Social Media & PsychiatryIris Thiele Isip Tan MD, MSc

@endocrine_witchProfessor, UP College of MedicineChief, UP Medical Informatics Unit

Growing social media by mkhmarketing, https://flic.kr/p/e1yRKg

22 Jan 2015

I am the Endocrine Witch. I am a netizen!

Facebook by Dimitris Kalogeropoylos, https://flic.kr/p/8kvsXB

Are there guidelines to

direct personal use of social

media by psychiatrists?

Twitter avatar by Ape Lad, https://flic.kr/p/71pTYY

How can the professional use of social

media help psychiatric

practice?

Should social media be used to monitor the

psychiatric patient?

Self snitch by Poster Boy, https://flic.kr/p/bwSEPg

Psychiatrists on social media?#TaoLang

In the meantime, I’m going to ask Dr. E. to change his privacy settings so the nice robots at Facebook can’t make the connection between us - or at least they won’t tell me about it if they do. That way, I can stop thinking about his personal life and get our sessions back to what they should be, which is all about me.“

Steven Petrow, www.washingtonpost.com

To what extent should patients’ potential access to online information shape psychiatrists’ use of social media?

Appelbaum P & Kopelman A.Social media’s challenges for psychiatry

World Psychiatry 2014;13(1):21-23

Disclosure of patient-related information even when patients are not directly identified, can raise doubts among the public about the privacy of their medical interaction.

selfie_stick by Ton Schulten, https://flic.kr/p/q8ppyD

[25/365] On the couch (Explored) by Pascal, https://flic.kr/p/8DVMLy

Negative comments about the healthcare system in general or a particular facility can shake patients’ trust and deter them from seeking care.

Appelbaum P & Kopelman A.World Psychiatry 2014;13(1):21-23

Content showing doctors “behaving badly” may call clinical judgment into question, raising doubts in patients’ minds about the quality of the treatment they will receive.

[25/365] On the couch (Explored) by Pascal, https://flic.kr/p/8DVMLy

Online news by Mike Licht, https://flic.kr/p/7XkhM7

Unreflective and excessive

self-disclosure by psychiatrists, especially when

they are engaged in psychotherapy, is another

concern... Crucially, the psychiatrist may be wholly

unaware if and when any self-disclosure has occurred, and

therefore never be able to address its significance with the patient.

Appelbaum P & Kopelman A.World Psychiatry 2014;13(1):21-23

girl 1 by Krzysztof Isbrandt, http://www.freeimages.com/photo/767957 “

Individuals whose presence among a psychiatrist’s friends becomes known (eg, via a wall post) are revealing their connection to the psychiatrist and other friends may surmise than an individual is a patient.

A beautiful friendship by Viktor Hertz, https://flic.kr/p/9oUtHV

“Mossman D & Farrell H. Facebook: Social networking meets professional duty. www.currentpsychiatry.com

Position statements such as this one tend, by their nature to propagate a string of warnings and prohibitions. The RANZCP recognizes that social media and internet presence can offer a range of benefits and enhance the therapeutic relationship between doctor and patient.

“The Royal Australian & New Zealand College of Psychiatrists

Position Statement 75 Aug 2012

Psychiatrists should be aware of, and manage, their online presence and image (This may include Google-ing oneself regularly).

The Royal Australian & New Zealand College of Psychiatrists Position Statement 75 Aug 2012 If it’s on the Internet, it isn’t private by DonkeyHotey,

https://flic.kr/p/9RYZvc

Psychiatrists should exercise judgment and caution when posting information online, including being mindful of maintaining confidentiality and professional boundaries with patients.

The Royal Australian & New Zealand College of Psychiatrists Position Statement 75 Aug 2012

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The Royal Australian & New Zealand College of Psychiatrists Position Statement 75 Aug 2012

Psychiatrists should understand all the privacy settings for all social media applications that they use, and apply the strictest settings when posting personal information.

Facebook & privacy by Tim Wayne, https://flic.kr/p/9qZKm4

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InformationRelationships, religious views, home address & tel. no. may be readily viewable to the general public and patients

PhotosIntoxication, sexually explicit material, risk-taking behavior

Wall postsBlatant comments about patients, disgruntlement with institution or supervisors

Mossman D & Farrell H. Facebook: Social networking meets professional duty. www.currentpsychiatry.com

Security settingsLack of privacy restrictions

“Friends” Friending patients and supervisors

“Like” “Liking” groups that contain pornographic material or other controversial topics

Facebook Errors: What to Avoid

Facebook by Dimitris Kalogeropoylos, https://flic.kr/p/8kvsXB

Are there guidelines to

direct personal use of social

media by psychiatrists?

Twitter avatar by Ape Lad, https://flic.kr/p/71pTYY

How can the professional use of social

media help psychiatric

practice?

