Presence of Emotions in Network Discourse on Mental Health: Thematic Analysis

Abstract

Mental health and emotions are two fundamental aspects of our overall well-being. Good mental health can help us manage and regulate our emotions in a healthy way. Similarly, emotions can affect our mental health if we are not able to recognize, express, and manage our emotions in a healthy way. The present research aims to conduct a thematic analysis on the presence of emotions in X (formerly known as Twitter) discourse on mental health. A total of 455 tweets dealing with mental health have been collected in this study. The results show that the presence of emotions in mental health discourse is quite limited compared to the non-use of emotions. Regarding those who do use emotions, love and anxiety stand out. When users do not address emotions, they do argue certain variables such as stress, depression, suicide, or job insecurity. It is argued that emotions do not receive the attention and importance they deserve in the field of mental health. If emotions are not properly recognized, understood, or managed, there may be several risks for society in general. Therefore, the need to promote emotional education with the intention of increasing people’s well-being and mental health is raised.

1. Introduction

The term emotion refers to a complex subjective experience that involves physical, psychological, and behavioral changes in response to a stimulus, whether internal or external [1]. The first explanatory models of emotions, which derived from the James–Langue and Cannon and Lange theory [2,3], established that an emotion is generated by the interaction of a physiological response to a stimulus, which would produce changes in the biological system of an individual, triggering an emotional state. Since the 21st century, this concept has changed its perspective, since the concept of emotion is also linked to behavioral and cognitive changes [4]. Nowadays, emotions play an important role in people’s daily lives, as they influence the way we perceive, interpret, and respond to the events that occur around us [5]. One aspect to highlight is that emotions have been shown to have an impact on mental and physical health, and can affect aspects such as behavior, interpersonal relationships, and quality of life [6].

There are several theories and approaches that have attempted to explain the concept of emotion, such as the theory of basic emotions proposed by Paul Ekman [7], which argues that there are universal emotions that are expressed through gestures and facial expressions that are similar in all cultures. On the other hand, James–Lange’s theory [2] suggests that emotion is a physiological response to a stimulus, and that emotional experience is the result of the interpretation of these responses. Based on the latter, the theory of Cannon–Bard [3] was created, which indicates that emotions are the result of the simultaneous activation of the physiological response and the emotional experience; thus, exposing that the physiological response and the emotional experience are two different and independent aspects of emotion. One aspect to highlight is that the concept of emotion can be approached from different perspectives as proposed by Bisquerra [8] such as (a) the emotional response that a person experiences before a specific stimulus; (b) the process that occurs (thoughts, feelings, behaviors, ...) in the individual when experiencing an emotion; (c) the influence that an emotion has on a person’s behavior, both in terms of facilitating or hindering action; (d) the relationship that emotions have within the social context, i.e., how these emotions are experienced and expressed; and, (e) emotion as a cultural construct, because emotions are constructed and expressed in different cultures and this can influence the way in which people experience and express their emotions. One of the classifications that organizes emotions into positive and negative is the one proposed by Bisquerra [8]. This author points out that positive emotions are joy, humor, love, and happiness, while negative emotions are fear, anxiety, anger, sadness, and rejection.

Mental health is a key aspect of overall well-being and has received increasing attention in research and clinical practice, as it contributes to happiness, social cohesion, and success in life [9].

The current scientific literature exposes the benefits of mental health in people’s lives. These studies point out that mental health is fundamental to quality of life, since positive changes in mental health over time are associated with improved life satisfaction and lower mortality risk [10]. Such research links to the idea that mental health is central to the prevention and treatment of chronic disease, as treatment of depression in patients with heart disease was shown to be associated with improved mental health and decreased risk of major cardiac events [11]. In addition, this positive relationship has also been found between mental health and academic and work performance, given that workers with better levels of mental health or who did not suffer workplace violence were found to be more productive, had fewer days of absenteeism, and more job satisfaction [12,13].

