Digital Psychiatry

ISSN: (Print) 2575-517X (Online) Journal homepage: https://www.tandfonline.com/loi/tdig20

Media and the role of digital psychiatry in mental

health

Suhas Chandran, Supriya Mathur & Kishor Manohar Rao

To cite this article: Suhas Chandran, Supriya Mathur & Kishor Manohar Rao (2019)
Media and the role of digital psychiatry in mental health, Digital Psychiatry, 2:1, 34-44, DOI:
10.1080/2575517X.2019.1651625

To link to this article: https://doi.org/10.1080/2575517X.2019.1651625

© 2019 The Author(s). Published by Informa

UK Limited, trading as Taylor & Francis
Group.

Published online: 14 Aug 2019.

Submit your article to this journal

Article views: 4631

View related articles

View Crossmark data

Citing articles: 1 View citing articles

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=tdig20
DIGITAL PSYCHIATRY
2019, VOL. 2, NO. 1, 34–44
https://doi.org/10.1080/2575517X.2019.1651625

REVIEW ARTICLE

Media and the role of digital psychiatry in mental health

Suhas Chandrana, Supriya Mathurb and Kishor Manohar Raob
a
Department of Psychiatry, St. John’s Medical College Hospital, St. Johns National Academy of Health Sciences, Bangalore, India;
b
Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore, India

ABSTRACT ARTICLE HISTORY

The mass media is largely regarded as an integral cogwheel in health service delivery, with Received 30 May 2018
a decisive influence on public attitudes. Numerous studies identify connections between Accepted 30 July 2019
media use and negative outcomes such as increased depression, suicide, anxiety, substance
KEYWORDS
use, aggressive behaviour, obesity and eating disorders. Digital tools in psychiatry may pro-
Media; mental illness;
mote change and improve health service delivery, augment clinical relationships and influ- negative portrayal; positive
ence the dynamic relationship between mass media depictions of mental illness and the portrayal; tool for change
publics understanding. Unlike most journalists, who must rely on second-hand accounts,
mental health professionals can weigh in directly with their advice, opinions, and expertise
on social media, based on direct accounts from patients.

Introduction which people are exposed to media representations

Definition
Media has been defined as any storage and trans-
mission channel or tool used to store and deliver
information or data. Mass media is synonymous to
media, which may refer to one single medium used
to communicate any data for any purpose [1].
Forms of Media
The term media commonly refers to the mediums of
books, radio, magazines, newspapers, cinema, televi-
sion, billboards and computer complexes. Each
medium is a symbolic model of a big industry, which
is further interlinked with other related industries.
The various studies cited in this chapter focus on
one or another of these media, and others examine
a combination of media. India being the largest
democracy and with fairly unrestricted media is likely
to be a case in point about how media influences
the perception of mental illnesses
Media and its influence in the society
Over the past few decades, considerable amount of
research has been conducted to examine the effect
of the mass media on the belief systems of the pub-
lic [2]. These studies have concluded that the
media’s power to influence public perception, the
frequency in which it is used, and the degree to
combine to make the mass media one of the most
significant influences in developed societies [3].
What people see and hear in the media impacts
their daily lives. It encourages them to buy some-
thing they saw in a commercial, informs them of the
latest ‘craze’ and also tells them how they ‘should
act.’ This becomes alarming because the power of
the media is easy accessible. The power that the
media holds has evolved over time, with people trust-
ing the message delivered, without really critically
evaluating the information received [4]. But there
have been differences in the levels of scepticism
about media, with some being more accepting than
the other. This article though, may be biased to first
world countries, and change in mindsets of individu-
als residing in third world countries like India need to
be further explored [5]. Hottentot and colleagues [6]
in a study reported the various sources of media from
which people gather information regarding mental ill-
ness or any information regarding psychiatry. These
are TV and news 70%, Newspapers 58%, News maga-
zines 34%, TV talk shows 31%, Radio news 26%,
Internet 25%, Non-fiction books 25%, Talk shows on
radio 18% [6] (Table 1). The limitation here, though, is
that the influence of social media has grown tremen-
dously in the interval between this study and current
times, and this needs to be considered in future
investigations.
Various studies have concluded that the different
forms of media are the most significant source of

