Facebook language changes before a trip to the E.R. - Futurity

Language posted on Facebook becomes subtly more formal before people go to hospital emergency rooms, a new study shows.

The finding suggests that social media language is an often unseen signal of medical distress and could serve as a way to better understand the context in which patients seek care, including during times of concern such as the COVID-19 pandemic.

Researchers recruited 2,915 patients at an urban hospital who consented to sharing their Facebook posts and electronic health records (EHRs). Of those patients, 419 had a recent emergency department (ED) visit, such as chest pain and pregnancy-related issues.

Researchers analyzed posts from as early as two-and-a-half months before the date of the patients' ED visit using a machine learning model that processed their language to find changes over time.

"The better we understand the context in which people are seeking care, the better they can be attended to."

As patients got closer to their eventual ED visit, the researchers found that Facebook posts increasingly discussed family and health more. They also used more anxious, worrisome, and depressed language and less informal language such as "lol," a smiley face emoji, or swearing.

"The decrease in informal language seems to go hand-in-hand with an increase in anxiety-related language," says H. Andrew Schwartz, assistant professor of computer science at Stony Brook University. "While it is hard to say right now if this would be the same result across multiple social media platforms, people live a lot of their lives online and Facebook is that dominant platform right now."

"The better we understand the context in which people are seeking care, the better they can be attended to," says lead author Sharath Chandra Guntuku, a research scientist in Penn Medicine's Center for Digital Health.

"While this research is in a very early stage, it could potentially be used to both identify at-risk patients for immediate follow-up or facilitate more proactive messaging for patients reporting doubts about what to do before a specific procedure."

Ultimately, researchers found that most patients underwent a significant change in Facebook language before they went to the ED. Before their visit, patients were less likely to post about leisure (not using words like "play," "fun," and "nap") or use internet slang and informal language (such as using "u" instead of "you").

When the researchers looked more closely at the context of some posts, they noticed there might be some clues to patients' health behaviors related directly to their hospital visit.

One post, for example, talked about the patient eating a cheeseburger and fries less than a month before they were admitted for chest pain related to having heart failure. Another patient confirmed that they were following directions from their care team, posting about fasting 24 hours before they had a scheduled surgery.

"How does life affect personal decisions to seek care? How does care affect life? These are the things I would hope that we could fully describe, how people's everyday lives intermix with health care," Schwartz says.

The study primarily looked at the change in language before a hospital visit, but a previous study from Schwartz and the paper's senior author, Raina Merchant, the director of the Center for Digital Health, showed that the language of Facebook posts as far ahead as three months before official diagnosis could predict a person's depression.

There is tremendous potential in user generated content (on Facebook, Twitter, and now on smartphones) to study the behaviors and mental states that lead to a healthcare visit, Guntuku says.

"Any research in this domain must give patient privacy and agency utmost priority and transparency about where, how, and by whom these digital markers are being used to understand health is critical," he says.

The researchers plan to study broader populations in subsequent studies in an attempt to understand what actionable and interpretable insights can be provided to patients who opted to share their data.

The study appears in Scientific Reports.