Marshall Paul, Caton Neil, Glossop Zoe, Jones Steven, Meacock Rachel, Rayson Paul, Robinson Heather, Lobban Fiona
Spectrum 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.
Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom.
JMIR Ment Health. 2025 Jun 27;12:e75320. doi: 10.2196/75320.
Online forums are used widely to facilitate mental health peer support. However, concerns exist regarding potential harm associated with their use, and little is known about forum safety from the user's perspective.
This study sought to understand how users experience safety within online mental health peer support forums. Following previous research, safety was conceptualized with reference to both experiences of harm and feelings of interpersonal safety within the forum environment.
Data were collected from 42 semistructured realist interviews and 504 cross-sectional survey responses from users of 3 UK-based online mental health forums. These included a forum hosted by a health service provider with subforums for anxiety, depression, and eating disorders; a corporate provider focused on young people's mental health; and a voluntary sector provider with subforums for general mental health support, eating disorders, and postpartum psychosis. A bespoke survey was used to obtain descriptive quantitative data regarding user perceptions of forum safety. Qualitative data were used to refine an initial program theories framework comprising context-mechanism-outcome configurations related to forum safety developed in previously published realist synthesis.
Survey responses revealed that over half of the participants felt safe to post because of online anonymity (n=202, 40.1% agreed and n=97, 19.2% strongly agreed), while a minority reported encountering distressing forum posts (n=95, 18.8% agreed and n=18, 3.6% strongly agreed) and expressed concern that talking about mental health online could make them feel worse (n=113, 22.4% agreed and n=17, 3.4% strongly agreed). Refined program theories highlight: (1) the disclosure-promoting effect of anonymity, related to the mitigation of concerns that users' mental health experiences could be linked to their offline identities; (2) the importance of proactive content moderation for addressing emerging safety issues; (3) a need for organizations to implement rule enforcement sensitively and balance between conversational openness and restricting topics likely to cause distress; (4) forum users' experiences of self-moderating their exposure to potentially distressing online content; and (5) how the perceived nonjudgement, authenticity, and similarity of other forum users generates interpersonal safety.
This is the first realist evaluation to directly assess processes underpinning safety in online mental health forums. A key novel finding of this study is that safety emerges not only from harm reduction procedures but also from a facilitative interpersonal atmosphere defined by sensitive moderation and the sharing of lived experiences. Hosts should therefore remain attentive to both potential risks and opportunities to foster connections between community members.
在线论坛被广泛用于促进心理健康方面的同伴支持。然而，人们对其使用可能带来的潜在危害存在担忧，而且从用户角度对论坛安全性了解甚少。
本研究旨在了解用户在在线心理健康同伴支持论坛中如何体验安全性。参照先前研究，安全性是根据论坛环境中的伤害经历和人际安全感来概念化的。
从英国3个在线心理健康论坛的用户那里收集了42次半结构化现实主义访谈数据和504份横断面调查回复。这些论坛包括一个由医疗服务提供商主办、设有焦虑症、抑郁症和饮食失调症子论坛的论坛；一个专注于年轻人心理健康的企业提供商；以及一个设有一般心理健康支持、饮食失调症和产后精神病子论坛的志愿部门提供商。使用定制调查来获取关于用户对论坛安全性看法的描述性定量数据。定性数据用于完善一个初始的项目理论框架，该框架包括与先前发表的现实主义综合研究中所开发的论坛安全性相关的背景 - 机制 - 结果配置。
调查回复显示，超过一半的参与者因在线匿名而感到发帖安全（n = 202，40.1%同意，n = 97，19.2%强烈同意），而少数人报告遇到令人痛苦的论坛帖子（n = 95，18.8%同意，n = 18，3.6%强烈同意），并表示担心在网上谈论心理健康会让他们感觉更糟（n = 113，22.4%同意，n = 17，3.4%强烈同意）。完善后的项目理论强调：（1）匿名对促进披露的作用，这与减轻用户对其心理健康经历可能与线下身份相关联的担忧有关；（2）积极的内容审核对于解决新出现的安全问题的重要性；（3）组织需要敏感地执行规则，并在对话开放性和限制可能导致痛苦的话题之间取得平衡；（4）论坛用户自我调节接触潜在令人痛苦的在线内容的经历；（5）其他论坛用户的感知非评判性、真实性和相似性如何产生人际安全感。
这是首次直接评估在线心理健康论坛安全性背后过程的现实主义评估。本研究的一个关键新发现是，安全性不仅源于减少伤害程序，还源于由敏感审核和分享生活经历所定义的促进性人际氛围。因此，论坛主办者应同时关注潜在风险和促进社区成员之间联系的机会。