CONTACT Suhas Chandran suhaschandran90@gmail.com Department of Psychiatry, St. John’s Medical College Hospital, St. Johns National
Academy of Health Sciences, Bangalore, Karnataka, India
ß 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Table 1. Popular sources of information about mental ill-
ness [2].
TV news and magazine shows 70%
Newspapers 58%
TV news 51%
News magazines 34%
TV talk shows 31%
Radio news 26%
Other magazines 26%
Internet 25%
Non-fiction books 25%
Talk shows on radio 18%
Women’s magazines 18%
information about mental illness for the common
man [7–9]. Conception and ideas of mental illnesses
for both positive and negative experiences in the
common man are distorted and synthesized by
media influences. A very compelling observation by
Philo in 1996 [10] was that media could supersede
people’s own personal experiences in relation to
how they view mental illness. The initial low interest
of media guilds about mental health have changed
significantly over time, with Rhydderch et al finding
a substantial increase in articles covering mental
health, including a reduction in stigmatization and
portrayal of mental health as dangerous, but a con-
comitant increase in articles depicting psychiatrically
ill persons as incapable [11]. These then advocate for
sensitization as a way of persuading media for more
effective involvement in mental health initiatives.
Long-term anti-stigma campaigns that encompass
human-rights-based, normalization, and educational
approaches are needed. Media involvement is crucial
for success, but for the media to be used effectively,
its motivations and limitations must first be implicit
and transparent. Many other studies have found a
definite connection between negative media por-
trayals of mental illness and the public’s negative
attitudes towards people with mental health issues.
Cutcliffe and Hannigan [12] further state that rarely
does a week go by without a reference to mental ill-
ness in the mass media [7,12,13].
Considerable research has concluded that the
media are the public’s most significant source of
information about mental illness and television
being one of the most powerful milieu for framing
public consciousness [14].
Negative images and stereotypes in
entertainment media
Media has certainly highlighted key social move-
ments and has promoted fundraising for several
worthwhile causes; but it has also served as a plat-
form for less beneficial and sometimes troubling
occurrences at both individual and societal levels.
According to Diefenbach’s [8] content analysis of
television programming, depictions of people with
DIGITAL PSYCHIATRY 35
inferred psychiatric conditions or stated psychiatric
diagnoses were highly correlated with the portrayal
of violent crime. 72.1% of the adult characters who
were portrayed as mentally ill in prime-time televi-
sion dramas injured or killed others. Characters with
a mental illness were nearly 10 times more violent
than the general population of other television char-
acters, and 10 to 20 times more violent during a
two-week programming sample than real individuals
with psychiatric diagnoses were over one entire year
in the U.S. population [15].
In both Bollywood and Hollywood movies, the
depictions of psychiatric treatment, especially elec-
troconvulsive therapy (ECT), were often inaccurate,
distorted and over dramatized. ECT was shown to be
administered by force to punish, to repress identity
and to induce insanity [16]. The clinical evidence of
safety and usefulness of ECT, which is one of the
most effective forms of psychiatric treatment in
severe mental illness, had been largely overlooked.
ECT treatment has been depicted to cause mental
disturbance and amnesia without clinical improve-
ment in movies like Raja, Damini, Khamoshi, Jewel
Thief, Rath aur Din, etc [17,18]. Extreme forms of
treatment like lobotomy like in the Hollywood movie
One flew over the cuckoo’s nest and forced medica-
tion have been depicted in movies without a clear
indication and rationale, suggesting a rather barbaric
side to psychiatric treatment [19].
Yet in reality, people suffering from a mental ill-
ness who do not have a concurrent substance abuse
disorder are no more likely to commit a violent
crime than anyone else [20]. In fact, one study found
that 95–97% of violent episodes in the United States
are committed by people with no mental illness [21].
Another study found that media representations of
mental illness are so powerful that they can override
people’s own personal experiences in relation to
how they view mental illness [22]. The truth is that
people with mental disorders do recover and make
significant contributions to our communities and
studies show that optimism about outcome from
severe mental disorders like schizophrenia is justified
[23]. Most people with mental disorders are our rela-
tives, neighbours, friends and peers who are caring
and law-abiding citizens [24].
Media as a risk factor in mental illness
The true relationship between the use of media and
mental health is a relatively new and a complex area
of study given the constantly changing technological
landscape. While some studies point to the positive
aspects and outcomes of our interactions online, a
growing base of research seems to reinforce the
opposite view.
36 S. CHANDRAN ET AL.
Media and suicide
Glamorised depictions of suicidal behaviour in the
media can have a negative influence and could pos-
sibly facilitate suicidal acts by people exposed to
such stimuli. The impact of the media on suicidal
behaviour seems to be most likely when a method
of suicide is specified, especially when presented
with over inclusive details, when the story is
reported or rendered overdramatically and strikingly
– for example with photographs of the deceased or
large headlines. The process by which one suicide
becomes a coercive model for another suicide is
termed the Werther effect [25]. In India, Chowdhury
et al. [26] looked into a judicial hanging in West
Bengal to study how news projections generated
copying of hanging behaviour. They reported 18
cases of copycat suicides, 17 other replica acts with
5 deaths. This imitative behaviour with copycat sui-
cides and attempts has been observed even in chil-
dren and adolescents. Many factors have been
postulated as risk factors for such cloned suicidal
behaviours. It has been seen that imitative suicides
are more common within 2 weeks of the first event,
with greater media coverage, repeated coverage and
high-impact stories, when the person described in
the story and the reader/viewer are similar in some
way especially core features such as age, sex and
nationality, when the person described in the story
is a celebrity and is held in high regard by the
reader/viewer, with the most vulnerable being young
people, people suffering from depression and sub-
stance use disorder [27]. A critical facet of the
media’s presentation of suicide is that it usually over-
simplifies the causes, attributing the act to solitary
factors such as broken relationships, financial disas-
ters or failure in examinations [28].
Stack and colleagues reviewing 55 studies deter-
mined that: (1) studies measuring the presence of
either an entertainment or political celebrity were
5.27 times more likely to find a copycat effect, (2)
studies focusing on stories that stressed negative
definitions of suicide were 99% less likely to report a
copycat effect, (3) research based on television sto-
ries (which receive less coverage than print stories)
were 79% less likely to find a copycat effect, and (4)
studies focusing on female suicide were 4.89 times
more likely to report a copycat effect [29].
On a positive note farmer suicide is an issue that has
been highlighted by the media in recent times, con-
structively raising awareness about the stress and plight
of the farmers and sensitizing the authorities [30].
WHO guidelines on reporting a suicide are
as follows:
1. Statistics should be interpreted carefully
and correctly
2. iAuthentic and reliable sources should be used
3. Impromptu comments should be handled care-
fully in spite of time pressures
4. Generalizations based on small figures require
particular attention, and expressions such as
‘suicide epidemic’ or ‘the place with the highest
suicide rate in the world’ should be avoided
5. Reporting suicidal behaviour as an understand-
able response to social or cultural changes or
degradation should be resisted.
Media and substance use
Media can play a key role in the initiation and accen-
tuation of substance use. Social media is a common
medium of exposure to two decisive factors associ-
ated with alcohol use: peer alcohol behaviour [31,32]
and alcohol advertising [33]. Social learning theory
postulates that individuals learn both by enactive
experience and by observation [34–36]. Especially,
early alcohol initiation is governed at least in part by
observation of alcohol use both by friends and by
social network characteristics [36]. In today’s techno-
logical world, this observation can occur both online
and offline.
The Media Practice Model suggests that media
users explore information or display content based
on experiences or behaviours they are considering,
which may lead to reinforcement or advancement of
these ideas. Thus, an adolescent who is considering
initiating alcohol consumption may choose to watch
a movie depicting drinking at a party, which in turn
may influence him or her to attend such a party in
the future. It has been shown that exposure to alco-
hol commercials is associated with positive beliefs
about alcohol consumption [37]. Displayed alcohol
references have been linked to alcohol behaviours
offline, because older adolescents whose Facebook
posts suggested problem drinking behaviours are
more likely to score as ‘at risk’ on a problem-drinking
screen [38].
Research has revealed that advertising may be
responsible for up to 30% of adolescent tobacco and
alcohol use [39,40]. Exposure to tobacco marketing
and advertising increases the smoking initiation rates
in teenagers more than twofold [41]. Advertisements
and promotion of cigarettes have been increasing in
developing countries like India due to a sharp
decline in sales in Western countries, and pose a
major concern [42]. Although such cross-sectional
studies do not prove causation and if only associ-
ation, it is of interest that in a 1990 study, 56% of
students in grades 5 to 12 said that alcohol advertis-
ing encourages them to drink. Findings showed that
girls who had watched more hours of TV advertise-
ments at ages 13 and 15 drank more wine and

