Role of media – social, electronic, and print media – in mental health and wellbeing

INTRODUCTION

For the public, the media is a major source of information and misinformation. Even after the digital revolution, newspapers and magazines remain popular and offer an efficient opportunity to convey mental health information to the masses with attached authenticity. Instead of leaving the write-ups on mental health to journalists and individuals from unrelated fields, psychiatrists should actively participate in the process to ensure that the published information is scientifically and culturally valid. In the realm of electronic media and social media (SM), where numerous biases, myths, and misconceptions are perpetuated, it becomes essential for psychiatrists to proactively spread accurate information and diplomatically debunk erratic posts. In addition, considering that inappropriate use of electronic and digital media can lead to diverse mental health issues, psychiatrists should possess expertise in recognizing, managing, and preventing such problems.

Why communicate science to the public?

If we fail to communicate science to the public in a clear and effective manner, they may fall prey to misinformation and pseudoscience. Studies have revealed a high prevalence of stigma and misconceptions regarding mental illness in India. Effective communication about the latest research is also vital to secure research funds and influence decision-making by individuals, organizations, and policymakers. However, imperfect educational attempts can lead to misunderstandings. Therefore, it is crucial for those endeavoring to educate the public through diverse media to be aware of the most effective methods to achieve this goal.

General principles of effective science communication

• Have a SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) objective for each activity.

• Remember that the public may include those who are genuinely interested in the topic, as well as those who have no interest or even opposing views. One should strive to reach all these groups. Some ways to ensure this are by including individuals from the disinterested or opposing groups in your planning team and beta-testing your write-up or video on some of them.

• Have one key message and repeat it in different ways.

• When addressing complex issues, try to involve an interdisciplinary team.

• Depending on the audience, in addition to providing reliable information, include some details of the research or other mechanisms that led to the facts shared. This would help them make informed decisions regarding the trustworthiness of the information and its sources.

• To effectively communicate a topic, one has to thoroughly understand it oneself.

ELECTRONIC AND SOCIAL MEDIA

Advances in technology have made life easier with respect to education, acquiring information across the globe, entertainment, social connectivity, monitoring one's lifestyle (smart watches), online gaming, and saving time and money required for physical presence. Overall, electronic media such as mobile, mobile applications, television, radio, news portals, and websites and SM platforms such as Facebook, Twitter, Snapchat, YouTube, and Instagram have resulted in comfort and ease of life at just a few fingertips distance. In an era dominated by electronic media, where technology is omnipresent, it is essential to recognize its potential for promoting mental health and well-being. It can be effectively used to impart information about mental health conditions and positive mental health, provide tips for the promotion of mental well-being, educate people of all ages about mental health and illnesses, and spread information about government programs/policies for mental health and services available.

The Digital India initiative of the Government of India and increasing internet penetration in recent years has resulted in India's digital population reaching up to 692 million active users (48.7% internet penetration). This increase is mainly because of the rise in mobile internet use.[1] The active internet use among the population of 12 years and more has increased enormously to reach around 595 million in 2022 (rise by >20%) (The Economic Times, March 2023). Out of this, the prevalence of SM users in the Indian population is 32.8% (467 million), as reported in January 2023. Research also says that in early 2023, the active mobile user count reached 77% of the total population.[2] This data is alarming as more the internet users, the higher the prevalence of pathological internet use, though it is not clear what exactly the internet users get addicted to. However, this can be viewed positively also as the higher the internet use, the more the opportunity to spread awareness about mental health to deeper sections of the country. It can also be used for empowering individuals to enhance their well-being and access support and resources in a digital landscape.

Using digital media effectively

Display professionalism: While appearing in a video, wear decent clothes and appropriate attire. Carry a smile. Speak to the point. Speak in a simple language appropriate to the intended audience. Convey clear and scientific information in understandable language, preferably using examples and experiences. Never use loose terms or sentences that create doubt in someone's mind. Share recent statistical figures about the topic. It is better to speak about what one is sure about. Anything said in a live program cannot be reverted, and it spreads quickly to millions of viewers; as such, one has to be careful while using words or comments.

During panel discussions, maintaining eye contact with the moderator and other panelists and alternately with the camera will impart a good way of communication on media. Respect others' opinions and views. If one disagrees with the other's perspective, a descent confrontation with a balanced approach and a complete scientific clarification of what one thinks is correct is needed. Avoid arguments or proving how the other person is wrong, especially in debates on sensitive topics such as suicide.

Counteracting myths and misbeliefs: While debunking a myth is necessary, do it non-judgmentally. Be aware of the cultural aspects of different communities or regions based on which the myths are usually built. The focus should be on minimizing the mental health risks associated with following and practicing the myths rather than proving them wrong. Sometimes psychiatrists have to find a middle way of following a myth and prescribing scientifically appropriate advice. It is crucial to explain how myths can harm mental well-being if followed mindlessly rather than just advising not to follow them based on scientific knowledge.

Television: Television is mainly utilized for entertainment and news, but it can be a highly impactful electronic medium to spread mental health awareness. Movies, web series, plays, panel discussions, live programs, or any other format can be considered for this.

However, how much time one should spend watching television must be regularized. Literature mentions that the amount of time spent on television is directly proportional to the negative view about a mentally ill person. News telecasted or displayed on television should be monitored by government-affiliated mental health professionals, especially for news related to mental health, stress, suicide, and other sensitive topics. There are two theories for the impact of mass communication. First is “cultivation theory,” according to which a person spending more time in the “virtual world” starts perceiving and looking at the “real world” as per its portrayal in the virtual world. A person watching television excessively may have a television view of mental illness or mentally ill patients. The second is “social learning theory” (learning by observation). People may learn how to deal with a person with psychiatric illness as shown on television. These theories can result in the spread of stigma about mental illnesses. Utilizing these theories in reducing the stigma and spreading the right information about mental health is essential.

