PDAs are phatic communications that offer diverse social media functions or features, such as ‘likes’ and ‘emojis’. One of the main motives for using PDAs in social media is to offer social support (Carr et al., 2016; Hayes et al., 2016b; Lyubenko, 2023; Sun et al., 2021). Several studies have investigated PDAs as a form of perceived social support. For example, Rawlings (2023), using a quantitative approach, found that receiving likes on Facebook is associated with social support. Johnson et al. (2020) collected posts related to infertility treatment and used content analysis to examine emoji use and social support on Instagram. One of their findings was that users received emotional support when they engaged in self-disclosure.

Various studies have highlighted how affordances are a relational property because different individuals may possess varying abilities, leading them to perceive and use social media platforms in different ways (Gibson, 2014; Page et al., 2022). Moreover, individuals seek various aspects of support on social media, depending on platform features and the user services (Hayes et al., 2016a). Even though affordances are similar in online health communities and general-purpose social media, health-focused online communities must consider the underlying contextual differences (Smith et al., 2023). Compared to other online health communities, posts in OMHCs have been shown to have more expressions of emotion (Gu et al., 2023). Thus, it is important to investigate PDAs in the context of OMHCs to gain a better understanding of how and why they are used in these platforms. This study examined how people with depression incorporate and use PDAs in their responses to OMHCs and investigated the role of PDAs in the relatively new context of OMHCs in Saudi Arabia.

Several studies have focused on investigating PDAs from a microscopic point of view, such as the frequency of PDA use (Marengo et al., 2021; Tang, 2022). The collective aspect of PDA use has been largely overlooked (Sun et al., 2021). Therefore, OMHCs feature the combination of emojis with text for social support extraction; hence, an analysis of both written text and visual symbols is needed to obtain better insights into people’s emotions and how people engage in such communities. It is also necessary to investigate the outcomes from using PDAs and social support for people with depression, as these outcomes do not always align with what they were likely intended to be. Thus, the study aimed to understand the role of PDAs in potentially benefiting or harming people with depression in OMHCs.

SST was initially developed in the mid-1970s and early 1980s. Formulated by Cobb (1976), SST describes information that can lead an individual to believe that they are loved and respected and that they belong to a community that provides mutual obligations. At its core, SST posits how social support might help others effectively, with individuals offered assistance available on a network. SST provides a person’s perceptions of a situation and involves respect, concern, or responsible regard for others. Cobb (1976) posited that social interaction can help individuals develop mental health resilience to negative emotions. Thoits (1982) indicated that the concept of social support is the degree to which individual social needs are fulfilled via interaction with others. Here, social support emphasizes the exchange of resources over interpersonal connections (Cohen & Hoberman, 1983). Subsequently, Shumaker and Brownell (1984) highlighted that the concept involves an exchange between at least two users to improve the well-being of the receiver (of the support). According to SST, the support that users receive (e.g., receiving care and help from the community) may improve their sense of competence (Hasan et al., 2023). The main role of social support concerns people’s ways of encouraging and helping others to experience more confidence in social settings. Therefore, establishing trust among members and addressing members’ psychological needs are important (Islam et al., 2018).

Generally, the existing literature has classified social support into various taxonomies. Information and emotional support are the main types of social support. Emotional support includes listening to others, offering encouragement, and showing trust, empathy, understanding, and concern (Johnson & Lowe, 2015; Krause, 1986; Zeitouni & Milstein, 2017), for example, making patients feel loved, valued, and empathized with. Informational support includes providing assistance in the form of knowledge, transmitting information, guidance, and advice, and helping others to make decisions and to minimize uncertainty, for example, when patients discuss health topics such as symptoms or how to cope with disease. This paper investigates how people with depression use PDAs to foster emotional and informational support.

Amer is one of the first OMHCs in Saudi Arabia, and it is approved by the Ministry of Health. The platform has 13 forum boards, such as ‘the past’, ‘self-development’, and ‘finding balance’, and various features that enable people with depression to write posts, adding text, emojis, and hashtags. People can read and reply to a thread or another comment in the same thread by either writing a comment and adding emojis or adding any PDAs, including likes, emojis, or other visual icons. The second OMHC is the Telegram public group, run by a moderator (not a therapist). This community discusses depression. Figure 1 presents examples of emojis used on Amer and the Telegram public group. The posts are public and written in Arabic. Additionally, people can anonymize themselves. The authors contacted the gatekeepers for their approval and obtained ethical approval, as described in the next section.

Ethics approval was obtained from the University of Sheffield in May 2024 (application no.: 059127). We received permission from OMHC gatekeepers to access and analyse the data, which are posts available to the public. The study followed the University of Sheffield research ethics policy (University of Sheffield, 2023).

One of the OMHCs has been renamed Amer to maintain its anonymity. Additionally, all details of posts were anonymized to ensure the confidentiality and privacy of the posts. Posters’ usernames were removed and replaced with pseudonyms. The quotations used in this study were translated into English. For posts with identifying markers after translation, the researcher changed the words of the posts but kept the same meaning; however, in practice, this was rarely necessary.

For Amer OMHC, the forum boards were selected purposively based on their richness and relevance to the study’s topic. Four boards were selected: self-development, general, recovery stories, and health. A sample of the data (1331 posts) related to threads in those boards and the Telegram public group was collected. The posts were sampled to reflect patients’ beliefs and provide different views. Data were stored and managed using ATLAS.ti. Inductive and deductive thematic analyses were conducted.

