Coping with depression: a narrative study of an online depression community in China

ABSTRACT

Purpose

The goal of this study was to explore the coping strategies of depression sufferers that have worked for them based on the study of an online depression community.

Methods

We conducted a thematic narrative analysis of 120 stories posted by the members in the largest online depression community in China. MaxQDA version 18 was used to code the data, and the analytic approach was consistent with the category-centred approach of grounded theory.

Results

The study found that the coping strategies mainly include self-reconciliation (e.g., perceiving/accepting feelings, accepting the present self, and holding hope for the future), actions (recreational activities, physical exercise, and engaging in volunteer work), addressing the stressors and symptoms (e.g., staying away from stressors, seeing the doctor), and seeking interpersonal support (e.g., seeking support from family, friends, and peers).

Conclusion

The findings revealed the coping strategies that were helpful and examined how they functioned for the affected members, which make up for the lack of attention to the individual experiences of depression sufferers in coping research. The findings also have practical implications for the related education and consultation, providing useful insights for doctors and patients. These ways of coping are based on depression sufferer’ anonymous narratives, which can be convincing to clients.

KEYWORDS:

• Depression
• online community
• coping
• self-reconciliation
• action
• stressors
• seeking support

Depression has become a worldwide issue. According to the Healthy China Action (2019–2030) released by the National Health Commission of China (2019), 2.1% of its population has been affected by depression in China. Complicated by the COVID-19, factors such as anxiety, reduced social contact and difficulty in seeing a doctor have further increased the number of this group and the difficulties they face (Li et al., 2020). Despite the large number of depression sufferers, the Chinese public is not well educated about depression. Many patients and their families still have a sense of shame about the illness and avoid disclosing it and seeking external support (Boerema et al., 2016). It is important to understand the appropriate coping styles in order to provide relevant support to the sufferers.

The development of online community provides opportunities for depression sufferers to gather information, interact with peers, and tell their stories to the public. In China, online communities where depression sufferers gather mainly include Douban group, Baidu tieba, Wechat group, Blog, etc. Compared with the professional websites established by the government or NGO organizations, the online groups formed spontaneously by the sufferers seem to have more peer interactions (Smit et al., 2021). Previous studies of depression were mostly based on psychological and medical perspectives, but few studies analysed the depression experience and coping strategies from the perspective of patients (e.g., Chukwuemeka et al., 2022; Jiang et al., 2021; Tait et al., 2022). Therefore, based on the narratives of depression sufferers in the largest online depression community in China, this paper hopes to explore the coping strategies that are helpful for the members.

Literature review

Depression and coping

Depression can have a profound impact on the suffers’ lives, and they usually employ certain coping strategies to adapt to it. Coping is often used to describe the cognitive and behavioural efforts that individuals make to reduce negative emotions (e.g., sadness, fear, anger) when facing stress, trauma or disease (Stallman, 2020). Research shows that coping strategies play an important role in dealing with life stress or traumatic events, and can moderate the relationship between stress and health outcomes (Nimrod et al., 2012). This effect is reflected in both short-term cognitive performance and long-term physical and mental health (Skinner et al., 2003). Compared with ordinary people, depression sufferers may lack the skills and social support to deal with negative emotions or events. Faulk et al. (2013) found that depression patients are more likely to adopt inappropriate coping strategies, such as venting, behavioural alienation, and self-blame. The use of inappropriate coping strategies may lead to more serious depressive symptoms, affect the individual’s interpersonal function, thus making them fall into a series of difficulties (D’Iuso et al., 2018).

In order to facilitate the introduction and evaluation of coping strategies, researchers have established a variety of frameworks to group specific coping strategies. The three common classification methods include: (1) problem versus emotion focused—the problem-centred strategy seeks to solve the problems that cause stress, while the emotion-centred strategy focuses on reducing the emotional consequences caused by stressors (Schoenmakers et al., 2015); (2) approach versus avoidance—the approach strategy means that an individual tries to take corresponding actions against a stressful state, while the avoidance strategy means that an individual tries to avoid and is unwilling to face the problems (Kuster et al., 2017); and (3) cognition versus behaviour—cognition emphasizes patients’ cognitive adjustment whereas behaviour emphasizes patients’ coping through appropriate actions (Skinner et al., 2003).

Stallman (2020) adopts the method of classification based on health results, and agrees that all coping strategies are adaptive and can usually help reduce pain in the short term. However, he believes that there are differences in the potential harm (physical, psychological or social) of coping strategies to individual health, so he divides coping strategies into two categories: healthy and unhealthy. According to the intensity of healthy strategies, they are divided into four dimensions from low to high: self-soothing, activities, social support, and professional support. However, when individuals lack alternative healthy strategies, for the purpose of reducing pain temporarily, individuals may use unhealthy strategies, involving risk from low-intensity (such as thinking rumination) to high-intensity (such as suicide).