Radio: Most programs aired on the radio are prepared by the working staff with strict control over what message is to be spread. There are fewer chances for wrongly portraying mental health, psychiatrists, or psychiatric treatments or spreading false information about psychiatric illnesses. Radio can be an excellent medium to spread mental health awareness and education. Private psychiatrists are already doing an excellent job of guiding people through various programs on the radio. Indian Psychiatric Society or the state and local mental health organizations can utilize this medium for mass education and awareness about mental health and well-being. Parasparam, a weekly interactive one-hour live phone-in program with mental health professionals, has been airing on All India Radio Cochin FM for the past 11 years. It serves as a good model that others can assimilate. The only limitation is that the number of radio listeners has decreased in recent years.[3]

Smartwatches/apps: Nowadays, smartwatches are used by most fitness-seeking individuals, especially the young generation, to monitor their calorie burnout, the distance they run/walk, etc. Exercise is considered to be a protective factor for mental health too. It acts as a stress booster; as such, these digital/smart watches indirectly help promote mental health and well-being. They may motivate the individual for regular exercise and sleep. Some smartwatches also sense the stress level and guide about relaxation techniques, breathing exercises, and mindfulness, which can be timely and accurately practiced. If these devices are developed with mental health professionals in the loop, the scientific validity of the assessments and interventions can be ensured. One limitation of such devices is that their regular notifications may cause distraction or anxiety.

Medical education (application-based): Medical institutes have recently been utilizing digital and application-based platforms for medical education. Empathy and emotional intelligence can be taught digitally by specifically designed applications/software (e.g., empathy learning programs). A new construct in the medical curriculum, the “AETCOM Module,” includes teaching/learning “Attitude, Ethics, and Communication.” This is taught by case discussions, role plays, panel discussions, debates, showing videos, etc., and this can be done on digital media. Applications such as “Marrow” are utilized by medical students for various teaching-learning modules in formats such as videos and question banks. Applications like this can also be utilized to teach Psychiatry.

Detox Applications: Numerous applications exist to diagnose excessive screen use, monitor and track the time spent on SM, block notifications and distracting apps, and provide an analysis of smartphone activities (e.g. AppDetox, OFFLINE, Flipd, Moment, ClearLock, and Antisocial).

MENTAL HEALTH BENEFITS OF DIGITAL MEDIA

Effects of social connectedness: Social contacts stimulate the secretion of stress-relieving hormones. Social networking may help fulfill many human needs such as support, safety, association, estimation, acknowledgment, and love and respect, leading to higher satisfaction.

Early detection: In many cases, a person's posts or comments directly indicate a psychological issue such as depression, anxiety, or the emotional turmoil one is going through. This can be a clue that the person is struggling with some mental problem and needs help.

Video games: Video games can challenge one's mental abilities, which can help improve performance in other areas. Gaming activities stimulate and increase brain function. Video games are known to have an addiction potential if played excessively, but research has shown that certain video games are helpful in enhancing cognitive abilities and functions like attention, processing speed, mathematical skills,[4,5] and memory. Cognition-enhancing abilities of video games can also be utilized for older people or dementia patients. User-friendly video games with guidance and supervision of family members (balancing their screen time) can help improve the performance of older people in cognitive tasks.[6,7]

Video games are a potential tool in the treatment of attention deficit hyperactivity disorder (ADHD).[8] Certain video games can help in cognitive training and provide structured challenges that target relevant, specific cognitive skills. A factor limiting their use, however, is that video games may increase the risk of violence and aggression.

Social media: In addition to being an excellent tool for entertainment, connectedness, etc., if people use a thoughtful approach to using it with a healthier balance (controlling their screen time, turning off the notifications, avoiding checking the phone repeatedly), it can prove to be an impactful way of promoting mental health. It helps to get social support, access mental health services easily (online consultation, helplines, or hotlines), cope with stress, improve the mood, and get positive inspiration for lifestyle modifications and provides various opportunities. SM platforms such as Facebook keep a record of old photos and memories and give timely notifications of the activities done on the platform.

Challenging stigma about the marriage of a mentally ill person: SM can also be utilized to find suitable partners among stable mentally ill persons as there are certain matrimonial sites specially designed for the marriage of stable mentally ill people. Some of such matrimonial sites are already functional. This helps reduce the stigma about mental illness in the context of marriage and may prevent the post-marriage consequences of hiding the mental illness during marriage. It may also help to get a sense of accomplishment to a stable mentally ill person, though specific policies about supervision of marriage by family members and guidance about having progeny need to be formulated.

Awareness and advocacy: SM platforms have facilitated increased awareness and conversations surrounding mental health issues. Activists, organizations, and individuals can use these platforms to raise awareness, challenge stigma, and advocate for change, leading to improved mental health support and resources. Various techniques for mental health promotion via electronic and SM are listed in Table 1.

Table 1.

