The Effect of Moderation on Online Mental Health Conversations

Many people struggling with mental health issues are unable to access adequate care due to high costs and a shortage of mental health professionals, leading to a global mental health crisis. Online mental health communities can help mitigate this crisis by offering a scalable, easily accessible alternative to in-person sessions with therapists or support groups. However, people seeking emotional or psychological support online may be especially vulnerable to the kinds of antisocial behavior that sometimes occur in online discussions. Moderation can improve online discourse quality, but we lack an understanding of its effects on online mental health conversations. In this work, we leveraged a natural experiment, occurring across 200,000 messages from 7,000 conversations hosted on a mental health mobile application, to evaluate the effects of moderation on online mental health discussions. We found that participation in group mental health discussions led to improvements in psychological perspective, and that these improvements were larger in moderated conversations. The presence of a moderator increased user engagement, encouraged users to discuss negative emotions more candidly, and dramatically reduced bad behavior among chat participants. Moderation also encouraged stronger linguistic coordination, which is indicative of trust building. In addition, moderators who remained active in conversations were especially successful in keeping conversations on topic. Our findings suggest that moderation can serve as a valuable tool to improve the efficacy and safety of online mental health conversations. Based on these findings, we discuss implications and trade-offs involved in designing effective online spaces for mental health support.Comment: Accepted as a full paper at ICWSM 2021. 13 pages, 12 figures, 3 table

Public or private religiosity: which Is protective for adolescent substance use and by what pathways?

While it is well understood that adolescent religiosity is associated with the use and abuse of licit and illicit substances, few studies have revealed the pathways through which religiosity buffers youth against involvement in such behavior. The aim of this study is to examine the complexity of the relationships between religiosity, sensation seeking, injunctive norms, and adolescent substance use. Using a national sample of adolescents (N = 18,614), negative binomial regression and path analysis were used to examine the various components of the relationship between religiosity and the use of cigarettes, alcohol, and marijuana. Results indicate that private religiosity moderates the relationship between key risk factors and substance use. Public and private religiosity were associated with tolerant injunctive substance use norms which, in turn, were associated with substance use. Implications for research and theory related to religiosity and adolescent substance use are discussed

Coping With Racism: Moderators of the Discrimination-Adjustment Link Among Mexican-Origin Adolescents

What strategies help ethnic minority adolescents to cope with racism? The present study addressed this question by testing the role of ethnic identity, social support, and anger expression and suppression as moderators of the discrimination-adjustment link among 269 Mexican-origin adolescents (Mage = 14.1 years), 12-17 years old from the Midwestern U.S. Results from multilevel moderation analyses indicated that ethnic identity, social support, and anger suppression, respectively, significantly attenuated the relations between discrimination and adjustment problems, whereas outward anger expression exacerbated these relations. Moderation effects differed according to the level of analysis. By identifying effective coping strategies in the discrimination-adjustment link at specific levels of analysis, the present findings can guide future intervention efforts for Latino youth

Conformity of Eating Disorders through Content Moderation

For individuals with mental illness, social media platforms are considered spaces for sharing and connection. However, not all expressions of mental illness are treated equally on these platforms. Different aggregates of human and technical control are used to report and ban content, accounts, and communities. Through two years of digital ethnography, including online observation and interviews, with people with eating disorders, we examine the experience of content moderation. We use a constructivist grounded theory approach to analysis that shows how practices of moderation across different platforms have particular consequences for members of marginalized groups, who are pressured to conform and compelled to resist. Above all, we argue that platform moderation is enmeshed with wider processes of conformity to specific versions of mental illness. Practices of moderation reassert certain bodies and experiences as 'normal' and valued, while rejecting others. At the same time, navigating and resisting these normative pressures further inscribes the marginal status of certain individuals. We discuss changes to the ways that platforms handle content related to eating disorders by drawing on the concept of multiplicity to inform design

Moral Incongruence and Perceived Addiction: A Contemporary Dilemma with Pornography Use

Exposure to pornography has become more widespread due to the Internet, with the age of exposure as early as 13 years of age. With the shift of the moral narrative that pornography use is harmful personally and relationally, many who advocate against pornography use do so primarily on the basis of its maladaptive effects on the user and the user’s relationships. Within the context of the moral disapproval of pornography use, this study assesses the relationship that age, church attendance, and spirituality have with perceived addiction to pornography. This study hypothesized that age, church attendance, and spirituality will have a moderating effect on perceived addiction. The 127 participants consisted of Protestants, Catholics, and nondenominational Christians. A cross-sectional design was used for this study. This study found a strong relationship between moral incongruence and perceived pornography addiction. Age was found to be negatively correlated with perceived pornography addiction. Spirituality was found to have a strong positive correlation with perceived pornography addiction. Also, spirituality was found to moderate the relationship between moral incongruence and perceived pornography addiction. This study informs practitioners who utilize spirituality when working with those who have maladaptive effects from pornography use

Barriers and enablers to the moderation of self-harm content for a young person’s online forum

