Changing the stereotype of depression: Rich social interactions, trust & technology use
This post summarizes the CSCW 2019 paper “I think people are powerful”: The sociality of individuals managing depression by Eleanor Burgess, Kathryn Ringland, Jennifer Nicholas, Ashley Knapp, Jordan Eschler, David Mohr and Madhu Reddy (Paper link here)
Millions of people worldwide struggle with depression. In day-to-day life, they experience and have to deal with negative moods, feelings of sadness, and lack of motivation. To learn about how people self-managed their condition — specifically how they sought to help themselves feel better when experiencing a negative mood — we interviewed and did design activities with 30 people managing depression in the Midwest U.S. We found that in contrast to current stereotypes of people with depression as withdrawing and closing themselves in, we instead saw people being social and connecting with others as a key aspect of their daily lives and condition management.
Changing the perspective
In the United States in 2016, 16.2 million people experienced a depressive episode. People often experience depression alongside other mental and physical health conditions, most commonly anxiety. Addressing depression-related challenges requires ongoing work to prevent or reduce the intensity of future depressive episodes. “Self-management” describes the day-to-day practices of an individual to control or reduce the impact of their condition within daily life. People self-manage their depression symptoms to get through their day, complete tasks, and carry out various life activities. The “self” in self-management practices may imply that these are solitary activities, but as shown in our research, these practices often happen within a social context and often involve other people.
What do people do when they are having a bad day?
People managing depression connected with people in their lives to help change how they were feeling, to achieve certain outcomes (for instance trying to understand what triggered a bad mood), and some sought ways to learn to control their depression. To achieve these expectations, people reached out to trusted others in their lives to express their moods, talk about solutions to current challenges, and hang out together to reduce the intensity of their current mood.
First, people expressed their moods through sharing stories and conversations about their issues and feelings. Being able to put words to an internal mood and describe a challenging situation helped people to feel better, especially when speaking or writing to a sympathetic listener. Although some people journaled their moods individually, most people expressed their moods to others.
Second, some people wanted to connect with others to help them identify a solution to issues underlying their negative mood(s). Through conversation, people shared details about their mood with others, and asked them for help coming up with solutions. These solutions took several forms ranging from advice, personalized tools and strategies, to detailed next step plans.
Third, people often reduced their feelings of distress through both distracting and soothing activities. One person described why this was useful because it helped him to “focus on one thing, instead of what’s going on in my head”. People described hanging out with friends or family, cuddling with a significant other, scheduling meals with friends, playing video games together, or otherwise interacting without discussing their mood or problems as a way of distracting themselves.
How does technology play into this?
Technologies enabled people to connect with their supportive network and offered an opportunity for in-the-moment support. People picked technology according to their mood, who they wanted to talk to, where they were, and what kind of outcomes they were hoping for. They used a variety of technologies including texting, phone calls, voice calls, social media, and online games.
Does location matter here?
Privacy, comfort, a new perspective, and social interaction were also important considerations when people managing depression reached out for support. First, people described the importance of privacy in their interactions.
“I would wanna be some where, whether that’s home, or at work, or even driving home in my car, or whatever, I would want it to be private”.
Second, being comfortable and feeling relaxed and safe allowed individuals to interact more freely with others. Home was most often the place participants wanted to be as they carried out self-management activities. When at home, they could more easily connect with a significant other, or call parents or friends.
Third, because participants described certain places or people as triggering or exacerbating of their negative moods, several people described a need to get away, particularly to de-escalate their moods. Going outside, sitting in one’s car, or taking a walk were common activities, and connecting with supportive others helped to enhance these context shifts.
Fourth, we also identified an activity we call “diffuse sociality” — sitting near others but not interacting directly. People did this in coffee shops or by sitting next to others playing online games. Participants viewed this as an important activity to support their depression self-management, both providing benefits of being in a social space without the tiring nature of direct interactions.
Overall Insights — Factors Influencing Social Activities
From people’s stories, we identified four key factors that influenced how they chose to be social:
(1) Their level of trust in the other person and background relationship. For instance, one person described that shared history is an important reason why she is comfortable expressing her moods to her long-time friend:
“[My best friend] and I have known each other for 20 years, so I can tell her something, and she has enough history to get it without me even saying it the right way.”
(2) People’s current mood and most accessible ways to communicate (either face-to-face or via technology) will guide how they choose to interact with others.
(3) Current location plays an important role, particularly in terms of privacy and comfort. For people seeking support, locations can take on new dimensions because of the social stigma associated with mental health challenges and the difficultly in managing moods and emotions.
(4) Perceived stigma and how people thought it best to ask for and receive support in managing their condition also influenced and guided people’s choices regarding social interactions. The social needs of our participants influenced the many ways they actively sought out connection to other people. In many cases, participant’s support networks were able to meet their needs. However, participants also spoke about the challenges they experienced including how tiring self-management and maintaining relationships can be.
We found that social interaction was a key aspect of self-management for our participants, who connected with others through direct and indirect methods and used technologies and locations in diverse ways. We can better support peoples’ self-management of depression by considering factors influencing their social interactions including relationship roles and expectations, mood, communication technologies, location, privacy, culture, and society. Future design of mental health support tools should consider approaches and solutions that facilitate social connection to meet a range of user expectations, across a variety of communication technologies and digital and physical locations.
Eleanor R. Burgess, Kathryn E. Ringland, Jennifer Nicholas, Ashley A. Knapp, Jordan Eschler, David C. Mohr and Madhu C. Reddy. 2019. “I think people are powerful”: The sociality of individuals managing depression. In Proceedings of the ACM on Human-Computer Interaction, Vol. 3, CSCW, Article 41 (November 2019). 29 pages, https://doi.org/10.1145/3359143