Mental health promotions through social and electronic media

Promotion activities	Social Media	Electronic Media
Creating mental health awareness and debunking myths	Booklets, guide statements, newsletters, videos, interviews, and live online programs.	Interviews (mental health professionals, recovered patients’ experiences), live question/answer or phone-in program
Information on mental illness	Reels, live programs on Facebook/Zoom/Google Meet	Talk show with the expert (TV/Radio)
Preventive psychiatry: Stress management, career guidance, work/life balance, lifestyle modifications, mindfulness, time management, goal setting, etc.	YouTube videos, interactive sessions, and recorded videos made publicly available.	Online sessions/live programs
Observance of national/international mental-health-related days	Uploading pre-recorded videos	Circulating videos and keynotes
Soft-skills training (communication skills, resilience, empathetic approaches, etc.)	Online programs on any social media platform	Live program and video recordings

Precautions required

Though electronic and SM are good means of sharing and disseminating personal or professional information quickly and easily, they carry a substantial risk of breach of privacy, misunderstanding of professionalism, break in confidentiality, etc. This increases the chances of blurring relationship boundaries with patients or colleagues. Distinct guidelines are required for the use of SM for professional and personal purposes. Psychiatrists should maintain ethical and professional standards while behaving on electronic and SM. While using SM, psychiatrists should weigh the potential benefits and risks. One should maintain a professional approach and avoid making comments that are not in their personal or professional capacity. One should remember that once information is disseminated in SM, removing it is usually impossible. It spreads easily and rapidly. While posting any information or communication, psychiatrists should always be aware of their online safety.

Use of media for health education and therapy: As the boundary between appropriate/inappropriate use or social/professional use of media is blurred, the possibility exists of violating the boundary knowingly or unknowingly. This may lead to allegations from patients, causing legal problems. Many mental health professionals have had to face the charges of being guilty of professional misconduct or nonprofessional relationships on media, especially SM [Box 1].

Box 1.

Recommendations for online consultation and therapy

Telepsychiatry has become increasingly important in India, particularly during the COVID-19 pandemic. The following are general guidelines and considerations for telepsychiatry in India. Regulatory framework: One should be familiar with the telemedicine guidelines issued by the National Medical Commission or Government of India and the Indian Psychiatric Society. These guidelines provide a framework for the practice of telemedicine, including telepsychiatry, in India. Ensure compliance with the guidelines related to patient consent, documentation, confidentiality, and prescription protocols. Patient Consent: Obtain informed consent from patients before initiating telepsychiatry sessions, ensuring they understand the limitations, benefits, and risks associated with remote mental health consultations. Document the patient’s consent as per the guidelines provided by the regulatory bodies. Privacy and Confidentiality: Use secure and encrypted platforms for telepsychiatry sessions to protect patient privacy and confidentiality. Educate patients about the importance of participating in sessions from a private and secure location to maintain confidentiality on their end as well. Recording the session should be practiced whenever possible. Technology Requirements: Ensure reliable internet connectivity and appropriate telecommunication infrastructure to support uninterrupted telepsychiatry sessions. Use good video conferencing platforms or secure communication tools that adhere to data protection laws in the country. Licensing and Credentials: A valid license to practice psychiatry is a must. Ensuring one’s adequate training and qualification in telepsychiatry practices is necessary. Consider additional training programs or certifications specific to telepsychiatry if available. It is also recommended to keep a record of the patient’s identity during an online consultation. Initial Assessment and Evaluation: Conduct a comprehensive initial assessment of the patient’s mental health status, medical history, and any potential contraindications for telepsychiatry. Assess the patient’s suitability for telepsychiatry and identify cases where in-person consultations may be necessary due to the severity of the condition or other factors. Emergency Preparedness: Establish protocols and mechanisms for managing psychiatric emergencies remotely, including clear guidelines for assessing risk, suicide prevention, and referrals to emergency services when needed. Communicate emergency contact information to patients and ensure they can access local crisis helplines or emergency services. Cultural Sensitivity and Language: Be aware of cultural differences and nuances while providing telepsychiatry services. To ensure adequate patient understanding and engagement, one must adapt the approach and communication style accordingly. Provide interpretation services or consider using multilingual staff or interpreters when language barriers exist. Continuity of Care and Follow-up: Develop a plan for ongoing care, including regular follow-up sessions and medication management through telepsychiatry. Coordinate with local healthcare providers or support systems to ensure continuity of care for patients, including referrals for in-person care whenever necessary. Evaluation and Quality Assurance: Regularly evaluate the effectiveness and safety of telepsychiatry services, seeking feedback from patients and monitoring outcomes. Engage in ongoing professional development, including attending relevant conferences, webinars, or workshops focused on telepsychiatry.

Managing an SM profile: Though what one should and should not post on SM is a personal decision, as a psychiatrist, there are many implications of publishing certain information on SM if it is accessible to everyone. This may seriously affect past, current, or future relationships with the patient or colleagues. Sharing personal details, relationship aspects, self-health-related information, political comments, opinions about certain persons or institutions, etc., can seriously impact the professional life of a mental health professional, along with threats to their safety. One should not post/disclose any information that can be a source of distress to any patients, their family members, or professional colleagues. Learning and utilizing the privacy settings of SM is recommended. Respect the information (of any kind) published by patients on their SM accounts. Ensuring confidentiality is expected from healthcare providers to avoid legal and countertransference issues. Any patient's information obtained from SM, if beneficial for clinical purposes, should be reverified for accuracy before use.

In this context, it is vital to be aware of National Medical Mission Guidelines regarding advertisements by registered medical practitioners (RMPs), including psychiatrists. Section 6.1.1 of the Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations, 2002, states that “A physician shall not make use of him/herself (or his/her name) as an advertising medium nor shall he/she promote any particular mode of treatment.” Section 6.1.2 of the same regulations prohibits doctors from soliciting patients directly or indirectly through advertisements, whether in the form of signs, displays, circulars, pamphlets, websites, or personal communications.[9] Doctors can also list their names in authorized directories and websites maintained by recognized professional medical associations or institutions. Physicians/groups of physicians/institutions cannot solicit patients directly or indirectly, which is considered unethical. An RMP is, however, permitted to make a formal announcement in the press regarding the start of practice, change of type of practice, change of address, temporary absence from duty, resumption of another practice, and public declaration of charges. Boxes 2–4 describe recommendations/guidelines for psychiatrists about media use, media reporting of mental illness and suicide (which are in line with the Indian Psychiatric Society guidelines on media coverage of suicide),[10] and managing promotional websites.