There are several factors that have serious consequences on people’s mental health. One of the most recently studied factors is the significant impact that the COVID-19 pandemic has had, as it has been noted that this health crisis increased levels of stress, anxiety, and depression in individuals, as well as cases of substance use disorders and domestic violence [14,15]. COVID-19 led us to take refuge in social media to feel connected, although this also increased anxiety due to uncertainty and worsened pre-existing anxiety problems [16]. It is estimated that social media usage points to around 5 billion users as of today [17]. At the national level, specifically in Spain, data indicate that 41 million people were users of social networks in 2023, representing 85% of its population, placing this country as one of the largest social networking markets in western Europe [18]. Excessive and uncontrolled use of social networks is linked to a significant negative impact on their level of psychological well-being [19]. This idea is related to loneliness and social isolation, because the lack of meaningful social connections produces an increased risk of depression and anxiety [20,21]. This increase in depression and generalized anxiety disorders is also shown in cases of people who suffer discrimination or racism, due to the fact that being a victim of rational and/or ethnic inequalities affects mental health [22]. Another variable that can have a negative impact on mental health are the effects of climate change such as rising temperatures and natural disasters [23]. Others studies have shown that people who experience extreme weather events have an increased risk of developing anxiety disorders and depression [24]. On the other hand, the excessive use of technology and social networks are also considered factors that alter people’s mental health, as this excessive use has been related to a higher incidence of anxiety disorders and depression, as well as to a decrease in sleep quality and lower satisfaction with life [25,26,27]. Having commented on the factors that can intervene negatively in people’s mental health, the next step is to argue the effects that emotions have on mental health.

Mental health recent findings argue that there is a significant positive correlation between positive emotions and mental health, as well as with other variables such as school adjustment, while the relationship between mental health and behavioral problems is negative [28]. Thus, it is estimated that feeling positive emotions such as joy, gratitude, and love can reduce the levels of cortisol, which is the stress hormone, so, in turn, it can improve physical and mental health [29,30]. In addition, it has been found that positive emotions can moderate the influence of depressive emotions on suicidal ideation in adolescents, thus obtaining a significant relationship between positive emotions and lower suicidal ideation [31]. Psychological trauma is noted to be a negative predictor of mental health, whereas resilience and positive emotion regulation help to reduce the impact of psychological trauma on mental health [32]. Aspects such as emotional regulation help mediate the relationship between insecure attachment and mental health, thus indicating that emotional regulation reduces depressive symptoms caused by insecure attachment [33]. Therefore, it is noteworthy how the experience of positive emotions can increase resilience [34], self-esteem [35], and life satisfaction [36], and reduce symptoms of depression and anxiety [37].

Attending to negative emotions, it is noted that low psychological well-being has a stronger risk when it comes to negative emotions compared to positive emotions [38]. Small short-term emotional disturbances can generate mental health risks and increase the likelihood of affective disorders [39]. Evidence supports that dynamic patterns of emotion anticipate changes in psychological well-being or psychopathology over time [40,41]. People experiencing some type of mental health illness such as post-traumatic stress disorder (PTSD) tend to consume harmful substances such as alcohol to regulate the effects of negative emotions such as discouragement and anger [42]. Thus, negative emotions such as sadness, anger, fear, and guilt can have adverse effects on mental health [43]. Prolonged experience of negative emotions may increase the risk of developing mental health disorders such as depression, anxiety, and post-traumatic stress disorder [44]. In addition, the way people manage and regulate their emotions can also have a significant impact on mental health. For example, emotional suppression and lack of emotional expression can increase stress and anxiety, whereas appropriate emotional expression and adaptive emotional regulation can improve emotional well-being and mental health [45,46]. One of the most used resources to solve these types of problems is therapy, as it can be effective in treating a wide range of mental health problems, including depression and anxiety [47]. Also, social networks can be an opportunity for people with any type of mental health disorder to disclose themselves, share their experience, seek support and help from others, and fight stigma [48].

