JMIR Publications

ABSTRACT

Background:

The chronic nature of depression and limited availability of evidence-based treatments emphasize the need for complementary recovery-oriented services, such as peer support interventions (PSIs). Peer support is associated with positive effects on clinical and personal recovery from mental illness, but little is known about the processes of engagement that foster change.

Objective:

This study assesses whether the level of user engagement in an online peer support community for individuals with depression promotes empowerment and the use of self-management strategies, and reduces symptom severity, and disability.

Methods:

In a longitudinal survey conducted from June 2019 to September 2020 we analyzed the data of users of Depression Connect, an online peer support community hosted by the Dutch Patient Association for Depression and the Pro Persona Mental Health Care institute on measures of empowerment (Netherlands Empowerment List, NEL), self-management (Dutch Assessment of Self-management in Anxiety and Depression questionnaire, ASAD), depression (Beck Depression Inventory-II, BDI-II-NL), and disability (World Health Organization Disability Assessment Schedule, WHODAS 2.0). Of the 301 respondents, 49 completed the survey again after three months and 74 after six months. Analysis of three parameters (ie, total time spend on the platform, number of page views, and number of posts) derived from their data logs yielded four engagement profiles. Linear mixed models were fitted to determine whether outcomes had significantly changed over time and significantly differed for the various profiles.

Results:

Baseline engagement was ‘very low’ (177/301, 59%) or ‘low’ (87/301, 29%) for the majority of the participants, with few showing ‘medium’ (30/301, 10%) or ‘high’ engagement patterns (7/301, 2%), while user profiles did not differ regarding demographic and clinical characteristics. All outcomes improved over time but none were associated with the intensity or nature of user engagement.

Conclusions:

Improvements in empowerment, self-management, depressive symptoms, and disability were not related to the intensity or nature of user engagement. With the great majority of Depression Connect members showing very-low-to-low engagement and only few being identified as high-frequency, active users, it is likely that this flexibility in use is what provides value to online PSI users, where they can adapt the intensity and nature of their engagement to their current needs on their personal road to recovery. Future studies should explore the content and quality of the interactions in online PSIs to identify optimal user engagement as a function of current, self-reported clinical parameters and reasons to engage in the PSI.