Should social media be used to monitor the

psychiatric patient?

Self snitch by Poster Boy, https://flic.kr/p/bwSEPg

Professional use of social media for psychiatrists

Benefits of Social Media in Mental Health PracticesDavid Ballard, Psyd, MBAwww.psychiatrictimes.com4 Dec 2012

Extend your reachBuild your practiceHelp people find youUse consistent brandingEstablish professional relationshipsConnect with others

Drowning in social media by mkhmarketing, https://flic.kr/p/dZxNRq

Geography of Twitter replies by Eric Fischer, https://flic.kr/p/avgZqq

For psychiatrists, being aware of topics that generate interest on social media sites not only fuels ideas for your own “tweets” or blog posts, but helps you anticipate concerns raised by your patients.

Brody D, Social Media for Psychiatrists: Ignorance is Not Bliss 7 Sept 2012 www.psychiatrictimes

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Brody D, Social Media for Psychiatrists: Ignorance is Not Bliss 7 Sept 2012 www.psychiatrictimes

A strong social media presence also helps generate referrals.Networking with colleagues on sites such as LinkedIn may also generate referrals.“

LinkedIn pen by Sheila Scarborough, https://flic.kr/p/azPUMz

http://psychiatrist-blog.blogspot.com/

We have the ability to disseminate knowledge of evidence-based strategies, provide context to mental health stories in the media, and dispel myths. There are certainly people who are putting false, misleading and potentially harmful information on the Internet.

Peek H, Social Media: An Opportunity for Psychiatrists 4 Aug 2014 www.physicianspractice.com

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Multiple Tweets Plain by mkhmarketinghttps://flic.kr/p/dVaqmj

Tweet chat Pre-arranged chat through tweets that include a predefined hashtag to link those tweets together in a virtual conversation

- Susan Gunelius http://weblogs.about.com/od/twitterfaqs/f/TwitterFAQTweetChat.htm

My Storify: Creating Healing Environments #HCLDR Chat. By Dan Dunlophttp://thehealthcaremarketer.wordpress.com/2014/04/17/my-storify-creating-healing-environments-hcldr-chat/

My Storify: Creating Healing Environments #HCLDR Chat. By Dan Dunlophttp://thehealthcaremarketer.wordpress.com/2014/04/17/my-storify-creating-healing-environments-hcldr-chat/

My Storify: Creating Healing Environments #HCLDR Chat. By Dan Dunlophttp://thehealthcaremarketer.wordpress.com/2014/04/17/my-storify-creating-healing-environments-hcldr-chat/

My Storify: Creating Healing Environments #HCLDR Chat. By Dan Dunlophttp://thehealthcaremarketer.wordpress.com/2014/04/17/my-storify-creating-healing-environments-hcldr-chat/

The goal of the Healthcare Hashtag Project is to make the use of Twitter more accessible for providers and the healthcare community as a whole.

By lowering the learning curve of Twitter with a database of relevant hashtags to follow, we hope to help new and existing users alike to find the conversations that are of interest and importance.

- Symplur.com

Partners

Screenshot from www.symplur.com/healthcare-hashtags

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Facebook by Dimitris Kalogeropoylos, https://flic.kr/p/8kvsXB

Are there guidelines to

direct personal use of social

media by psychiatrists?

Twitter avatar by Ape Lad, https://flic.kr/p/71pTYY

How can the professional use of social

media help psychiatric

practice?

Should social media be used to monitor the

psychiatric patient?

Self snitch by Poster Boy, https://flic.kr/p/bwSEPg

Monitor the psychiatric patient on social media?

Social-media-despair by Gary Koelling, https://flic.kr/p/6DtPYC

In the world of mental health, we’re not far from the day when scrolling through your Twitter feed might be a practitioner’s last step before pulling out the prescription pad.

“http://www.slate.com/articles/technology/future_tense/2014/11/

amanda_bynes_twitter_using_social_media_to_track_mental_health_problems.html

http://www.slate.com/articles/technology/future_tense/2014/11/amanda_bynes_twitter_using_social_media_to_track_mental_health_problems.html

While monitoring social media without consent is obviously unethical, a patient who’s willing to examine her social media

presence might find an ally in the data.

Dr. Jan KalbitzerCharite-University Medicine Berlin

Sad by Kristina Alexanderson, https://flic.kr/p/9g5Gg8

http://time.com/1915/how-twitter-knows-when-youre-depressed/

Predicting Postpartum Changes in Emotion and Behavior via Social MediaDe Choudhury M, et al. CHI ’13 Proceedings of the SIGCHI Conference on Human Factors in Computing Systems pp 3267-3276

P: 376 Twitter accounts of new mothers (validated by key phrases in tweets)

I: Changes in tweets (social engagement, emotion, social network & linguistic style)

O: Predictive model for postpartum depression

M: Cross-sectional

Sad young woman by beermug, http://www.freeimages.com/photo/1414071

Sad young woman by beermug, http://www.freeimages.com/photo/1414071

De Choudhury M, et al. CHI ’13 Proceedings of the SIGCHI Conference on

Human Factors in Computing Systems pp 3267-3276

The predictive models can classify mothers who will change significantly following childbirth with an accuracy of 71% ... could be valuable tools in public health ...