After discussing the existing literature on the relationship between emotions and mental health, the aim of this study is to obtain an answer to the objective of this research. The present study aims to identify the presence of emotions in the discourse on mental health in the social network X (formerly known as Twitter).

2. Materials and Methods

2.1. Study Design

The present research for the exploration of a theme is based on a qualitative design through the use of new technologies. This type of methodology makes it possible to bring meaning to the data obtained from X, thus combining the capabilities offered by computer techniques with in-depth qualitative research methods [49]. In the writing of this study, the guidelines provided by COREQ [50] for the elaboration of qualitative studies were followed, such as the selection criteria for the tweets collected, the software used to analyze the data, the data coding process, and examples of quotations (tweets), as well as the acknowledgement of the limitations of the study.

2.2. Sampling and Data Collection

The database consisted of a total of 455 tweets that had been obtained by searching for the hashtag #saludmental. This search was the one that returned the most data, after several initial searches. The ATLAS.ti program was the tool used to import information from the X social network.

The collection of tweets was carried out on 24 April 2023, and includes the most recent and relevant tweets from the previous seven days. This compilation provided information such as the number of retweets and favorites of the tweet itself, its author, language, and location.

2.3. Analysis of the Data Set

Once the database was obtained, it was analyzed. Both data collection, as mentioned above, and data analysis were performed using the qualitative data program ATLAS.ti version 23 [51].

For the analysis, the thematic analysis method proposed by Braun and Clarke [52] was followed, consisting of six phases. First, both authors read the collected tweets to familiarize themselves with the content and note the main ideas in a second reading. Subsequently, one of the authors created a list of codes based on the most interesting features of the collected data, such as whether they referred to emotions or not. After resolving discrepancies by consensus and analyzing the code system, the codes were classified into sub-themes, which were then grouped into main themes. This classification was based on the objective of the study, which was to know the use of emotions in the social network. In the next phase, the themes were reviewed to ensure that all codes fit into the analysis map. The themes were defined to provide greater clarity and the most relevant quotes were selected for inclusion in the research report, along with the corresponding subthemes. This categorization referring to the main themes and sub-themes can be seen in detail in

Table 1. Categorization of the analysis performed.

Main Theme	Related Sub-Themes
1. Users who do use emotions in their speech	1.1 Positive emotions
	1.2 Negative emotions
2. Users who do not use emotions in their speech

.

3. Results

The analysis of the 455 tweets resulted in a total of two main themes, classifying one of these main themes into two sub-themes (Figure 1).

A Sankey diagram has been developed to determine the different co-occurrences that exist between each of the codes analyzed (Figure 2). This visual resource makes it possible to show the flow (number of times coded) of the different codes analyzed in this qualitative study. As can be observed, some of the codes that tend to be mentioned together are love in the tweets that mention emotions and well-being or work in the tweets that do not mention emotions. Attending to the co-occurrences that exist between codes, a high association is observed between the codes anxiety and depression, self-esteem and mental disorder, and love and self-esteem.

3.1. Users Who Do Use Emotions in Their Speech

This first theme addresses X users who use emotions when expressing themselves about mental health. Considering the 455 initial tweets, 79 were coded for mentioning emotions in their discourse on mental health. Thus, it is established that only 17% of the collected tweets referred to some type of emotion. To specify the type of emotion, the contributions of Bisquerra [8], who distinguished between positive and negative emotions, were considered.

Table 2. Co-occurrences between codes.

Codes	It Does Mention Emotions
Physical activity	4
Love	27
Anxiety	33
Support	2
Self-care	1
Self-esteem	12
Welfare	13
Depression	20
Empathy	2
Stress	9
Happiness	3
Healthy habits	4
Illusion	1

shows the co-occurrences obtained between the codes identified and the tweets that do present emotions, the most common being anxiety, love, and depression.