A large number of studies have analysed the relationship between coping strategies and depression outcomes based on quantitative methods. Research has shown that appropriate coping strategies can effectively help individuals reduce depression feelings and improve mental health, while inappropriate coping strategies may aggravate the severity of the illness and even damage the health of patients (D’Iuso et al., 2018; Morgan et al., 2017). Research also finds that seeking comfort significantly buffered the negative impact of depression, but avoidance showed a high correlation with stress, and even directly predicted the development of depression in the future (Skinner et al., 2003). Horwitz et al. (2011) found that although specific problem-focused coping strategies did not independently predict lower levels of depression or suicidal ideation, emotion-focused coping (e.g., self-blame) and avoidant coping (e.g., behavioural disengagement) are associated with depression and suicidal ideation. Some meta-analyses also support this conclusion and shows that adaptive coping such as active coping and acceptance was negatively associated with depression; however, those who used maladaptive methods of coping such as denial and disengagement reported a higher level of depression (Allman et al., 2009; Duangdao & Roesch, 2008).

Some researchers have investigated the effect of religious coping and found positive religious coping was negatively and significantly related to depression (Carleton et al., 2008; Chow et al., 2021). For example, Chow et al. (2021) find that positive religious coping is vital in reducing anxiety and depression among health care workers (HCWs) amid the COVID-19 pandemic. Chukwuemeka et al. (2022) revealed that participants who turned to religion were less depressed or anxious, and those engaging in substance use, behavioural disengagement, and seeking social support for emotional reasons had increased feelings of depression and anxiety about the future.

Recently researchers examined the effect of coping on mental health during the COVID-19 pandemic. For example, Mong and Noguchi (2022) found that for emergency physicians, active and adaptive coping skills were related to a lower level of psychological distress during the COVID-19 pandemic whereas maladaptive coping strategies such as self-blame, denial, disengagement, venting, and substance abuse, were related to lower overall mental health.

However, the effect of coping strategies may not be stable, and may change with the specific situation. For example, Nimrod et al. (2012) studied how patients in online depression communities use entertainment to cope, and found that although entertainment is a useful coping strategy, for patients with severe depression, it is difficult for them to participate in leisure activities and benefit from them. Tait et al. (2022) found that lower pre-treatment engagement coping and higher rumination predicted higher post-treatment depression, but both of these effects became non-significant after controlling for baseline depression severity. In other words, the effects of coping strategies are contingent upon specific situations.

Qualitative studies of depression

Qualitative studies of depression have been growing recently, and they mainly examined identity change or meaning of depression (Xu & Li, 2023; Bjørkløf et al., 2015; Grob et al., 2020; Nguyen et al., 2014; Viduani et al., 2021). A few researchers have attempted to investigate depression patients’ coping strategies. For example, Frounfelker et al. (2020) studied the coping strategies of older Bhutanese with refugee life experience and found that the participants utilized strategies including interpersonal support, reappraisal of experiences of trauma, and helping oneself by helping others, which strengthened their collective identity. Rose-Clarke et al. (2021) found that adolescents in Nepal identified helpful and unhelpful relationships in order to find ways to manage their depression. Aarethun et al. (2021) examined the explanations and coping strategies of Syrian refugees and revealed that participation in the society of settlement, as a form of integration into the new society, is regarded as an important coping strategy by the participants. Tang et al. (2021) found that mothers in China often choose to cope with their postpartum depression symptoms through self-help strategies such as talking to someone, enlisting help, and positive thinking, but seeking professional help is not preferred.

Recently the study of online depression narrative has emerged and yielded a series of insightful findings. Hinyard and Kreuter (2007) define narrative as any cohesive and coherent story with an identifiable beginning, middle, and end that provides information about scene, characters, unanswered questions or unresolved conflict, and resolution. People use narratives to reflect on their experiences and social environment, and also look for explanations about what happened to them. Online depression communities facilitate the telling of illness stories and providing peer support (Nimrod, 2013). Kotliar (2016) found that depression blogs offer people an opportunity to share intimate life experience, form communal bonds with their readers, and collaboratively revise their narratives, in an attempt to quest for coherent and satisfactory explanation about depression.

The online interaction process can improve the patient’s social ability and make up for interpersonal relationships that they lack in reality. In a study of “Depression Connect,” a Dutch depression community, Smit et al. (2021) found that the online community can help the members practice their social skills and adapt to the interpersonal social environment; through reading, posting, replying and other participation processes, the members have enhanced their sense of belonging, self-efficacy, and empowerment through “creating value for others.” Sik’s (2021) analysis of online depression forums shows that they enabled expressions of unconditional recognition and support of peers, which serve the function of secular ritual healing.

