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Abstract

Objective

This study explores how smartphones are depicted in the illness narratives of patients with mental health issues, focusing on the roles smartphones play and their affordances within online depression communities.

Methods

We analyzed discussions from an online depression group with over 60,000 members using Semantic Network Analysis (SNA) and Critical Discourse Analysis (CDA).

Results

The study identified three key roles of smartphones—as information brokers, communication tools, and emotional valves—which correspond to affordances of visibility, connectivity, and persistence. These affordances both facilitate and constrain behaviors in illness narratives, revealing a double-edged sword effect where smartphones provide essential support and emotional relief but also exacerbate negative experiences such as anxiety and rumination.

Conclusion

The findings bridge affordance theory and online narrative studies, deepening the understanding of media technologies’ interplay with mental health. This study offers insights into how smartphone affordances shape lived experiences, contributing to the development of digital narrative therapy.

Keywords

Smartphone affordance illness narratives depression semantic network analysis critical discourse analysis

Introduction

Smartphones have become indispensable in daily life, offering rich affordances that both connect users and introduce online risks, especially for psychologically vulnerable individuals.^1–3 While these patients often rely on smartphones for support, their use can also amplify negative emotions.^4,5 Although prior research has examined smartphones in mental health illness narratives, it mainly treats them as background tools rather than as active actors within the narratives themselves.^6,7 However, this perspective risks overlooking the relational and processual nature of how technologies are perceived and integrated into everyday life. To address this gap, this study draws on the concept of affordance, which refers to the perceived possibilities for action that emerge from the relationship between an object and a user within specific contexts. Unlike functionalist interpretations, affordance is not fixed or deterministic—it is relational, contingent, and often contradictory. This allows us to overcome the limitations of tool-based views of smartphones by emphasizing not just what they allow, but also what they constrain. The dual nature of affordance—both enabling and constraining—has yet to be fully explored in this context.^8,9

This study investigates how smartphones and their affordances appear in the illness narratives of an online depression community with over 60,000 members. Using Semantic Network Analysis (SNA) and Critical Discourse Analysis (CDA), we examine smartphones’ dual role as sources of support and of negative emotions. The research also explores whether patients recognize this double-edged effect. By situating smartphone affordances within online illness narratives, this study contributes to affordance theory by empirically demonstrating how affordances are not only perceived but also discursively constructed through narrative practices. It also extends narrative research by highlighting how everyday digital stories can serve as sites where technological agency and user vulnerability intersect.

Literature review

Smartphone: A metamedia bearing affordance

Smartphones, the fastest-spreading medium in history,¹⁰ are widely recognized as infrastructural technologies that support multiple forms of mediated interaction.^11,12 Beyond communication tools, they function as “transportal homes” that offer users emotional security and private space.¹³ Some scholars even describe them as extensions of the body—“cyberlimbs” that reshape perception and presence.¹⁴

Smartphones do not function autonomously; their meanings and uses are activated through users’ situated perceptions and practices.^15,16 To better account for this relational process, researchers frequently apply the concept of affordance—first proposed by Gibson¹⁷ to describe how environmental features offer action possibilities to organisms. In media and communication studies, this concept was introduced by Wellman and colleagues, who argued that internet affordances shape everyday social practices.^18,19 Building on this, Schrock developed the notion of communicative affordances,²⁰ referring specifically to how mobile media—like smartphones and tablets—offer and constrain possibilities for interpersonal interaction. He emphasized four core properties: portability, availability, locatability, and multimediality, stressing that affordances are not inherent in technology itself but emerge from the subject–object relationship within specific social contexts.

Media affordances—such as visibility, editability, persistence, and association—shape how users interact with platforms.²¹ Crucially, affordances are not fixed functions but relational and context-sensitive perceptions.²² They both enable and constrain action: visibility, for example, can promote expression but also overload users, leading to withdrawal.^8,23–25 This dialectical nature is especially salient in smartphone use, where affordances carry both supportive and disruptive potential.

