Addictive Behaviors 42 (2015) A1–A2
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Cyberbullying of mental health patients: Ethical and professional considerations for publication of case reports in the digital age Keywords: Case reports Social media Cyberbullying
Our group at the Substance Abuse Rehabilitation Program, Naval Medical Center San Diego recently published a case report titled “Internet Addiction Disorder and Problematic Use of Google Glass™ in Patient Treated at a Residential Substance Abuse Treatment Program” in the journal Addictive Behaviors (Yung, Eickhoff, Davis, Klam, & Doan, 2014). The Guardian wrote an article about the case report, and within 48 h, CNN, ABC, NBC, CBS, USA Today and major news organizations reported about the paper. Vloggers, i.e. video bloggers, published videos on YouTube.com, and social media channels propagated the information around the world. In the age of social media, the public has been empowered to comment on all of these online mediums. Thousands of comments were written with numerous comments making jokes about the patient and with several comments verging on an accepted deﬁnition of cyberbullying. Within the initial 48 h, the patient in the case report read the comments, broke his anonymity in a defensive tone, and engaged by posting replies to comments. Similarly, the Conan O'Brien Show aired a video suggesting that the best way to cure “Google Glass™ Addiction” is by ﬁlling a special rehab center with the addicts and blowing up all the addicts with 30 tons of dynamite (Jaworski, 2014, October 23). The digital age has facilitated rapid communication of medical discoveries and research. On the other hand, there are serious concerns when patients, particularly mental health patients, may be exposed to the comments from individuals who have little understanding of disease processes, the beneﬁts of research contributions, and medicine. Clearly, there are signiﬁcant advantages for medical publications in the age of social media; however, in this article, we reﬂect on the pitfalls of social media and the possibility of cyberbullying that may jeopardize the mental health of patients in these case reports. Cyberbullying is a growing problem, and there have been published cases of suicidal ideation and suicide attempts associated with online attacks towards individuals (Sampasa-Kanyinga, Roumeliotis, & Xu, 2014). When the public comments in a way that appears to be derogatory or engages in outright cyberbullying of a patient, health care providers should consider the ramiﬁcations to patients when publishing medical case reports. The media channels should also consider removing these types of comments, or do a thoughtful job screening comments that may cause harm.
http://dx.doi.org/10.1016/j.addbeh.2014.11.015 0306-4603/Published by Elsevier Ltd.
The following are comments written online about our case report by anonymous individuals: “That's crazy … whose life is so empty they would end up like that? ‘The patient — a 31-year-old US Navy serviceman.’ Ok, now I understand…” “It's called ‘malingering’. Endemic in the service.” “This is so ridiculous. Addiction, my behind. Try using some self control and quit using it if you ﬁnd it's taking over your life. I am so tired of people who whine and cry and blame everybody else for their vices.” “The only workable way to deal with Google Glass™ users is lobotomization.” Considering the impact of social media on patients, informed consent and thorough discussion with patients before publishing a case report are essential (Hanson, Martinez, & Candilis, 2014). In our case, informed consent was obtained, but we did not anticipate the high number of comments online nor did we anticipate the possibility that the patient would reply to comments. Therefore, health care providers should encourage patients to not read the comments online and advise patients to not engage in social media discussions. There have been reported cases of worsening of underlying mental disorders associated with social media utilization and engagement (Krishna et al., 2013). Patients with mental health issues are presumably more vulnerable to cyberbullying, and additional research is needed in this area. The speed of distribution and inﬂuence of medical publications facilitated by social media raises an interesting phenomenon regarding the social media impact factor. In light of social media, bloggers, and worldwide distribution of news at nearly instantaneous speeds, the reach of a medical publication and its impact on science, social opinion, and human behavior should be considered. Perhaps in addition to the traditional impact factor calculated for peer-reviewed journals, a social media impact factor can be assigned to articles and academic journals. A formula modeled after Google's PageRank for webpages may be applicable in calculating this social media impact factor (Yao, Wei, Zeng, Fan, & Di, 2014). Technology is advancing quickly and social media growth is explosive. The widespread ownership of smartphones and accessibility to high speed Internet fuel rapid dissemination of important medical publications and research. However, there are negative aspects of publishing case reports in the digital age, and these negative aspects should be part of the informed consent process.
Role of funding sources No ﬁnancial support was used for this research. No investigational or off-label use of drugs. Contributors All authors contributed to writing and review of this manuscript. Conﬂict of interest None.
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Andrew P. Doan Department of Ophthalmology, Naval Medical Center San Diego, San Diego, CA, United States Department of Mental Health, Naval Medical Center San Diego, San Diego, CA, United States Substance Abuse Rehabilitation Program, Naval Medical Center San Diego, San Diego, CA, United States Corresponding author at: Bldg 2, 34800 Bob Wilson Drive, San Diego, CA 92134, United States. E-mail address: [email protected]
Kathryn Yung Department of Mental Health, Naval Medical Center San Diego, San Diego, CA, United States Substance Abuse Rehabilitation Program, Naval Medical Center San Diego, San Diego, CA, United States Frank Bishop Department of Ophthalmology, Naval Medical Center San Diego, San Diego, CA, United States Warren P. Klam Department of Mental Health, Naval Medical Center San Diego, San Diego, CA, United States Substance Abuse Rehabilitation Program, Naval Medical Center San Diego, San Diego, CA, United States