How Confidence in Prior Attitudes, Social Tag Popularity, and Source Credibility Shape Confirmation Bias Toward Antidepressants and Psychotherapy in a Representative German Sample: Randomized Controlled Web-Based Study

J Med Internet Res. 2019 Apr 23;21(4):e11081. doi: 10.2196/11081.


Background: In health-related, Web-based information search, people should select information in line with expert (vs nonexpert) information, independent of their prior attitudes and consequent confirmation bias.

Objective: This study aimed to investigate confirmation bias in mental health-related information search, particularly (1) if high confidence worsens confirmation bias, (2) if social tags eliminate the influence of prior attitudes, and (3) if people successfully distinguish high and low source credibility.

Methods: In total, 520 participants of a representative sample of the German Web-based population were recruited via a panel company. Among them, 48.1% (250/520) participants completed the fully automated study. Participants provided prior attitudes about antidepressants and psychotherapy. We manipulated (1) confidence in prior attitudes when participants searched for blog posts about the treatment of depression, (2) tag popularity -either psychotherapy or antidepressant tags were more popular, and (3) source credibility with banners indicating high or low expertise of the tagging community. We measured tag and blog post selection, and treatmentefficacy ratings after navigation.

Results: Tag popularity predicted the proportion of selected antidepressant tags (beta=.44, SE 0.11; P<.001) and blog posts (beta=.46, SE 0.11; P<.001). When confidence was low (-1 SD), participants selected more blog posts consistent with prior attitudes (beta=-.26, SE 0.05; P<.001). Moreover, when confidence was low (-1 SD) and source credibility was high (+1 SD), the efficacy ratings of attitude-consistent treatments increased (beta=.34, SE 0.13; P=.01).

Conclusions: We found correlational support for defense motivation account underlying confirmation bias in the mental health-related search context. That is, participants tended to select information that supported their prior attitudes, which is not in line with the current scientific evidence. Implications for presenting persuasive Web-based information are also discussed.

Trial registration: NCT03899168; (Archived by WebCite at

Keywords: Germany; antidepressive agents; attitude; consumer health information; culture; health literacy; information dissemination; information systems; professional competence; psychotherapy.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antidepressive Agents / pharmacology
  • Antidepressive Agents / therapeutic use*
  • Attitude*
  • Bias
  • Depression / drug therapy*
  • Depression / therapy*
  • Female
  • Germany
  • Humans
  • Internet
  • Male
  • Middle Aged
  • Psychotherapy / methods*
  • Research Design
  • Young Adult


  • Antidepressive Agents

Associated data