{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:12:27Z","timestamp":1786738347882,"version":"build-2736575974"},"reference-count":63,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Internet support groups (ISGs) provide accessible peer support for individuals with depression; yet, their withdrawal rates are substantially higher than those observed in general online groups. Existing research has focused primarily on retention as a marker of intervention success. The significance and mechanisms of withdrawal, therefore, remain underexplored.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to examine how individuals with depression use withdrawal from ISGs as a strategy for empowerment. It also sought to clarify how autonomy, courage, and responsibility are enacted through the process of leaving.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a qualitative study using semistructured interviews with 19 participants. They were recruited through purposive and snowball sampling on a major Chinese social media platform. The sample comprised 18 former ISG members diagnosed with depression and 1 in-group psychological counselor. Among the former members, 5 had served as group founders or administrators. Data were collected through audio-, video-, and text-based interviews and were subsequently transcribed and deidentified. Analysis followed a hybrid deductive and inductive approach. A priori categories drawn from the empowerment framework were treated as provisional and remained open to revision based on the data. In parallel, inductive grounded theory procedures identified emergent patterns of strategic withdrawal. Negative case analysis, blind coding, external expert review, and member checking were used to strengthen rigor.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In participants\u2019 accounts, withdrawal from ISGs emerged as a multidimensional empowerment process rather than a single act. Autonomy grounded the process. Participants reassessed the gap between their expectations and the group reality and came to judge their recovery by their own standards. Courage carried that judgment into action. Whether through decisive exits or gradual disengagement, participants broke the inertia of habitual connection and re-established personal boundaries. Responsibility did not wait for the exit. It surfaced beforehand as a felt obligation to protect one\u2019s own health, which helped drive the decision to leave. After withdrawal, it matured into sustained self-management as participants redirected their energy toward offline recovery and alternative sources of support. The 3 dimensions did not form a linear sequence. Instead, they unfolded in a staggered and interwoven manner throughout the process. Negative cases, including externally imposed exits and returns driven by fluctuating symptoms, delimited the scope of these findings.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study challenges the retention-focused perspective in ISG research by showing that strategic withdrawal can be an empowering process for individuals with depression. Empowerment is achieved not only through ongoing participation but also through the autonomy to disconnect, the courage to set boundaries, and the responsibility to manage one\u2019s own recovery. Mental health professionals and platform designers should recognize and support strategic withdrawal as a legitimate and positive outcome. Such recognition would help foster a more resilient and patient-centered digital support ecosystem.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/92690","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:22:45Z","timestamp":1786735365000},"page":"e92690-e92690","source":"Crossref","is-referenced-by-count":0,"title":["Strategic Withdrawal as Empowerment for Individuals With Depression in Internet Support Groups: Qualitative Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2215-6711","authenticated-orcid":false,"given":"Yufan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2927-3523","authenticated-orcid":false,"given":"Zhentao","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"issue":"2","key":"R1","doi-asserted-by":"publisher","first-page":"103198","DOI":"10.1016\/j.ipm.2022.103198","article-title":"Effects of members\u2019 response styles in an online depression community based on text mining and empirical analysis","volume":"60","author":"Yao","journal-title":"Inf Process Manag"},{"issue":"10328","key":"R2","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1016\/S0140-6736(21)02141-3","article-title":"Time for united action on depression: a Lancet-World Psychiatric Association Commission","volume":"399","author":"Herrman","journal-title":"Lancet"},{"issue":"7","key":"R3","doi-asserted-by":"publisher","DOI":"10.2196\/25917","article-title":"A newly developed online peer support community for depression (depression connect): qualitative study","volume":"23","author":"Smit","journal-title":"J Med Internet Res"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1002\/wps.20444","article-title":"Mental health internet support groups: just a lot of talk or a valuable intervention?","volume":"16","author":"Griffiths","journal-title":"World Psychiatry"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/BF00919275","article-title":"Terms of empowerment\/exemplars of prevention: toward a theory for community psychology","volume":"15","author":"Rappaport","journal-title":"Am J Community Psychol"},{"issue":"5","key":"R6","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1007\/BF02506983","article-title":"Psychological empowerment: issues and illustrations","volume":"23","author":"Zimmerman","journal-title":"Am J Community Psychol"},{"issue":"4","key":"R7","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1590\/S0080-623420160000500018","article-title":"Concepts and measures of patient empowerment: a comprehensive review","volume":"50","author":"Cerezo","journal-title":"Rev Esc Enferm USP"},{"issue":"7","key":"R8","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1016\/j.pec.2020.02.017","article-title":"Empowerment in healthcare: a thematic synthesis and critical discussion of concept analyses of empowerment","volume":"103","author":"Halvorsen","journal-title":"Patient Educ Couns"},{"issue":"8","key":"R9","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1176\/ps.48.8.1042","article-title":"A consumer-constructed scale to measure empowerment among users of mental health services","volume":"48","author":"Rogers","journal-title":"Psychiatr Serv"},{"issue":"4","key":"R10","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1176\/appi.ps.52.4.482","article-title":"What is recovery? 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