Based on the literature from the above two parts, we find that the existing frameworks of coping strategies with regard to depression are predominantly drawn from surveys of patients through quantitative studies (Jiang et al., 2021; Muñoz-Cruz et al., 2023; Tait et al., 2022). More qualitative research of coping is needed to understand how certain strategies work for the affected individuals. The narratives of depression patients in online communities reflect their real views of the coping strategies because these narratives are not interfered by researchers. However, there is a lack of research analysing the coping strategies of patients based on online communities. Therefore, this paper hopes to answer the following research questions by analysing the members’ narratives in the largest online depression community in China, especially the narratives related to coping strategies: in the online depression community, what are the main coping strategies that have been helpful for the members and how do these strategies function for the affected individuals?

Method

Z community, based on the online platform Doban, is the largest online depression community in China (Doban, 2022; see Figure 1). The community was founded in August, 2020. Although it was established only for a short time, about 60,000 members have gathered in the community, including both diagnosed patients with depression and their family members. Judging from the content of the posts, most of the members are young people in their 20s to 30s. Many members mentioned that they are studying or have worked for several to ten years. By posting their stories and leaving comments below others’ posts, the members share their illness experiences and feelings and provide support to each other. The original intention of the community founders is to explore the possibility of curing depression, rather than as a “place to pour out despair and depression.” With the participation of a large number of members, the forum has gradually developed into a space with a lot of stories and interactions about depression. These online narratives, compared with the narratives obtained through traditional interviews, are more natural and free from the interference of researchers, and may better reflect the real thoughts of the narrators.

Figure 1. Screenshot of the online depression community.

After joining the group in June 2021, the authors began to read the posts in the forum from January to December 2021 in order to obtain research data. The criteria for data selection are as follows: (a) Only the stories are included, excluding the comments of other members below the stories; (b) the narrative is fully developed with the members’ various experiences and reflections, excluding posts that are simply emotional expression; (c) the content is in line with the research purpose of this paper, meaning that the members talked about how they tried to cope with depression in the story; and (d) the narrative should entail coping strategies that are helpful for the narrators because our goal is to find ways of coping that are helpful for depression sufferers. There were about 1,000 postings during this time period, and more than half did not satisfy these criteria. The two authors selected 240 stories based on these criteria and then randomly selected half of the stories for analysis. Because most of the members are curious about how to deal with depression and have tried various ways to cope with it, the ways of coping that are viewed as helpful by the narrators are the subject of this article.

The analysis focuses on identifying the themes in the narratives that relate to the narrators’ coping with depression that have worked for them. The two authors carefully read the full texts of the stories, paying special attention to the content that entails coping. The two authors tried coding 20 stories and achieved consistency after discussion. Then, the first author coded the remaining data, and the results were reviewed and refined by the two authors together. We employed MaxQDA version 2018 to conduct a systematic thematic narrative analysis, which shares some features with grounded theory: our interest is in generating thematic categories across narratives (Riessman, 2008). Consistent with grounded theory, the data collection and analysis were carried out simultaneously. The coding process continued from open coding to focus coding, axial coding, and then to theoretical theme coding. Open coding stayed close to the data and remained open to all possible theoretical directions. Focused coding sorted out significant and frequently appearing codes including, for example, codes entail various ways of dealing with depression—stop self-blaming, build one’s own standard, self-affirmation or self-encouragement, stay away from stressors, see the doctor, etc. Axial coding sorted out the major codes and their dimensions (e.g., “accepting the present self” includes three dimensions: stop self-blaming, build one’s own standard, and self-affirmation or self-encouragement; a higher level of axial coding grouped “accepting the present self” with “perceiving/accepting feelings” and “holding hope for the future” to form a common category “self-reconciliation”). During the thematic coding phase, provisional themes were compared and all the codes and the relevant data under each theme were examined to ensure that the data formed a consistent theme. We find that four overarching themes can govern all the codes and data: narrative of self-reconciliation, action, addressing the stressors and symptoms, and seeking interpersonal support. Theoretical saturation was obtained after coding about 100–110 narratives when no new codes appeared. The analysis used the original Chinese text, and the excerpts used in the article were translated into English by the corresponding author who holds a PhD from a US university, which helped to guarantee accuracy of the translation.

This study was exempt from institutional review because the data are from Douban, a public online platform. The online community members know that their posts are available to the public; therefore, they use pseudonyms to tell their stories and their identity is anonymous. Even so, the researchers still sought consent from the online platform to use the data, following suggestions in previous research (Kinloch & Jaworska, 2021). We also changed the pseudonyms of the members to further protect their privacy. Therefore, this study has met with ethical requirements.

