Estimating Determinants of Attrition in Online Eating Disorder Community: An Instrumental Variables Approach (Preprint)

BACKGROUND The use of social media as key health-information source has increased steadily among people affected by eating disorders. Intensive research has examined characteristics of individuals engaging in online communities, while little is known about discontinuation of engagement and the phenomenon of participants dropping out of these communities. OBJECTIVE This study aims to investigate characteristics of dropout behaviors among eating disordered individuals on Twitter and to estimate the causal effects of personal emotions and social networks on dropout behaviors. METHODS Using a snowball sampling method, we collected a set of individuals who self-identified with eating disorders in their Twitter profile descriptions, as well as their tweets and social networks, leading to 241,243,043 tweets from 208,063 users. Individuals’ emotions are measured from their language use in tweets using an automatic sentiment analysis tool, and network centralities are measured from users’ following networks. Dropout statuses of users are observed in a follow-up period 1.5 years later (from Feb. 11, 2016 to Aug. 17, 2017). Linear and survival regression instrumental variables models are used to estimate the effects of emotions and network centrality on dropout behaviors. An individual’s attributes are instrumented with the attributes of the individual’s followees (i.e., people who are followed by the individual). RESULTS Eating disordered users have relatively short periods of activity on Twitter, with one half of our sample dropping out at 6 months after account creation. Active users show more negative emotions and higher network centralities than dropped-out users. Active users tend to connect to other active users, while dropped-out users tend to cluster together. Estimation results suggest that users’ emotions and network centralities have causal effects on their dropout behaviors on Twitter. More specifically, users with positive emotions are more likely to drop out and have shorter-lasting periods of activity online than users with negative emotions, while central users in a social network have longer-lasting participation than peripheral users. Findings on users’ tweeting interests further show that users who attempt to recover from eating disorders are more likely to drop out than those who promote eating disorders as a lifestyle choice. CONCLUSIONS Presence in online communities is strongly determined by individual’s emotions and social networks, suggesting that studies analyzing and trying to draw condition and population characteristics through online health communities are likely to be biased. Future research needs to examine in more detail the links between individual characteristics and participation patterns if better understanding of the entire population is to be achieved. At the same time, such attrition dynamics need to be acknowledged and controlled for when designing online interventions so as to accurately capture their intended populations.