“... people may be uncomfortable with others performing and sharing these predictions, even if the inferences are based solely on data that they have shared openly with the public.

Tracking Suicide Risk Factors Through Twitter in the US Jashinsky et al. Crisis 2014;35(1):51-59

P: 37,717 at-risk tweets (keywords/phrases from suicide risk factors) filtered from Twitter stream I: No. of “suicide tweeters” vs national data of suicide ratesO: Correlation

M: Cross-sectionalHeadshot by Martin Gommel, https://flic.kr/p/4cZBj4

Depressive feelingsI feel so worthless today.

Prior suicide attemptsI tried to commit suicide before ... several times.

Jashinksy et al. Crisis 2014;35(1):51-59

Psychological disorders... what to say but yes, I’ve been diagnosed with anorexia since late 2009 and early 2010.

Example tweets for suicide risk factors

Depression symptomsI’ve been sleeping a lot lately. I take like 6 hour naps.

Drug abuseDear Prozac, time for upping in your dosage.

Suicide ideationI have had thoughts on suicide and running away from home ... and sometimes I still do.

Headshot by Martin Gommel, https://flic.kr/p/4cZBj4

An association exists between the proportion of Twitter users determined to be at risk for suicide and actual suicide rates.Twitter may be a viable tool for real-time monitoring of suicide risk factors on a large scale.

“Jashinksy et al. Crisis 2014;35(1):51-59

Samaritans Radar applaunched 29 Oct 2014

Algorithm looks for specific keywords and phrases within a tweetSends an email alert to user with link to tweet detected

Offers guidance on best way of reaching out and providing support

The Samaritans has no legitimate purpose to collect this information, let alone to share it with other unknown and untrusted people without the subject’s knowledge or consent.While this could be used legitimately by a friend to offer help, it also gives stalkers and bullies an opportunity to increase their levels of abuse at a time when their targets are especially down.

Adrian ShortCampaigner, Change.org

Hopeless by spekulator, http://www.freeimages.com/photo/612222

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P: 200 public Facebook profiles from sophomore/junior undergrads

I: Analysis of personally written text: “status updates”

O: Prevalence of displayed depression symptoms and major depressive episode (MDE) criteria

M: Cross-sectional

Depressed moodErika is really really really unhappy.

IndecisivenessLisa is not sure about anything ... can’t make up my mind.

Moreno et al. Depress Anxiety 2011;28)6:447-55

Feelings of guilt, worthlessness, negative self-appraisal Kate hates herself right now.

DSM-IV criteria for Major Depressive Episode and examples from FB data

Increase or decrease in appetiteAmy has no appetite right now.

Decreased interest or pleasure in activities Jane doesn’t feel like getting up today, or doing anything.

Recurrent thoughts of death or suicidal ideationNone in this dataset

Sleep problemsAnn needs to stop being lame and so tired so that she can go out and socialize more instead of having to sleep so much.

Loss of energyJoe has lost his motivation.

39.365 #106 in explore ! fact by Ashley Rose, https://flic.kr/p/5anfdu

25% of FB profiles displayed depressive symptoms and 2.5% met criteria for MDE.

Those who receive online reinforcement from friends are more likely to discuss depressive symptoms publicly on Facebook.

“

Moreno et al. Depress Anxiety 2011;28)6:447-55

You could be mislabeling millions of people. There would be all sorts of negative consequences. And then you can have sophisticated employment consultants who will do the vetting on people’s psychiatric states, derived from some cockamamie algorithm, on your Twitter account. “

Dr. Allen J. Frances Professor Emeritus Duke University School of Medicine

Facebook by Dimitris Kalogeropoylos, https://flic.kr/p/8kvsXB

Are there guidelines to

direct personal use of social

media by psychiatrists?

Twitter avatar by Ape Lad, https://flic.kr/p/71pTYY

How can the professional use of social

media help psychiatric

practice?

Should social media be used to monitor the

psychiatric patient?

Self snitch by Poster Boy, https://flic.kr/p/bwSEPg

Social Media Class by mkhmarketing, https://flic.kr/p/e1HpQq

With these precautions, which should be inculcated as part of psychiatric training, the twenty first century psychiatrist should be able to be a cautious but vigorous participant in the social media revolution.

Appelbaum P & Kopelman A.World Psychiatry 2014;13(1):21-23

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