3.1.1. Positive Emotions

Regarding the positive emotions used by X users, a distinction was made, as established by the selected classification, between joy, humor, love, and happiness. It should be noted that of these four emotions mentioned, only love and happiness appear in the speeches analyzed.

The emotion of love is sometimes mentioned with the variables of self-esteem, well-being, emotional intelligence, empathy, or therapy. In addition, this emotion is also linked to the love towards a partner or the self-love that every person should have for him/herself.

“Mental Health is also important. If you need help please shout out, we all matter. Don’t stop fighting, we’ll be here to support you, 😔❤️ We all deserve respect, love, ayuda ❤️ #MentalHealth”

“There are prices you don’t have to pay to be loved #psychology #love #partner #self-esteem #self-love #self-health #emotionalhealth #emotions #emotionalintelligence”

On the other hand, the other positive emotion mentioned is happiness. This emotion is expressed in connection with personal well-being and therapy.

“Those little details are the ones that make the difference and that generate happiness for us ✨ #psychotherapy #psychologyonline #therapyonline #mentalhealth #help #wellness #wellness #psychology #happiness #happy #uniquedetails #details #detailswithlove”

“🟠#WellnessTour We visited the #AdultoMayor program in the municipality of #Nemocón where we conducted training in emotion management for #MentalHealth 🥳 #Happiness is a matter of training”

3.1.2. Negative Emotions

The negative emotions that were sought in the analysis of the transcripts were fear, anxiety, anger, sadness, and disgust. Based on these five emotions, all of them have been mentioned at some time in the analyzed speeches, with the exception of disgust.

As for these negative emotions, anxiety is one of the most mentioned by X users when referring to mental health. This type of emotion is related by participants to other variables that have a close link with mental health such as depression and stress. Some of the other codings that have been made with anxiety are well-being, loneliness experienced by people, or certain healthy habits such as physical exercise.

“Stress has a thousand faces and contributes to as many as 300 million people having had anxiety at some point, according to WHO. #saludmentalhealth”

“Regularly #exercising 🤸🏻‍♀️ reduces stress levels, helps improve depression and #anxiety and makes it easier to rest and sleep better. Discover the 4 benefits of exercising for your #mentalhealth”

The next emotion addressed is sadness, which is used as a way of expressing the feelings people have about a particular event.

“The sad, very sad thing is to see how on #MentalHealth issues society is at zeros. How they downplay and make fun of what happened. To all those people, I hope they are never in that hell, which is lethal”

“That’s how sad the reality is that many sweep under the rug along with the dirt. Calling all cases #MentalHealth issues is costing lives”

As for anger, this emotion has often also been mentioned through the expression of anger. However, due to their similarity, both expressions have been coded as the same code. Although users do not mention the emotion of anger as such, the understanding of the tweet gives rise to this emotion indirectly.

“Cascade of unnecessary barbarities said to a patient. #MentalHealth Really? I’ve read things that get on my nerves. This gives me a lot of anger, a lot of impotence...”

Finally, the negative emotion of fear was the least mentioned within this categorization. In addition, this emotion does not appear reflected within a phrase as such but within a set of keywords or hashtags that the user has published with the intention of exalting these words.

“#friends #self-esteem #self-love #self-love #amorsano #resilience #emotionalintelligence #emotions #assertiveness #therapy #psychology #anxiety #fear #stress #women #self-care #self-care #mentalhealth #depression #couples #families #nurturing #emotionaleducation #wellness #assertiveness #adolescence”

3.2. Users Who Do Not Use Emotions in Their Discourse

The second main theme obtained after the data analysis deals with users who do not mention emotions when discussing mental health on X. One aspect to note, compared to users who did mention emotions, is that there are a higher number of people who do not make reference to emotions to those who do. Specifically, of the 455 initial tweets, 376 of them made no mention of emotions, which represents 83% of the sample. By means of

Table 3. Co-occurrences between codes.