Findings

The research question guiding this study asks what are the main coping strategies of the depression community members. The analysis aims to reveal the most salient coping strategies that have been helpful for them. The results show that the members’ coping strategies can be divided into four types: self-reconciliation, action, addressing stressors and symptoms, and seeking interpersonal support. Self-reconciliation includes perceiving/accepting feelings, accepting the present self, and holding hope for the future. Action includes recreational activities, physical exercise, and engaging in volunteer work. Addressing stressors and symptoms refers to staying away from stressors and seeing the doctor. Seeking interpersonal support includes getting support from family, friends, and peers online. Table I shows the above strategies and the frequency that they appear in the posts.

Table I. Coping strategies and the frequency.

Coping strategy	Indicator	The Number of Posts Using This Strategy
Self-reconciliation	Perceiving/accepting feelings	32
	Accepting the self	16
	Holding hope for the future	18
Action	Recreational activities	44
	Physical exercise	37
	Engaging in volunteer work	12
Addressing Stressors and Symptoms	Staying away from stressors	17
	Seeing the doctor	32
Seeking Interpersonal Support	Seeking support from family, friends & peers	29

Note: N = 120.

Self-reconciliation

As a kind of mental illness, depression is often regarded as the result of cognitive “problems.” Depression sufferers are more likely to be pessimistic than ordinary people, which means that it is difficult for them to perceive the existence of positive things. Therefore, the members put forward a series of self-reconciliation measures in order to handle negative emotions such as tension, anxiety, emptiness or depression. Specifically, it is mainly manifested in perceiving/accepting feelings, accepting the present self, and holding hope for the future. These measures helped the members to accept the impact of the past on the present and develop hope about the future.

Perceiving/Accepting feelings

As a way of coping, emotion observation is a process in which members perceive their own feelings under pressure. The focus is to improve the understanding of their emotional states during the observation process and reduce the judgement or response to the feelings of any nature. In other words, the purpose of observation is not to change the internal emotional state, but to observe their emotional states from a third person perspective. When an individual can accept unwanted feelings, such as sensitivity, sadness, dullness or anger, it is also the acceptance of the self to some extent. Of course, to observe feelings is not to passively connive at the breeding of emotions, but to purposefully understand feelings through observation and reduce the anxiety and panic caused by the uncertainty of emotions. Members of this online community proposed different observation methods, including perception, meditation and recording, and reported the positive effects, such as stabilized emotional state, improved physical control, and a lower level of depression.

Some members mentioned that they had the experience of “observing feelings by perceiving the body.” In this process, members feel the emotional state in their bodies and follow the changes to increase their understanding of feelings. They emphasize that it is best to observe the emotional state from an objective, third person perspective. According to them, without the self, there is no need to consider the impact of the nature (positive/negative) or consequences (good/bad) of the feelings on the self. For example, the member “Yuzi” described this perception skill in the metaphor of a car:

To feel your body, to breathe slowly and deeply, to feel the thoughts and feelings in your head, without any suppression or explanation, just to observe, just like a car passing in front of you, don’t think about what brand it is, where it is going, just see a car passing in front of you.

Other members mentioned that they have observed their feelings through recording emotions. Compared with observing and perception, the process of defining feelings with words has more interactive and exploratory significance. It turns abstract perception into concrete understanding, providing the members with a clearer understanding of the trigger of specific emotional states. This kind of certainty can alleviate the sense of losing control for the members. For example, the member “big eyed cat” thinks that keeping a log of emotions is a way of positive communication with the illness, reducing her fear when facing with it:

I can observe where the mood fluctuates when I feel inexplicably uncomfortable, which makes me have a sense of control… Write down my feelings in the form of words, so that I won’t fear and worry when it (depression) will come, because when it comes, I can look directly at it and have a good communication with it.

This way of coping can help members to alleviate some specific depressive feelings, develop their ability of emotion regulation, and thus improve their self-efficacy and confidence in fighting the illness. Another member told his story:

I have been recording my state and making emotional records every day. Obviously, from writing a lot every day to now, there are only one or two sentences or no needs to write, because I can self-regulate my emotions and find a lot of dopamine to calm my traumatic emotions, so depression is not uncontrollable!

Accepting the present self

Depression patients usually experienced an identity crisis after diagnosis. Many of them feel that they have lost the abilities and characteristics of “healthy people,” which leads to self-denial or rejection of reality. In order to restore the lost meaning of life, members of this community reappraised their situations, e.g., stopping self-blame, establishing one’s own standard, and self-affirming/encouraging. Stopping self-blame can reduce the negative emotions related to the self, and establishing one’s own standard can help members disregard external pressure. Self-affirmation/encouraging can improve self-efficacy, mobilize positive emotions, and provide long-term motivations for self-acceptance.

