An Analysis of Blog Content and Survival
We used a purposive-snowball sampling approach to identify 951 healthrelated blogs (Patton, 2002). Initially, blogs were identified on the basis of
keyword searches using various search engines and blog aggregators (e.g., Google, Technorati).
Subsequently, additional blogs were identified using links
provided on the blog rolls of the initially selected blogs. This sampling strategy is
appropriate in cases such as blogs and blogging where a true random sample is
not possible due to the absence of a known population but a sample with specific
characteristics (i.e., blogs about health and health care) needs to be put together
(Hindman, Tsioutsiouliklis, & Johnson, 2013; Karpf, 2008).
The specific sampling approach employed is also appropriate when the focus
is on identifying the most widely read and influential blogs rather than putting
together a sample representative of the entire blogosphere. Hindman et al. (2013)
conclude that “any site which is more than three clicks away from any of the top
200 Google or Yahoo results on a given topic is definitely off the beaten track, and
not likely to have any substantial impact.” Blogs that are reported by search
engines and blog aggregators are much more visible than those that are not, a
level of visibility that declines exponentially among blogs one, two, or three times
removed from the blogs that come up in search results. Indeed, those blogs that
fail to be identified by Google, for example, are essentially invisible (Hindman
et al., 2013). The sampling approach employed, therefore, enables scholars to
focus on identifying the most heavily linked blogs—that is, those that are most
widely read and hence, presumably, influential, rather than having to catalog
thousands of blogs, most of which few, if anyone, reads.
Health-related blogs were identified during two data collection periods, June–
July 2007 and April–May 2008. Eligible blogs, focused on a health-related topic,
were written in English, were U.S.-based, and had at least one new post in the
6 months prior to data collection. Blog authors were not informed about this
research prior to data collection. Blogs were treated as publicly available
documents. This project received Institutional Review Board approval.
To compile the June–July 2007 sample, we relied upon links, search engines,
and blog aggregators such as Technorati and Google Blog, primarily using
Miller/Pole/Usidame: Life and Death in the Mental-Health Blogosphere 61
general keywords such as “health blog,” “medical blog,” “mental health blog,”
“health policy,” “mental health policy,” “physician,” “patient,” and “disease.”
However, domain-specific keywords were used as well, including, for example,
“cancer,” “heart disease,” “depression,” “schizophrenia,” “nutrition,” etc. Additional blogs were then identified using blogrolls. Sampling ceased once the same
blogs appeared multiple times with no new blogs being identified. The June–
July 2007 sample consisted of 622 blogs.
To compile the April–May 2008 sample, we used Healthcare 100 Blogs (www.
edrugsearch.com/edsblog/healthcare100/), a global ranking of the top Englishlanguage health-care blogs. Of approximately 800 blogs listed, 329 new blogs were
eligible for inclusion and 114 were identified already. The remaining blogs were
ineligible based on the inclusion criteria outlined above. In all, 951 health-related
blogs were identified in 2007 and 2008, 188 of which focused on mental health.
Data Abstraction of characteristics
Data abstraction took place at initial data collection in 2007 and 2008 and
included quantifying objective measures and identifying subjective themes. Initial
categories describing blog characteristics derived from prior research (McKenna
& Pole, 2008; Pole, 2006, 2009). These categories were refined over several
iterations using an initial set of blogs before applying them to all blogs in the
final sample (Glaser & Strauss, 1967; Miles & Huberman, 1984). Baseline
categories include blogger demographics (gender, age, education, occupation),
blog age, blog features (blogrolls, archives, comment sections, audio/video clips,
external/internal links, sponsorship/advertising), general topic (disease/disability experiences, health policy and law, health research and news, doctoral-level
practitioner experiences, non-physician practitioner experiences, nutrition), and
perspective (patient/consumer, caregiver, professional).
Most blog/blogger characteristics were easily identifiable through a cursory
review of the blogs identified; some information, however, required a deeper
exploration of blog content, the examination of multiple posts when necessary. A
research assistant coded all of the data under the direct supervision of the
authors. To examine reliability, a random subset of 100 blogs was coded
independently by two coders trained and familiarized with the codebook. The
reliability index was calculated by computing the percent agreement between the
data abstracted by these two individuals, both overall and for each of the study
variables examined. Results reveal an overall level of agreement of 88.0 percent.
