Given the prominence of Google as a search engine (eg, Google accounts for roughly 88% of the search engine market in the United States [23 ]), these analyses leveraged Google Trends, which allows for public access to search term volume for a given time and location. Several studies have leveraged Google Trends data to examine how mental health information is sought out [22 (link),24 (link),25 (link)]. As can be found in the documentation for Google Trends, the raw counts for a given search term are normalized by location and time of search and then scaled to a number from 0 to 100 representing the proportion of searches on all topics that the given term constitutes. Such normalization allows for easier comparison across geographic regions, where population may play a significant role in relative search term popularity. This analysis downloaded data from Google Trends using the gtrendsR package in R (version 1.4.8; R Foundation for Statistical Computing) [26 ]. To obtain data with the most granularity, hourly trend data were queried. The areas of interest were the 50 states constituting the United States; thus, search terms were normalized across states. As Google Trends only stores hourly data for up to 7 days, hourly data were programmatically pulled each Monday from March 23, 2020, to March 29, 2021. This period of 372 days spans the early days of the pandemic to the widespread availability of the COVID-19 vaccine in the United States. During this time frame, 39 states implemented statewide mask mandates, most of which went into effect before or during the summer of 2020. Thus, the given time frame allowed for careful introspection into the short- and long-term effects of mask mandate implementation on mental health search term activity.
The following 19 mental health search terms were queried from Google Trends, as described previously: “anxiety,” “depression,” “ocd” (obsessive-compulsive disorder), “hopeless,” “angry,” “afraid,” “apathy,” “worthless,” “worried,” “restless,” “irritable,” “tense,” “scattered,” “tired,” “avoiding,” “procrastinate,” “insomnia,” “suicidal,” and “suicide.” Aligning with previous work by the authors [10 (link),22 (link)], these terms were validated from previous research on using Google Trends to assess mental health [27 (link)], as well as from previous research assessing rapid affective symptom changes as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [28 ,29 (link)]. In addition to these terms, physical health search terms, both without known associations to COVID-19 (“abrasion,” “allergic,” “angina,” “apnea,” “bleeding,” “blister,” “bruising,” “conjunctivitis,” “constipation,” “discharge,” “earache,” “flatulence,” “fracture,” “hemorrhage,” “incontinence,” “inflammation,” “itching,” “lesions,” “rash,” “spasms,” “swelling,” and “syncope”; 22 terms) and with known associations to COVID-19 (“bloating,” “blurry,” “congestion,” “cough,” “coughing,” “croup,” “diarrhea,” “dizzy,” “fainting,” “fever,” “pain,” “sneezing,” “strep,” “stuffy,” and “vomiting”; 15 terms) were queried to ascertain whether any significantly detected patterns in mental health search term activity were unique to and distinct from those pertaining to physical health. Note that each mental and physical health search term was considered independently in this study; in other words, composite scores aggregating the individual search term counts to create a composite score capturing total mental and physical health activity were not created. This decision was made because combining individual search terms with differential trends throughout the pandemic may attenuate these individual trends in the composite score such that the composite score may not be reflective of changes in specific mental or physical health symptoms, therefore making it uninformative.
The following 19 mental health search terms were queried from Google Trends, as described previously: “anxiety,” “depression,” “ocd” (obsessive-compulsive disorder), “hopeless,” “angry,” “afraid,” “apathy,” “worthless,” “worried,” “restless,” “irritable,” “tense,” “scattered,” “tired,” “avoiding,” “procrastinate,” “insomnia,” “suicidal,” and “suicide.” Aligning with previous work by the authors [10 (link),22 (link)], these terms were validated from previous research on using Google Trends to assess mental health [27 (link)], as well as from previous research assessing rapid affective symptom changes as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [28 ,29 (link)]. In addition to these terms, physical health search terms, both without known associations to COVID-19 (“abrasion,” “allergic,” “angina,” “apnea,” “bleeding,” “blister,” “bruising,” “conjunctivitis,” “constipation,” “discharge,” “earache,” “flatulence,” “fracture,” “hemorrhage,” “incontinence,” “inflammation,” “itching,” “lesions,” “rash,” “spasms,” “swelling,” and “syncope”; 22 terms) and with known associations to COVID-19 (“bloating,” “blurry,” “congestion,” “cough,” “coughing,” “croup,” “diarrhea,” “dizzy,” “fainting,” “fever,” “pain,” “sneezing,” “strep,” “stuffy,” and “vomiting”; 15 terms) were queried to ascertain whether any significantly detected patterns in mental health search term activity were unique to and distinct from those pertaining to physical health. Note that each mental and physical health search term was considered independently in this study; in other words, composite scores aggregating the individual search term counts to create a composite score capturing total mental and physical health activity were not created. This decision was made because combining individual search terms with differential trends throughout the pandemic may attenuate these individual trends in the composite score such that the composite score may not be reflective of changes in specific mental or physical health symptoms, therefore making it uninformative.
Free full text: Click here