In the sample, many users shared their achievements in their depression journey, while others encouraged them by using PDAs, for example:

Others responded using a variety of PDAs, as shown in Figure 3

As a sense of achievement, Samer shared that he overcame a depression episode, and some users encouraged him by providing the above emojis, e.g., a thumbs-up sign to indicate approval, and an arm symbol to indicate strength. PDAs help people to offer support more easily and faster in a single click. This is especially useful in a depression context, where some people may have difficulty writing and reviewing the post. PDAs can facilitate the process of providing support to others. On the other hand, posters who receive these PDAs as a way to encourage them may be helped in terms of receiving various emojis, with different styles and frequencies for each PDA.

Others responded with different emojis, as shown in Figure 4

Thai shared a thread that she got stronger and overcame her problems, while some users used PDAs to encourage her. The diverse PDAs used indicate various positive feelings for the poster, such as graduating, loving what she did, admiring her post, and applauding her. All these affirmative feelings can provide emotional support and encouragement to a person.

Others responded, as shown in Figure 5

Hessah felt loneliness and wanted to share her achievements with others. While some users used PDAs to offer support, she received diverse PDAs that can be interpreted with various positive feelings, such as encouragement and love.

The above quotations demonstrate how Samer, Thai, and Hessah’s posts elicited affirmative reactions. This highlights the pivotal role of PDAs in efficiently enhancing the process of offering support. Additionally, people who read those threads and view the number of PDAs received can be motivated to do the same.

Several posts offered empathy to others who are suffering and facing difficulties caused by depression. Many posters stated that they felt lonely and isolated from the physical world. Online communities can offer them love, a sense of belonging, and empathy, which they may not be receiving from their families or society due to social and cultural factors. For example, expressing problems or sharing emotions with others can be considered a weakness. (Even when people offer emotional support or love, they may view vulnerability as a sign of weakness). Utilizing nonverbal PDAs can enhance the ability to express empathy and understanding toward others. For example,

Zyana responded,

I feel you none. (Zyana, General)

Abdul-Karim expressed their struggle through their depression journey and the loneliness they felt. Using online communities helped them to share their feelings and seek the support they needed. Others, such as Zyana, responded to Abdul-Karim by offering support and empathy. Zyana felt Abdul-Karim’s loneliness and empathized with him. Using PDAs in this context can help to easily interpret the emotions Zyana felt for Abdul-Karim. Although the emoji used (crying) here can be interpreted as a negative emotion, receiving such an emoji in this context may indicate that users feel or understand the poster’s emotions and pain, which can be interpreted as comforting positive feelings.

Others responded, as shown in Figure 6

Reem’s depression was partly caused by unemployment. She shared her story with others to express her current feelings and, in response, people used various PDAs to show support. These gestures could be interpreted as empathy and sympathy, offering positive emotional reinforcement. The use of PDAs not only helps the recipient feel supported but can also benefit the sender. By simply selecting an emoji that conveys their emotions, the sender may experience a sense of satisfaction and pleasure from helping others.

Various people who posted reassured others with their opinions, which may indicate an understanding of the person’s situation:

Nawal posted a common issue, which is that people can hide their depression and try to avoid the situation in the physical world. In Saudi Arabia, some people do not accept depression as a real condition; this may be due to cultural traditions or wrong beliefs. Thus, people hide their depression and pretend that nothing is happening. Online communities offer a free place to access and share stories with people in similar situations. Using various PDAs, many people agreed with what Nawal posted, as indicated in some noting their full acknowledgment.

A further post, by Saafe below, provided advice for others:

Others responded, as shown in Figure 7

Saafe shared his opinions, which were based on his experience and offered a sense of hope while others acknowledged his views. Offering an agreed opinion using emojis as well as the number of people who agree can further encourage users to engage more actively in online communities.

When members express their isolation or other bad feelings, others often respond with kindness and well wishes as a form of emotional support and include PDAs themselves.

Amal replied to a poster stating that it was her birthday, and she was lonely, with no one celebrating with her. Other posters replied to her, wishing her a happy year, just like Amal. The types of PDAs used indicated that Amal was very happy, as there was a virtual party with a cake and a balloon suggesting a cause for celebration. These emojis can help with receiving positive emotions and reducing isolation.

In contrast, Naasira expressed she felt exhausted and in pain:

Oh God, I’m tired. (Naasira, General)

For which others offered her kindness and wished her well, as shown in Figure 8

Using PDAs such as the plaster emoji can be an indicator of wishing for better mental health as a sense of wishing for recovery, and others replied by praying. These affordances enable people with depression in online communities to access, share, and facilitate communications that foster emotional support with a set of various PDAs, and more can help in engaging in online communities.

Despite the important role of PDAs in receiving emotional and informational support, PDAs can be used to convey frustrating emotions. When users in online communities use negative emojis and add them in a context in which people expect to receive positive feelings, such emotions can be harmful, especially for people with depression. Receiving frustrated emojis can lead to being less active in online communities, which can increase loneliness and isolation.

Khaled posted to Nouf, who had previously started a thread and received a bone emoji, which symbolizes negativity. Nouf was active in the forum, but later, she became less active.