Trends and Correlates of Internet Support Group Participation for Mental Health Problems in the United States, 2004-2018

Background and Purpose: We are living in a historical moment in which Internet-based therapeutic options for mental health problems such as Internet support groups (ISGs) are more relevant than ever. However, a number of important questions about ISG remain unanswered. As a step to fill this research gap, this study sought to (1) examine trends in ISG participation among all U.S. adults and (2) uncover subtypes of ISG participants based on their behavioral health characteristics. Achievement of these objectives will provide a necessary up-to-date empirical platform to inform next stage implementation and evaluation of ISG interventions.

Methods: The present study used data from the National Survey on Drug Use and Health (NSDUH). The NSDUH is a nationally representative survey and uses a multi-stage probability sampling design to sample civilian, noninstitutionalized U.S. residents ages 12 and older. This study’s analytic sample included 625,883 adults ages 18 and older interviewed between 2004 and 2018. To examine the ISG participation trend, we conducted survey-adjusted logistic regression analysis and joinpoint regression. To investigate behavioral health factors, we conducted multivariable regression analyses controlling for sociodemographic factors and survey year. Additionally, we modeled the subtypes of ISG participants based on their behavioral health characteristics, using latent class analysis.

Results: The proportion of U.S. adults participating in ISG increased significantly from 2.29% (2004-2007) to 3.55% (2016-2018). Joinpoint analysis revealed a significant increase in ISG participation among women (but not men) beginning in 2015 (b = .72, SE = .28, t = 2.56, p < .05). ISG participants were less likely to be male, 35 or older, be part of an ethnic/racial minority group, or have household incomes between $20,000 and $49,999. Black/African American participants and those classified as “other” race showed the largest percent increases, while Hispanics showed no change. ISG participants were more likely to have experienced a depressive episode and to have used cannabis. Three subtypes of ISG participants were identified, including the Lower Behavioral Health Risk group (62%), the Elevated Behavioral Health Risk group (24%), and the Depression, Cigarettes, and Cannabis group (14%).

Conclusion: Overall, we found an increasing trend in seeking mental health care through ISGs among US adults since the early 2000s. We observed the diminishing disparities in ISG participation among some disadvantaged groups such as Blacks/African Americans and individuals with lower household income. However, our findings about the lack of increase in ISG participation among men and Hispanics as well as the lack of participation in ISGs among older adults underscore the importance of continuing efforts to engage these populations. In addition, this investigation sheds light on the distinct subtypes of ISG participants based on their behavioral health risks and provides valuable implications for future research on the development of Internet interventions for mental health problems. Finally, we were only able to examine the NSDUH data from years before the COVID-19 pandemic and future research should examine the impact of the pandemic on the use of ISG and other internet-based psychotherapeutic interventions.