By Patricia Timi, MD
VCU Health System
Richmond, VA
I have noticed as time moves on that the discussion of mental illness has become more and more destigmatized. People are more willing to talk to family, friends, and even mental health professionals about their struggles with mental health. This is obviously multifactorial, but I do think one important factor is the rise of social media in everyday life.
As we have all seen, people are sharing more and more intimate details of their lives on social media. They are sharing their high points but, more importantly, their low points, which people do usually like to share. There have been #hashtags about showing the pills that they take for their mental health, discussions on how getting a therapist have helped people immensely, and a rise in mental health providers who are influencers on social media. This makes the discussion about mental health less stigmatized than it was in the past.
This de-stigmatization has unfortunately come at a time when the nation is in a mental health crisis. In 2021, 10.6% of people with mental health disorders did not have insurance coverage and 106 million people live in a designated mental health provider shortage area (NAMI 2023). The crisis is due to multiple factors: not enough mental health providers, cost of treatment, insurance coverage for therapy, stigma of getting treatment, and lack of diversity of providers. Regardless of the reasons, this makes more and more people reach towards what is available to them for mental health information: the internet and, more importantly, social media. Mental health topics are being talked about and shared by millions and billions of people on social media apps like Facebook, Instagram, TikTok, etc. Some social media apps get more use by different age groups, but a lot of the information shared is similar across apps.
There have been some benefits from the public turning to social media for mental health information. People with mental health issues have found a sense of community and support through social media groups. They have found a place to discuss their diagnoses and symptoms and how it affects them. Just as cancer survivors need a place to talk about their own struggles where others can relate to them, people with mental health issues are finding places on social media apps. With social media, there is more of a level of removal and some anonymity (with private and hidden accounts) than talking to someone in person. A cross sectional study of 100 #mentalhealth videos on TikTok showed that 40% of videos were about personal experiences and 60% of video comments had themes of general support and validation. Forty-nine percent of all comments described other mental health issues and struggles (Basch et al. 2022).
Some of the concerns that become apparent with social media and mental health information is the spread of misinformation. As we have seen with the COVID pandemic and politics, social media has had a large part to play in the spread of misinformation and disinformation. Especially when the qualifications of the person sharing the information cannot be confirmed, the quality of information is not known. Another cross-sectional study about social media content quality investigated 100 #adhd videos on TikTok and found that 52% of videos were found to be misleading. Most of the misleading videos were found to be by non-healthcare providers, and a small minority were made by healthcare providers (Yeung et al. 2022). Another concern is the rise in, usually flawed, self-diagnosis. With the rise in misinformation comes a rise in misguided attempts for people to understand their symptoms and find a community in that diagnosis.
These benefits and concerns bring up the question that if mental health is becoming more destigmatized, then does having a mental health disorder become cool or trendy? Will people start to pretend or convince themselves that they have a mental illness in order to get some sort of attention or internal gratification online? A possible factitious disorder by social media? A possible answer to that question can be seen in the paper discussing “TikTok Tics”, which brings up the topic of the spread of symptoms being a mass sociogenic illness. (Olvera et al. 2021)
There are many clinical considerations with these benefits and concerns with the de-stigmatization of mental health by social media. We as clinicians need to consider that many people will have likely already consulted the internet/social media about their mental health symptoms before we see them for patient evaluation. They may have already created their own diagnosis and treatment plan due to misinformation seen online. They may have already created a community of people who have a similar set of symptoms, that are not common, and they are worried that they may get poor treatment that others have received. We need to have an appropriate level of suspicion for flawed self-diagnosis from misinformation, but not outright dismissal for these patient presentations that could hinder people from continued treatment and make them go back to social media. Are there questions that we can ask to allay fears and get to the root of misinformation during our patient encounters? Are there ways that we as clinicians can put better quality information out on social media?
Sources:
- Basch CH, Donelle L, Fera J, Jaime C. Deconstructing TikTok Videos on Mental Health: Cross-sectional, Descriptive Content Analysis. JMIR Form Res 2022;6(5):e38340. doi: 10.2196/38340
- Olvera, C., Stebbins, G.T., Goetz, C.G. and Kompoliti, K. (2021), TikTok Tics: A Pandemic Within a Pandemic. Mov Disord Clin Pract, 8: 1200-1205. https://doi.org/10.1002/mdc3.13316
- https://www.nami.org/mhstats
- Yeung A, Ng E, Abi-Jaoude E. TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality. The Canadian Journal of Psychiatry. 2022;67(12):899-906. doi:10.1177/07067437221082854