Box 2.

Recommendations for psychiatrists regarding the use of digital media

While doing any activity on social media, one should ensure whether that particular action has any legal consequences, whether it will bring any disrepute as a professional or to the psychiatry specialty, whether one is breaching any confidentiality related to the patient, and whether the step taken is going to help in the care of a patient. Social media should be utilized with a professional approach (e.g., making such a comment online that one would not make in a personal or professional life). Be aware of professional boundaries with colleagues and patients, and maintain confidentiality while using social media. Be careful while posting any information/image online or commenting on any issue. Use judgment and be mindful of ethical and moral responsibility while posting anything online. Be careful about what is to be posted publicly; if one notices the post of some inaccurate information, correct/remove it as early as possible and apologize if required. Be watchful about online presence and impression. Keep searching for yourself using any search engine regularly. Keep a separate login for personal and professional social media profiles so as to use professional media profiles for patients. Focus on whether the post is appropriate or not rather than whether it is professional or personal. Do not post any images/taglines (profanity, violence, sexuality, intoxication, illicit substance use, and other questionable behavior) that may bring one as a professional and Psychiatry to disrepute. If a patient’s information is sought online, ask for permission and ensure that you use the information only for the well-being of the patient. Be careful about diagnosing pathological internet use after clarifying the essential and non-essential internet use. Use the media to promote positive mental health, spread information about common mental illnesses to the general public, improve treatment adherence, and use separate forums to discuss professional dilemmas, gain knowledge, and hone clinical skills online. Take caution while advertising oneself in media to avoid misunderstanding and getting trapped in legal trouble. Psychiatrists must treat colleagues fairly and with respect. This covers all situations and all forms of interaction and communication. One must not bully, harass, or make gratuitous, unsubstantiated, or unsustainable comments about individuals online. Email communication with a patient: Use a separate email for professional purposes. Advise patient not to communicate via mail in emergencies or during acute drug reactions. Set up an automatic reply (will help especially in anxious patients). Keep a record and request an acknowledgment receipt. Use discretion in the subject line and keep the language scientific, with no personal comments (to avoid misinterpretation). If multiple emails are required, request a face-to-face/phone consultation. Take care of confidentiality during email communication.

Box 4.

Recommendations for managing a mental health promotional website

Ensure that all information on the website is accurate, evidence-based, and supported by reputable sources such as scientific journals, government health agencies, or renowned medical organizations. Clearly distinguish between information and promotional content, clearly labeling any sponsored or advertising material. Ensure that promotional material is not presented as objective health information. Regularly update the website to reflect the most current and accurate health information available. Clearly disclose the website’s purpose, ownership, and funding sources to provide users transparency. To establish credibility, provide information about the qualifications and expertise of the website authors or contributors. Clearly communicate the website’s privacy policy, informing users about the types of data collected, how it will be used, and whether it will be shared with third parties. Obtain explicit user consent before collecting any personally identifiable information and provide options for users to control the use of their data. Adhere to ethical advertising practices and comply with relevant regulations and guidelines. Avoid endorsements or testimonials that may misrepresent the effectiveness or safety of mental health services. Design the website to be user-friendly, accessible, and inclusive, considering different user needs, including those with disabilities or language barriers. Provide opportunities for users to interact with the website through features such as comments, forums, or contact forms, enabling them to seek clarification or ask questions. Respond promptly and professionally to user inquiries or feedback, to foster trust and engagement. Comply with legal and regulatory requirements. Do not disclose the patient’s identity on a website if any material related to patients is displayed, even for educational purposes. Regularly reviewing and updating the website’s content, addressing user feedback, and staying updated with medical research and guidelines are crucial for maintaining a trustworthy and reliable health-related website.

Box 3.

Guideline to media on reporting of suicide and mental illness

The headline should promote the Papageno effect (e.g., how wrong the step of suicide taken is), or it should never be a headline. Describe, in short, the facts without sensationalizing or romanticizing them. Minimal details about the method, lethality, or location of the act. No picture of the body, actual place, weapon, or complete personal details of the victim is to be shown. The cause of suicide should not be oversimplified. Precipitating factors can be mentioned. The history of psychiatric illness/problem should be clearly mentioned with a suggestion to seek help from mental health professionals. Repetitive reporting in the news should be avoided. Suicide victims should not be glorified (like by calling them martyrs). Publicizing the interviews of surviving relatives should not be done or should be done with great caution. News should never end without detailing how suicide could have been prevented by various measures, including a psychiatrist’s help. Guidelines for reporting a mental illness on media: The goal should be to promote mental health or treatment and not the fear, stigma, embarrassment, or negative view about persons with mental illness. The focus should be on how common, real, and treatable mental illnesses are. Family members’ role in treating mental illness and the possible impact on their mental health should be emphasized. Recovered patients’ experiences can be publicized (news/interview/video) with their consent. Accurate, factual, understandable, and simplified descriptions of mental illness should be publicized. Information about mental health care facilities should be widely displayed or flashed. Reliable references should be provided for accurate information, symptom complexity, etiology, treatment options, the importance of compliance, and the treatability of the condition, based on facts/statistics. Stigmatizing words should be avoided, such as lunatic, mad, psycho, mental, and sleeping pills. Usual myths and misbeliefs about mental illness should be specified and clarified.

Medico-legal aspects: Healthcare providers must be aware of the local laws, regulations, and guidelines governing patient privacy and adhere strictly to these standards when using electronic and SM platforms.

Some tips on recognizing and handling online misinformation are provided in Box 5.

Box 5.