spirits at age 18 than those who had watched fewer
hours of TV [43]. One study suggested independent
associations between marijuana and alcohol use, and
media exposure. In particular, music exposure is
associated with marijuana use while movie exposure
is related to alcohol use [44]. These findings suggest
a clear cause–effect relationship between media
influence and substance use but may be an oversim-
plification of the problem, as multiple other bio-
logical, psychological and social factors may be in
play in different contexts.
Media research also shows that illicit drugs were
commonly shown in a large proportion of movies as
well as through the television [45,46]. Characters are
often shown smoking as a part of daily life. Covert
sponsoring of mega sport events like international
cricket matches and bravery awards surreptitiously
aim to promote tobacco products. These may attract
the vulnerable adolescents toward smoking as a
desirable ‘grown up’ activity [47]. A study from India
suggests that those children who are exposed to cig-
arette brand names through television are more
likely to smoke, while those exposed to anti-tobacco
messages are less likely to smoke [48].
Media literacy can teach youth to understand,
analyse, and evaluate mass media messages, ena-
bling them to actively process the information rather
than passively remaining targets of mass media.
India wrestled with a lot of polarized debates and
controversy for the ban on on-screen smoking in
films and television programs. Initially, ban was
imposed from January 1, 2006 and then on January
23, 2009, the Delhi High Court lifted the smoking
ban in films and TV [49]. There is a dire need for evi-
dence based guidelines for such issues.
Media and eating disorders
Exposure of women to alluring thin images in the
media has been speculated to lead to body image
discontent, poor self-esteem, an intense urge for
thinness and a drive for dieting which may result in
eating disorders [50–52]. Media can have a causal
effect; act as a trigger or a confounder for those
who are otherwise predisposed. It is possible that
only those individuals having pre-existing anxiety,
depression, low self-esteem or a genetic liability are
susceptible to cultural demand and go on to
develop symptoms of eating disorders post expos-
ure. Looking at factors that may lead some women
to be more vulnerable to the messages and images
portrayed in the media the review by Groesz et al.
[53] indicated that females who have already inter-
nalized the thin beauty ideal and already have high
levels of body dissatisfaction are most vulnerable. A
meta-analytic review further indicated that
DIGITAL PSYCHIATRY 37
adolescent girls with initial deficits in social support
are also more vulnerable to the effects of the media
messages [54].
In the context of mass media, regional differences
exist in body image dissatisfactions. Until the advent
of televised media on the Fiji islands, eating disor-
ders had not been recorded [55,56]. In Iran, ban on
Western media after the fall of the Shah averted
being exposed to the thin body beauty, leading to a
higher body esteem of Iranian female students [57].
Both India and China reported cases of eating disor-
ders after 1990 with increased and more consistent
exposure to the Western media [58]. Shroff and col-
leagues in Mumbai in 2004 [59] examined the rela-
tionships among the variables of body mass index,
interpersonal teasing, media internalization, body
dissatisfaction, and drive for thinness in 96 and 93
adult females. Their findings reflect previous work
with U.S, and Swedish samples, suggesting that
there are similar potential risk factors, cross-cultur-
ally, that may explain the development of eating
and shape-related problems. Muscular dysmorphia, a
type of ‘reverse anorexia’ in males with a fixation on
muscle bulk, has surfaced as a male counterpart of
anorexia nervosa seemingly sustained by media por-
trayal of lean and muscular men [60]. Women’s mag-
azines remain a significant source of such exposure.
One prospective study examining the thin ideal-
endorsing media use in young adolescent girls found
that decreases in magazine reading over 16 months
was associated with decrease in disordered eating
symptoms [50].
The age of exposure also seems to be an import-
ant determinant. A meta-analysis of 25 studies
involving female subjects, examined the effect of
exposure to media images of the slender body ideal.
Body image was significantly more negative after
viewing thin media images than after viewing
images of average size models, plus size models or
inanimate objects especially in women younger than
19 years of age [53]. Field et al found that both boys
and girls aged 9 to 14 years who were making an
effort to look like the figures in the media, were
more likely than their peers to develop weight con-
cerns and become regular dieters [59].
Media and depression
The rise and acceptance of social media has been
particularly marked around the globe. Although it
may act as a means of making friends and gathering
social support, it may lead to stress in some individ-
uals [61]. Because social media websites are among
the most commonly accessed websites with a large
quantum of users [62]. Multiple studies have linked
social media use with declines in subjective mood,
38 S. CHANDRAN ET AL.
sense of well-being, and life satisfaction [63,64].
Passive consumption of social media content, as
opposed to active communication has been linked
with decrease in bonding and increase in loneliness
[65]. One hypothesis is that exposure to highly ideal-
ized representations of peers on social media evokes
feelings of envy and the erroneous belief that others
lead happier lives. Subsequently, these envious feel-
ings may gradually lead to a sense of self-inferiority
and depression [27]. In a longitudinal study of ado-
lescents by Frison and Eggermont in 2016 [66], the
association between negative online comparisons
and decreased life satisfaction was reciprocal. Thus,
depressed adolescents with less life satisfaction can
be more vulnerable to negative online social com-
parisons even as these comparisons are unlikely to
be based on reality.
Cyberbullying is an emerging public health con-
cern that has been associated with several negative
consequences. Victims report increased levels of
depression and suicidal ideation, as well as elevated
levels of emotional distress, externalized hostility,
and delinquency compared to non-victimized peers
[67]. While much media attention has focused on its
targets, research has shown that perpetration of
cyberbullying is also associated with negative health
effects. For example, adolescent girls who cyberbully
others have been found to have increased rates of
depression and anxiety compared with uninvolved
peers [68].
Media exposure at night can disturb sleep, which
is integral for normal cognitive and emotional devel-
opment [69]. In addition, messages transmitted
through the media could lead to fear, anxiety and
aggression [70]. Whether media multitasking is used
by persons who are depressed and anxious as a
means of distraction needs to be further eval-
uated [62,71].
Media and social anxiety disorder
Two different hypotheses have been proposed in
order to interconnect media use and social anxiety.
The first hypothesis proposed is the social compen-
sation hypothesis, according to which individuals use
online social networking sites in order to compen-
sate for deficits in social skills or discomfort in face-
to-face situations. The second theory is called the
social enhancement hypothesis. According to which,
socially skilled individuals use online social network-
ing sites to find additional opportunities to interact
with others. There is mixed evidence regarding the
two hypotheses, as both have received sup-
port [72,73].
Media and sexual behaviour
The influence of media on sexual behaviour was first
documented in a sex education newsletter in 1981
and since then several overviews have examined
adolescents’ use of media and its possible effect on
their sexual behaviour [74–76]. Concerns have been
raised about the influence of media depictions on
sexual attitudes, sexual behaviours and the normaliz-
ing expectations of adolescents at a critical develop-
mental stage [77–79].
Media exposure to pornography may lead to
experience of conflict and sexual dissatisfaction [80].
Media exposure to sexual themes could have a
negative effect on the attitudes towards women and
may harbinger to a greater disposition to indulge in
coercive encounters and experimentation [81,82].
There is an increasing trend of messaging of sex-
ual contents through mobiles among school going
adolescents. Survey results indicate that TV programs
watched by adolescents contain high levels of sexual
content and include little information about sexual
risks [83]. A study found that nearly 75% of 15- to
17-year-olds believe that sexual content on television
influences the behaviour of their peers ‘somewhat’
or ‘a lot’ Adolescents who selectively viewed more
sexual content on television were more likely to
have sexual intercourse in the preceding year [84].
Ashby, et al. with the use of longitudinal data exam-
ined the relationships between amount of television
viewing and parental regulation of content on sexual
initiation and observed that watching TV 2 or more
hours per day and lack of parental regulation of tele-
vision programming were each associated with
increased risk of initiating sexual intercourse within a
year [85]. Peterson, et al. concluded that co-viewing
television and discussing television with parents
were linked with decreased sexual initiation in cer-
tain adolescents [86]. It is true that individuals
already exposed to and engaging in such behaviour
may have a higher chance of watching or reading
similar content on media. But it is equally true that
media can influence new people coming across the
content as well as validate behaviours of the ones
who are already engaging in them.
Sending or receiving sexually explicit content –
texts, pictures or videos is referred to as sexting.
Some people hold positive attitudes of sexting, due
to the thrill and excitement of it; it may also be a
normal practice in the current technologically
advanced environment for many romantic relation-
ships. It may also be used as a way to seek accept-
ance and to fit in a peer group and may lead to
sharing compromising images of themselves, without
due consideration about how widely these images
can be disseminated. The downside though, is the
ease with which this content can be misused, as it

