (6) | 23 (6.9) |
Columne (n=336) | 177 (53.2) | 83 (24.9) | 59 (17.7) | 11 (3.3) | 2 (0.6) | 1 (0.3) |
aReacting to other users’ activities.
bReading other users’ profiles and stories.
cA cognitive behavioral therapy exercise through which users can develop a simple formulation.
dA cognitive behavioral therapy exercise through which users can post what they had achieved or enjoyed.
eA cognitive behavioral therapy exercise through which participants can write a 5-column thought record.
Mean (SD) and correlations to the frequency of participants’ activity.
Values and U2plus functions | Values, mean (SD) | Correlation factor | |||||
|
|
Signing in | Reactiona | U2Friendb | FunCanc | Columnd | U2Cyclee |
PHQ-9f | 12.38 (6.95) | 0.048 | 0.072 | 0.099 | 0.046 | 0.161g | 0.125h |
D-Di scale | 48.97 (10.42) | 0.001 | –0.015 | –0.018 | –0.005 | 0.027 | 0.042 |
GHSQj-formalk | 4.53 (1.27) | 0.110l | 0.103 | 0.063 | 0.111l | 0.037 | 0.049 |
GHSQ-informalm | 3.72 (1.33) | –0.032 | –0.036 | –0.011 | –0.02 | –0.045 | –0.048 |
aReacting to other users’ activities.
bReading other users’ profiles and stories.
cA cognitive behavioral therapy exercise through which users can post what they had achieved or enjoyed.
dA cognitive behavioral therapy exercise through which participants can write a 5-column thought record.
eA cognitive behavioral therapy exercise through which users can develop a simple formulation.
fPHQ-9: Patient Health Questionnaire-9.
g
h
iD-D: Discrimination-Devaluation.
jGHSQ: General Help-Seeking Questionnaire.
kHelp-seeking intentions from formal sources.
l
mHelp-seeking intentions from informal sources.
Multiple regression analyses of stigma and help-seeking predicted by frequency use of the U2plus functions.
Dependent variable | D-D scalea | GHSQb-formalc | GHSQ-informald | ||||||||
|
B | β | B | β | B | β | |||||
Signing in | 0.015 | .002 | 0.015 (321) | 0.084 | .091 | 0.671 (321) | –0.073 | –.076 | –0.556 (321) | ||
Reactione | 0.617 | .092 | 0.556 (321) | 0.072 | .087 | 0.530 (321) | 0.141 | .163 | 0.987 (321) | ||
U2Friendf | 0.135 | .014 | 0.126 (321) | –0.108 | –.089 | –0.827 (321) | –0.031 | –.024 | 0.223 (321) | ||
FunCang | 0.787 | .072 | 0.721 (321) | 0.038 | .028 | 0.285 (321) | –0.054 | –.038 | –0.384 (321) | ||
Columnh | –0.783 | –.119 | –0.674 (321) | 0.013 | .016 | 0.089 (321) | –0.127 | –.150 | –0.848 (321) | ||
U2Cyclei | –0.313 | –.04 | –0.391 (321) | –0.046 | –.048 | –0.472 (321) | 0.087 | .086 | 0.849 (321) |
aD-D: Discrimination-Devaluation.
bGHSQ: General Help-Seeking Questionnaire.
cHelp-seeking intentions from formal sources.
dHelp-seeking intentions from informal sources.
eReacting to other users’ activities.
fReading other users’ profiles and stories.
gA cognitive behavioral therapy exercise through which users can post what they had achieved or enjoyed.
hA cognitive behavioral therapy exercise through which participants could write a 5-column thought record.
iA cognitive behavioral therapy exercise through which users can develop a simple formulation.
Regarding the relationships between U2plus function use frequency, stigma, and help-seeking behavior, our results highlighted mixed outcomes: the D-D scale and help-seeking intention from informal sources were not associated with any use frequency of U2plus functions. The use frequency of the signing in and FunCan functions was correlated only with help-seeking intentions from formal sources. However, these use frequencies did not predict help-seeking intentions from formal sources in the multiple regression analysis.
We also analyzed participants’ demographic characteristics to better understand the personal characteristics of the average user of the U2plus platform, namely, those who use online support groups for depression. Participants’ average score in PHQ-9 was 12.38, suggesting that those who use the platform may be moderately depressed. Moreover, almost 88% (308/350) of the participants had been medicated for their mental health problems, suggesting that most users may be looking for something other than (or in addition to) pharmacological interventions to help them deal with their mental health issues. About 21.7% (74/341) of the participants signed in and used FunCan and Reaction more than once a week. This suggests that some users use U2plus on a regular basis, and they use simpler functions such as posting whatever they have achieved and enjoyed over the past few days, and responding to those posts, than other functions such as U2Cycle and Column, which may require more time and effort. In addition, depression measured by PHQ-9 was positively associated with the frequency use of Column and U2Cycle. Thus, for other users, the U2plus platform may be more of an
Our results showed that stigma was not associated with any of the functions of the U2plus platform. This suggests that U2plus users may feel normalized when they discover that many people have depression, as well as when they share their experiences; however, they are constrained by the limitations imposed by the platform; for example, they can only react to other users’ posts by clicking the
Our results also showed that the use frequency of the signing in and FunCan functions of the U2plus platform were associated with (but did not uniquely predict) help-seeking intentions from formal sources. These results may not fully support a notion proposed by previous study, that is, when going to a medical visit, having to undergo hospitalization, or learning about others’ experiences may help individuals to feel more at ease with the situation and have a better understanding of what questions need to be asked and what to expect [
First, we asked all users of U2plus for their participation; this means that our participants might have had various mental health problems, not only depression. Owing to the low response rate, the sample may not have been representative of the users registered to the program in terms of basic demographic information. Thus, future studies need to recruit individuals with a specific mental health problem and establish their diagnosis by conducting structured clinical interviews. Second, we relied on participants’ self-reports about how often they used each U2plus function; thus, future studies are warranted to measure these frequencies in more objective ways, as we were not allowed to track users’ operation histories. Third, we used a cross-sectional design; thus, future studies need to use a longitudinal design and examine how these variables fluctuate with time as participants use these online support groups.
Fourth, we tested the effects of an online support group on only stigma and help-seeking intentions; therefore, future studies should examine other variables, such as sense of control, self-confidence, sense of independence, and social interaction [
Our findings revealed that most of the U2plus users were receiving pharmacological treatment and used U2plus as an alternative treatment option, with approximately 21.7% (74/341) of them signed in to it on a regular basis. In addition, the use frequency of some functions was correlated with help-seeking intentions from formal sources. Future studies need to more closely investigate how online support groups can help mental health stakeholders, including those who are on medication but unable to fully recover, those who are on the waiting list for evidence-based psychological treatment, and those who try to prevent relapse after recovery.
cognitive behavioral therapy
Discrimination-Devaluation
General Help-Seeking Questionnaire
Patient Health Questionnaire-9
The authors would like to thank Ms M Sakuramoto and Mr K Chiba at Cotree Ltd for administrating U2plus.jp and for data collection. This work was supported by the Telecommunication Advancement Council (grant 2018HKjK).
None declared.