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A Content Analysis of Depression-Related Discourses on Sina Weibo: Attribution, Efficacy, and Information Sources Jiabao Pan1, Bingjie Liu2* and Gary L

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A Content Analysis of Depression-Related Discourses on Sina Weibo: Attribution, Efficacy, and Information Sources Jiabao Pan1, Bingjie Liu2* and Gary L Pan et al. BMC Public Health (2018) 18:772 https://doi.org/10.1186/s12889-018-5701-5 RESEARCH ARTICLE Open Access A content analysis of depression-related discourses on Sina Weibo: attribution, efficacy, and information sources Jiabao Pan1, Bingjie Liu2* and Gary L. Kreps3 Abstract Background: Depression is a mood disorder that may lead to severe outcomes including mental breakdown, self-injury, and suicide. Potential causes of depression include genetic, sociocultural, and individual-level factors. However, public understandings of depression guided by a complex interplay of media and other societal discourses might not be congruent with the scientific knowledge. Misunderstandings of depression can lead to under-treatment and stigmatization of depression. Against this backdrop, this study aims to achieve a holistic understanding of the patterns and dynamics in discourses about depression from various information sources in China by looking at related posts on social media. Method: A content analysis was conducted with 902 posts about depression randomly selected within a three- year period (2014 to 2016) on the mainstream social media platform in China, Sina Weibo. Posts were analyzed with a focus on attributions of and solutions to depression, attitudes towards depression, and efficacy indicated by the posts across various information sources. Results: Results suggested that depression was most often attributed to individual-level factors. Across all the sources, individual-level attributions were often adopted by state-owned media whereas health and academic experts and organizations most often mentioned biological causes of depression. Citizen journalists and unofficial social groups tended to make societal-level attributions. Overall, traditional media posts suggested the lowest efficacy in coping with depression and the most severe negative outcomes as compared with other sources. Conclusions: The dominance of individual-level attributions and solutions regarding depression on Chinese social media on one hand manifests the public’s limited understanding of depression and on the other hand, may further constrain adoption of scientific explanations about depression and exacerbate stigmatization towards depressed individuals. Mass media’s posts centered on description of severe outcomes of depression without suggestions of solutions’ effectiveness, which may induce more anxiety among depressed individuals. Campaigns promoting comprehensive understandings about depression and popular works translating scientific findings on depression to the public are called for. Keywords: Depression, Attribution, Efficacy, User-generated content * Correspondence: [email protected] 2Donald P. Bellisario College of Communications, The Pennsylvania State University, 115 Carnegie, University Park, PA 16801, USA Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Pan et al. BMC Public Health (2018) 18:772 Page 2 of 10 Background 15,879 depression-related posts on Sina Weibo found Depression is a common yet severe mood disorder with that 6.09% of the posts indicated stigma [17]. holistic impact on individuals including their mood, per- Research suggests stigma and blame on individuals de- ceptions, cognitions, and daily activities such as sleeping, pend on what factors the outcome is attributed to [20]. food intake, working, etc. [1, 2], affecting more than 300 Attribution is a process of causal analysis of behaviors million people worldwide [3]. In China, more than 54 and events. Different typologies of attribution exist such million people (4.2% of the population) were suffering as internal-external [21], controllable-uncontrollable, from depression by 2015 [4]. Despite the increasing stable-temporary, global-specific attribution [22], etc. prevalence of depression in China, compared to other which are applicable to different research contexts. countries, the rate of diagnosed depression is relatively When it comes to stigma, the controllable-uncontrollable low [5, 6], suggesting a collective denial and under treat- typology is the most relevant [20]. Research suggests that ment of depression as a disease [6]. the public is more tolerant with diseases caused by uncon- Although development of depression is a complex trollable factors than those caused by factors that can be process with biological, psychological and social factors controlled by individuals such as sexually transmitted dis- involved [7], public’s understanding about it is often sim- eases or tobacco use related diseases [23]. Unfortunately, plistic. In a survey conducted with citizens of three mental diseases, as compared with physical diseases, are major cities in China, most respondents thought symp- more subject to attribution to controllable factors, toms of depression could be relieved by themselves and as a result, people with mental diseases are often without professional help and considered “talking to stigmatized [23]. As Weiner suggested, if one’sde- families and friends” and “resting more” as sufficient so- pression is believed to be caused by his/her own do- lutions [8]. The lack of scientific understanding of de- ings instead of environmental factors, people tend to pression contributes to stereotyping and stigmatization hold negative attitudes towards the depressed [24]. towards depressed individuals. In an online survey, Even portraying mental illness as a physical malfunc- nearly half of the Chinese participants described de- tion of the brain can reduce the blame placed on pa- pressed individuals with terms like “pessimistic suicide” tients because it is considered as out of individual’s or “with rabid, aggressive and weird character” [9]. control [25]. Stigma brings shame and guilt to both the depressed in- Wang and Liu analyzed depression-related posts gen- dividuals and their families, further discouraging them erated by top 10 mainstream media organizations and to reach out for professional help [10, 11]. public opinion leaders and their followers’ responses to During recent years, social media are playing an in- them on Sina Weibo. By putting attribution into four creasingly important role in disseminating knowledge categories, namely biological/genetic (i.e., family genes), about health issues and shaping public attitudes with environmental (i.e., accidents, work issues, and changes user-generated content (UGC) [12]. Compared with in the life cycle), parental (i.e., parental mistakes or mass media, research suggests that discussions on men- abuse) and personal (i.e., character flaws), they found tal health issues on social media are more objective and that when these influential users claim relatively uncon- more educational [13], which warrants a closer examination trollable factors as causes of depression, such as of social media content about mental health [14]. However, biological/genetic and environmental factors, their fol- to our knowledge, investigations of depression-related dis- lowers’ comments contained less stigmatization [15, 16]. course on Chinese social media are still rare [15–17]. Therefore, to understand the root of stigmatization to- Against this backdrop, the current study aims to wards depression, it is important to examine how con- study how depression is represented on Sina Weibo, trollable are the factors that depression is attributed to the most popular social media platform and venue for by depressed individuals. civic engagement and activism in China today [18], with a focus on users’ understandings of depression Solution oriented attribution in terms of its causes, solutions, and their general at- Depression is not only a negative private experience but titudes to depressed individuals. also a public health issue calling for a solution. Besides the controllable-uncontrollable dimension, whether it is Attributions, solution, and efficacy attributed to individual-level or institutional factors is Social stigma and attribution more relevant in terms of determining whose responsi- A major obstacle for depressed individuals when reach- bility it is to solve the problem, which has important im- ing out for help is the stigma associated with depression. plications on health policies [26, 27], practices, and Research has found that depressed individuals are often public opinions [28]. Attribution to biological and med- associated with negative labels such as “weak mind,” ical factors suggests changes to make in the scientific “drama,” and “psycho” in China [19]. An analysis of and medicine domain. If it is the depressed individuals Pan et al. BMC Public Health (2018) 18:772 Page 3 of 10 who are primarily responsible for their suffering, argu- All these potential influences of UGC about depres- ably, they should take actions such as self-help. Factors sion warrant closer investigation of communication related to parental and other close relationships suggests about depression flowing on social media. However, little
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