Stop self-blaming. Due to the personality of low self-esteem, many members tend to attribute the “regretful events” in their lives to themselves (Alberts et al., 2012). Self-blame will aggravate depression patients’ identity crisis and sense of worthlessness. Most of the members described the harmfulness of self-blame in their narratives. Therefore, some members suggest that the connection between the past and the present be reshaped, and the impact of past events on the present be viewed in alternative ways. For example, a member suggests split the past from the present:

We might as well treat ourselves as another child who once lived in a great sense of fear, shame and guilt, and treat us and him as two people, because now we have enough ability to protect ourselves… We are actually very powerful. Although the past trauma has controlled our life, the reality is that the trauma has passed, and the fear is just a memory.

Build one’s own standard. One’s standard is a reflection of his or her own needs. It emphasizes following their own ideas, and refuses to be defined or coerced by external pressure. The establishment of self-standard can help members eliminate the feeling of “life being controlled by others,” so as not to fall into negative self-doubt. They believe that societal standards are just one of the many standards and not necessarily the correct one. Individuals should accept their own particularity, as a member mentioned the following reflection:

Accept what you have, no matter whether your point is good or bad in the secular concept… You need to know that there are different starting points and results, and it is precisely because of these differences that each of us is unique.

Self-affirmation/encouragement. Self-affirmative words can motivate and promote individual performance, and produce positive emotions. The role of self-affirmation has been recognized by many members. For example, a member told her experience:

I will keep repeating such words as “I love what I am doing now,” calmly repeat them almost ten times, and then observe my emotional changes… As long as I keep repeating, my brain can produce positive emotions, and repeatedly doing so will change your emotions accordingly.

Holding hope for the future

Members believe that it is very important to maintain the confidence to recover from depression. If depression is regarded as an incurable “lifelong” disease, the affected individuals may lose their desire for treatment, reduce help-seeking actions, and even develop the thoughts of suicide. In order to avoid negative consequences, members emphasized the importance of hope when sharing their coping strategies. They often illustrated the positive effects of this strategy with their personal experience, and emphasized it from different perspectives. For example, some members highlighted the need to look at problems from the future-oriented perspective, and patiently give the body time to heal. A member wrote:

I used to be the last person who didn’t believe that I would get better. Now I will comfort my friends from time to time and pass them positive energy to live a good life… So you see, everything will change. Don’t deny everything just because of the darkness in front of you. Life is really long, and the future can be bright….

Action

Members also attempt to divert their attention from depression and negative emotions by participating in recreational activities and physical exercises. Although the functions of recreational activities and physical exercises are similar—disperse the members’ feeling of illness and achieve the effect of relaxation through focusing on activities, recreational activities mainly focus on the positive impact on emotion, while physical exercises have a dual regulatory effect on body and emotion, and the members’ narratives also involve the thinking of the relationship between body and emotion. Finally, some members engaged in volunteer work which helped them find value about themselves.

Recreational activities

Recreational activities have a positive effect on relieving depression. Research has found that by diverting patients’ attention from the illness, recreational activities can help patients reduce negative emotions and alleviate anxiety (Stallman, 2020). At the same time, it can also be used as a way to relax, mobilize patients’ positive emotions, and reduce the use of unhealthy coping strategies, such as alcoholism, emotional diet, etc. In the online community, recreational activities used by the members range from literature and art (e.g., reading, painting, music, calligraphy, playing chess), audio-visual entertainment (e.g., TV dramas, movies, radio), philosophy and religion (e.g., worshiping Buddha) to life and leisure (e.g., shopping, travel).

From a functional point of view, the process of participating in recreational activities can alleviate depression, shape a sense of order and achievement, attain positive emotional sources, and reduce the impact of negative emotions on the narrators. For example, a member named “the star in the river” wrote, “I began to learn painting and chess, and restored the habit of reading books. Every day, I became so full and felt the happiness in my heart.” In addition, the learning and cultivation of new skills can promote the member’s sense of achievement, enhance confidence in his or her personal abilities, which can alleviate the low self-esteem or worthlessness caused by depression. After being diagnosed, a member named “goodbye Liz” tried various recreational activities, such as practicing ukri, learning and applying for the barista certificate, learning Korean, etc. The learning process altered her self-evaluation, “These seemingly useless skills make me feel that life is becoming fun. My sense of value has also increased, reducing the negative feeling that I am useless and I am good for nothing.”