They also reveal a 59.0–99.0 percent range of agreement across the study variables
abstracted. Those categories with levels of agreement below 80 percent include:
health research and news (71 percent), health policy and law (69 percent), internal
links (74 percent), advertising (60 percent), and education (74 percent).
In July 2014, we examined the status of each of the 188 mental-health blogs
identified in 2007 and 2008. Data abstracted include whether or not a blog was
still visible. If visible, we recorded the year; if not visible, we recorded whether or
not the blog was password protected or closed.
Data Analysis Of ANOV
The purpose of the present study is to conduct exploratory analyses that
identify characteristics of mental-health blogs at baseline, the subsequent survival
of the blogs identified, and the correlates of that survival. First, we describe the
mental-health blogs sampled at baseline (2007–08). This includes reporting the
baseline characteristics of the 188 mental-health blogs sampled. It also includes
comparing the baseline characteristics of the 188 mental-health blogs identified to
763 other health-related blogs sampled during the same time period. To do so, we
use x-square tests to examine the relationship between blog type and other
categorical variables, and t-tests to examine the relationship between blog type
and the two continuous variables in the dataset, blogger age and blog age.
Examples of mental-health blogs and their characteristics are shown in Table 1.
We also uncover differences across the 188 mental-health blogs with varying
foci: severe mental illness (bipolar disorder, schizophrenia; 53 blogs), developmental disorders (autism spectrum disorder, Down syndrome; 58 blogs), eating
disorders (43 blogs), general mental health (25 blogs), and depression (9 blogs).
To make the number of comparisons manageable, the number of categories had
to be reduced for purposes of analysis. Thus, blogs focusing on bipolar disorder
and schizophrenia were combined into a single category, severe mental illness,
and blogs focusing on autism spectrum disorder and Down syndrome were
combined into a single category, developmental disorders.
Chi-square/exact tests were used to examine the relationship between blog focus and other categorical
variables, and one-way ANOVAs to examine the relationship between blog focus
and the two continuous variables analyzed, blogger age and blog age.
Second, we report the proportion of mental-health blogs still posting at
follow-up. Survival rates were calculated using four different definitions of blog
survival based on the inclusion/exclusion of password-protected blogs and the
inclusion/exclusion of blogs last posting in 2013.
Third, we report the relationship between the characteristics of the mental-health
blogs sampled at baseline and subsequent survival. In doing so, we employed a
conservative definition of blog survival, excluding the 25 blogs that were password
protected at follow-up since we could not know whether or not they were still in
fact posting. Two sets of analyses were, therefore, conducted: one defining survival
as a last post in 2013 or 2014, the other defining survival as a last post in 2014 only.
Chi-square tests were used to examine the relationship between blog survival and
other categorical variables, and t-tests to examine the relationship between blog
survival and the two continuous variables analyzed, blogger age and blog age.
Results
What Were the Baseline Characteristics of the Mental-Health Blogs Sampled?
Table 2 displays the baseline characteristics of the mental-health blogs
studied. The average age of the mental-health blogs sampled was 3.3 years.
Almost all blogs had archives (98.4 percent), internal links (97.3 percent), external
links (87.2 percent), and sections for readers’ comments (97.3 percent). Audio
clips (5.3 percent), video clips (17.0 percent), sponsorship (8.5 percent), and
advertising (18.1 percent) were less common attributes.
Women comprised 83.1 percent of mental-health bloggers. Bloggers’ mean
age was 35.6 years. Almost half of mental-health bloggers had college graduate
degrees or less (47.1 percent), fewer had master’s degrees (28.6 percent) or
doctorate degrees (24.3 percent). The largest proportion worked in a non-healthrelated profession (86.2 percent); just 3.3 percent worked as a doctoral-level
practitioner and 10.5 percent as a non-doctoral-level practitioner.
Most blogs focused on disease/disability experience (96.8 percent). Very few
focused on other issues, whether, for example, health policy/law (0.5 percent),
health research/news (3.7 percent) or doctoral-level practitioner experiences (1.1
percent). More than half of the blogs assumed a patient/consumer perspective
(56.4 percent), about a third (33.5 percent) the perspective of a caregiver, and just
10.1 percent the perspective of health/other professional.
Were There Differences Between Mental-Health and Other Health-Related Blogs?