Smartphones, as metamedia, integrate multiple media forms and functions,²⁶ creating a layered environment of affordances.²⁷ Users engage with them not as static tools but as flexible interfaces connecting internal experiences with the external world.²⁸ Previous research has mainly explored the affordances of smartphones in terms of accessibility, mobility, and digital compensation, and the positive social impacts they bring.^29,30 However, these same affordances can deepen exclusion—for example, through technological barriers faced by marginalized users.³¹ As Evans et al.⁸ emphasized, considering the constraining aspect of affordance, it is essential to adopt a dynamic and dialectical perspective when examining smartphones.

Smartphones, mental health, and illness narratives

Smartphones play an ambivalent role in mental health. On the one hand, they enhance subjective wellbeing, facilitate social support, and foster prosocial engagement.^32–36 During the COVID-19 pandemic, their role in maintaining connectivity proved especially valuable.³⁷ On the negative side, problematic smartphone use is associated with a range of mental health concerns, including depression, anxiety, sleep disruption, and compulsive behaviors like phantom vibrations and fear of missing out.^4,38–44 While many studies suggest that smartphone use may worsen depressive symptoms,^38,45 others highlight its potential for emotional relief and therapeutic support—especially through internet-based self-help and social platforms.^46,47 These contradictory findings reveal the complexity of smartphone use in depression contexts.

Smartphones offer vulnerable individuals a private, accessible space for online self-disclosure, often unavailable in offline contexts.⁴⁸ Through participation in digital health communities, users share illness narratives—personal stories of pain, stigma, and recovery—that help build social support and foster emotional healing.^3,49 Illness narratives are dynamic, contextual accounts through which people articulate bodily suffering and reconstruct meaning.^50–52 In the social media era, smartphones help render these stories visible in real time, facilitating empathy and reinforcing users’ sense of connection.^53,54 Thus, narrative sharing becomes not only expressive, but also therapeutic.

Although previous research has largely treated smartphones as background tools, they also function as narrative subjects,^6,7 deeply intertwined with media, daily life, and traumatic experiences. As an important media product, smartphones can play central roles in everyday narratives. For example, a study on the narratives of news and advertisements found that descriptions of smartphones reflect people's technological values,⁵⁵ while interviews with American and Korean university students showed that smartphones were regarded as a “second hand” they could rely on.⁵⁶ These studies reflect the interaction between humans and technology. However, portrayals of smartphones in illness narratives remain underexplored. A recent study on psychological counseling found that patients frequently mentioned social media, framed in narratives focusing on interpersonal conflict, digital detox, and self-expression. The focus on media in illness narratives enabled patients to provide more information and helped therapists tailor treatment plans.⁵⁷ However, such research has emphasized formal medical settings, overlooking the informal and everyday contexts where digital health support is increasingly prevalent and impactful.⁵⁸ Exploring how smartphones become narrative subjects in the illness stories of people with mental health issues thus offers valuable insights into digital media's influence on wellbeing and informs narrative therapy practices in the digital health era.

Bridging affordance and online narratives

Since the meaning of smartphones is typically perceived through the interaction between users and smartphones, framed by affordance, this study attempts to integrate the affordance framework into online illness narratives to establish a crossover between affordance and online narrative studies.

Previous research identifies two paths through which affordance and narrative converge. The first examines how the affordances of different media shape online narratives. For instance, Georgakopoulou⁵⁹ examined how YouTube's platform affordances reshaped narrative logic through video rescripting practices. Studies on Facebook suggest that discursive affordances construct narratives by enabling users to share resonant personal stories.⁶⁰ However, scholars like Ryan⁶¹ argue that the interactivity and fluidity of digital media may disrupt traditional narrative coherence. Another study on Telegram similarly shows that certain affordances can compromise coherence and facilitate misinformation.⁶² Overall, this perspective emphasizes how affordances intervene in narrative structures, framing narrative as a digital technical practice shaped by platform design.^63,64

The second, less examined, path explores how online narratives articulate affordances. That is, narratives can stimulate affordance perception, as their internal logic shapes how users interpret media possibilities.⁶⁵ Media narratives offer contextual grounding for unfolding events, creating a discourse environment that shapes user interpretation. In doing so, they mediate the relationship between users and media environments, influencing perceived affordances.