Recommendations about handling online misinformation

Keep up to date with latest medical research in the field and continuous medical education about emerging medical issues to stay well informed and updated. Always verify the source of information before accepting or sharing it with others. It is better to get information from reliable and reputed journals, academic institutions, and validated guidelines by reputed professional organizations. Always cross-check the information from different sources before accepting it as accurate. Always evaluate the credibility of the author or researcher. Make a habit of checking for citations and references as genuine medical information is usually supported by references. Ensure that the tone and language have scientific and professional nature with no sensationalist language. It is better to evaluate the credibility of the website or platform where the information in published. Anecdotal stories or personal testimonials should not be considered as scientific evidence. Always display genuine resources of information for patients and promote digital health literacy among patients. Spread of potentially harmful misinformation should be addressed through public communication channels such as social media, articles, or interviews along with providing right information.

HARMS TO MENTAL HEALTH

Apart from physical harms ranging from eye strain and headache to poor immune system functioning and cardiac arrest,[11] increased and inappropriate use of electronic gadgets and SM has diverse adverse consequences on mental health:

Figure 1 depicts the vicious cycle of the use of media and mental health disturbances.

Figure 1.

The vicious cycle of media use and mental health disturbances

Many people use media to express themselves, to relieve their sense of inadequacy, low self-esteem, and anxiety associated with expressing one's views in person, to approach a person of the opposite sex, which they could not do in person, etc. Many people succeed, and it is rewarding for them, especially when they get positive responses to their posts. However, many others may further end up aggravating the feelings of inadequacy and decrease in self-esteem when they do not get the expected response to their posts or when they compare themselves with others online. This can be an indicator of mental health problems.

FOMO: Fear of missing out on something important, such as an inside joke or some information, leads to repeated checking of media and spending much time at the cost of neglecting many other priorities, along with procrastination. Individuals may feel pressured to participate in various activities, events, or trends, increasing stress and anxiety.

Distorted identity: Using excessive filters to appear good or get more responses and likes can lead to a distortion of the real self with false boosting of self-image.

Cognitive problems: Reduced concentration, problems with memorizing, impaired judgment, easy distractibility, poor academic performance, etc.

Emotional and behavioral problems: Irritability, loneliness, anxiety, depression, insomnia, competitiveness, insecurity, low self-esteem, risk-taking behavior, delinquent behavior, poor self-care, excessive use of pornography, indulging in or being victims of cybercrimes, etc. Binge-watching on media increases the risk for behavioral addictions, sleep problems, sedentary behavior, and distress (loneliness, anxiety, and depression).

Information overload and digital exhaustion: The constant bombardment of information through electronic media can lead to information overload and mental fatigue. Continuous exposure to screens, notifications, and digital distractions can impair sleep, contribute to attention deficits, and negatively impact overall mental well-being.

Indirect effects: Negative view or fear about anything (e.g., diseases such as COVID-19, a specific situation), copycat acts (suicide/risky games or stunts), getting inappropriate/harmful clues for illegal/unethical activities, etc.

Social issues: Social isolation, decreased confidence for physical social exposure, reduced interactions leading to problems in social relations, less time spent with colleagues or friends, social out-casting, marital problems, risk of divorce, etc.

Social comparison and self-esteem: Constant exposure to carefully curated images and idealized lives on SM can trigger social comparison, leading to feelings of inadequacy, low self-esteem, and increased anxiety. The pressure to present a perfect online image can harm mental well-being.

Occupational: Reduced concentration and frequent mistakes at work, procrastination, lethargy, more time required for work completion, irritability, etc.

Munchausen by proxy: The internet has increased the prevalence of Munchausen by proxy cases wherein mothers fake severe illnesses in their children to get support and sympathy on SM.

Cyber-psychiatric disorders

This group of disorders is characterized by preoccupation with the use of the internet, inappropriate or compulsive internet use, internet used with malicious intent or to harm others, etc. Individuals also keep secrecy about the extent of online (internet) use and there is an impairment in real-life functioning.[4] A few are enumerated below.

Cyber-sexual addiction: It refers to excessive downloading, watching, and trading of online pornography. Excessive porn watching can have complications such as erectile dysfunction.

Cyber-relational addiction: Here, an individual gets involved in an online relationship (chatrooms, social networks) and gives more importance to virtual encounters than real-life ones, resulting in marital discord and unstable family relations.

Internet compulsions: It is an inability to control internet use and mental and behavioral preoccupation with online activities, associated irritability when the person is unable to go online, mood changes, and conflicts with significant others over internet use. Examples include online gambling, online shopping, and trading online.

Computer addiction: An individual is excessively engaged with the use of a computer to the extent of ignoring or avoiding other important aspects of daily life.

Cyberbullying and online harassment: SM platforms can become breeding grounds for cyberbullying, trolling, and online harassment. Such experiences can lead to significant psychological distress, anxiety, depression, and even suicidal ideation among survivors.

Revenge porn (non-consensual pornography) is the sharing of sexually explicit images without a person's consent with an intent to humiliate or cause distress, typically posting images on SM, personal chat groups, or online.

Cyberchondria is associated with repeated internet searches for medical information, resulting in excessive concerns regarding physical health.

Use/abuse: It is difficult to accurately differentiate appropriate from inappropriate use of media. Pathological use of media is considered a behavioral addiction. It is comparable to substance-related addiction with respect to tolerance, craving, inability to control the use of media, continuing use despite knowing/having negative consequences, withdrawal symptoms, impairment in social, occupational, relationship, and other domains of life, along with spending excessive time online/offline on electronic gadgets. Some authors have formulated the criteria for internet addiction, but overall, there are no structured criteria for inappropriate use of media (electronic/social).