Table 2 also compares the characteristics of mental-health blogs to other
health-related blogs. Most mental-health bloggers were female (83.1 percent) as
compared to half of other health bloggers (52.4 percent) (p < .001). Virtually all
mental-health bloggers worked in a non-health-related field (86.2 percent); in
contrast, more than half of other health bloggers worked as either doctoral (26.2
percent) or non-doctoral (32.7 percent) level practitioners (p < .001). There also
were significant differences with respect to highest educational achievement, with
mental-health bloggers being substantially less likely to have doctoral degrees
than other health-related bloggers (24.3 percent vs. 49.0 percent) and substantially
more likely to be college educated or less (47.1 percent vs. 30.5 percent) (p < .001).
Average age was similar between the two groups (35 years).
Compared to other health bloggers, a lower proportion of mental-health
bloggers included sponsorship (8.5 percent vs. 18.3 percent) (p < .01) and
advertising (18.1 percent vs. 30.5 percent) (p < .01) on their blogs. There were no
statistically significant differences between mental health and other blogs across
the other blog features analyzed.
Mental-health bloggers were much more likely than other health bloggers to
blog about disease and disability experiences (96.8 percent vs. 29.2 percent) but
substantially less likely to blog about practitioner-related experiences, doctoral
(1.1 percent vs. 11.8 percent), or otherwise (1.6 percent vs. 13.6 percent) (p < .001).
Mental-health bloggers were also considerably less likely than other health
bloggers to blog about health research and news (3.7 percent vs. 18.0 percent)
(p < .001), health policy and law (0.5 percent vs. 21.2 percent) (p < .001), and
nutrition (0.5 percent vs. 4.3 percent) (p < .01).
Last, mental-health bloggers were considerably more likely than other health
bloggers to blog from a patient/consumer (56.4 percent vs. 33.2 percent) and
caregiver (33.5 percent vs. 1.7 percent) perspective but substantially less likely to
blog from the perspective of a professional (10.1 percent vs. 65.1 percent)
(p < .001).
Were There Differences Across Mental-Health Blogs With Varying Foci?
Table 3 compares the characteristics of mental-health blogs with differences
foci. On average, the age of those blogging about developmental disorders (40.2
years) and eating disorders (29.1 years) were significantly older and younger,
respectively, than those blogging about other mental-health areas (35.6–38.5 years)
(p < .001). Nearly all blogging about developmental disorders and eating
disorders were female (87.0 percent and 93.0 percent, respectively), as compared
to three quarters blogging about severe mental illness (78.8 percent) and
depression (77.8 percent) and two thirds about general mental-health concerns
(65.0 percent) (p < .05).
Doctoral degrees were most prevalent among general mental-health bloggers
(61.5 percent vs. <26.0 percent); college degrees or less among those blogging
about depression and severe mental illness (66.7 percent and 52.6 percent,
respectively, vs. <48.0 percent) (p < .05). Doctoral-level practitioners were most
common among general mental-health bloggers (26.1 percent); other practitioners
among general mental health (17.4 percent) and eating disorder (18.6 percent)
bloggers (p < .001); non-practitioners among those blogging about depression
(100.0 percent), severe mental illness (94.0 percent), and developmental disorders
(93.1 percent) (p < .001).
At 2.6 years, on average, eating disorder blogs were significantly younger
than the other blog analyzed; at 3.7 years, developmental disorder blogs were
significantly older (p < .001). Sponsorship was especially common among general
mental-health blogs (24 percent) and eating-disorder blogs (14.0 percent) relative
to other blog areas (<6.0 percent) (p < .01). There were no statistically significant
differences between mental health and other blogs across the other blog features
analyzed.
All blogs about severe mental illness, development disorders, and depression,
and virtually all about eating disorders (97.7 percent) emphasized disease and
disability experiences, as compared to 80.0 percent of blogs focusing on general
mental health (p < .001). General mental health blogs, in contrast, were more
likely than other blogs to emphasize health research and news (28.0 percent vs.
0.0 percent, p < .001) and health practitioner experiences, both doctoral-level (8.0
percent vs. 0.0 percent, p < .05) and other (12.0 percent vs. 0.0 percent, p < .01).
Blogs focusing on developmental disorders were much more likely to be
authored by caregivers than the other blog areas studied (91.4 percent vs. <12.0
percent) (p < .001). By contrast, patients/consumers were much more likely to
author blogs focusing on severe mental illness (88.7 percent), eating disorders
(86.0 percent), and depression (100 percent). Professional bloggers were most
common among general mental-health blogs (56.0 percent), though about one
third (36.0 percent) were authored by patients/consumers as well.
What Was the Survival Status of the Mental-Health Blogs Sampled at Follow-Up?
