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Understanding Safety in Online Mental Health Forums: Realist Evaluation
Paul Marshall1, Neil Caton1, Zoe Glossop1
1Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, D01, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, United Kingdom, 44 01524522187.
JMIR Mental Health
|June 27, 2025
Summary
Online mental health forums foster safety through anonymity and peer connection. Sensitive moderation and user self-care are key to managing risks and promoting well-being in these digital support spaces.
Area of Science:
- Digital Health
- Mental Health Research
- Online Communities
Background:
- Online forums are widely used for mental health peer support.
- Concerns exist regarding potential harm and user-perceived safety in these forums.
Purpose of the Study:
- To understand user experiences of safety in online mental health peer support forums.
- To conceptualize safety through experiences of harm and interpersonal safety.
Main Methods:
- Conducted 42 semistructured interviews and 504 survey responses from users of 3 UK online mental health forums.
- Utilized a bespoke survey for quantitative data on user perceptions of forum safety.
- Employed qualitative data to refine program theories on forum safety.
Main Results:
- Over half of participants felt safe due to online anonymity.
- A minority encountered distressing posts or felt worse after discussing mental health online.
- Key factors for safety include anonymity, proactive moderation, sensitive rule enforcement, user self-moderation, and perceived non-judgment from peers.
Conclusions:
- This is the first realist evaluation of safety processes in online mental health forums.
- Safety is derived from harm reduction, sensitive moderation, and shared lived experiences.
- Forum hosts must balance risk management with fostering community connections.
Keywords:
digital mental healthdiscussion forumpeer-to-peer supportsocial networkingweb-based discussionMore Related Videos
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