Young described the excessive use of the internet as an addiction for the first time. She also modified the DSM-IV criteria for pathological gambling to formulate criteria for pathological internet use.[12] DSM-5 describes it under Appendix and not in the text of addictive disorders. Several instruments are available for the assessment of internet addiction, but none of them are the “gold standard.”[13] The most commonly used ones are the Internet Addiction Test (IAT), the Internet Addiction Diagnostic Questionnaire (IADQ), Chen's Internet Addiction Scale (CIAS), and the Internet Addiction Scale (IAS). Most of the findings about internet addiction in the literature are based on surveys and self-prepared non-validated questionnaires. In addition, the majority of the studies do not differentiate essential from non-essential use of the internet, such as an employee remaining logged in all the time to timely check their mail, trade workers doing online trading, software workers doing their job, spending time on online studies and research, and people remaining online for searching of jobs. One meta-analysis showed the pooled prevalence of internet addiction in Indian youths as 22% (95% CI: 0.2%–66%).[14]

Suicide: Risk of suicide is higher in people with inappropriate use of digital media. There is increasing evidence about the internet and media influencing suicide-related behavior.[15]

Effects on children/adolescents: Though electronic gadgets and the internet have become a reality for children and adolescents' lives with considerable importance in education and development, they are exposed to online risks of abuse/addiction, cyberbullying, accessing inappropriate material, etc. Other risks include reduced physical growth due to less time spent playing outdoor games/activities and changes in the pattern of thinking as instead of looking to adults around them for cues about how to interpret social behavior in people, children have become dependent on SM peers for the purpose, imitating violent behavior (violence is almost a norm in movies/games/serials), reduced interactions, irritability, stubbornness, poor scholastic performance, antisocial behavior, sleep disturbances, memory issues, poor attention, impulsivity, etc.

Recommendations regarding media use for adults and children/adolescents are provided in Boxes 6 and 7, respectively. Recommendations that may help teachers keep themselves up to date in digital literacy to ensure their own and their students' online safety are provided in Box 8.

Box 6.

Proposed and possible healthy ways of media use for adults

Have a deliberate plan of usage based on the need and duration of the use of the gadget. Look out for gadget-free fun and educational activities. Have a plan of action to deal with unintended reactions to posts, such as not responding to them immediately. Schedule specific times to reply to posts/messages/emails. Responding only when one has the time to craft a thoughtful response is better. To get optimum sleep, keep the bedroom free of gadgets and avoid using them within one hour of bedtime. Remove from the phone all unnecessary applications that had been downloaded impulsively or are not currently used. While working, and if there is no need for the phone, keep it away and make it difficult to access until the work is accomplished. Use applications (e.g., AppDetox and Moment) to track and regulate smartphone usage. Such applications give feedback about the extent of screen use and help set rules for using social media apps. Talk to a trusted person about encountering online difficulties. One may also consult a mental health professional (such as a counselor or a psychiatrist) if there is difficulty with judicious screen use.

Box 7.

Recommendations regarding children's media use

Children should have access to age-appropriate content suitable to their values and maturity level. Daily screen time should not exceed 1–2 hours. Utilize parental control features and privacy settings provided by electronic devices, websites, and social media platforms. Foster open communication with children about their digital experiences, including encouraging them to share their concerns, questions, or online encounters. Educate children about online safety. Parents should proactively look for possible evolving threats (online sexual predators) and warn them about the same. They should gently guide them on how to respond when they encounter disturbing or inappropriate content. Teach children about the difference between virtual and real-life interactions and the potential risks of sharing personal information online. Encourage children to engage in educational and creative activities that promote learning and skill development. Motivate them for a balance between online and offline activities. Adults should serve as positive role models for responsible media usage. Ensure that the child does not sleep with electronic gadgets.

Box 8.

Recommendations for teachers about keeping themselves up to date in the context of digital literacy and ensuring their and students' online safety

Teachers should be aware about various initiatives taken by the Ministry of Education and Government of India regarding digital learning and safety. Teachers should keep themselves updated about the latest digital platforms used for education, safety tools, and current digital trends and applications. It is desired that they subscribe to educational blogs, follow reliable and genuine technology news sources, and keep themselves updated by attending webinars, conferences, and workshops related to digital literacy. They can also lean from colleagues. It is important to acquire new skills and adapt to new technologies to keep oneself updated. For online security and privacy, they should use unique and strong passwords for their accounts. They can consider using a password manager. They should be cautious about sharing their personal information online on social media in professional or personal context. To ensure latest security services they should regularly update their devices and software. During online research and information gathering, they should critically assess the obtained information for reliability, credibility, accuracy, and presence of bias. They should practice effective digital communication skills while using emails, social media, or any other online platforms and teach the students about online safety and etiquettes. Teachers should train students in media literacy and help them identify and analyze different types of media such as images, videos, and articles for authenticity as well as purpose. It is crucial to remain aware about copyright laws and promote ethical and fair use of digital content among students. Teachers should educate students about cyberbullying and responsible online behaviour and sensitize them about the consequences of cyberbullying. They should lead by examples with positive environment during online teaching. Teachers should teach data literacy to students by helping them analyze data, charts, and graphs online. It is important to remain familiarized with educational platforms, learning management systems, and digital collaboration tools and keep experimenting about what works best for individual teaching pattern. Schools can have a digital learning monitoring cell so as to keep digital literacy activities strictly supervised. Teachers should also keep parents updated about digital literacy initiatives and provide them resources to support their children in digital literacy.