This distinction reflects Roine et al.'s⁶⁵ view that narrative functions both as agentic form and as content in digital media. The first path emphasizes how interaction with platforms structures narrative experience, while the second highlights how narrative content shapes our understanding of affordances. However, prior research has focused more on structure than content, overlooking how narrative meaning influences media engagement. Affordances are not only perceived but also written into narratives—recorded, storified, and made tangible through storytelling.

Research questions

Although previous studies have examined smartphone affordances in mental health contexts,^20,38 gaps remain in treating smartphones as active narrative subjects and in exploring their enabling and constraining roles within illness narratives.^6,65 To address these gaps, this study aims to investigate:

RQ1: What role do smartphones play in the illness narratives of online health communities for people with mental issues?

RQ2: How are the affordances of smartphones perceived and integrated into these illness narratives?

Exploring these questions is valuable both theoretically and practically. Theoretically, it deepens the understanding of affordance as a dynamic, dialectical concept embedded within digital narratives,^8,59 expanding the intersection of media studies and health communication.⁵² Practically, insights from this study can inform digital mental health interventions and narrative therapies by highlighting how smartphones shape lived experiences of mental illness in online communities.^3,49

Methods

Data collection

This study used discussions from the “Depression” online health group on the Douban platform (https://www.douban.com/group/melancholy/), a platform similar to Reddit in China, as a textual corpus to explore the illness narratives of individuals with mental issues. Depression was chosen as a window to explore this population not only because the number of individuals affected by depression is large and growing, making it one of the most prominent mental health issues,⁶⁶ but also because depression and its symptoms are closely linked to smartphone use.^67,68 For instance, research has shown that depression is a risk factor in predicting smartphone addiction and dependence.⁶⁹ The “Depression” online health group is a valuable resource for this study. With a large membership of 61,462 members and an established presence since August 2020, it serves as an important platform for exploring vulnerable narratives about depression in Chinese internet spaces. Moreover, this group and platform have been examined in previous studies and have been regarded as an appropriate space for individuals to disclose their pain and seek help.^49,70

Although this study involved noninterventional data mining, ethical considerations were addressed. Communication was made with forum administrators, and a post was published in the forum about data collection to mitigate potential ethical concerns.^71,72 Based on this, this study employed a Python program to scrape data over a 4-year period, from August 2020 to August 2024. All posts and replies were included, obtaining 10,731 posts and 150,799 replies. The researchers further filtered these texts by using “smartphone” and a series of smartphone brand names like “iPhone” and “Huawei” as keywords, yielding text data that contained these terms. After deduplication, 1303 texts were obtained, in which posts and replies were not differentiated. After manually reviewing and removing commercial advertisements, 1276 texts related to “smartphones” were retained, totaling 558,421 words, which served as the corpus for the analysis. This study follows the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines as recommended by the EQUATOR Network, to ensure the transparency and comprehensiveness of the qualitative data collection and analysis procedures.

Analytical approaches

This study combined SNA and CDA to discuss how “smartphones” are integrated into people's illness narratives in the online health group. Both SNA and CDA are text-based analytical methods that have been used in previous research to explore the themes within illness narratives.^73,74 Therefore, they naturally align with the objectives of this study. Specifically, SNA is a method used to map and quantify the relationships between words based on their co-occurrence patterns, revealing latent thematic structures within textual data, focusing more on the topological structure of the network in the text,^75,76 while CDA delves into the discourse and reflect on the relationships, identities, knowledge, and power interactions behind the text.⁷⁷ Moser et al.⁷⁸ called for combining network analysis and discourse analysis. This integration not only provides contextual meaning to the network discovered by SNA by examining word nodes from a contextual perspective, but also offers a quantitative and generalized guide to CDA, thereby addressing the possible excessive detail and subjectivity found in qualitative research.⁷⁹ Therefore, SNA and CDA not only serve as methods for cross-validation but also complement each other's shortcomings.

