title: Variations in Facebook Posting Patterns Across Validated Patient Health Conditions: A Prospective Cohort Study.
abstract: Social media is emerging as an insightful platform for studying health. To develop targeted health interventions involving social media, we sought to identify the patient demographic and disease predictors of frequency of posting on Facebook.
  
  
  
  The aims were to explore the language topics correlated with frequency of social media use across a cohort of social media users within a health care setting, evaluate the differences in the quantity of social media postings across individuals with different disease diagnoses, and determine if patients could accurately predict their own levels of social media engagement.
  
  
  
  Patients seeking care at a single, academic, urban, tertiary care emergency department from March to October 2014 were queried on their willingness to share data from their Facebook accounts and electronic medical records (EMRs). For each participant, the total content of Facebook posts was extracted. Using the latent Dirichlet allocation natural language processing technique, Facebook language topics were correlated with frequency of Facebook use. The mean number of Facebook posts over 6 months prior to enrollment was then compared across validated health outcomes in the sample.
  
  
  
  A total of 695 patients consented to provide access to their EMR and social media data. Significantly correlated language topics among participants with the highest quartile of posts contained health terms, such as "cough," "headaches," and "insomnia." When adjusted for demographics, individuals with a history of depression had significantly higher posts (mean 38, 95% CI 28-50) than individuals without a history of depression (mean 22, 95% CI 19-26, P=.001). Except for depression, across prevalent health outcomes in the sample (hypertension, diabetes, asthma), there were no significant posting differences between individuals with or without each condition.
  
  
  
  High-frequency posters in our sample were more likely to post about health and to have a diagnosis of depression. The direction of causality between depression and social media use requires further evaluation. Our findings suggest that patients with depression may be appropriate targets for health-related interventions on social media.
authors.affiliation: Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Robert J
authors.identifier: 0000-0001-9746-1230
authors.initials: RJ
authors.lastname: Smith
authors.affiliation: Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.|Positive Psychology Center, Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Patrick
authors.identifier: 0000-0003-4400-9309
authors.initials: P
authors.lastname: Crutchley
authors.affiliation: Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.|Positive Psychology Center, Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States.|Department of Computer and Information Science, Stony Brook University, Stony Brook, NY, United States.
authors.forename: H Andrew
authors.identifier: 0000-0002-6383-3339
authors.initials: HA
authors.lastname: Schwartz
authors.affiliation: Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.|Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Lyle
authors.identifier: 0000-0003-2047-1443
authors.initials: L
authors.lastname: Ungar
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Frances
authors.identifier: 0000-0001-6813-4791
authors.initials: F
authors.lastname: Shofer
authors.affiliation: Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Kevin A
authors.identifier: 0000-0002-5000-4742
authors.initials: KA
authors.lastname: Padrez
authors.affiliation: Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.|Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Raina M
authors.identifier: 0000-0002-9801-6881
authors.initials: RM
authors.lastname: Merchant
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003371:Cough / Q000453:epidemiology; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006261:Headache / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology; D061108:Social Media / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Facebook; depression; natural language processing; social media