CYBERCRIMES AND COMPLAINTS

Cybercrimes are criminal activities committed using computers, networks, and digital technologies. Common and increasing cybercrimes include hacking (unauthorized access to computer systems, networks, or devices to steal, manipulate, or destroy data), phishing (sending fraudulent emails or messages that appear legitimate, to trick individuals into revealing personal or sensitive information), identity theft (stealing personal information, such as financial details or Aadhar number, to commit fraud or other criminal activities), online fraud (deceptive schemes conducted over the internet, including investment scams, lottery fraud, and fake online shopping websites), cyberbullying (harassment, threats, or intimidation using digital platforms, targeting individuals, particularly minors), cyberstalking (persistent online harassment or stalking behavior), online scams (fraudulent schemes conducted on the internet, such as romance scams and fake job offers), malware (malicious software, including viruses, worms, Trojans, and spyware, designed to damage, steal, or control computers and networks), data breaches (unauthorized access or disclosure of sensitive or confidential information, usually resulting in the compromise of personal data), credit card scams, cyberterrorism, developing and distributing child pornography, etc.

These cybercrimes can be informed to the nearest police station, or one can reach out to the National Cyber Crime Reporting portal (helpline number: 1930) to register any complaint about cybercrime, including cyber fraud. One can also visit the website www.cybercrime.gov.in to lodge a complaint.

Complaining about misinformation in the media

We can complain against false or offending reporting that violates the code of practice of media.

Print media: One can first write to the editor. If there is no reply, one can blog and share it on SM. If there is no reply within a reasonable time, one can complain to the Press Council of India within a specified time frame ranging from 2 to 4 months, based on the type of print media (email: pcibppcomplaint@gmail.com, website: http://presscouncil.nic.in).

Broadcasting channels: One can write a formal complaint to the broadcaster before complaining to the News Broadcasting Standards Authority. The following details are necessary for a complaint: a copy of the complaint letter consigned to the broadcaster, a copy of the response from the broadcaster, details of the broadcaster, details of the story or program with date, time, and channel of broadcast, and brief mention about the code that was violated. An online complaint form is available at https://www.nbdanewdelhi.com/complaint-form.

Social media: One can file complaints online through the concerned SM platform's website or take a lawyer's help to file a case in a civil or criminal court.

FUTURE ADVANCES

The future of electronic and SM use in relation to mental health and well-being holds both opportunities and challenges. While technology can enhance mental health support, foster community connections, and raise awareness, careful attention must be given to potential risks and ethical considerations. Striking a balance between the benefits and risks of electronic and SM will require ongoing research, collaboration, and responsible use to ensure a positive and supportive digital environment for all.

Personalized mental health support: The future holds immense potential for the use of electronic and SM in the field of mental health support. With the rise of artificial intelligence and machine learning, personalized mental health applications and chatbots could be developed to provide timely interventions, support, and therapy to individuals experiencing mental health challenges. These tools may leverage user data and patterns to offer tailored coping mechanisms and resources. Thus, access to mental health literature and mental health care services will be easy in the future.

SM influencers as mental health advocates: In recent years, many SM influencers have used their platforms to raise awareness about mental health issues and promote self-care practices. This trend is expected to continue, with influencers becoming more proactive in sharing evidence-based strategies, encouraging open conversations, and combating the stigma associated with mental health. The influence of these individuals can play a significant role in shaping positive online communities and fostering a sense of support and understanding. SM influencers can be an excellent resource for mental health awareness, promotion of positive mental health, and preventive psychiatry if mental health professionals join hands with them as they have the potential to reach the masses due to their fan following and reach.

PRINT MEDIA

Print publications, including newspapers, general magazines, and specialized health publications, continue to be popular in India despite the digital revolution. They serve as excellent platforms for spreading awareness about mental health. However, in today's era of short attention spans due to SM and reels, it can be challenging to capture the masses' attention. Unless one is diligent, written articles may not reach the audience they deserve. Here are some remedies recommended by experts in popular science writing:

Depend on accurate sources

• Base the articles on evidence: Instead of filling the pages with personal opinions and experiences, provide information from the latest research in the field. Search for appropriate articles on PubMed and Google Scholar by using filters to get recent results. While it may not be possible to go through each paper in detail, review articles and introduction sections of research papers can provide valuable insights. Develop the ability to critically review research findings (one common error is confusing between correlation and causation). Focus on summarizing and synthesizing information rather than listing individual study findings. Instead of hyperaccuracy, use approximate figures (e.g., “about 90%” instead of “91.45%”).

• Include local research data: Data from abroad may not always be applicable to India or a specific region. Whenever possible, include research information, such as prevalence rates, from the relevant geographical area. For instance, when writing about the complications of cannabis use, mention the prevalence of cannabis use found in studies conducted in your state or nearby ones. As such papers may not be available in PubMed or Scopus, utilize resources such as Google Scholar and general search engines.

• Sources of tips: If your intention is to share with the readers several practical tips related to a mental health topic, journal articles may not provide you with usable information. Websites such as Psychology Today and WikiHow, as well as foreign books written for the general public, can be helpful sources. If you frequently write for the public, consider a Kindle Unlimited subscription to access such books at a lower cost. Ensure that the tips selected have face validity based on your professional training and experience and are relevant to the local culture.

Clarity in writing

To improve the clarity of your writing, consider employing the following techniques:

• Metaphors: Use metaphors to explain complex concepts. For example, liken iron channels to gates or compare synaptic pruning to pruning plants.

• Examples: Accompany concepts with relatable examples that the general public can understand.

• Handling jargon: Avoid using technical terms whenever possible. If they are essential, first present them in a shorter sentence. If a technical term is crucial to the article, use it in the title of the article and as the first word in the sentence in which it first appears. Otherwise, place the term in the middle of a sentence instead. Always explain them with examples. For example, after defining “oversharing,” one can say, “Examples include posting on SM the photos of every meal or most places you visit.” Should you mention the technical term as its original English version, or should you translate it to the Indian language in which you are writing? That should be decided on a case-by-case basis. If you feel the English version of the term would be familiar to many, you can use that itself. Sometimes, one may have to use both the English and the translated versions. If one translation in your language is likely to be familiar to the readers, use that word instead of creating a new translation yourself.