(A) Semantic network analysis

Specifically, this study first applied SNA to the 1276 texts. Second, after preprocessing the text data, a semantic matrix of word co-occurrence was constructed. Previous research suggests that individuals can only process one unit of information containing five to nine words at a time.⁸⁰ Thus, if two words appear within a five-word block in a text, they are considered to have a co-occurrence relationship.^81,82 Third, the visualization software Gephi (Gephi is an open-source network visualization software used to compute and display network metrics such as density, centrality, and modularity, making it a useful tool for analyzing the semantic structure of large text corpora) was used to calculate network indicators (such as network density, degree centrality, and modularity) and to present the semantic network. To better present the network, this study only displayed the top 50 most frequent words and filtered out edges below the average degree.

(B) Critical discourse analysis

Subsequently, this study employed CDA to explore the texts. Guided by Fairclough's⁸³ framework, during the first round of close reading, one of the researchers examined the texts, discourse practices, and sociocultural practices within the posts, attempting to extract recurring themes. In the second round of reading, the researcher combined the modular data results from SNA and repeatedly compared and integrated the results of SNA with those from CDA. This process ultimately established the connection between smartphone affordances and illness narratives, further revealing their dialectical effects. The detailed explanation of these findings is provided in the results section to address the research questions.

Statistical analysis

SNA was performed using Gephi version 0.10 to construct and visualize the co-occurrence network of keywords. Key network metrics, including network density, degree centrality, and modularity, were calculated to assess the structure and clustering of the semantic network. Network density indicates the overall level of connectivity among nodes, degree centrality measures the average number of direct connections per node, and modularity quantifies the strength of division of the network into modules.

Results

Outcome of SNA: Narratives centered on smartphones

The semantic network generated in this study comprises 50 nodes and 657 edges, centered around the keyword “smartphone” (see Figure 1). It demonstrates a moderate density (0.54), suggesting strong thematic interconnection among concepts. The average degree centrality is 26.28 (SD = 11.45; max = 47; min = 3), indicating that, on average, each term is directly linked to 26 others. Besides, the network diameter is 2, reflecting a compact structure in which any 2 nodes are separated by no more than 2 steps.

Figure 1.

Semantic network surrounding smartphone.

Using modularity analysis (Q = 0.08), we identified three major semantic modules within the network. Each module forms a cohesive cluster of closely associated terms, reflecting distinct thematic dimensions of smartphone-related illness narratives. The modules were labeled through collaborative interpretation based on the most central terms in each cluster, ensuring alignment between semantic structure and thematic meaning. Table 1 presents these modules, including their thematic labels, central keywords, relative proportions, and sample excerpts.

Table 1.

Outcome of the semantic network.

No.	Themes	Top associations	Count	Share of the network (%)	Samples
1	Smartphones as information brokers	Thinking-Self	326	42%	When the depressive feelings become unbearable, I unconsciously open my phone, scrolling through social media or playing games. They serve as a quick refuge, allowing me to temporarily forget the pain inside
		Thinking-Search	204
		Thinking-Distraction	180
2	Smartphones as communication tools	Video-Chat	156	30%	The phone is like a nonjudgmental friend, a sounding board where I can pour out my thoughts without fear of being judged. It's like a silent companion, offering a space where I can vent, express my feelings, and let out everything that's been bottled up inside
		Chat-Contact	140
		Work-Friends	132
3	Smartphones as emotion valves	Sad- Happiness	166	28%	Every time I get my hands on my phone, it feels like I've found a refuge where I can temporarily forget everything. I uncontrollably, like a “beast,” seek emotional satisfaction from it. There are so many novels, movies, and even virtual romantic relationships on my phone, as if they can fulfill my longing for warmth and affection
		Breakdown-Happiness	151
		Happiness-Afraid	146

Specifically, the module “Smartphones as Information Brokers” accounts for 42% and primarily highlights the significant value of smartphones as a platform for information exploration. However, it also emphasizes that many users use smartphones to distract themselves, thereby distancing themselves from the stressors of real life. The second-largest module, “Smartphone as Communication Tools,” makes up 30% of the network. This module focuses on how smartphones, as communication devices, help facilitate conversations and interactions, including informal daily conversations as well as functional dialogues like psychological counseling. The final module, which comprises 28% of the network, is “Smartphones as Emotional Valves.” The core nodes and edges in this module reveal different types of emotional expressions, including both positive and negative emotions.