BACKGROUND: Self-harm amongst young people in the United Kingdom is higher than in other European countries. Young people who self-harm are often reluctant to seek professional help, turning increasingly to the internet for support, including online forums. There are concerns about misinformation or harmful content being shared, potentially leading to self-harm contagion. Moderation of online forums can reduce risks, improving forum safety. Moderation of self-harm content, however, is an under-researched area. AIMS: Using the Behaviour Change Wheel (BCW), this study examines the barriers and enablers to moderation of self-harm content and suggests behaviour change techniques (BCTs) to address barriers. METHOD: Qualitative interviews with 8 moderators (of a total of 16) from the UK’s leading young people’s support service for under 25s, The Mix, were conducted. RESULTS: Thematic analysis identified eleven enablers, four barriers and one both an enabler and a barrier. Barriers included emotional exhaustion, working with partial information, access to timely support, vagueness within the guidelines and influence of community users. BCTs selected included increasing social support through a moderation buddy. CONCLUSIONS: Optimisation strategies focus on increasing the support and level of information available to moderators and could be considered by other organisations providing similar services

"For an App Supposed to Make Its Users Feel Better, It Sure is a Joke" -- An Analysis of User Reviews of Mobile Mental Health Applications

Mobile mental health applications are seen as a promising way to fulfill the growing need for mental health care. Although there are more than ten thousand mental health apps available on app marketplaces, such as Google Play and Apple App Store, many of them are not evidence-based, or have been minimally evaluated or regulated. The real-life experience and concerns of the app users are largely unknown. To address this knowledge gap, we analyzed 2159 user reviews from 117 Android apps and 2764 user reviews from 76 iOS apps. Our findings include the critiques around inconsistent moderation standards and lack of transparency. App-embedded social features and chatbots were criticized for providing little support during crises. We provide research and design implications for future mental health app developers, discuss the necessity of developing a comprehensive and centralized app development guideline, and the opportunities of incorporating existing AI technology in mental health chatbots

Exploring the emergence and disappearance of transableism on transabled.org: Digital ethnography of a transient mental illness

Transableism is an historical condition that originated in an online community named transabled.org, existing between 1996 and 2013. Transableism manifested as the desire to be disabled, arising out of a felt sense of incongruence between one’s inner sense of identity as disabled, and one’s bodily reality as abled. During its existence, transableism attracted clinical attention and was proposed for entry into the Diagnostic and Statistical Manual of Mental Disorders (DSM) under the descriptor Body Integrity Identity Disorder (BIID). However, despite its growing visibility, in 2012 BIID failed to enter the DSM and the online transabled community disappeared. The aim of this thesis is to explore transableism’s rapid emergence and subsequent failure to achieve formal medical recognition. The key questions underpinning this thesis are (1) why did transableism emerge and (2) why did it disappear? Taking a qualitative approach, this thesis uses digital ethnography to analyse all content posted to transabled.org in its active years. The originality of this thesis lies in the way it uses the theoretical lens of an ecological niche of ‘transient mental illness’ (Hacking, 1998) to examine the historical, cultural and social factors which informed transableism, opening up a new, never before explored perspective. Use of the ecological niche of transient mental illness model provides a nuanced and holistic answer to the questions which underpin this thesis. I argue that transableism emerged because it reflected and expressed broader cultural understandings and tensions surrounding authentic versus inauthentic disability. Its emergence was also facilitated by a centralised model of community leadership which, for a time, successfully fostered a coherent group identity and enlisted the interests of clinicians. On the other hand, transableism disappeared because BIID failed to conform to an accepted authenticity politics of disabled identity and was policed accordingly. In addition, although the centralised model of community leadership initially facilitated transableism, towards the later years, this model collapsed, leading to conflict, community attrition and moderator burn out. Overall, this thesis makes 6 original contributions to knowledge by advancing understandings within (1) extant transableism scholarship, (2) broader medical sociological literatures, (3) the disability studies literature, (4) scholarship that explores claims to authentic identities, and the limits of such claims, (5) the literature on leadership and moderation practices within online communities and (6) the health advocacy community literature

Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis

Background:Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation.Objective:This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users.Methods:We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff.Results:Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users’ perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety.Conclusions:This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability

The Telehealth Skills, Training, and Implementation Project: An evaluation protocol

External stabilization is reported to improve reliability of hand held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry. Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to four weeks. Within session reliability was assessed using intraclass correlations calculated for within session data grouped prior to surgery, immediately after surgery and in the sub-acute phase of injury. Minimum detectable differences were also calculated. In the same timeframe categories, construct validity was explored using regression analysis incorporating burn severity and demographic characteristics. Thirty-eight participants with total burn surface area 5 – 40% were recruited. Reliability was determined to be clinically applicable for the assessment method (intraclass correlation coefficient \u3e0.75) at all phases after injury. Muscle strength was associated with sex and burn location during injury and wound healing. Burn size in the immediate period after surgery and age in the sub-acute phase of injury were also associated with muscle strength assessment results. Hand held dynamometry is a reliable assessment tool for evaluating within session muscle strength in the acute and sub-acute phase of injury in burns up to 40% total burn surface area. External stabilization may assist to eliminate reliability issues related to patient and assessor strength