can be used for bullying, cybercrimes such as creat-
ing pornography, the consequences of which are
profound, such as anxiety, depression and even sui-
cide of the victim who is involved [87].
Media and aggression
Exposure to violence via media has been positively
associated with subsequent aggressive behaviour,
ideas, and with higher rates of aggression in later
life [88,89]. During childhood children encode social
scripts in memory to guide behaviour though obser-
vation of family, peers, community, and different
media. Further on, observed behaviours are often
imitated long after they were observed [90]. During
this period, children’s social cognitive schemas about
their environment are also elaborated. For instance,
protracted observation of violence has been shown
to bias children’s world schemas toward attributing
hostility to others’ actions [91,92]. Conversely, there
is a significant negative impact on helping behav-
iour. Ray, et al. reported that children having expos-
ure to violence through media had poorer school
performance and a deleterious impact on their psy-
chosocial adjustment [93]. One other study from
India revealed how vivid display of violence through
media during the 9/11 terrorist attack caused signifi-
cant stress in adolescents [94].
Few studies suggest that television violence does
not directly influence children’s behaviour or make
them excessively prone to violence but genetic and
environmental factors apparently interact to increase
the risk of the development of aggression among
violence-prone personalities [95]. Media may just act
as an impetus, in the sense that when an individual
with high-violence proneness exhibits aggression, he
or she may model it on what was encountered
through media. However, since aggression is multi-
factorial in origin, no single factor including media
influence can be attributed as a dominant influ-
ence [96].
Desensitization
Repeated exposures to emotionally activating media
or video games can lead to habituation of certain
natural emotional reactions. This process is called
‘desensitization.’ Increased heart rate, perspiration,
and self-reports of discomfort often follow exposure
to blood and gore. However, with repeated expo-
sures, this negative emotional response habituates,
and the child becomes ‘desensitized.’ The child can
then think about and plan proactive aggressive acts
without experiencing negative affect [97].
DIGITAL PSYCHIATRY 39
Discussion
Media as a tool for change
Media is a tool that can be potently used to increase
knowledge, create favourable attitudes and change
overt behaviour. We need to find ways to optimize
the role of media in our society, taking advantage of
their positive attributes and minimizing their nega-
tive ones, to use the media to help people avoid
behaviours that reduce their wellbeing and increase
behaviours that promote it. If the media can worsen
stigma in the field of mental illness, it is reasonable
to assume that media can also potentially be used
to reduce stigma as well [98]. Documentary films can
be used to educate the general public about mental
health and disease. Viewing a documentary about
schizophrenia have led schizophrenia to be per-
ceived as less dangerous [99]. Reading an article
containing corrective information has led to a
greater acceptance of persons with mental illness
and less fear about mental illnesses [100].
Developing a new unified, integrative identity and
working on the positive public image of psychiatry
and its public relations are of great importance for
the future of our profession. The media can have a
substantial imprint on the demand and supply of
mental health treatment as well as on the position
of psychiatry in the society. One of the most compel-
ling image builders is how psychiatrists present their
profession with patients and their families, and other
medical doctors, and the public. It is very interesting
to note that the father of public relations was a
nephew of Sigmund Freud, Edward L Bernays.
Suggestions have been made about how psychia-
trists and mental health professionals should interact
with the media while discussing about psychiatric ill-
nesses. A sensitive use of language and terminology
that preserves the dignity of those with mental ill-
nesses, and at the same time avoiding miscommuni-
cation, is beneficial. Interaction with media should
be taken as an opportunity to debunk myths and
give a lucid account of the psychiatric illnesses in
question. It is imperative to abstain from speculation
and to provide clear instructions about how to avail
services when in need.
Education of the media and using fake news
screens can help control the problem to some
extent, but possibly would not impact much on indi-
viduals working through social media accounts.
Actions such as suspending the account for a brief
period of time if there are lapses in the rules against
propagating fake news, and reinstation on retraction
of the particular content could be attempted, but
this requires significant resources and further plan-
ning, as it has to be done without impinging on the
personal right to freedom of speech. This can make
40 S. CHANDRAN ET AL.
it difficult to report the ‘citizen reporter’ and there-
fore make it difficult to block fake news and misin-
formation that makes the rounds on social media.
Digital psychiatry in clinical practice
Telepsychiatry first was recorded in 1957 is time sav-
ing and cost saving. Advancing technology has led
to its widespread use to help mentally ill patients’.
With the help of telephones, crisis help lines and sui-
cide prevention centres are set up. Emergency psy-
chiatric services are provided through telephones or
mobiles. Email has been increasingly accepted as a
mode of communication with the therapist. Tape
recording of psychotherapy sessions is helpful for ini-
tiation of a session. They are easy to store and
retrieve. It can be passed on to another therapist if
needed. Videotaped group therapy and other psy-
chotherapy sessions help patients see themselves as
other saw them. Through television and TV shows as
well as movies proper portrayal of mental illness can
increase its awareness. Radio can reach the
unreached and unmet. Talk shows and radio pro-
grammes related to psychiatry can also increase
awareness regarding mental illness. Through Internet
self-help groups and support groups can be con-
nected. Internet is an important source of
International Electrotechnical Commission activities.
The internet provides information about mental
health problems such as suicide, anxiety, depression.
Increasing knowledge can improve help seeking
behaviour. There is evidence that mobile phones can
lead to a number of positive health effects like
quicker diagnosis and management, better stress
management, improving adherence and compliance
to medication [101].
The availability of digital media and Internet
makes it extremely easy to share, download and
engage in playing video games, to the extent that
this behaviour can go to the extent that the person
has impaired control over gaming, with playing tak-
ing precedence over daily activities and may result
in the development of gaming disorder. On the
other hand, games are being used for positive
results too, with gamification- the use of game
design elements in non-game contexts, and can
be used in the management of several medical and
psychiatric conditions in a creative and effective
manner, such as depression, anxiety, schizophrenia,
post-traumatic stress disorder and eating disorders. It
is also being used in medical education, and lends
itself suitably to the digitalisation of medical educa-
tion, when used effectively [102]. The juxtaposition
between addictive potential of gaming and its
advantages in being of use in treatment and educa-
tion needs further investigation.
Media can have significant positive impacts on
sexual health-related attitudes, beliefs and behav-
iours. Mass media can provide knowledge about
healthy sex, contraception, family planning, sexually
transmitted diseases and treatment of sexual disor-
ders. Viewing advertisements about human immuno-
deficiency virus (HIV) have led to a reduction in the
reported number of sexual partners by both men
and women and increased condom usage [103].
Several international studies have found that women
who view more family planning messages on televi-
sion, radio and print media are more likely to use
contraceptives than those who see fewer mes-
sages [104].
Resistance to change is a serious obstacle to
effective utilization of new knowledge, but media
can help to overcome resistance. Although media
training is common among business professionals, it
is relative rare within academic psychiatry. This is a
missing opportunity, especially in view of growing
public dependence upon mass media for both fac-
tual information and perspective [105]. Learning how
to use mass media effectively to educate the public
about issues like quality of life, community health,
mental health vs. mental disorders and its treatment,
and the workings of the delivery system for mental
health care (when, how and where to seek help) is
quintessential for the advancement of public
health psychiatry.
A much more active involvement of mental health
professionals in creation of media related to mental
health is the need of the hour, with a successful
attempt involving active liaison of individuals from
the media houses and health industry. Unless the
media is conscientious about what it streams out, it
is difficult to regulate what kind of content reaches
the public. Although psychiatrists do make educa-
tional videos, write newspaper articles and blogs,
participate in seminars, panel discussions directed
towards education of the non-medical population,
these rarely get dispensed through the mainstream
channels which are utilised by most of the gen-
eral population.
Internet based technology has the wherewithal to
revolutionize digital psychiatry. For instance internet
CBT, has the potential to treat patients who currently
are unable to access care, to prevent disease, and to
provide early intervention and quality treatment—it
can be the gateway to psychiatric care. With these
new modalities, clinicians are better able to provide
quality care to all patients with mental health and
other problems. We need to understand emerging
telemedicine trends that will lead the way to better
health and greater opportunity for our patients to
access help. Smartphones in patient care can be
used as adjunctive interventions for to collect and