These three modules collectively form the narrative framework surrounding smartphones in online health communities, aligning with the three entangled layers of digital media: hardware, software, and content.⁸⁴ The communication tool narrative represents the hardware aspect of smartphones, while the information broker narrative is often supported by a variety of applications, focusing on the software layer. The emotional valve narrative emphasizes the emotional content mediated by smartphones. These three frameworks fully encapsulate the smartphone, shaping illness narratives about smartphones in everyday contexts.

Outcome of CDA: The dialectical effects of affordance

SNA reveals the framework of illness narratives in discussions related to depression within online health groups. This study integrates the results of SNA and follows the analytical path of CDA to link illness narratives with affordances. It identifies that the affordances of smartphones, including visibility, connectivity, and persistence, are embedded within the illness narratives and present a dialectical effect of both enabling and constraining. While CDA cross-validates the results of SNA, it also deeply explores the dialectical effects of affordances behind the narratives. Figure 2 illustrates the bridging and integration of the SNA and CDA results. Moreover, whether affordance or illness narrative, the distinction between the two is not clearly defined. The three—illness narratives, affordances, and their dialectical effects—intermingle and penetrate one another, collectively contributing to the understanding of smartphones.

Figure 2.

The integration framework of SNA and CDA results. CDA: Critical discourse analysis; SNA: Semantic network analysis.

Information brokers: The visibility of smartphones

Smartphones serve as a crucial source of information. Through search and exploration, users can access various information sources via brokers—smartphones, aligning with the subaffordances of visibility, such as searchability and reachability.²² In illness narratives, the visibility of smartphones provides patients with positive significance. On the one hand, smartphones provide essential medical information, acting as a platform for patients to understand depression, including basic symptoms and assessment tools. This helps patients self-diagnose and correct early on, assisting them in adopting a healthy mindset and somewhat easing the stigma of the illness. One patient wrote, “I felt my mental state was bad, and it affected my body, so I took a depression test on my phone. It showed moderate depression and mild anxiety, and the website gave some tips and a helpline, helping me not to be afraid.”

On the other hand, in illness narratives, the smartphone is seen as a distraction tool. Patients often use smartphones to watch movies, short videos, or play games as a way to divert attention from the pressures of real life—an emotion-focused coping strategy.⁸⁵ One patient mentioned, “The reason I like using my phone is probably because it allows me to see different things.” The complex sources of information distract users and stimulate interest in life, as patients recognize the smartphone's visibility and embrace it for this reason.

However, both the strategy of information supplementation and distraction through media consumption exhibit significant flaws in part of the illness narratives, limiting psychological recovery. Some patients report that information overload leads to compulsive rumination: “I was extremely scared and could only keep staring at my phone, thinking about past traumatic experiences late into the night. My mind kept going over it, and I didn't know what to do.” This kind of thinking consumes cognitive space, increasing emotional exhaustion for depression patients. Additionally, the high visibility and diversity of information increase the likelihood of encountering negative content: “During that time, I stayed up late every night scrolling through negative news, and the more I scrolled, the more anxious I became. I was particularly afraid of what the next day would bring.” Negative emotions seeped through the phone screen, intensifying feelings of dread.

In terms of using the phone as a distraction, patients are also acutely aware that playing on the phone is merely a temporary escape. One patient wrote, “When I get home, I spend hours on my phone and don’t go to bed until four in the morning. It seems to be the only way to make me happy, but afterward, I feel empty, followed by a new wave of anxiety.” Another patient even compared the smartphone to “morphine for the brain,” vividly describing the immersive and addictive nature of smartphones and their immediate, though temporary, alleviation of depression's pain. Smartphone use is also intertwined with the somatic symptoms of depression, as reflected in self-disclosures: “I keep repeating the motion of scrolling through my phone screen. Even though I know I’m draining my body and energy, I can’t stop. The more I scroll, the sicker and more uncomfortable I feel, but I just keep doing it.” For some patients, playing on the phone seems like “finding something to do.” By consuming new information and stimuli through the phone, they avoid sinking into emotional rumination, but when they put the phone down, they face withdrawal symptoms. “As soon as I stop playing on my phone and sit quietly, I easily fall into despair.”

