How Mental Health Self-Disclosure Becomes Visible: Evidence from Eight Conditions on Reddit

Objectives: To develop a codebook for self-stigma across cognitive, affective, and behavioral domains, and to estimate the prevalence, co-occurrence, and temporal patterns of these indicators in Reddit posts by people who use drugs. Methods: We developed a ten-indicator codebook through consensus-based abductive coding spanning cognitive (self-labeling, pessimism/self-defeatism, deservingness/worthlessness), affective (shame, guilt/self-blame, despair/hopelessness), and behavioral (concealment, anticipated rejection, desire to quit, ambivalence) domains; two coders reached substantial agreement (Cohen's k = 0.72). We then scaled classification with a large language model validated against expert coding (k = 0.73, F1 = 0.80), analyzing 72,115 thread-initiating posts from 1,660 English-language users (2006-2025). Results: 3,838 posts (5.3%) from 1,228 users (74.0%) contained self-stigma; all ten indicators discriminated self-stigma posts (RR 3.6 to 86.2), led by self-labeling (56.0%) and despair/hopelessness (48.5%). Self-stigma was integrated: core and behavioral indicators were strongly associated at the user level (OR = 4.65, 95% CI 3.12-6.94, p < 0.001), and 87.0% of posts with behavioral indicators also contained a core indicator. Contrary to progressive models, behavioral indicators emerged earlier than core ones (desire to quit at median position 0.08 vs. shame at 0.38). Nine of ten indicators were stable across posting trajectories; only pessimism increased (OR = 1.62, 95% CI 1.25-2.10). Conclusion: Among people who use drugs online, self-stigma is an integrated phenomenon in which behavioral indicators rarely appear without internalized ones and often precede them. Most expressions remain stable over time, but pessimism about change deepens, marking a target for early digital intervention and showing that progressive stage models do not map directly onto textual disclosure.

Computational mental health research has predominantly centered on English-speaking populations, leaving Arabic-language discourse comparatively under-examined. We present an exploratory computational study of 8,147 tweets from 607 users classified by a GPT-4.1 personal-disclosure pipeline as likely lived-experience authors in three condition-specific Arabic-language X (formerly Twitter) Communities. We focus on discourse related to borderline personality disorder (BPD), bipolar disorder, and ADHD, and characterize community-associated linguistic patterns using a multi-domain cultural keyword framework. The results suggest that in this corpus, Bipolar tweets contain more religious and medical vocabulary, BPD tweets contain more relational, identity, and emotional-distress vocabulary, and ADHD tweets more often focus on practical symptoms and medication management. We treat these patterns as hypothesis-generating rather than confirmatory because the corpus is imbalanced across conditions, some subcorpora are temporally concentrated, and the keyword framework is an initial operationalization rather than a validated measurement instrument. The paper contributes a reusable LLM-assisted personal-disclosure pipeline and an exploratory cultural keyword framework for Arabic mental health discourse.

Most prior work on predicting mental health help-seeking treats it as post-hoc classification of users already active in clinical communities, which cannot tell whether someone approaching a transition can be identified in advance. We instead frame help-seeking as a time-to-event problem and ask which Reddit users will eventually seek mental health support, and how imminent that transition is. We build a two-arm cohort: a control frame of 6,337 ordinary users with genuine right-censoring (12.1% transition rate) to answer who will transition, and a clinical frame of 5,023 eventual transitioners to answer how soon. Features come only from posts written before any clinical activity, and user-grouped five-fold cross-validation plus a four-year temporal holdout guard against leakage. We compare TF-IDF, MentalBERT embeddings and behavioural activity features using Cox proportional hazards models, Random Survival Forests and an LSTM sequential model. Behavioural features alone outperform text for predicting who will seek help (C-index 0.797 vs. 0.763), and combining both is best (0.823 under cross-validation, 0.856 on the holdout). The pattern reverses for predicting how soon a known transition will happen: text remains a stable predictor (C-index 0.698) while behavioural features become unstable. Structural engagement patterns therefore carry information about future help-seeking beyond linguistic content, and separating who from when yields a cleaner analysis.