Codes	No Mention of Emotions
Physical activity	8
Anxiety	2
Support	4
Self-esteem	3
Welfare	30
Depression	16
Empathy	1
Stress	6
Healthy habits	8
Anger	1
Addiction problems	6
Soledad	1
Suicide	19
Therapy	10
Job	12
Mental health disorders—diseases	30
Violence	6

, we can visualize the co-occurrences obtained between the codes analyzed and the fact of not using emotions, the most used codes being well-being, mental health disorders/illnesses, and suicide.

In terms of the topics that X users emphasize the most when dealing with mental health, it is necessary to mention disorders such as depression or certain degenerative diseases such as Parkinson’s disease.

“Depression prevention is essential to our mental health and well-being. Talk to someone you trust, seek professional help and practice daily self-care. Let’s take care of our mind as much as our body! #MentalHealth #DepressionPrevention”

“Parkinson’s not only affects the body, it can also have a significant impact on mental health Learn more about this disease and how we can better support people living with it!💪🏽💙 #Parkinson’s #MentalHealth”

Healthy lifestyle habits are also mentioned as a way to prevent stress or certain disorders. Participants highlight physical activity, rest, and a healthy diet as means of promoting personal wellbeing.

“Insomnia is a disorder that affects many people around the world. To improve sleep quality, establish a sleep routine, avoid stimulants, create a suitable sleep environment, practice relaxation and exercise regularly. #insomnia #mentalhealth”

“Reducing exposure to #stress and including #rest #time increases your #mental #health and #integral #wellness #today #network #community #coaching #solitude”

Another issue that is of special attention for users of this social network is suicide. People use this medium to express this problem and claim the need for resources to prevent this public health problem.

“States should not keep using mental health for advertising, they need to get serious about this once and for all and get citizens help! #mentalhealth #MentalHealth #SuicidePrevention”

“You are absolutely right, #suicide is not an act of cowardice, these things should not be talked about so lightly, it is a very serious issue, there are many, many people with that problem that can be very affected by the things that are said #MentalHealth #Depression”

The workplace is another of the topics mentioned with a negative connotation with mental health. X users address the need to take into account the mental health of employees, as well as the consequences of aspects such as unemployment or job insecurity.

“The importance of leading by seeking people’s well-being. New studies suggest that for 70% of the population, their bosses have the same impact on their #MentalHealth as their partner”

“That’s where leadership is going to play a key role in counteracting #mentalhealth issues, with conscientious managers generating a space to be able to talk. Let the question of how an employee is feeling be followed by, “How can I help you?”

All these topics are the ones most exposed by users. However, although not in the same proportion, there are also other social issues that concern Internet users, such as death, loneliness, problems of addiction to certain substances, or the violence to which certain vulnerable people are involved.

“And this can lead to suffering from anxiety and depression. This more can produce unwanted loneliness. #DidYouKnow #MentalHealth”

“#HealthYouDeserve is the one that also protects #MentalHealth for depressive, psychiatric, addicts, we all have the right to comprehensive health system, where life prevails and not death and neglect that now exists”

4. Discussion

The importance of studying emotions lies in the fact that they influence the way people perceive experiences and can affect mental and physical health [5,6]. Several authors have focused their research on explaining the concept of emotion, as well as on presenting theories on the types of existing emotions [7].

The aim of this research was to analyze the discourse on mental health in social networks in terms of the presence of emotions. The results obtained show that the presence of emotions in the discourse on mental health is quite limited compared to not addressing emotions. However, the tweets that did mention emotions in their discourse on mental health were analyzed according to the classification proposed by Bisquerra [8] of positive and negative emotions. Regarding positive emotions, the most representative were love for oneself or another person and happiness as a variable linked to well-being. The scientific literature shows that there is a positive relationship between positive emotions and mental health, as it reduces stress levels and symptoms of depression [28,29,30,32,33,37]. In addition, this type of positive emotions increases aspects such as resilience, life satisfaction, and self-esteem of individuals [34,35,36]. Regarding negative emotions, in the discourse in networks, anxiety is the most predominant as it tends to be linked to depression and stress. This idea is linked to the fact that a prolonged experiencing of negative emotions tends to present mental health problems such as depression [44]. The next negative emotions that are also expressed are sadness, anger, and fear. It is worth highlighting how negative emotions are related to low psychological well-being, substance use, and negative effects on people’s mental health [38,42,43]. The same occurs when there is no adequate emotional regulation or expression, which is associated with greater anxiety and stress problems [45,46].