Communication tools: The connectivity of smartphones

The most fundamental function of smartphones is communication, and the development of social media has made communication methods more convenient and diverse. In illness narratives involving smartphones, connectivity is one of the key affordances, bridging the individual's connection to the world, and to some extent, making them feel less isolated in the information age.^9,86 The concept of smartphones frequently appears in narratives of seeking help. As a platform medium, smartphones convey patients’ cries for help and assist them in gaining social support. Most commonly, patients receive informal support from friends: “Every day, I stare at the computer, trying to seek help through my phone. I contacted everyone who could comfort me, and they all gave me advice, support, and encouragement.” This informal supportive communication can expand from one-on-one interactions to group settings, where patients can also find solace by joining online support groups.

Moreover, with the rise of online psychological counseling, some patients share experiences of participating in online therapy, showcasing smartphones’ ability to facilitate formal therapeutic interventions. Depression patients, who tend to speak less in real life, find that smartphones provide a space and opportunity for disclosure, acting as an “alternative mouth.” As one support group member noted, “I use my phone to talk, almost never using my mouth. I have a greater desire to express myself through my phone.” For some patients, there is no need to seek external listeners; the smartphone itself becomes a companion to confide in, as one user explained: “I spent hours talking to my phone, and I felt much better.” Interestingly, some patients recount stories of finding comfort through conversations with artificial intelligence (AI): “I kept crying while talking to my phone, listening to ChatGPT's continuous voice, as it scrambled to suggest various random solutions.” As media technology evolves, human–AI interactions have also become possible through smartphones, further extending the relational and communicative affordances of smartphones from interpersonal to human–machine interaction.

However, in illness narratives, smartphone connectivity also fosters pervasive social comparison and social fatigue. For example, one patient wrote: “First thing in the morning, I open my social media and see others making crafts, hiking, or learning new hairstyles. In contrast, I can’t bring myself to do anything but scroll through videos and check my phone every day.” Here, the smartphone is not only a medium for spreading information about others but is also self-defined by the patient as a tool for idleness. Smartphones simultaneously serve as both the means and the object of social comparison. Another challenge stems from the “always-online” feature of smartphones, which to some extent allows the pressures of real life to permeate the screen and invade individuals’ private spaces. In many illness narratives, patients mention how family pressure (e.g. urging marriage) or work pressure (e.g. exploitation by bosses) is delivered through the phone, to the point where some develop generalized anxiety toward phone notifications: “Seeing a WeChat notification pop up on my phone makes me panic, and I feel like vomiting immediately.” This invasive connectivity forces depression patients into prolonged digital anxiety.

The other side of connectivity is exclusion. Depression patients who rely too much on online social interactions often exclude offline relationships, leading to a different form of loneliness and alienation. Many patients note that when they open their phones and find no messages on WeChat or other social platforms, they experience feelings of loneliness and inferiority, which then spiral into further negative emotions: “The world is silent. I pick up my phone, and there's no message. I can’t sleep, and I often cry, wondering what the meaning of life is.” While smartphones build networks of communication, they also separate individuals from real-life social communities, forming a kind of networked individualism that leaves each person—each node—more vulnerable.⁸⁷ In a media-driven society, smartphones amplify people's vulnerabilities, thrusting depression patients into the noisy world of social media while rendering them invisible behind a screen.

Emotional valves: The persistence of smartphones

For depression patients, smartphones serve as an essential emotional valve, allowing emotions to surge when facing the screen. Just as previous studies found that smartphones are users’ “transportal home,”¹³ in the illness narratives of depression patients, smartphones provide a sense of security to counteract their illness and the emotional issues that stem from it. For example, one patient noted, “Even if I’m at home all day, only my phone gives me a sense of security.” This sense of security comes from the persistence affordance of smartphones. The persistence of smartphones provides a stable platform for patients to release negative emotions. As one patient expressed, the smartphone is like a “venting hole that never judges,” where all negative emotions can be poured out freely. Smartphones can also offer emotional compensation to users. One patient compared her phone to “emotional food,” saying that she uncontrollably seeks emotional value from her phone like a beast, using it to read novels, watch movies, and even engage in online romances to fulfill her expectations for romantic relationships. However, when she returned the phone and resumed her school routine, this emotional need disappeared, revealing the phone as an emotional valve. Since smartphones contain a wealth of emotional affordances, they stimulate patients’ desire to seek emotional satisfaction whenever they interact with the device. In this way, smartphones become a reliable source of emotional energy, meeting users’ needs.