Table 4 summarizes the current status of the mental-health blogs sampled in
2007 and 2008. Two thirds (66.5 percent) of the blogs were still visible in 2014, the
remainder were either password protected (13.3 percent) or closed (20.2 percent).
Among visible blogs, 38.4 percent and 7.2 percent had last posts dated in 2014
and 2013, respectively. Not surprisingly, survival rates varied depending on the
definition of blog survival employed. The most liberal definitions included
password-protected sites; here, survival rates ranged from 38.8 percent when
only accounting for blogs with last posts in 2014 to 43.6 percent when accounting
for blogs with last posts in either 2013 or 2014. The most conservative definitions
excluded password-protected sites; here, survival rates ranged from 25.5 percent
when only accounting for blogs with last posts in 2014 to 30.3 percent when
accounting for blogs with last posts in either 2013 or 2014.
Were There Differences Across Mental-Health Blogs Based on Survival Status?
Table 5 examines the relationship between survival status and baseline
characteristics using the two conservative definitions of survival described.
Results reveal few baseline correlates of survival. Nonetheless, findings suggest
that blogs still posting in 2013 or 2014 were more likely to be authored by health
practitioners than blogs that had ceased posting (22.2 percent vs. 10.2 percent),
whereas blogs that had ceased posting were more likely to be authored by
someone working outside the health sector than blogs that had continued to post
(89.8 percent vs. 77.8 percent) (p < .10).
Sponsorship and advertising proved to be significant correlates of survival no
matter which definition of survival was used. Thus, blogs still posting in 2013 or
2014 were more likely than blogs that had ceased posting to have had
sponsorship (14.0 percent vs. 6.1 percent, p < .10) and advertising (26.3 percent
vs. 14.5 percent, p < .10) at baseline. Similarly, blogs still posting in 2014 were
more likely than blogs that had ceased posting to have had baseline sponsorship
(16.7 percent vs. 5.7 percent, p < .05) and advertising (27.1 percent vs. 15.0
percent, p < .10).
Blogger perspective was an especially significant correlate of survival when
using the most stringent definition of survival applied in this study. Thus,
mental-health blogs still posting in 2014 were more likely than terminated blogs
to be authored by professionals (18.8 percent vs. 7.1 percent) and caregivers (39.6
percent vs. 31.4 percent) (p < .05). In contrast, blogs that had ceased posting were
more likely to be authored by patients/consumers (61.4 percent vs. 41.7 percent).
Discussion
This study analyzed the content of 188 mental-health blogs identified in 2007
and 2008, compared the content of those blogs to 753 other health-related blogs
also collected during this time period, and explored differences across mentalhealth blogs with varying foci. It also determined the proportion of mental-health
blogs continuing to post at follow-up (2014) and the correlates of survival up until
that point. In sum, findings indicate that mental-health bloggers were most likely
to be females without graduate degrees blogging as patients/consumers or
caregivers about various mental illnesses or conditions. This is in contrast to
bloggers in other health-related areas who were more likely than mental-health
bloggers to be male master’s- or doctoral-level graduates blogging as professionals about a variety of topics, which, in addition to various illnesses or conditions
included health policy and law, health research and news, and practitionerrelated experience. Blogs in other health-related areas were also more likely than
mental-health blogs to rely on sponsorship and advertising.
Differences across mental-health blogs were apparent, however. In particular,
findings indicate that general mental-health blogs were more likely than blogs
about specific mental illnesses or conditions to be authored by male doctoral-level
graduates blogging from a professional perspective. Although less likely to focus
on various illnesses or conditions, general mental-health blogs were more likely
than other mental-health blogs to discuss health research and news and
practitioner-related experience and to include sponsorship and advertising.
Interestingly, blogs about developmental disorders (primarily autism) were
much more likely to reflect a caregiver perspective than blogs focusing on severe
mental illness, eating disorders, and depression, which were much more likely to
be authored from a patient/consumer point of view. Eating-disorder bloggers
tended to be younger and blog for shorter periods of time than bloggers in other
mental-health areas. Eating-disorder bloggers were also most likely to be
authored by females, though a comparatively high proportion of developmentaldisorder bloggers were female as well.
