Millions of U.S. Americans suffer from major depressive disorder, which is characterized as persistent feelings of sadness, fatigue, and thoughts of death or suicide, among other things. Numerous researchers have found that people with mental health struggles—including depression—benefit from online spaces where they can find emotional support. This dissertation investigates the specific conditions under which people with depression intend to access emotional support. More specifically, as informed by Büchi and Hargittai’s (2020) model on digital skills and online well-being, I attempted to understand how digital skills (i.e., privacy skills, algorithm skills, communication skills) are related to how people with depression disclose about their depression and perceive emotional support from others. I also investigated how anonymity is related to group identification with other people online and their depression disclosures. I measured anonymity in two ways: affordance anonymity and self-anonymity. I administered a cross-sectional survey from 446 people with depression and employed quota sampling of 224 of whom had disclosed about their depression on Reddit and 222 on Facebook in order to ensure variation in anonymity. To reduce memory bias and provide more insights into the type of communication skills utilized by people with depression, I also collected the text from recent online depression disclosures from these same participants. My quantitative findings showed that for all participants, depression stigma did not significantly predict either type of online anonymity. Further, self-disclosure fully mediated the relationship between both types of anonymity online and online emotional support, and online group identification only partially mediated the relationship between affordance anonymity and self-disclosure. In addition, I found that privacy skills marginally moderated the relationship between self-anonymity and depression disclosures such that those who had high privacy skills disclosed the most. There was not, however, a significant moderation of algorithm skills on the relationship between depression disclosure and emotional support.
Finally, I conducted a qualitative thematic analysis of the depression disclosure text and found that people with depression use two main communication skills to seek support online: direct and indirect. Direct skills are defined as strategies that people with depression used to seek support—which were known by the recipient (Crowley & Faw, 2014)—and include skills such as the use of hypothetical questions, requests for advice, requests for friendship, and requests for relating (i.e., asking if others relate to their experiences). Indirect skills are defined as strategies used that are done without the recipient’s awareness (Crowley & Faw, 2014) and include skills such as the use of narrative, metaphor, and venting. A holistic analysis of the posts and their accompanying comments indicated that Reddit disclosures were more detailed and explicit, eliciting more substantive disclosures from commenters, and Facebook disclosures were vaguer, inviting more pity platitudes of support from commenters.
The theoretical contributions of this dissertation are threefold: a) the findings validate and extend Büchi and Hargittai’s (2022) model of how digital skills relate to perceptions of online social support, b) the findings reveal the benefit of online anonymity for people with stigmatized health concerns by exploring how different conceptualizations of anonymity might shape online disclosure practices, and c) the findings extend theoretical understanding of how people with depression utilize communication skills in an attempt to gain support online. This dissertation also has a number of practical implications, including that online platform designers should consider features that boost the privacy skills of their users with depressive symptoms.