Smartphones also serve as a symbol that represents depressive symptoms and anxiety. Patients incorporate smartphones into their depression narratives through diverse narrative logics. Since smartphones are generally perceived as tools for entertainment and relaxation, many depression patients use phrases like “even playing on my phone feels pointless” to illustrate their loss of interest: “My main problem now is that I don’t want to do anything, I’m not interested in anything, and I have no motivation. Most people find watching shows or playing on their phones fun, but I don’t find them interesting at all.” Some patients even share their unique smartphone experiences as expressions of their medication reactions. For example, after taking sleeping pills, one patient described: “Today, my phone felt like a purple lotus pond, the text was swimming, and the squares were irregular stones. One ripple after another.”

Another common depression narrative involving smartphones is the projection of oneself onto the smartphone, comparing their mental state to the phone's battery. One patient shared: “From the moment I started scrolling in the morning, my restored energy drained like the battery of an old phone, and by noon, it was almost completely depleted.” This metaphor of battery drain vividly conveys their mental exhaustion. Additionally, the online risks associated with smartphones can trigger anxiety. Some patients fear that their phone might compromise their privacy, leading to unnecessary hallucinations and paranoia: “When my phone isn’t nearby, I sometimes worry that someone has installed a listening device in it.”

Discussion

Through the SNA and CDA of illness narrative texts, this study explores how discussions of smartphones within the illness narratives of depression patients reflect affordances, transforming smartphones from mere narrative tools and platforms into written objects.

Critical interpretation of the findings

The findings reveal that, on the one hand, the narrative modules align with smartphone affordances. The three narrative modules correspond to the software, hardware, and content layers of digital media, establishing subtle connections with affordances. For instance, the information brokers narrative module highlights the visibility of smartphones, the communication tool narrative emphasizes smartphone connectivity, and the emotional valve narrative focuses on smartphone persistence. In a sense, narratives stem from the affordances of the medium itself, while also representing affordances, creating a subtle feedback loop between the two. This aligns with Treem and Leonardi's emphasis that affordances are not solely technical features, but are perceived relationally through ongoing communicative practice and narrative engagement.²¹

On the other hand, the writing of smartphone affordances presents a dialectical logic where enabling and constraining effects coexist. The double-edged nature of smartphones is deeply integrated into users’ illness narratives. Visibility may reinforce unwanted self-focus and compulsive rumination; connectivity can amplify feelings of comparison, rejection, and digital surveillance; persistence allows emotional expression but also anchors patients to technological dependencies. These constraints, however, do not negate the logic of affordance; rather, they constitute affordance as a dialectical relation, where potential and limitation are inseparable. The patient is not a passive user of technology but an agent negotiating agency within structural constraints. In this sense, smartphones are often depicted metaphorically as “emotional prostheses,” extending the affective space of the user, while simultaneously absorbing their cognitive and social vulnerabilities. This dual construction illustrates how patients subjectivize themselves through their phones—seeking recognition, emotional containment, and social presence, even as they report feelings of detachment or overload. In online health groups, the smartphone becomes both the narrator and the narrated: a platform of disclosure, a repository of trauma, and a site of mediated healing. The very writing of the illness narrative, therefore, is shaped by the platform affordances it seeks to describe.

