title: Ethical issues in using Twitter for population-level depression monitoring: a qualitative study.
abstract: BACKGROUND
  Recently, significant research effort has focused on using Twitter (and other social media) to investigate mental health at the population-level. While there has been influential work in developing ethical guidelines for Internet discussion forum-based research in public health, there is currently limited work focused on addressing ethical problems in Twitter-based public health research, and less still that considers these issues from users' own perspectives. In this work, we aim to investigate public attitudes towards utilizing public domain Twitter data for population-level mental health monitoring using a qualitative methodology.
  
  
  METHODS
  The study explores user perspectives in a series of five, 2-h focus group interviews. Following a semi-structured protocol, 26 Twitter users with and without a diagnosed history of depression discussed general Twitter use, along with privacy expectations, and ethical issues in using social media for health monitoring, with a particular focus on mental health monitoring. Transcripts were then transcribed, redacted, and coded using a constant comparative approach.
  
  
  RESULTS
  While participants expressed a wide range of opinions, there was an overall trend towards a relatively positive view of using public domain Twitter data as a resource for population level mental health monitoring, provided that results are appropriately aggregated. Results are divided into five sections: (1) a profile of respondents' Twitter use patterns and use variability; (2) users' privacy expectations, including expectations regarding data reach and permanence; (3) attitudes towards social media based population-level health monitoring in general, and attitudes towards mental health monitoring in particular; (4) attitudes towards individual versus population-level health monitoring; and (5) users' own recommendations for the appropriate regulation of population-level mental health monitoring.
  
  
  CONCLUSIONS
  Focus group data reveal a wide range of attitudes towards the use of public-domain social media "big data" in population health research, from enthusiasm, through acceptance, to opposition. Study results highlight new perspectives in the discussion of ethical use of public data, particularly with respect to consent, privacy, and oversight.
authors.affiliation: Minnesota Population Center, University of Minnesota, Twin Cities, 50 Willey Hall, 225 - 19th Avenue South, Minneapolis, MN, 55455, USA.
authors.forename: Jude
authors.initials: J
authors.lastname: Mikal
authors.affiliation: Department of Family Medicine & Public Health, University of California, San Diego, MTF 162E, 9500 Gilman Drive, La Jolla, CA, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Hurst
authors.affiliation: Department of Biomedical Informatics, University of Utah, Rm 2008, 421 Wakara Way, #140, Salt Lake City, UT, USA. mike.conway@utah.edu.
authors.forename: Mike
authors.initials: M
authors.lastname: Conway
mesh_terms: D000328:Adult; D001290:Attitude; D003863:Depression; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D018907:Privacy; D061108:Social Media / Q000941:ethics*; D055815:Young Adult
keywords: Depression; Ethics; Social networking; Twitter messaging