Social networking sites: an adjunctive treatment modality for psychological problems.

BACKGROUND: Social networking is seen as a way to enhance social support and feeling of well-being. The present work explores the potentials of social networking sites as an adjunctive treatment modality for initiating treatment contact as well as for managing psychological problems.
MATERIALS AND METHODS: Interview schedule, Facebook intensity questionnaire were administered on 28 subjects with a combination of 18 males and 10 females. They were taken from the in-patient and out-patient psychiatry setting of the hospital.
RESULTS: Facebook was the most popular sites and used to seek emotional support on the basis of the frequent updates of emotional content that users put in their profile; reconciliations, escape from the problems or to manage the loneliness; getting information about illness and its treatment and interaction with experts and also manifested as problematic use.
CONCLUSIONS: It has implications for developing social networking based adjunctive treatment modality for psychological problems.

INTRODUCTION

Social networking sites (SNSs) are found to be growing in popularity for various types of usages. Amongst the internet users, one-third use SNSs and 10% of the total time spent online is spent on SNSs.[1] Just as any other means of communication, SNSs allow its users to meet others, both familiar and non-familiar ones. It also enable users to make their social network visible. It helps them to identify people available in the site with whom they can maintain relationships. Most SNSs provide facilities for private messaging as well as for sending public comments and posts. Many SNSs also have such features as photo sharing, video sharing, build-in blogging and instant messaging. SNSs differ widely on the basis of the basic objectives for which they are designed. There are an online business networking sites (Ryze.com), sites for arranging meetings for communities with like-minded interests (MeetUp.com, evite.com) and sites providing blogging service (LiveJournal.com), but the most popular ones are those dedicated for initiation and maintenance of online friendships (Frendster.com, Orkut.com, MySpace.com and Facebook.com). With increased use of SNSs people can initiate new contact along with the existing ones and these relationships that are formed over SNSs can extent to offline interactions also and hence that the social network of the person increases and correspondingly social capital also increases.[2] It is also possible that with increased time spend on SNSs, people start spending lesser and lesser time for other social activities and community participation so that their social circle will get limited to these virtual social interactions.[3]

Its usages are also associated with feeling better to handle loneliness and depression; increase in self-esteem/social support, increase in time spent with online friends and increased general well-being.[4] It helps to overcome bad mood in 50% of online users.[5] Individuals with social anxiety show greater comfort and self-disclosure when socializing on-line compared with face-to-face interactions.[6] Heavy internet users experience a higher level of psychological distress and use internet significantly to meet their social needs.[7] Introverts are found to develop a compulsive pattern of internet use, in surfing or downloading.[89] It (surfing) does not result in any long-term gratification this may lead to depression and social anxious feelings.[10]

There is low treatment seeking behavior and poor follow-up's for psychological problems due to stigma, myths, availability of the facility or post treatment support group. Epidemiological studies across different nations shows that only about one third of people with a mental disorder consult the mental health service provider, others seek help from non-specialized professionals. Even in the high-income countries, a substantial number of patients with mental health problems don’t seek treatment from the mental health sector.

In India, the mental health resources are very low compared with high-income countries. There is significant number of users of information technology. The present work explore the potentials of SNSs as an adjunctive treatment modality for initiating treatment contact as well as for managing psychological problems.

MATERIALS AND METHODS

Aim

The primary aim of this study is to explore the SNSs as an adjunctive treatment modality for psychological problems.

Objectives

The secondary aim of this study is to investigate the usages of SNSs in the subject with depression and anxiety spectrum disorder.

Study design

A survey method was used to 28 participants which comprised of 18 males and 10 females participants from clinical population meeting inclusion criteria (People who use any SNSs for at least 15 min or more per sessions; between 18 and 35 years; Any of the depressive or anxiety spectrum disorder; having an ICD-10 diagnosis: F32, F33, F34.1, F40 – F48; Working knowledge in English) from out-patients and in-settings of National Institute of Mental health and Neuroscience, Bangalore, Karnataka, India. Tools: Interview schedule developed by the team to covers the basic demographic details and other details concerning SNS use as the SNS that he likes the most; the age of registering with SNSs; the friends and family members attitude about his/her SNS use and the impact of SNS use on his/her personal or professional life, their opinion about the positive and negative aspects of use of SNSs. The extent to which they discussed their personal or illness related issues to SNS friends. Details of the illness were obtained from patient directly as well as from the psychiatry file. Facebook intensity scale[11] is a measure of Facebook usage, which includes two self-reported assessments of Facebook behavior, designed to measure the extent to which the participant was actively engaged in Facebook activities: the number of Facebook “friends” and the amount of time spent on Facebook on a typical day. This measure also includes a series of Likert-scale attitudinal questions designed to tap the extent to which the participant was emotionally connected to Facebook and the extent to which Facebook was integrated into their daily activities. It has a Chronbach's Alpha of 0.83.

