JMIR Publications

ABSTRACT

Background:

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 perspective.

Objective:

This study sought to understand how users experience safety within online mental health peer support forums by refining realist programme theories developed in a previously published realist synthesis.

Methods:

Data was collected from 42 semi-structured realist interviews and 504 cross-sectional survey responses from users of three online mental health forums hosted by providers in the UK health service, corporate sector and voluntary sector, respectively. Analysis was informed by the principles of realist evaluation.

Results:

Survey responses revealed that over half of participants felt safe to post because of online anonymity (40.1% agreed, 19.2% strongly agreed), while a minority reported encountering distressing forum posts (18.8% agreed, 3.6% strongly agreed) and expressed concern that talking about mental health online could make them feel worse (22.4% agreed, 3.4% strongly agreed). Refined programme 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 non-judgement, authenticity, and similarity of other forum users generates interpersonal safety.

Conclusions:

Online forums hold promise as an accessible form of support for mental health. Results of this realist evaluation suggest that by better integrating timely harm-reduction procedures and cultivating a supportive interpersonal culture, forums are more likely to be perceived as safe spaces to seek mental health support.