Life and Death in the Mental‐Health Blogosphere: An Analysis of Blog Content and Survival

• Author: Bukola Usidame,Edward Alan Miller,Antoinette Pole
• DOI: http://doi.org/10.1002/wmh3.133
• Published date: 01 March 2015
• Date: 01 March 2015

Life and Death in the Mental-Health Blogosphere:

An Analysis of Blog Content and Survival

Edward Alan Miller, Antoinette Pole, and Bukola Usidame

The purpose of this study was to describe a sample of mental-health blogs, to determine the proportion

of sampled blogs still posting severalyears after identif‌ication, and to identify the correlates of survival.

One hundred eighty-eight mental-health blogs were identif‌ied in 2007–08 and revisited in 2014.

Eligible blogs were U.S.-based, in English, and active. Baseline characteristics and survival status were

described and variation based on blog focus and survival examined. Mental-health bloggers tended to

be females blogging as patients and caregivers focusing on specif‌ic mental illnesses/conditions. The

proportion of blogs still active at follow-up ranged from 25.5 percent to 30.3 percent depending on the

def‌inition of survival employed. Factors associated with survival included sponsorship/advertising and

assumption of a professional/caregiving rather than patient/consumer perspective. Becauseprofessional-

ly authored blogs with sponsorship/advertising tend to be longer lived, they may have disproportionate

impact on the help-seeking behavior of individuals referred to them by search engine results. This

suggests the need to promulgate and adhere to rules governing disclosure of real or perceived conf‌licts

of interest, particularly given the growing use of industry paid/driven content.

KEY WORDS: e-health, Internet, blogs

Background

The role of the Internet in health care has increased dramatically since the onset

of Web 2.0 and free and easy-to-use software that promotes content creation and not

just consumption (Cormode & Krishnamurthy, 2008). This increase in content

creation is ref‌lected in tools ranging from social networking sites to free encyclope-

dias and blogs. A blog, abbreviated from “web-log,” is a prime example of a Web

2.0 application. Virtually anyone with an Internet connection can create a blog with

easy uploading of text, pictures, and audio and video f‌iles (Sauer et al., 2005).

Blogs are characterized by dated posts presented in reverse-chronological

order. Common features include archived posts (grouped by dates), links to other

websites, a blogroll (other recommended blogs), and a reader comment section.

Between 18.7 and 31 million people in the United States author close to 42 million

blogs read by more than one in four active Internet users (NM Incite, 2012;

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Rampton, 2012). Worldwide, the number of blogs has increased remarkably, from

just 3.0 million in 2004 to 50 million in 2006 and 164 million in 2011

(Treanor, 2011).

Research on health blogs tends to focus on descriptions of individual blogs

and the use of blogs by health-care providers and consumers (Cohen, 2007;

Harty-Golder, 2005; Jacobs, 2007; Kennedy, 2008). Research on blogs also explores

the potential role of blogging in improving health awareness, education, and

research (Anonymous, 2009; Boulos, Maramba, & Wheeler, 2006). Some examina-

tion of comparatively large samples of health-related blogs has taken place

(Clauson, Ekins, & Goncz, 2010; Kovic, Lulic, & Brumni, 2008; Lagu, Kaufman,

Asch, & Armstrong, 2008; Miller & Pole, 2009; Miller, Pole, & Bateman, 2011;

Wagner, Paquin, & Persky, 2012). By contrast, there has been little systematic

research reported on the content and characteristics of mental-health blogs; most

of what has been reported consists of small samples focusing on particular

mental-health topics and/or populations (Clark & Lang, 2012; Marcus, Westra,

Eastwood, & Barnes, 2012; Sundar, Edwards, Hu, & Stavrositu, 2007; Tong,

Heinemann-Lafave, Jeon, Kolodziej-Smith, & Warshay, 2013). Moreover, to our

knowledge, no study has sought to quantify health blog survival, mental health

or otherwise, or to identify factors that promote or impede whether or not blogs

continue to post after a period of time.

The Internet has become increasingly important in the domain of health

services delivery/treatment, information dissemination, disease prevention/pro-

motion, and public health. Health researchers have, therefore, begun to investi-

gate and discuss potential advantages and disadvantages of health-related online

activities by consumers and professionals, including, for example, seeking

information on medical diagnoses and treatment options; purchasing prescription

drugs and medical devices; participating in online communities/networks; and

marketing, providing, and receiving treatment (Deen, Withers, & Helleterstein,

2013; Fox & Brenner, 2013; Fox & Duggan, 2013; Moessner & Bauer, 2012; West &

Miller, 2009). Because feelings of shame, fears of stigma, and lack of information

are prevalent in mental disorders (Arboleda-Flo

´rez & Sartorius, 2008; Corrigan,

2007; Hinshaw & Stier, 2008), affected individuals may be especially susceptible

to benef‌iting (or being harmed) by the Internet’s f‌lexibility and anonymity.

Describing and understanding mental-health blogs and other online activities is,

thus, important not only for researchers but also for consumers, practitioners, and

policymakers navigating this important and sensitive area.

Previously, we examined the content and characteristics of 951 health blogs

identif‌ied during 2007 and 2008 (Miller & Pole, 2009; Miller et al., 2011).

Approximately one f‌ifth, or 188 of the 951 blogs analyzed, focused on mental

health, including autism spectrum disorder (26.6 percent), bipolar disorder (25.5

percent), eating disorders (22.9 percent), depression (4.8 percent), Down syn-

drome (4.2 percent), schizophrenia (2.6 percent), and general mental health (13.3

percent). The present investigation drew data from this larger effort to examine

the nature and content of mental-health blogs and bloggers identif‌ied during the

formative years of the mental-health blogosphere. In doing so, the purpose of the

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