The present work has NIMHANS Institute Ethics committee, Bangalore, Karnataka, India approval.

PROCEDURE

The inpatients and out-patients with the diagnosis of anxiety spectrum disorder or depressive illnesses were approached. Prior consent was obtained from the treating team for inclusion of these participants in the study as well as the informed consent was obtained from the participants. Confidentiality of the obtained information was assured. The interview schedules, Facebook Intensity Scale were administered to the 28 participants individually. Discussions were held about their motivation for SNSs use. Descriptive statistics such as mean, standard deviation, percentages and frequencies were used to analyze demographic data and pattern of use of SNSs. Content analysis was performed on qualitative data.

RESULTS

The Facebook was the commonly visited sites among the group. The mean age of registering with SNSs was 21 years 0.46.7% of family members were unconcerned about their usages. Sample includes subjects −10 Obsessive compulsive; 8 mild depression; 5 social anxiety a; 5 with adjustment problems. Nearly 5% of them had the problematic usage of Facebook in term of losing control, having desire to be online and repeated engagement despite its negative effects on their interpersonal life. A significant positive correlation exists between number of friends and emotional connectedness to the SNSs (r = 0.32, P < 0.01) and between number of hours spent on SNSs and emotional connectedness to SNSs (r = 0.36, P < 0.01) [Table 1].

Table 1

Correlation of emotional connectedness to SNSs with number of friends and time spent

Nearly, 2% misrepresented themselves to opposite sex as well as in relation to working style, leisure time activity, social gathering, financial status and physical appearance [Table 2].

Table 2

Percentage distribution of content of communication over SNSs

Table 2 shows the content of communication that occur over SNSs. 52.30% discuss their psychological problems in general term and 14% discuss in complete details. However, others used it for discussion of neutral topics.

Analysis of others usages of SNSs also revealed the following areas: Communicating with friends’ was the most frequently identified (50%) positive aspect of SNSs. SNSs provided an opportunity for reconciliations (24%) or to make up the fights and to escape form the problems (24%). About 40% of the participants expressed their worries and apprehensions online. Amongst them 32% of them expressed in general terms, whereas 7% expressed in complete details. Compared with males, females used SNSs more frequently to manage real-life problems (P = 0.04).

Qualitative analysis of the discussion about the usages of SNSs revealed

Usages of SNSs for emotional support was identified as an advantage in form of to talking to already known friends as well as it also enhances the accessibility toward existing friends at times of distress for them. Qualitative information also revealed the formation of an online group to “fight against depression”/obsessive compulsive disorder. It had membership of fifty two people and they used to provide comments/suggestions/references to available information related to psychological problems as well as for cheering up. It was used to provide reassurance and comment. It helped them to know others people with similar illness, nature of illness and biopsychosocial nature and to initiate treatment. Participants perceived the online group helpful in terms of getting information about the disorder, getting expert opinion about the illness as well as the management strategies. Others usages included feeling better with available online support, increased awareness about the illness, sharing of emotional difficulties, used relaxation techniques or maintaining contact with the treating doctor.

DISCUSSION AND CONCLUSIONS

SNSs (Facebook) are used as a way to seek emotional support on the basis of the frequent updates of emotional content that users put in their profile; reconciliations, escape form the problems or to manage the loneliness; provide emotional connectedness [Table 1]; getting information about illness and its treatment and interaction with experts. 2% misrepresented themselves to the opposite sex as well as in relation to working style, leisure time activity, social gathering, financial status and physical appearance; 52.30% discuss their psychological problems in general term and 14% discuss in complete details and others use it for discussion of neutral topics [Table 2].

It has been corroborated with findings observed in other studies. Facebook were used for social interaction, passing time, entertainment, companionship and communication. These were also associated with developing addiction to Facebook. Expressing one's current emotional state dominated use of Facebook's status-update tool. Larger networks and larger estimated audiences were associated with higher levels of life satisfaction and perceived social support on Facebook.[12] Nearly 25% of the profiles of the students displayed depressive content.[13] Loneliness as a predictor of increased use of the internet as well as SNSs has been well documented in the literature.[14] The present work reflect the usages of Facebook for building support system as well as for improving one's psychological well-being. The present work has limitation in the absence of wider representation of clinical categories. The work has implications in terms of initiating treatment contact, its role in getting support to manage the psychological problems, assessing the efficacy of e support group to develop psychological support and evolving SNSs as a adjunctive treatment modality of psychological problems.