• Avoid the “curse of knowledge”: Do not assume that readers possess basic information about your topic. Define and explain basic terms to ensure clarity.

• Utilize images: Incorporate appropriate photos and diagrams to enhance understanding. Create your own visuals or find copyright-free images online. Provide acknowledgments when using images from other sources and ensure they have sufficient size and resolution for printing.

Making it engaging

To make your write-up more interesting, consider the following techniques:

• Quotations: These can be provided at the beginning of an article or anywhere in the middle. For example, an article on the psychology of violence may start with the following quotation from Isaac Asimov: “Violence is the last refuge of the incompetent.” While translating a quotation to an Indian language, do not do it word-by-word. Instead, draft a version that conveys the essence of the sentence. Using quotations from literary works or sayings in your language would be more effective. Utilize online resources or books of quotations to find relevant quotes.

• Proverbs: Incorporate proverbs from the local language when appropriate.

• Anecdotes: Include anecdotes from news reports or your own clinical experience. For instance, when writing about delirium tremens, mention cases reported in the news or from your own practice. Maintain a personal collection of anecdotes by using software such as Evernote, tagging them with appropriate keywords for easy retrieval when writing on specific topics.

• Humor: Use jokes related to the topic to engage readers. Find suitable jokes online and acknowledge the source.

• Creative titles and subheadings: Avoid academic-sounding titles and opt for wordplay, rhymes, or puns. Learn from the titles journalists use in sports pages. Strive for creative and attractive subheadings as the readers might scan them before deciding to read the whole article.

• Supplementary boxes: Prepare boxes with interesting trivia, significant tips, or additional material that may not fit in the main article. For example, in an article about the health benefits of happiness, include a box mentioning the study that found a decrease in cardiac deaths in French men on the day France won the football world cup in 1998.

Balancing breadth and depth

When writing within word count restrictions, it is important to strike a balance between breadth and depth. Prioritize providing the essential first-level information that the public needs to know. Avoid diving into controversies or delving into advanced topics meant for professionals.

Sentences and words

Prefer short words and sentences, especially when discussing complex ideas. Vary the length of consecutive sentences to break monotony, ensuring readability and clarity in longer sentences. Maintain a smooth flow between adjacent sentences by using transitional phrases such as “moreover,” “nevertheless,” “however,” and “secondly” to improve the overall coherence of the writing.

Choose simple and specific words that best convey the intended meaning. Continuously expand your vocabulary by reading general literature and non-fiction articles from various fields and using a thesaurus.

Rewriting and editing

As Ernest Hemingway famously said, “The first draft of anything is shit.” Editing is crucial to remove redundancies and improve precision and clarity, the overall quality of the writing, and the “sound” of the passages. It is beneficial to wait a few days before editing, to gain a fresh perspective. While editing, pay attention to ambiguities, lengths of sentences and paragraphs, punctuation, and typos. Ensure that the words used are the best ones to convey the intended meaning. Useful methods to detect errors that might otherwise be missed include taking a printout of a typed article and listening to it using appropriate tools.

Finding ideas

Magazines often propose topics, especially to individuals who can provide high-quality drafts within deadlines. Beginners can start by preparing articles and publishing them on SM or in small publications to gain visibility. Another approach is to find interesting and novel topics, write articles, and submit them to suitable publications with a well-crafted cover letter. Keeping up with the news can provide ideas about the most discussed mental health topics that magazines might find worthy of publication. In addition, apps such as “Researcher: Discover and Discuss” can help follow scientific journals in your areas of interest and identify cutting-edge research.

Table S1 provides a list of recommended books on writing in general and popular science writing in particular.

Table S1.

Suggested books on writing and popular science writing

General books on writing “WRITING TOOLS: 50 Essential Strategies for Every Writer” by Roy Peter Clark “It Was the Best of Sentences, It Was the Worst of Sentences: A Writer’s Guide to Crafting Killer Sentences” by June Casagrande “Building Great Sentences: How to Write the Kinds of Sentences You Love to Read” by Brooks Landon “How to Write a Sentence: And How to Read One” by Stanley Fish “Make Every Word Count: A Guide to Writing That Works—for Fiction and Nonfiction” by Gary Provost “Beyond Style: Mastering the Finer Points of Writing” by Gary Provost “The Sense of Style: The Thinking Person’s Guide to Writing in the 21st Century” by Steven Pinker “The Oxford Essential Guide to Writing” by Thomas S. Kane “The Art of Nonfiction: A Guide for Writers and Readers” by Ayn Rand Books on science writing “Don’t be such a scientist” by Randy Olson (Quoting someone) “When it comes to mass communication, it’s as simple as two things: arouse and fulfill. You need to first arouse your audience and get them interested in what you have to say; then you need to fulfill their expectations”. “Juxtaposing of serious science with silly and even sexual humor… has the potential to be extremely powerful in mass communication”. “Am I making myself clear? A scientist’s guide to talking to the public” by Cornelia Dean (Quoting someone) “Glocal” approach - taking a global issue and making it meaningful on a local level. “State your conclusions in a way that is interesting and informative but not dogmatic.” “The craft of scientific writing” by Michael Alley “The science writers’ handbook” Edited by Thomas Hayden and Michelle Njhuis “The science of communicating science: the ultimate guide” by Craig Cormick “Health writer’s handbook” by Barbara Gastel

CONCLUSION

By harnessing diverse media effectively, we can empower individuals, reduce stigma, and support mental well-being. It is also crucial to recognize and address the potential negative impacts of digital media on mental health and well-being.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.