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For people diagnosed with mental health conditions, psychiatric hospitalization is a major life transition, involving clinical treatment, crisis stabilization and loss of access of social networks and technology. The period after hospitalization involves not only management of the condition and clinical recovery but also re-establishing social connections and getting back to social and vocational roles for successful reintegration - a significant portion of which is mediated by social technology. However, little is known about how people get back to social lives after psychiatric hospitalization and the role social technology plays during the reintegration process. We address this gap through an interview study with 19 individuals who experienced psychiatric hospitalization in the recent past. Our findings shed light on how people's offline and online social lives are deeply intertwined with management of the mental health condition after hospitalization. We find that social technology supports reintegration journeys after hospitalization as well as presents certain obstacles. We discuss the role of social technology in significant life transitions such as reintegration and conclude with implications for social computing research, platform design and clinical care.

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BACKGROUND: Previous studies have suggested that social media data, along with machine learning algorithms, can be used to generate computational mental health insights. These computational insights have the potential to support clinician-patient communication during psychotherapy consultations. However, how clinicians perceive and envision using computational insights during consultations has been underexplored. OBJECTIVE: The aim of this study is to understand clinician perspectives regarding computational mental health insights from patients' social media activities. We focus on the opportunities and challenges of using these insights during psychotherapy consultations. METHODS: We developed a prototype that can analyze consented patients' Facebook data and visually represent these computational insights. We incorporated the insights into existing clinician-facing assessment tools, the Hamilton Depression Rating Scale and Global Functioning: Social Scale. The design intent is that a clinician will verbally interview a patient (eg, How was your mood in the past week?) while they reviewed relevant insights from the patient's social media activities (eg, number of depression-indicative posts). Using the prototype, we conducted interviews (n=15) and 3 focus groups (n=13) with mental health clinicians: psychiatrists, clinical psychologists, and licensed clinical social workers. The transcribed qualitative data were analyzed using thematic analysis. RESULTS: Clinicians reported that the prototype can support clinician-patient collaboration in agenda-setting, communicating symptoms, and navigating patients' verbal reports. They suggested potential use scenarios, such as reviewing the prototype before consultations and using the prototype when patients missed their consultations. They also speculated potential negative consequences: patients may feel like they are being monitored, which may yield negative effects, and the use of the prototype may increase the workload of clinicians, which is already difficult to manage. Finally, our participants expressed concerns regarding the prototype: they were unsure whether patients' social media accounts represented their actual behaviors; they wanted to learn how and when the machine learning algorithm can fail to meet their expectations of trust; and they were worried about situations where they could not properly respond to the insights, especially emergency situations outside of clinical settings. CONCLUSIONS: Our findings support the touted potential of computational mental health insights from patients' social media account data, especially in the context of psychotherapy consultations. However, sociotechnical issues, such as transparent algorithmic information and institutional support, should be addressed in future endeavors to design implementable and sustainable technology.

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For people diagnosed with a mental illness, psychiatric hospitalization is one step in a long journey, consisting of clinical recovery such as removal of symptoms, and social reintegration involving resuming social roles and responsibilities, overcoming stigma and self-maintenance of the condition. Both clinical recovery and social reintegration need to go hand-in-hand for the overall well-being of individuals. However, research exploring social media for mental health has considered narrower, disjoint conceptualizations of people with mental illness - either as a patient or as a support-seeker. In this paper, we combine medical records with social media data of 254 consented individuals who have experienced a psychiatric hospitalization to address this gap. Adopting a theory-driven, Gaussian Mixture modeling approach, we provide a taxonomy of six heterogeneous behavioral patterns characterizing peoples' mental health status transitions around hospitalizations. Then we present an empirically derived framework, based on feedback from clinical researchers, to understand peoples' trajectories around clinical recovery and social reintegration. Finally, to demonstrate the utility of this taxonomy and the empirical framework, we assess social media signals that are indicative of individuals' reintegration trajectories post-hospitalization. We discuss the implications of combining peoples' clinical and social experiences in mental health care and the opportunities this intersection presents to post-discharge support and technology-based interventions for mental health.

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As public discourse continues to progress online, it is important for mental health advocates, public health officials, and other curious parties and stakeholders, ranging from researchers, to those affected by the issue, to be aware of the advancing new mediums in which the public can share content ranging from useful resources and self-help tips to personal struggles with respect to both illness and its stigmatization. A better understanding of this new public discourse on mental health, often framed as social media campaigns, can help perpetuate the allocation of sparse mental health resources, the need for educational awareness, and the usefulness of community, with an opportunity to reach those seeking help at the right moment. The objective of this study was to understand the nature of and engagement around mental health content shared on mental health campaigns, specifically #MyTipsForMentalHealth on Twitter around World Mental Health Awareness Day in 2017. We collected 14,217 Twitter posts from 10,805 unique users between September and October 2017 that contained the hashtag #MyTipsForMentalHealth. With the involvement of domain experts, we hand-labeled 700 posts and categorized them as (a) Fact, (b) Stigmatizing, (c) Inspirational, (d) Medical/Clinical Tip, (e) Resource Related, (f) Lifestyle or Social Tip or Personal View, and (g) Off Topic. After creating a "seed" machine learning classifier, we used both unsupervised and semi supervised methods to classify posts into the various expert identified topical categories. We also performed a content analysis to understand how information on different topics spread through social networks. Our support vector machine classification algorithm achieved a mean cross-validation accuracy of 0.81 and accuracy of 0.64 on unseen data. We found that inspirational Twitter posts were the most spread with a mean of 4.17 retweets, and stigmatizing content was second with a mean of 3.66 retweets. Classification of social media-related mental health interactions offers valuable insights on public sentiment as well as a window into the evolving world of online self-help and the varied resources within. Our results suggest an important role for social media-based peer support to not only guide information seekers to useful content and local resources but also illuminate the socially-insular aspects of stigmatization. However, our results also reflect the challenges of quantifying the heterogeneity of mental health content on social media and the need for novel machine learning methods customized to the challenges of the field.

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BACKGROUND: Linguistic analysis of publicly available Twitter feeds have achieved success in differentiating individuals who self-disclose online as having schizophrenia from healthy controls. To date, limited efforts have included expert input to evaluate the authenticity of diagnostic self-disclosures. OBJECTIVE: This study aims to move from noisy self-reports of schizophrenia on social media to more accurate identification of diagnoses by exploring a human-machine partnered approach, wherein computational linguistic analysis of shared content is combined with clinical appraisals. METHODS: Twitter timeline data, extracted from 671 users with self-disclosed diagnoses of schizophrenia, was appraised for authenticity by expert clinicians. Data from disclosures deemed true were used to build a classifier aiming to distinguish users with schizophrenia from healthy controls. Results from the classifier were compared to expert appraisals on new, unseen Twitter users. RESULTS: Significant linguistic differences were identified in the schizophrenia group including greater use of interpersonal pronouns (P<.001), decreased emphasis on friendship (P<.001), and greater emphasis on biological processes (P<.001). The resulting classifier distinguished users with disclosures of schizophrenia deemed genuine from control users with a mean accuracy of 88% using linguistic data alone. Compared to clinicians on new, unseen users, the classifier's precision, recall, and accuracy measures were 0.27, 0.77, and 0.59, respectively. CONCLUSIONS: These data reinforce the need for ongoing collaborations integrating expertise from multiple fields to strengthen our ability to accurately identify and effectively engage individuals with mental illness online. These collaborations are crucial to overcome some of mental illnesses' biggest challenges by using digital technology.

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