Physical exercise

Physical exercise can effectively stimulate the central nervous system and alleviate the symptoms of depression. Research has shown that physical exercise is an effective way to help individuals fight depression (Jiang et al., 2021; Li et al., 2015; Ströhle, 2009; Wang, 2021). Some members in the online community found that exercise can alleviate depression by inhibiting the breeding of negative emotions and increasing positive emotions. The member “ah Wu” mentioned his experience:

I have been at home for about four or five months since the pandemic. Later I exercised for one hour every day with medium and high intensity, trying to lose weight. I didn’t expect that it turned out to be a great emotional relief. It’s hard to get anxiety now.

The effects of exercise make some members recognize the relationship between body and emotion. Such an understanding changed their interpretation of depression as an “emotional disease” they once held in the past, and began to see the relationship between the body and emotion. A member told his story:

After climbing mountains, strolling in the countryside and basking in the sun with my mother every day, I felt that I had recovered… It turns out that depression is not only an emotional problem, but also an illness caused by physical reasons. The body is weak, and the spirit is vulnerable. Therefore, the body, mind and behaviour habits should be paid attention to in the treatment process.

Engaging in volunteer work

Members in the online community also mentioned that they engaged in volunteer work to cope with depression. Doing volunteer work can help them realize their value that they have not realized before. It can also foster a sense of responsibility for others. Helping others is a way to fulfill the human needs of nurturing, which alleviate the members’ sense of uselessness and emptiness. Several members who have recovered from depression talked about their experience and value of doing volunteer work. For example, a member wrote:

I applied for leave from college and hoped to do something meaningful during the leave. Later I became a volunteer teacher. When teaching these children, I found that helping others can also heal myself and let me find my own value.

Another member had similar experience and also thought highly of the meaning of volunteer work, “I have come out of depression… I suggest you try some volunteer work. It is very effective. At that time, I found happiness from the volunteer work of cleaning toilets.”

One member used a metaphor to describe his new understanding of life after doing volunteer work:

People have the need to help others. Even if people are very selfish, they also have the need to help others. Helping others can really make themselves happy. I did volunteer work almost every holiday. And the more you do, the more you will find that the world is big and you are small, and your troubles are a small drop in the ocean. It is foolish to give up the vast human world for this small drop in the ocean.

Addressing the stressors and symptoms

Depression patients usually suffer from stressors and physical symptoms that caused pain to them. Addressing the stressors, including both the original sources of depression and the current stressors in their work and life, is a way for them to alleviate pain. At the same time, because depressive symptoms can be lasting, it is beneficial for the members to seek professional support from psychiatrists and psychologists, who play an important role in the diagnosis, treatment, and rehabilitation of depression.

Staying away from stressors

Dealing with stressors is a way for members in the community to alleviate depression. The members mainly used a method of “staying away from stressors” to deal with stressors. It is an intentional separation from the source that caused stress on the affected individual. When other measures fail to achieve results, it becomes a better choice to alleviate the stress. It blocks the affected individuals from the source of pressure including family, school, or the workplace. For example, members who are depressed due to their family will live separately from the family, working in other places, studying abroad, and not answering the phone and Wechat messages. Some members’ psychological pressure is relieved to a great extent after they are far away from their families.

Members who are depressed due to school or workplace pressure tend to separate themselves from the stressors by changing their life environments, such as dropping out, changing schools, or resigning. A relatively new environment can provide members with a buffer space for self-healing. For example, the member “Miya” chose to resign after being diagnosed with depression. With the reduction of pressure from the workplace, she gradually recovered from depression:

The first step of recovery is to get away from the source of depression. I had done too many things I was not good at in the past three years, so the result was obvious. I was depressed. I was not relieved until I resigned… I am really happy now.

Similarly, the depressed members who were bullied by their fellow students in schools are also in a relaxed state after entering a new environment, as a member said:

When encountering campus bullying, it’s better to leave the class or school that makes you sad. I have left the devil high school. After entering the university, I adjusted for two years. Although I can’t completely forget it, I feel very happy now.

Seeing the doctor

Resources of professional service, such as psychiatrists and psychologists, play an important role in the diagnosis, treatment, and rehabilitation of depression, and also play a positive role in providing informational and instrumental support. The motivation of seeking professional support is affected by the attitude of individuals. Relatively speaking, members who accept their illness have higher initiative in seeking professional support than those who hold an avoidance attitude. These members believe that there is no difference between depression and other types of illness, which is an inevitable health crisis that may occur to any individuals. The “normal understanding” of depression often urges them to actively seek professional support after detecting their own symptoms so that they can obtain appropriate diagnosis and treatment. A member mentioned her thoughts:

Depression is an illness, just like a cold. Don’t demonize it. If you are ill, you should go to see a doctor early, get intervention and treatment early. I don’t have too much psychological burden, so I made an appointment with the Shanghai Mental Health Center.