monitor information and sensing big data to predict
relapse in bipolar and schizophrenic disorders. Torus
J [106], in demonstrating a patient-driven innovation
for mobile mental health technology at Harvard
medical school, helped a patient who wanted to be
able to quantify the effects of this new medication
use a smart tally counter, a digital device that, with
the push of a button, wirelessly transmitted the cur-
rent count to an online portal. This digital tally coun-
ter was convenient to use as it offered easy access
to automatically time-stamped data which could be
analysed later. The patient noted that there was a
correlation between higher doses of medication and
fewer symptoms and it was possible not just to track
and quantify his own mental health experience, but
also that such data could be useful for assessing the
effectiveness of treatment. The fact that the tally
counter tracked the time of each button press
allowed him to gain insight into times of the day
that were more triggering and to recognize weekly
fluctuations in symptoms [106]. Clinical technology is
progressing in tandem with structural changes in the
mental health care delivery system. One of the big-
gest moves from a systems perspective has been in
leveraging digital tools to create and improve care
coordination. Virtual clinics that can support the
digital therapeutic relationship also offer an unex-
plored avenue to potentially realize the value of new
technologies like smartphone apps for mental health
disorders. Instead of forcing traditional clinics to
adopt apps and alternate technologies in a setting
that is not well suited to foster a digital therapeutic
relationship, these new clinics could potentially be
established for exactly that purpose. Since the clini-
cians and workflow of this virtual clinic would be
constructed around digital care and patients self-
selecting for this type of care, an opportunity exists
for the true potential of digital psychiatry to be real-
ized [102]. This represents a shift in thinking of apps
as tools that can themselves revolutionize care to
envisioning them as resources to facilitate and aug-
ment clinical relationships.
Conclusion
There is an intricate dynamic relationship between
mass media depictions of mental illness and the
public’s understanding. The link appears bi-dimen-
sional in the sense that negative images in the
media cultivate negative attitudes, and the resultant
media coverage feeds off an already negative public
perception. Accurate information must therefore be
circulated to the public, and here, not only the main-
stream media, but blogs, forums and social media
platforms would do well to adhere to desirable
standards of exercising restraint and caution before
DIGITAL PSYCHIATRY 41
broadcasting or uploading inaccurate matter onto
public domains. Psychiatrists have a potentially a
pivotal role to play in educating the public about
the current state of the psychiatry. Unlike most jour-
nalists, who have to rely on second-hand accounts
or expert opinion, psychiatrists can weigh in directly
with their advice, opinions, and expertise on social
media, based on direct accounts from patients based
on doctor-patient relationships. But this is unusual,
as most psychiatrists would prefer to not contribute
to such discussions, in view of potential breach of
clinical and institutional guidelines, and also medical
litigation. The onus therefore, at least for now, falls
on the media itself, and it is fundamental to high-
light stories of successful recovery, stories of resili-
ence and hope, which if presented properly, can
both educate and entertain the audiences.
Disclosure statement
No potential conflict of interest was reported by
the authors.
Notes on contributors
Suhas Chandran, MD, is a Senior Resident from the
Department of Psychiatry at St. John’s Medical College
Hospital. His research interests include child and adoles-
cent psychiatry, suicide and role of digital technology in
mental health.
Supriya Mathur is a Junior Resident from the Department
of Psychiatry at J.S.S Medical College and Hospital, Mysore.
Her research interests include substance use disorders,
internet addiction and geriatric mental health.
Kishor Manohar Rao, MD, is an Associate Professor from
the Department of Psychiatry at J.S.S Medical College and
Hospital, Mysore. His research interests include suicide, use
of psychotherapy in clinical practice and use of internet
based technology in mental health.
References
[1] Institute of Medicine (US) Committee on Assuring
the Health of the Public in the 21st Century. The
Future of the Public’s Health in the 21st Century.
Washington (DC): National Academies Press (US).
2002. 7, Media. Available from: https://www.ncbi.
nlm.nih.gov/books/NBK221224/
[2] Wimmer RD, Dominick JR. Mass media research: an
introduction. Belmont Calif.: Wadsworth Pub.;
1997.
[3] Canadian Mental Health Association. Mass media
and mental illness: A literature review [Internet].
Ontario: CMHA; 2004. p. 1–27. Available from:
https://ontario.cmha.ca/wp-content/files/2012/07/
mass_media.pdf
[4] Smith B. Mental illness stigma in the media.
Review J Undergrad Stud Res. 2015;16:50–63.
[5] Ingram M. In India, the fake news problem isn’t
Facebook, it’s WhatsApp. Columbia Journalism Rev
42 S. CHANDRAN ET AL.
2018; [cited 2019 Aug 05]. Available from: https://
www.cjr.org/the_media_today/india-whatsapp.php
[6] Hottentot EI. Print media portrayal of mental
Illness: an Alberta study. Draft. Edmonton: Alberta