The proportion of blogs still active at follow-up ranged from 42.5 percent
when using the most liberal definition of survival employed (inclusion of
password-protected blogs and blogs last posting in 2013 and 2014) to 25.5 percent
when using the most conservative definition (exclusion of password-protected
blogs, blogs continuing to post in 2014 only). Mental-health blogs that continued
Miller/Pole/Usidame: Life and Death in the Mental-Health Blogosphere 73
to post new content at follow-up were more likely than mental-health blogs that
ceased posting to exhibit sponsorship and advertising at baseline. Terminated
mental-health blogs, on the other hand, were more likely than surviving blogs to
be written from a patient/consumer than professional or caregiving point of
view.
Most mental-health bloggers were female as compared to the bare majority
being female in other health-related areas. On the one hand, this finding contrasts
with some studies which suggest that the broader population of bloggers are
more likely to be male than female (Nielsen Company, 2012a). Alternatively, it is
consistent with other studies that show that American women are particularly
active online with one in three bloggers being, in fact, mothers (Lenhart & Fox,
2006; Nielson Company, 2012b). The disproportionate presence of female bloggers
in the sample studied may stem from the fact that women are more likely than
men to assume responsibility both for their own and their families’ health and
mental-health needs (Misra, 2001). Indeed, our study suggests that when females
blog about mental-health issues they often do so from the perspective of a parent
taking care of a child, typically with autism. The high prevalence of females
blogging about caregiving issues in mental-health contrasts with other healthrelated topics, such as reproduction, where women are much more likely to blog
about their own illnesses or conditions (Miller et al., 2011).
Very few mental-health blogs had audio or video content; most relied
exclusively on text and narration. This finding could, in part, reflect the time
period from which our sample was drawn, before audio and video content
became more widely ubiquitous. On the other hand, it also highlights the
journaling nature of blogging, which in increasing self-awareness and permitting
self-expression may serve as a source of catharsis among the patients and
caregivers who authored most of the mental-health blogs analyzed (Ressler,
Bradshaw, Gualtieri, & Chui, 2012; Ridgway, 2001). By providing a forum on
which to share experiences, blogs may play a role in reducing isolation and
increasing connection with others (Blass, 2007; Ressler et al., 2012). Indeed,
virtually all the blogs studied were written about one’s personal experience with
a disease or disability, again, from the perspective of either a patient/consumer
or caregiver. Thus, it would seem that mental-health blogs may be used to create
support networks and, perhaps, to enlighten others, including providers, about
the experiences of people impacted by mental illness (Bauer, Bauer, Spiessl, &
Kagerbauer, 2013; Cohen, 2007; Gowen, Deschaine, Gruttadara, & Markey, 2012;
Ressler et al., 2012; Wehbe-Alamah & Wolgamott, 2014).
By enabling people to express themselves in a relatively risk-free context, the
anonymity blogging provides may be especially important for achieving catharsis
and coping among those suffering from or caring for someone with a stigmatizing
mental illness or condition (Boniel-Nissim & Barak, 2013; Ko & Kuo, 2009; Rains,
2014; Sundar et al., 2007). That this may be the case is reflected in a recent study
which found a positive relationship between anonymity and self-disclosure
among bloggers who were embarrassed by their ailments (Rains, 2014). Selfdisclosure is important to the extent that it promotes coping and helps draw in
74 World Medical & Health Policy, 7:1
additional social support, a factor in promoting improvements in subjective wellbeing and understanding.
Although often positive, the anonymity, self-disclosure, and social/
emotional support that blogging provides can have potentially negative
ramifications, particularly among people partaking in or contemplating selfdestructive behavior. On the one hand, for example, pro-eating disorder
websites and blogs provide authors and readers with opportunities to cope
with a stigmatizing condition by engaging in self-expression and seeking out
and obtaining information and social support (Tong et al., 2013; Tubaro &
Mounier, 2014; Yeshua-Katz & Martins, 2013). On the other hand, pro-eating
disorder websites may promote unhealthy standards of thinness, extreme
dieting and exercising, damaging lifestyle choices (anorexia, bulimia), and
strategies for avoiding detection (Borzekowski, Scenk, Wilson, & Peebles, 2010;
Peebles et al., 2012; Tong et al., 2013; Yeshua-Katz and Martins, 2013). This
exposure may, in turn, have adverse effects on users, contributing to negative
perceived body image, knowledge and engagement in unhealthy weight loss
techniques, and lower overall quality of life (Jett, LaPorte, and Wanchisn,
2010; Peebles et al., 2012; Rouleau & von Ranson, 2011). The same is true for
websites that promote or condone suicide and non-suicidal self-injury where
evidence suggests a correlation between online content, suicidal ideation, and
knowledge about engaging in and/or concealing the behaviors highlighted
(Durkee, Hadlaczky, Westerland, & Carli, 2011; Harris, McLean, & Sheffield,
2009; Lewis, Rosenrot, & Messner, 2012; Sueki, Yonemoto, Takeshima, &
Inagaki, 2014).
