Having good connections online can help reduce depression in young people

Building a good connection with others is important for digital tools and services to help improve young people’s mental health, a new study suggests.

A major review of evidence has shown that having a good social connection while accessing online support, for example through virtual therapy sessions or peer support sites, reduced symptoms of depression in young people by as much as 26%.

Led by Imperial College London’s Institute of Global Health Innovation, the analysis also found evidence that having a good social connection within this context could also help to improve anxiety and wellbeing, although the relationship was not as clear cut.

"Our review showed that having a good connection with somebody within a digital setting comes in different packages, yet all of these factors helped to improve depression and anxiety in young people." Dr Lindsay Dewa Institute of Global Health Innovation

In contrast, having negative online interactions led to worse mental health, the researchers report in the Journal of Medical Internet Research.

The team also identified a series of key factors that can facilitate having a good social connection online, such as feeling safe and able to be open, which the researchers say could be used to guide the development of new digital mental health services or assess existing ones.

Project lead Dr Lindsay Dewa, Advanced Research Fellow at the Institute of Global Health Innovation, said: “We know having good connections with people can help improve our mental health. Having a good connection is becoming increasingly important because more and more of our interactions are online. Our review showed that having a good connection with somebody within a digital setting comes in different packages, from having a sense of belonging to being emotionally connected, and yet all of these factors helped to improve depression and anxiety in young people.

“I’m looking forward to continuing to work with young people to co-design and evaluate a new tool focussed on digital social connection. Hopefully this work will show when social connection happens online, and whether it improves mental health across different populations, digital tools and situations.”

The importance of social connections for mental health

Feeling lonely or socially disconnected from others can have a negative impact on people’s health, while on the other hand, research has shown that feeling socially connected has a strong protective effect against depression and can reduce anxiety.

As the pandemic has shifted interactions away from face-to-face and towards digital, the research team wanted to find out what key characteristics of online connections can help to improve mental health. The study focussed on young people with depression and/or anxiety who were aged 14-24.

The researchers reviewed literature and identified 42 relevant studies that explored this research topic, all of which took place in developed countries. The studies looked at a range of digital tools or mental health interventions, including both prevention and treatment strategies. These ranged from smartphone apps and remote psychiatry to social networking and gaming.

Young people with experience of depression and/or anxiety were involved in all stages of the research.

Factors that facilitate quality social connections

The researchers identified a series of characteristics that can help to demonstrate the presence of a good or ‘quality social connection’, defined by the team as the value people place on certain aspects of an interaction between two or more people.

These factors included feeling normalised, having a sense of belonging, developing an emotional connection and the presence of shared understanding. While loneliness, feeling ignored and having negative interactions, for example through cyberbullying, indicated the absence of a quality social connection.

Of the 10 studies that reported a change in depression in young people, the researchers found that symptoms decreased by 26% after having a good social connection within a digital intervention. And of the five that observed a change in anxiety, there was a 15% decrease in symptoms. In contrast, factors linked with no social connection, such as loneliness, were all linked with worse mental health.

The study also identified a number of mechanisms within the digital interventions that helped to facilitate having a good social connection, such as anonymity and confidentiality. In addition, signals that can help to build a connection in face-to-face interactions, such as body language, were found to be lost in digital platforms, which could prevent the formation of good connections, the researchers say.

Striking a balance

The team have summarised the factors important for quality social connections online into a framework called RIVER (Rapport, Identity and commonality, Valued interpersonal dynamic, Engagement, Responded to and accepted). The hope is that in future, this could aid the development of measures that healthcare professionals or developers can use to assess digital tools for their potential to build good social connections.

"We are excited to continue this work to ensure we can get the balance right when shifting more into digital support for mental health." Dr Emma Lawrance Institute of Global Health Innovation

Study author Dr Emma Lawrance, Mental Health Innovations Fellow at the Institute of Global Health Innovation, said: “It was fascinating to work alongside young people in this first-of-its-kind project to start to unpick what it means to have a good connection with other people in digital spaces, and how important this is for mental health.

“By characterising the components of a good social connection we have opened the door for further research and digital tool development. We are excited to continue this work to ensure we can get the balance right when shifting more into digital support for mental health.”

The research was funded by Wellcome.