A Typology of Moderator Practices and Community Guidelines in Online Mental Health Communities to Establish a Framework for Digital Safety: Systematized Review.

Background: The rise of online mental health communities has reshaped the ways individuals seek and receive mental health support. Although online mental health communities (OMHCs) offer a valuable space for peer support, including through experience-sharing, they also present challenges, including moderation practices to cultivate supportive interactions and secure member safety. No comprehensive framework of moderation practices has been established. Developing such an understanding is important, as moderators play a central role in facilitating a sense of community and determining whether OMHCs function as safe and supportive spaces. Objective: This study aimed to develop typologies of moderator practices used to support safety and facilitate a sense of community within OMHCs for people with mental health problems, and the content of OMHC community guidelines. Methods: A systematized review of empirical research studies focusing on moderation practices and community guidelines in OMHCs was conducted using MEDLINE, Web of Science, Association for Computing Machinery Digital Library, supplemented with a purposive search to identify gray literature on community guidelines for OMHC moderation. Inclusion criteria: online, text-based component, asynchronous or synchronous moderation, mental health-related focus, and human moderation. Exclusion criteria: crisis-focused, audience-based, nonmoderated or bot-moderated, profession not peer support, non-English, and academic review or thesis. The search period was 2014 to 2024. A bespoke data extraction sheet was piloted, then populated, capturing document, OMHC, member, and moderator characteristics. Thematic analysis was used to synthesize the findings relating to each objective. Results: The systematized search identified 11,347 studies and other documents, from which 80 studies were included, comprising 48 empirical papers and 32 gray literature documents. These related to 52 different OMHCs. Four categories of moderator practices were identified: (1) premoderation and postmoderation processes, (2) reactive moderation processes, (3) building the community, and (4) monitoring members. Premoderation and postmoderation processes were used within 41 (79%) of the 52 OMHCs. Three categories of community guideline content were identified: (1) content of post, (2) member conduct, and (3) moderation. The category, content of post, was the most widely used component of community guidelines, used in 35 (67%) of the 52 OMHCs. Conclusions: The two typologies provide a foundational framework that can be adapted and applied to community guidelines and moderation strategies across a range of contexts. When operationalized, they could provide benefit to people with mental health problems by using them to guide the development of moderator training, digital tools, and governance policies that align with the specific characteristics and objectives of individual OMHCs. Effective translation and application of these typologies require careful, nuanced consideration of each community's goals, membership, and cultural context to ensure their relevance, effectiveness, and impact.