JMIR Publications

ABSTRACT

Background:

Internet support groups (ISGs) provide accessible peer support for individuals with depression, yet their withdrawal rates remain substantially higher than those observed in general online communities. However, existing research primarily focuses on ISG retention as it is considered a marker of intervention success. The significance and mechanisms of withdrawal from ISGs remain largely underexplored.

Objective:

This study aimed to examine how individuals with depression use withdrawal from ISGs as a strategy for empowerment, and to clarify the mechanisms by which autonomy, courage, and responsibility are enacted through the process of leaving.

Methods:

We conducted a qualitative study using semi-structured interviews with 19 former ISG participants diagnosed with depression, recruited via purposive and snowball sampling on a major Chinese social media platform. The sample included a wide range of ages, engagement backgrounds, and roles (including ISG founders, administrators, and a counselor). Data was collected through audio, video, and text-based interviews, then transcribed and de-identified. Analysis followed a hybrid deductive-inductive approach. The deductive coding was guided by the empowerment framework (autonomy, courage, responsibility), while inductive coding identified emergent patterns of strategic withdrawal. To verify the results, we included negative cases and performed rigorous validation, including blind coding, external expert review, and member checking.

Results:

We found withdrawal from ISGs to be a multi-dimensional empowerment process. Participants first developed autonomy by critically reassessing the gap between their initial expectations and the actual group experience, which led to independent decision-making. Building on this self-awareness, they demonstrated courage by overcoming the inertia of digital connection and actively establishing personal boundaries-sometimes through decisive exits, other times via gradual disengagement. Ultimately, this process fostered a sense of responsibility, as individuals redirected their energy toward offline recovery, constructed alternative support systems, and internalized self-management as an ongoing commitment.

Conclusions:

This study challenges the retention-focused perspective in ISG research by demonstrating that strategic withdrawal can be an empowering process for individuals with depression. Empowerment is not solely achieved through ongoing participation, but also through the autonomy to disconnect, the courage to set boundaries, and the responsibility to manage one’s own recovery. Our findings highlight the need for mental health professionals and platform designers to recognize and support withdrawal as a legitimate and positive outcome, thereby fostering a more resilient, patient-centered digital support ecosystem.