Mental Health Board Consumer Advisory Council.
2000.
[7] Cutcliffe JR, Hannigan B. Mass media, “monsters”
and mental health clients: The need for increased
lobbying. J Psychiatr Ment Health Nurs. 2001;8:
315–321.
[8] Diefenbach DL. The portrayal of mental illness on
prime-time television. J Community Psychol. 1997;
25:289–302.
[9] Francis C, Pirkis J, Dunt D, et al. Mental health and
illness in the media: A review of the literature.
Canberra: Mental Health and Special Programs
Branch, Department of Health and Aging
[Australia]. 2001; [cited 2019 Aug 05]. Available
from: http://www.auseinet.com/resources/other/
mhimedia.pdf
[10] Philo G, Secker J, Platt S. The impact of the mass
media on public images of mental illness: media
content and audience belief. Health Educ J. 1994;
53:271–281.
[11] Rhydderch D, Krooupa AM, Shefer G, et al.
Changes in newspaper coverage of mental illness
from 2008 to 2014 in England. Acta Psychiatr
Scand. 2016;134:45–52.
[12] Coverdale J, Nairn R, Claasen D. Depictions of
mental illness in print media: a prospective
national sample. Aust N Z J Psychiatry. 2002;36:
697–700.
[13] Olstead R. Contesting the text: Canadian media
depictions of the conflation of mental illness and
criminality. Sociol Health Illness. 2002;24:621–643.
[14] Philo G. Mass media representations of mental
health: a study of media content. Glasgow:
Glasgow University Media Group. 1993.
[15] Signorielli N. The stigma of mental illness on tele-
vision. J Broadcast Electr Media. 1989;33:325–331.
[16] Swaminath G, Bhide A. ’Cinemadness’: in search of
sanity in films. Indian J Psychiatry. 2009;51:
244–246.
[17] Andrade C, Shah N, Venkatesh BK. The depiction
of electroconvulsive therapy in Hindi cinema. J
ECT. 2010;26:16–22.
[18] Bhugra D. Mad tales from Bollywood: Portrayal of
mental illness in conventional Hindi cinema. 1st
ed. Cornwall, UK: Psychology Press. 2006. p. 328.
[19] Gabbard G, Gabbard K. Cinematic stereotypes con-
tributing to the stigmatization of psychiatrists. In:
Fink PJ, Tasman A, editors. Stigma and mental ill-
ness. 1st ed. Arlington (VA): American Psychiatric
Association; 2019. p. 113–126.
[20] Steadman H, Mulvey E, Monahan J, et al. Violence
by people discharged from acute psychiatric
inpatient facilities and by others in the same
neighborhoods. Arch Gen Psychiatry. 1998;55:
393–401.
[21] Monahan J. Mental illness and violent crime.
National Institute of Justice Research Preview.
Washington (DC): US Department of Justice; 1996.
[22] Philo G. Media and Menial Distress. London:
Longman; 1996.
[23] Warner R. Does the scientific evidence support the
recovery model? Psychiatrist. 2010;34:3–5.
[24] U.S. Department of Health and Human Services –
SAMHSA’s resource center to promote acceptance,
dignity, and social inclusion associated with men-
tal health: the power of the media and its impact
on mental health recovery. 2010. [cited 2019 Aug
05]. Available from: http://www. promoteaccep-
tance.samhsa.gov
[25] The Werther effect: suicide contagion and the
media. Mydigitalpublication.com. 8, December
2017. [cited 2019 Aug 05]. Available from: http://
mydigitalpublication.com/publication/?i=440251&
article_id=2887356&view=articleBrowser&ver=
html5#
[26] Chowdhury AN, Brahma A, Banerjee S, et al. Media
influenced imitative hanging: a report from West
Bengal. Ind J Pub Health. 2007;51:222–224.
[27] Gould M, Jamieson P, Romer D. Media contagion
and suicide among the young. Am Behav Sci.
2003;46:1269–1284.
[28] Hassan R. Effects of newspaper stories on the inci-
dence of suicide in Australia: a research note. Aust
N Z J Psychiatr. 1995;29:480–483.
[29] Stack S. Media impacts on suicide: a quantitative
review of 293 findings. Soc Sci Q. 2000;81:957–971.
[30] Mohanty BB. We are like the living dead”: farmer
suicides in Maharashtra, Western India. J Peasant
Stud. 2005;32:243–276.
[31] Ali MM, Dwyer DS. Social network effects in alco-
hol consumption among adolescents. Addict
Behav. 2010;35:337–342.
[32] Mundt MP, Mercken L, Zakletskaia L. Peer selection
and influence effects on adolescent alcohol use: a
stochastic actor-based model. BMC Pediatr. 2012;
12:115.
[33] Jernigan DH. Importance of reducing youth expos-
ure to alcohol advertising. Arch Pediatr Adolesc
Med.. 2006;160:100–102.
[34] Bandura A. Social learning theory. Englewood
Cliffs, N.J.: Prentice Hall; 1977.
[35] Bandura A. Social foundations of thought and
action: a social cognitive theory. Englewood Cliffs,
NJ: Prentice-Hall; 1986.
[36] Ellickson PL, Hays RD. Antecedents of drinking
among young adolescents with different alcohol
use histories. J Stud Alcohol. 1991;52:398–408.
[37] Brown JD. Adolescents’ sexual media diets. J
Adolesc Health. 2000;27:35–40.
[38] Moreno MA, Christakis DA, Egan KG, et al.
Associations between displayed alcohol references
on Facebook and problem drinking among college
students. Arch Pediatr Adolesc Med. 2012;166:
157–163.
[39] Agostinelli G, Grube JW. Alcohol counter-advertis-
ing and the media. A review of recent research.
Alcohol Res Health. 2002;26:15–21.
[40] Nunez-Smith M, Wolf E, Huang HM, et al. Media
exposure and tobacco, illicit drugs, and alcohol
use among children and adolescents: a systematic
review. Subst Abuse. 2010;31:174–192.
[41] Wellman RJ, Sugarman DB, DiFranza JR, et al. The
extent to which tobacco marketing and tobacco
use in films contribute to children’s use of
tobacco: a meta-analysis. Arch Pediatr Adolesc
Med. 2006;160:1285–1296.
[42] Warren CW, Riley L, Asma S, et al. Tobacco use by
youth: a surveillance report from the Global Youth