Seeking interpersonal support

Social support is part of a social network in which a person perceives that he or she is cared for and respected and belongs to a community of mutual support. The feeling of being accepted and valued in interpersonal relationships can enhance the individual’s self-esteem, confidence, and efficacy, which are helpful to prevent and alleviate depression (Alsubaie et al., 2019; Stallman, 2020; Stice et al., 2004). Many members in the online community have sought support from interpersonal relationships, especially from family and friends. A member told his story:

I told my two sisters that I was suffering from depression. I was surprised that they understood me very well and cared about me very much. They also said that they wanted me to do something I liked and be happy. There was no sense of blame in their words. They were warm and powerful, which comforted me.

As individuals become independent from their families, peers become an important source of interpersonal relationships. Whether they can obtain peer support has an important impact on the recovery from depression. Interaction and communication with friends can help enhance their capability in action and restore the normal life order affected by depression. A member told her story:

In high school, my friend Z would grab the tip of the compass that I pricked to my wrist and give me with watermelon flavored chewing gum. I always hid and cried in the classroom after school at noon; he did not go to lunch and silently accompanied me… In college, my friend Y would often listen to my negative energy. He never despised me even a little. I still remember the day when it was almost 40 degrees, he told me never to die on the playground, and if one day I died, they would be very sad. This sentence made me through a lot of painful moments.

In addition to real-life interpersonal relationships, other depression sufferers they met in the social media platform are also a source of support. The same illness experience and feelings enable them to have empathy and understand each other more easily. This makes the communication between them more open. For things that cannot be told to family and friends or are difficult to be understood by them, members can be honest with the peers so as to avoid scrutiny from the outside world. At the same time, the communication with peers also means equality. Members will not feel uncomfortable because of their “sufferer” identity, but can accept and face up to the challenges brought by the illness.

I met a sister with depression on Soul… For a month, she kept me on the phone for at least one hour every day in a role like a psychologist for free to analyse my current mood, my feelings, and reasons. She always talked about the point and sent me books on literature, art, philosophy, and psychology. Like my team leader, she would give me strength… Later, my psychological state was much better, we have become more close. Now we are both teachers and friends. We will discuss our lives, feelings, and work, and become partners in each other’s lives, even if we have never met in real life.

Discussion

Based on the investigation of the members’ narrative in the largest online depression community in China, this paper analyzes the main coping strategies that are viewed by them as helpful for alleviating depression. The study found that the members responded to the illness with four main strategies: self-reconciliation, action, addressing stressors and symptoms, and seeking interpersonal support. Self-reconciliation includes perceiving/accepting feelings, accepting the self, and holding hope for the future. According to the narrators, these measures can help them alleviate depression by reducing negative emotions. Action includes recreational activities, physical exercises, and engaging in volunteer work. Addressing stressors and symptoms includes staying away from the stressors and seek professional support from psychiatrists and psychologists. Seeking interpersonal support includes seeking support from family members, friends, and peers.

Previous qualitative studies of depression mainly focused on the support provided to sufferers in the interaction process, such as informational support and emotional support (Kotliar, 2016; Sik, 2021; Smit et al., 2021), and identity change and meaning of depression (Xu & Li, 2023; Grob et al., 2020; Viduani et al., 2021). Coping, a topic widely discussed in the online depression community, has not received enough attention in qualitative or narrative research of depression. At the same time, coping research in quantitative studies often focuses on testing the relationship between specific coping strategies and health outcomes (e.g., Faulk et al., 2013; Morgan et al., 2017; Schoenmakers et al., 2015; Yoo, 2019). The classification of coping strategies also mainly serves the measurement of patient behaviour in clinical practice (Skinner et al., 2003). Based on an analysis of the coping narratives posted by members in the online depression community, this study revealed the coping strategies that are viewed as helpful by the members and how these different strategies function, which makes up for the lack of attention to the individual experience and feelings of depression sufferers in coping research.

The findings of this study offer an alternative framework for understanding coping. Previous studies put forward three main frameworks on coping: problem versus emotion focused (Schoenmakers et al., 2015), approach versus avoidance (Kuster et al., 2017), and cognition versus behaviour (Skinner et al., 2003). Although they are helpful for understanding the complex process of coping, such binary frameworks are nevertheless oversimplified. For example, for the framework of problem vs. emotion, it may capture the characteristics of “addressing stressors and symptoms” and “self-reconciliation” in our framework; however, the categories of emotion versus problem focused are not mutually exclusive because most ways of coping can serve both functions (Skinner et al., 2003). On the contrary, “self-reconciliation” and “addressing stressors and symptoms” are mutually exclusive and can be more clearly differentiated. Also, “action” and “seeking interpersonal support” in our framework are neglected by the problem versus emotion framework, e.g., actions like exercises and doing volunteer work are neither problem nor emotion focused. For the approach versus avoidance framework, “approach” means taking corresponding actions against a stressful state and may be similar to “action” in this study; however, it includes every kind of proactive actions even though they might be unhealthy; “avoidance,” a negative strategy according to this framework, may be positive as we find that “staying away from stressors” is a helpful strategy. Therefore, our framework may be clearer and more specific than this framework. Finally, the framework “cognition versus behaviour” is similar to “self-reconciliation” and “action” in our framework. However, cognitive adjustment does not cover perceiving feelings from the third person perspective as in “self-reconciliation,” and “action” in our framework highlights the agency of the member whereas “behaviour” includes both active and responsive behaviours. The purpose of action is to produce desired (or prevent undesired) outcomes.

