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

AuthorBukola Usidame,Edward Alan Miller,Antoinette Pole
Published date01 March 2015
Date01 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
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;
World Medical & Health Policy, Vol. 7, No. 1, 2015
1948-4682 #2015 Policy Studies Organization
Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford, OX4 2DQ.
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
60 World Medical & Health Policy, 7:1

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