Tobacco Survey project. Bull World Health Organ.
2000;78:868–876.
[43] Connolly GM, Casswell S, Zhang JF, et al. Alcohol
in the mass media and drinking by adolescents: a
longitudinal study. Addiction. 1994;89:1255–1263.
[44] Primack BA, Kraemer KL, Fine MJ. et al. Association
between media exposure and marijuana and alco-
hol use in adolescents. J Adolesc Health. 2008;42:
S1–S14.
[45] Roberts DF, Henriksen L, Christenson PG.
Substance use in popular movies and music.
Rockville (MD): Office of National Drug Control
Policy and Control Department of Health and
Human Services Substance Abuse and Mental
Health Services Administration; 1999.
[46] Christenson PG, Henriksen L, Roberts DF.
Substance use in popular prime-time television.
Rockville (MD): Office of National Drug Policy and
Department of Health and Human Services
Substance Abuse and Mental Health Services
Administration; 2000.
[47] Chadda R, Sengupta S. Tobacco use by Indian ado-
lescents. Tob Induc Dis. 2002;1:111–119.
[48] Shah PB, Pednekar MS, Gupta Pc SD. The relation-
ship between tobacco advertisements and smok-
ing status of youth in India. Asian Pac J Cancer
Prev. 2008;9:637–642.
[49] Times N. Delhi High Court lifts smoking ban in
films, TV. 13, [accessed 2009 Nov]. Available from:
http://news.bollysite.com/bollywood/hc-lifts-ban-
on-smoking-in-films.html.
[50] Vaughan KK, Fouts GT. Changes in television and
magazine exposure and eating disorder sympto-
matology. Sex Roles. 2003;49:313–320.
[51] Van den Berg P, Neumark-Sztainer D, Hannan PJ,
et al. Is dieting advice from magazines helpful or
harmful? Five-year associations with weight-control
behaviors and psychological outcomes in adoles-
cents. Pediatrics. 2007;119:e30–e37.
[52] Sargent JD, Beach ML, Adachi-Mejia AM, et al.
Exposure to movie smoking: its relation to smok-
ing initiation among US adolescents. Pediatrics.
2005;116:1183–1191.
[53] Groesz LM, Levine MP, Murnen SK. The effect of
experimental presentation of thin media images
on body satisfaction: a meta-analytic review. Int J
Eat Disord. 2002;31:1–16.
[54] Stice E, Schupak-Neuberg E, Shaw HE, et al.
Relation of media exposure to eating disorder
symptomatology: an examination of mediating
mechanisms. J Abnorm Psychol. 1994;103:836–840.
[55] Becker AE. Television, disordered eating, and
young women in Fiji: negotiating body image and
identity during rapid social change. Cult Med
Psychiatry. 2004;28:533–559.
[56] Becker AE, Burwell RA, Gilman SE, et al. Eating
behaviours and attitudes following prolonged
exposure to television among ethnic Fijian adoles-
cent girls. Br J Psychiatry. 2002;180:509–514.
[57] Akiba D. Cultural variations in body esteem: how
young adults in Iran and the United States view
their own appearances. J Soc Psychol. 1998;138:
539–540.
[58] Lee S. Eating disorders are becoming more com-
mon in the East too. BMJ. 2000;321:1023.
DIGITAL PSYCHIATRY 43
[59] Field AE, Cheung L, Wolf AMH, et al. Exposure to
the mass media and weight concerns among girls.
Pediatrics. 1999;103:E36.
[60] Murray SB, Rieger E, Touyz SW, et al. Muscle dys-
morphia and the DSM-V conundrum: where does
it belong? A review paper. Int J Eat Disord. 2010;
43:483–491.
[61] India: girl commits suicide after obscene posts on
Facebook. The News Tribe. [accessed 2013 Mar
26]. Available from: http://www.thenewstribe.com/
2012/08/16/india-girl-commits-suicide-after-
obscene-posts-on-facebook/.
[62] Becker MW, Alzahabi R, Hopwood CJ. Media multi-
tasking is associated with symptoms of depression
and social anxiety. Cyberpsychol Behav Soc Netw.
2013;16:132–135.
[63] Kross E, Verduyn P, Demiralp E, et al. Facebook
use predicts declines in subjective well-being in
young adults. PLoS One. 2013;8:e69841.
[64] Chou HTG, Edge N. They are happier and having
better lives than I am”: the impact of using
Facebook on perceptions of others’ lives.
Cyberpsychol Behav Soc Netw. 2012;15:117–121.
[65] Geeta MG, Krishnakumar P. Television and suicidal
behavior. Indian Pediatr. 2005;42:837–838.
[66] Frison E, Eggermont S. Exploring the relationships
between different types of Facebook use, per-
ceived online social support, and adolescents’
depressed mood. Soc Sci Comput Rev. 2015;45:
1–19.
[67] Tokunaga R. Following you home from school: a
critical review and synthesis of research on cyber-
bullying victimization. Comput Human Behav.
2010;26:277–287.
[68] Ybarra ML, Mitchell KJ. Online aggressor/targets,
aggressors, and targets: a comparison of associ-
ated youth characteristics. J Child Psychol
Psychiatry. 2004;45:1308–1316.
[69] Primack BA, Swanier B, Georgiopoulos AM, et al.
Association between media use in adolescence
and depression in young adulthood: A longitudinal
study. Arch Gen Psychiatry. 2009;66:181–188.
[70] Moreno MA, Christakis DA, Egan KG, et al. A pilot
evaluation of associations between displayed
depression references on Facebook and self-
reported depression using a clinical scale. J Behav
Health Serv Res. 2012;39:295–304.
[71] Moreno MA, Jelenchick LA, Christakis DA.
Problematic internet use among older adolescents:
A conceptual framework. Comput Hum Behav.
2013;29:1879–1887.
[72] Dobrean A, Pasarelu CR. Impact of social media on
social anxiety: a systematic review. In: Federico
Durbano, editor. New Developments in Anxiety
Disorders. Romania: In Tech; 2016. Available From:
https://www.intechopen.com/books/new-develop-
ments-in-anxiety-disorders/impact-of-social-media-
on-social-anxiety-a-systematic-review
[73] Desjarlais M, Willoughby T. A longitudinal study of
the relation between adolescent boys and girls’