Using smartphones as a case study, this research further establishes the relationship between affordances and online narratives. While previous research has emphasized how affordances influence narratives,^59,60 this study focuses more on how narratives shape affordances. This complements the perspective proposed by Roine et al.,⁶⁵ who suggest that narrative forms themselves act as mediating structures that reveal and reinforce perceived affordances in platform-based interactions. In this study, illness narratives are not only discourses of expression and support but also reveal the logic of human–technology interaction. In a sense, the dialectical affordance characteristics of smartphones—enabling and constraining—disclosed in illness narratives reflect the daily struggle for control between depression patients (as the subjects) and smartphones (as the mediating objects). Depression patients often face disorder in daily life, and their interactions with smartphones either help restore order or exacerbate chaos. Smartphones, as easily accessible media, offer patients a temporary sense of control. When patients use smartphones strategically, such as for distraction, they regain a sense of control over their daily routines. However, prolonged smartphone use can allow the phone to control their attention, time, and emotions, weakening their autonomy and leading to emotional deterioration and energy depletion. As one patient noted, “The more I scroll, the more sick and tired I feel, but I just can’t stop.” While smartphones offer a sense of escape and control, they ultimately erode control over one's life, with patients gradually ceding power over their bodies. Illness narratives document this power struggle, and the tension of this back-and-forth dynamic is reflected through the lens of affordances. A complete narrative structure allows for a more holistic, dialectical view of the affordances of information technologies, revealing how narratives contribute to understanding the interaction between humans and technology in a media-saturated society, enriching online illness narratives and expanding the value of narrative exploration.

Theoretical and practical implications

Regarding implications, first, this study extends the affordance theory and online narratives. While outlining the dual paths of the integration between narratives and affordances, it also reveals a unique approach to discussing the affordances of mobile devices within a deeply mediatized context. Second, in terms of smartphone research, this study focuses specifically on the role of smartphones within illness narratives in everyday contexts, highlighting the double-edged sword effect of smartphones. This echoes Mâalej et al.'s warning that smartphones represent a “double-edged weapon” in mental healthcare, simultaneously offering empowerment and risk.² Additionally, this study makes a methodological contribution by further exploring the potential combination of SNA and CDA, providing a foundation for developing analytical pathways from word networks to discourse. Finally, from a practical perspective, this study discusses the multifaceted intervention of smartphones on individual mental health and provides insights for psychological narrative therapy in the digital health era. For example, narrative therapy could help patients redefine the role of smartphones, reconstruct the meaning of technology (e.g. transforming it from a “source of addiction” to a “supportive partner”), and enhance their sense of control over technology use.

Limitations and future research

The limitations of this study are primarily as follows: first, the research sample mainly comes from an online depression group, so the results may not represent the broader population of mental health patients. Future research could include more diverse samples to enhance generalizability. Second, the text-based analysis cannot capture nonverbal cues, such as emojis, which may influence the narrative. Future studies could incorporate multimodal data to address this. Additionally, this study does not incorporate longitudinal tracking to validate causal relationships. Longitudinal research could provide deeper insights into the long-term effects of smartphone use.

Conclusion

This study highlights how smartphones play multifaceted roles in the illness narratives of people with mental health issues, revealing both enabling, and constraining affordances. By combining semantic network and discourse analyses, we show that smartphones actively shape experiences of depression rather than serving as neutral tools. The findings deepen theoretical understanding of affordance and offer practical implications for digital mental health support. Future research should broaden the sample and include multimodal data to further explore technology's impact on mental health narratives. Overall, this work underscores the complex, double-edged influence of smartphones in shaping illness experiences in the digital era.

Footnotes

ORCID iD

Zizhong Zhang

Ethical considerations

This article does not contain any studies with human or animal participants.

Author contributions

Considering the issue of anonymity, this section will be added before the final publication.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Guarantor

ZZ.

Peer review

This article has undergone peer review by two anonymous reviewers selected by the journal. All comments were carefully addressed to improve the manuscript’s clarity and scientific rigor.

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Between support and strain: How do the illness narratives of patients with mental issues articulate the affordances of smartphones?

Abstract

Objective

Methods

Results

Conclusion

Keywords

Introduction

Literature review

Smartphone: A metamedia bearing affordance

Smartphones, mental health, and illness narratives

Bridging affordance and online narratives

Research questions

Methods

Data collection

Analytical approaches

Statistical analysis

Results

Outcome of SNA: Narratives centered on smartphones

Outcome of CDA: The dialectical effects of affordance

Information brokers: The visibility of smartphones

Communication tools: The connectivity of smartphones

Emotional valves: The persistence of smartphones

Discussion

Critical interpretation of the findings

Theoretical and practical implications

Limitations and future research

Conclusion

Footnotes

ORCID iD

Ethical considerations

Author contributions

Funding

Declaration of conflicting interests

Guarantor

Peer review

References