As mentioned above, the presence of emotions when talking about mental health is scarce. However, people do address the issue of mental health in their discourse in networks. This appreciation makes us think that emotions do not receive the attention and importance they deserve in the field of mental health or that people do not feel comfortable expressing them through a social network under the argument that they could be misinterpreted. Despite this, the tweets collected that did not mention emotions were analyzed with the aim of identifying which variables X users referred to in relation to mental health. One of the most frequently addressed topics within mental health are aspects related to certain diseases or the prevention of disorders such as depression. This idea is linked to the fact that mental health is fundamental to prevent this type of disorders [11]. In addition, different healthy habits such as physical exercise and rest are mentioned as variables that improve mental health. X users address suicide as a health problem that needs to be addressed, since as stated by Kim et al. [10] positive changes in mental health reduce the risk of mortality and improve life satisfaction. Another concern of the participants in relation to mental health is the workplace, as they argue the importance of taking into account the mental health of employees. Recent studies identify that workers who are in a positive work environment without violence and, therefore, have better levels of mental health, are more productive and are more satisfied at work [12,13]. It is worth noting another type of issue that is also important within mental health, such as violence, since people who suffer discrimination can be mentally affected [22]. On the other hand, the issue of addictions is also exposed as a factor that alters mental health. Previous research in the literature identifies not only addiction to certain substances but also to social networks as an aspect that enhances anxiety and depression [25,26,27].

5. Limits

Some of the limitations obtained in this study is that only the social network X has been considered, since it is one of the social media where people tend to express themselves the most. In addition, the number of tweets and their timing was limited by the analysis program used. Another limitation to comment on is that other types of social variables such as user demographics, gender, age, or geographic location among others were not taken into account. This type of information would have provided greater academic quality to the study, since it would have been possible to discuss the existing differences according to these variables.

6. Conclusions

In conclusion, it is important to highlight how in the discourse on social networks as popular in our society as X, there is a tendency for emotions not to be taken into account when posting or commenting on something about mental health among users. Through this research, we have discovered that despite not taking emotions into account when commenting on mental health, the aspects that most tend to expose are the variables related to mental health disorders, wellbeing, depression, or even suicide. However, the most commented positive emotion is love as opposed to anxiety as a negative emotion. All emotions are part of the human experience and play important roles, such as communicating our needs and adapting to our environment. When emotions are not properly understood, recognized, or managed, mental health problems can arise. It also involves fostering an environment in which people feel safe to express their emotions and seek support when needed. Thus, the practical implications of this study include identifying the importance of emotions on mental health. Through this research, the crucial importance of emotions in mental health is highlighted and can be a guide for the development of educational programs in communities and schools. In addition, knowing how emotions are used in mental health can promote new avenues of research focused on emotional well-being. These actions can significantly transform the way we approach and treat mental health in everyday life. About future lines of research, it would be interesting to know why emotions are not considered in emotional health. In order to go deeper into this type of study, interviews or focus groups could be carried out to find out in greater detail the social opinion on mental health and its relationship with emotions. It is important to emphasize that emotions play a fundamental role in our mental health. Therefore, recognizing, understanding, and managing our emotions in a healthy way is essential to promote emotional and psychological well-being. Thus, it is necessary that both at an individual and societal level they are given the importance they deserve, and that emotional education and adequate emotional support are promoted.