The engagement behaviors and treatment barriers for depressed patients in an online health community: a pre-/post-treatment comparison

The treatment of depression involves numerous barriers, both before and after individuals seek professional care. Online health communities (OHCs) have emerged as valuable platforms for people coping with depression. We collected 1,585,429 posts from a depression-focus OHC in China between May 2022 and September 2023. Based on both keyword filtering and deep learning classification, we identified two user groups: 25,743 post-treatment users (those currently or previously under treatment) and 4891 pre-treatment users (those who had not yet sought formal care). We examined engagement differences between these two groups across four key dimensions: information sharing, continued participation, community status, and interaction preference. Furthermore, the content analysis was conducted to gain insights into the treatment barriers they faced. The results showed that post-treatment users emerge as central figures in OHC, exhibiting higher engagement levels and actively driving information exchange. The barriers for pre-treatment patients include fear and hesitation regarding treatment (26.63 %), difficulty accessing mental health services (19.41 %), financial barriers (18.62 %), lack of understanding and support (15.53 %), shame and stigma (12.20 %), and a lack of information (7.61 %). Medication side effects (34.23 %), medication management (20.29 %), emotional fluctuations (19.36 %), lack of social support (14.54 %), doctor-patient relationship (6.30 %), financial and healthcare access challenges (5.28 %) are the barriers for post-treatment patients. This study contributes to the understanding of the multifaceted nature of depression treatment and underscores the potential of online communities to play a transformative role in mental health care.