Understanding How Discourse Themes in an Online Mental Health Community on Twitter/X Drive Varied Population-Specific...

Social media, encompassing online mental health communities (OMHCs), has revolutionized mental health discourse by fostering open discussions that drive population-specific empowerment. These discussions generate diverse empowerment processes, such as informational, family awareness, and social awareness support, that can empower different health-consumer populations based on their support needs. However, how OMHC discourse themes drive these empowerment processes remains unexplored.

This study sought to understand how discourse themes in Twitter/X OMHCs drive three categories of population-specific empowerment processes aligned with all populations in Strategy 1 of the World Health Organization's (WHO's) Integrated People-Centred Health Services (IPCHS) framework: (1) individual-level processes for individuals with mental health conditions, including underserved and marginalized individuals (informational, self-expression, network, emotional, esteem, and tangible support); (2) informal carer processes for families and friends (family and friend awareness support); and (3) society-level processes for the broader public (main process: social awareness support). Specifically, it identified the discourse themes, their resonance with OMHC members, and the population-specific empowerment processes they drive.

We analyzed discussions in the Twitter OMHC #bipolarclub. We collected 2068 tweets using its #bipolarclub hashtag between December 2022 and January 2023, of which 547 were eligible for analysis. We identified the discourse themes using qualitative thematic analysis and defined their resonance with OMHC members based on their prevalence in the tweets. We determined the population-specific empowerment processes driven by these themes by examining the processes embedded within them.

We identified six overarching discourse themes, ranked by prevalence: (1) symptom, medication, treatment, and health care system experiences (187/547, 34.2%); (2) daily life challenges, coping experiences, and recommendations (94/547, 17.2%); (3) socializing and connecting (87/547, 15.9%); (4) mental health awareness and stigma prevention initiatives (69/547, 12.6%); (5) behavioral coaching and motivational dialogue (63/547, 11.5%); and (6) personal feelings, thoughts, experiences, and reflections (47/547, 8.6%). Theme 4's discussions extended beyond the OMHC's online environment to involve real-world settings. While all themes generated empowerment processes to different extents across the three population-specific categories, only themes 4 and 5 drove all processes within these categories. Informational support (the most common individual-level process in the discussions) and social awareness support were strongly driven by theme 4, whereas family awareness support and friend awareness support were primarily driven by themes 6 and 2, respectively.

Our analysis highlights the multifaceted roles and ability of Twitter OMHC discourse themes in generating varied population-specific empowerment processes supporting all populations in Strategy 1 (WHO's IPCHS framework). This demonstrates Twitter-based OMHCs' potential to foster a comprehensive empowering environment aligned with global standards. This study provides significant insights that can help health care stakeholders develop more tailored OMHC empowering services for diverse populations. Additionally, we present a conceptual framework linking the discourse themes to the three categories of population-specific empowerment processes.