computer use with friends and friendship quality:
support for the social compensation or the rich-
get-richer hypothesis? Comput Human Behav.
2010;26:896–905.
[74] Corder-Bolz C. Television and adolescents’ sexual
behavior. Sex Edu Coalition News. 1981;3:40–41.
44 S. CHANDRAN ET AL.
[75] Malamuth NM. Pornography’s impact on male ado-
lescents. Adolesc Med. 1993;4:563–576.
[76] Malamuth NM, Impett EA. Research on sex in the
media: what do we know about effects on children
and adolescents? In: Singer DG, Singer JL, editors.
Handbook of children and the media. Thousand
Oaks, CA: Sage Publications; 2001. p. 269–287.
[77] Rich M. Virtual Sexuality: the influence of entertain-
ment media on sexual attitudes and behavior.
Washington, DC: The National Campaign to
Prevent Teen and Unplanned Pregnancy; 2008.
[78] Stern SE, Handel AD. Sexuality and mass media:
the historical context of psychology’s reaction to
sexuality on the Internet. J Sex Res. 2001;38:
283–291.
[79] Gruber E, Grube JW. Adolescent sexuality and the
media: a review of current knowledge and implica-
tions. West J Med. 2000;172:210–214.
[80] Huston AC, Wartella E, Donnerstein EI, et al.
Measuring the effects of sexual content in the
media: A report to the Kaiser Family Foundation.
CA, USA: The Henry J. Kaiser Family Foundation;
1998.
[81] Check JV, Guloien TH. Reported proclivity for coer-
cive sex following repeated exposure to sexually
violent pornography, nonviolent dehumanizing
pornography, and erotica In: Zillmann D, Bryant J.
editors. Pornography: research advances and policy
considerations. Hillsdale, NJ: Lawrence Erlbaum
Associates; 1989. p. 159–184.
[82] Tyden T, Rogala C. Sexual behaviour among young
men in Sweden and the impact of pornography.
Int J Std AIDS. 2004;15:590–593.
[83] Kunkel D, Eyal K, Finnerty K, et al. Sex on TV4: a
biennial report to the Kaiser Family Foundation.
Santa Barbara, Calif: Henry J. Kaiser Family
Foundation; 2005. Available from: http://www.kff.
org/entmedia/upload/Sex-onTV-4-Full-Report.pdf.
[84] Collins RL, Elliott MN, Berry SH, et al. Watching sex
on television predicts adolescent initiation of sex-
ual behavior. Pediatrics. 2004;114:e280–e289.
[85] Ashby SL, Arcari CM, Edmonson MB. Television
viewing and risk of sexual initiation by young ado-
lescents. Arch Pediatr Adolesc Med. 2006;160:
375–380.
[86] Peterson JL, Moore KA, Furstenberg FF. Jr.
Television viewing and early initiation of sexual
intercourse: is there a link? J Homosex. 1991;21:
93–118.
[87] Chaudhary P, Peskin M, Temple JR, et al. Sexting
and mental health: a school-based longitudinal
study among youth in Texas. J Appl Res Children.
2017;8:11.
[88] Fitzpatrick C, Barnett T, Pagani LS. Early exposure
to media violence and later child adjustment. J
Dev Behav Pediatr. 2012;33:291–297.
[89] Robertson LA, McAnally HM, Hancox RJ. Childhood
and adolescent television viewing and antisocial
behavior in early adulthood. Pediatrics. 2013;131:
439–446.
[90] Hopf WH, Huber GL, Weiß RH. Media violence and
youth violence. J Media Psych. 2008;20:79–96.
[91] Christakis DA, Zimmerman FJ, DiGiuseppe DL,
et al. Early television exposure and subsequent
attentional problems in children. Pediatrics. 2004;
113:708–713.
[92] Hassan Y, Begue L, Scharkow M, et al. The more
you play, the more aggressive you become: a
long-term experimental study of cumulative vio-
lent video game effects on hostile expectations
and aggressive behavior. J Exp Soc Psychol. 2013;
49:224–227.
[93] Malhi P. Adolescent RM. Violence exposure, gender
issues and impact. Indian Pediatr. 2006;43:607–612.
[94] Ray M, Malhi P. Reactions of Indian adolescents to
the 9/11 terrorist attacks. Indian J Pediatr. 2005;72:
217–221.
[95] Charlton T, Gunter B. TV-violence effects: excep-
tionally vulnerable viewers? Emot Behav
Difficulties. 1999;4:36–45.
[96] Huesmann LR, Malamuth NM. Media violence and
antisocial behavior: an overview. J Soc Issues.
1986;42:1–6.
[97] Huesmann LR, Kirwil L. Why observing violence
increases the risk of violent behavior in the obser-
ver In: Flannery DJ, Vazsonyi AT, Wakdnab ID, edi-
tors. The Cambridge handbook of violent behavior
and aggression. Cambridge, UK: Cambridge
University Press; 2007. p. 545–570.
[98] Stuart H. Fighting the stigma caused by mental
disorders: past perspectives, present activities, and
future directions. World Psychiatry. 2008;7:
185–188.
[99] Penn DL, Chamberlin C, Mueser KT. The effects of
a documentary film about schizophrenia on psy-
chiatric stigma. Schizophr Bull. 2003;29:383–391.
[100] Thornton JA, Wahl OF. Impact of a newspaper art-
icle on attitudes toward mental illness. J
Community Psychol. 1996;24:17–25.
[101] Klasnja P, Pratt W. Healthcare in the pocket:
Mapping the space of mobile-phone health inter-
ventions. J Biomed Inform. 2012;45:184–198.
[102] Torous J, Hsin H. Empowering the digital thera-
peutic relationship: virtual clinics for digital health
interventions. npj Digital Medicine. 2018;1:16.
[103] Shrotri A, Shankar AV, Sutar S, et al. Awareness of
HIV/AIDS and household environment of pregnant
women in Pune, India. Int J STD AIDS. 2003;14:
835–839.
[104] Olenick I. Women0 s exposure to mass media is
linked to attitudes toward contraception in
Pakistan, India and Bangladesh. Int Fam Plan
Perspect. 2000;26:48–50.
[105] Kutner L, Beresin EV. Media training for psychiatry
residents. Acad Psychiatry. 1999;23:227.
[106] Torous J, Roux S. Patient-driven innovation for
mobile mental health technology: case report of
symptom tracking in schizophrenia. JMIR Ment
Health. 2017;4:e27.