Findings suggest that blogging’s potential benefits and drawbacks may be
fleeting, at least when applied to any particular blog. According to our most
conservative estimates, relatively few blogs, 25.5–30.3 percent, continued to post
6–7 years after initial inclusion in our sample. Moreover, blogs authored by
patients/consumers were less likely to survive until follow-up than blogs
authored by caregivers or professionals. That patient/consumer blogs might
struggle to survive could, in part, reflect the physical and emotional toll imposed
by mental illness over time. It could also, in part, reflect the lack of effective
treatment among mentally ill bloggers who because of stigma, inadequate
insurance coverage, and preference for virtual rather than in-person contact may
be less likely than others to seek treatment offline (Germanotta & Swearer, 2014;
Marcus et al., 2012; Moessner & Bauer, 2012; Peebles et al., 2012; Wehbe-Alamah
& Wogamott, 2014). In addition, it could, in part, reflect less frequent use of
sponsorship, advertising, and other revenue-generating strategies among patient/
consumer than professional bloggers (Miller et al., 2011). That so few mentalhealth blogs survived until follow-up could also derive, in part, from exponential
growth in online activity across a broad array of social media platforms.
Over the last decade, there has been a greater than 10-fold increase in the proportion of
Internet users engaging in social media, from just 7.0 percent in February 2005 to
72.0 percent in May 2013 (Fox, 2014). Commonly used social media options now
include a growing array of traditional blogs, microblogs (Twitter, Tumblr), social
Miller/Pole/Usidame: Life and Death in the Mental-Health Blogosphere 75
networks (Facebook, LinkedIn, Google þ), and photo/video sharing applications
(Instagram, YouTube, Snapchat). Since we collected our original data, therefore,
the number and variety of options available to connect virtually about mental
health has broadened considerably. The resulting competition has likely led to
subsequent reduction in blogging as a means of online expression in this area.
This, in turn, may be another reason why so few blogs in our 2007/2008 sample
remain active in 2014.
Although few mental-health professionals blogged, the prevalence of
blogging among patients/consumers and their caregivers suggests an opportunity for mental-health providers to use blogs as an avenue to better understand
and connect with their clients. This possibility is reflected in a study which
sought to identify barriers to accessing mental-health treatment by analyzing
eight mental-health blogs written by young adults between the ages of 18 and
25 (Marcus et al., 2012). Based on the results, recommendations were made to
address young people’s negative views and disconnect from the mental-health
system. The potential for using mental-health blogs to better understand and
connect with clients is also reflected in a study that asked bloggers and their
readers with borderline personality disorder (BPD) to evaluate and suggest
changes to the Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV) (Kalapatapu, Patil, & Goodman, 2010). Results highlighted
both the willingness of the BPD population to share their opinions with mentalhealth professionals and the consistency between how those with BPD
described their condition and the manner in which BPD was represented in the
DSM-IV.
Limited blogging by mental-health professionals in the sample studied
suggests an opportunity to use this and other social networking formats to more
broadly disseminate mental-health information. If professionalism is to be
maintained and blogs used as an effective tool for outreach and education,
standards governing content quality, client confidentiality, and real or perceived
conflicts of interest need to be promulgated and followed (Harty-Golder, 2005;
Kennedy, 2008; West & Miller, 2009). Sponsorship and advertising play an
especially important role when considering the implications of real or perceived
conflicts of interest. Sponsorship involves ongoing relationships between bloggers
and entities that pay for and/or host their blogs; for example, a health system,
media conglomerate, or pharmaceutical company. Advertising involves placement of specific messages intended to lead visitors to external websites that sell particular products or services. Our results indicate that professionally authored blogs with sponsorship and advertising are longer lived and, hence, more visible
than other mental-health blogs. This longevity, in turn, likely leads these blogs to
have a disproportionate impact on the help-seeking behavior of individuals
referred to them by search-engine results. This suggests that the promulgation
and adherence to professional guidelines governing the disclosure of real or
perceived conflicts of interest are especially critical, particularly in an era
characterized by growing concern over “advertorials” and other industry paid/
driven content (Slegg, 2013).