This study also demonstrated several strategies that have not been well addressed by previous research. For example, the findings show that perceiving/accepting feelings from the third person perspective and holding help for the future are found to be frequently used by many members in this study, which are relatively rare in prior qualitative studies of depression. Building one’s own standard, a new and useful strategy, can help members eliminate the feeling of “life being controlled by others or the society,” so as not to fall into negative self-doubt. In addition, engaging in volunteer work and staying away from stressors are identified to be important coping strategies in this study. Doing volunteer work can help the members realize their value and foster a sense of responsibility for others. Staying away from the stressors and going to a relatively new environment can provide patients with a buffer space for self-healing.

The findings also have practical implications for coping with depression and the related education and consultation. The specific coping strategies and the ways in which they have worked for the affected individuals, as illustrated from the perspective of the members in this study, provide insights for doctors and volunteers in their practice. The results are based on depression sufferers’ anonymous narratives, which are not interfered by researchers and more naturalistic and plausible than interview or survey based data, can be more convincing to clients. The specific experiences and narratives can also be shared with clients, who are likely to resonate with and learn from them.

This study also has limitations that need to be addressed in future research. First, although the focus of our study is on coping strategies that are helpful for depression sufferers, the members of this online community have also shared the coping experiences that are viewed by them as unhelpful or unhealthy. Future research can further examine these experiences because they can also shed light on coping. Second, the paper is mainly based on an analysis of the members’ evaluations of their coping experiences who post their narratives online, but lacks the analysis of the their coping experiences in the long-term coping process. As Skinner et al. (2003) argued, as individuals’ adaptive response, coping is a dynamic process. Therefore, the framework of the coping process needs to be further examined. Future research can study how these coping strategies progress and play a role through in-depth interviews with depression patients, so as to better understand the functions of the different coping strategies at different stages. Finally, researchers can also study the driving factors of individuals’ choosing specific coping strategies, which will help to provide more insights into this topic.

Conclusion

This study explored the experiences and coping of depression sufferers by analysing their stories posted in the largest online depression community in China. We attempted to find the ways of coping that are helpful for them and examine how these different strategies function. Four types of coping narratives were predominant among the community members: self-reconciliation, action, addressing stressors and symptoms, and seeking interpersonal support. These strategies are helpful and complementary for dealing with the difficult experiences of depression according to the narrators. Although there exist overlaps with the frameworks found in previous studies, our framework has it particular strengths and some of the strategies are rarely explored in previous research (e.g., “engaging in volunteer work”) and may provide insights for coping (e.g., “action” can highlight the agency of the members than “behaviour”). Even though not our research focus, some members tell that they have used unhealthy coping strategies, which demonstrate the difficulty of handling the troubling stress cause by depression. The findings have implications for education and consultation on depression for the public and those who may suffer from it.

Ethical Statement

Our study is exempt from an ethical board approval. The reason is that Douban is a public online platform and people use pseudonyms to post messages and their identity is anonymous. Moreover, users know that their posts are available to the public and participants automatically give their consent when posting anonymously. Therefore, following suggestions proposed in previous research Kinloch and Jaworska (2021), consent was sought from the Douban platform to use the forum data for the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Xin Li

Xin Li (Ph.D., Wuhan University, China) is a lecturer in the College of Communication Science and Art at Chengdu University of Technology, Chengdu, China. Her research focuses on health communication. Her work has been published in Qualitative Health Research. Email: [email protected]

Kaibin Xu

Kaibin Xu (Ph.D., University of Colorado, Boulder, USA) is a professor in the Foreign Studies College at Hunan Normal University, Changsha, China. His research focuses on health, culture and communication. His work has appeared in academic journals including Communication Monographs, Management Communication Quarterly, Journal of Business Ethics, Qualitative Health Research, Health Communication, Journal of Loss and Trauma, Feminist Media Studies, Asian Journal of Communication, and International Journal of Communication. Email: [email protected]