Flattening the Mental Health Curve: COVID-19 Stay-at-Home Orders Are Associated With Alterations in Mental Health Search Behavior in the United States

Jacobson, Nicholas C.; Lekkas, Damien; Price, George; Heinz, Michael V.; Song, Minkeun; O’Malley, A. James; Barr, Paul

doi:10.2196/19347

Cited by 171 publications

(148 citation statements)

References 26 publications

(34 reference statements)

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“…2Additionally, personal exposure (e.g., self or close other tested positive to COVID-19) was associated with higher acute stress and depressive symptoms, whereas community-level exposures (e.g., stay-at-home orders) were not, suggesting that concerns about contracting the disease outweighed concerns about pandemic-related disruptions in daily life. Unlike big data findings suggesting that stay-at-home orders may "flatten the curve" of psychological symptoms (e.g., anxiety, hopelessness, suicide) in the U.S., (18) our findings offer evidence that respondents' acute stress and depressive symptoms continued rising after the stay-at-home orders were implemented. Furthermore, our data suggest that individuals who continued working during this early phase of the pandemic were less depressed than individuals who were not working, even though they were at greater risk for contracting the virus.…”

Section: Discussioncontrasting

confidence: 89%

“…(17) However, analysis of Goog-leTrends data suggests that stay-at-home orders may have flattened rising distress as the number of distress-related searches in the U.S. plateaued soon after the lockdowns began. (18) At present, little is known about the relative impact of these various exposures-direct, media-driven, or community wide -on individuals' early pandemic-related psychological responses. Understanding the risk and protective factors affecting public response is critical to promoting community resilience as countries across the globe face a surge of new COVID-19 infections.…”

Section: Introductionmentioning

confidence: 99%

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The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States

et al. 2020

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The COVID-19 pandemic is a collective stressor unfolding over time, yet rigorous published empirical studies addressing mental health consequences of COVID-19 among large probability-based national samples are rare. Between 3/18-4/18/20, during an escalating period of illness and death in the United States, we assessed acute stress, depressive symptoms and direct, community, and media-based exposures to COVID-19 in three consecutive representative samples across three 10-day periods (total N=6,514) from the U.S. probability-based nationally representative NORC AmeriSpeak panel. Acute stress and depressive symptoms increased significantly over time as COVID-19 deaths increased across the U.S. Pre-existing mental and physical health diagnoses, daily hours of COVID-19-related media exposure, exposure to conflicting COVID-19 information in media, and secondary stressors were all associated with acute stress and depressive symptoms. Results have implications for targeting of public health interventions and risk communication efforts to promote community resilience as the pandemic waxes and wanes over time.

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Section: Discussioncontrasting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States

et al. 2020

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“…We did observe decreases in anxiety and depression that paralleled the typical post–final examination drop, which suggests some resilience in the face of COVID-19; however, the overall values remained elevated above those observed during typical academic breaks. This may also be consistent with the adjustment period to the rapidly changing landscape of social media, policies, and media coverage [ 25 ].…”

Section: Discussionsupporting

confidence: 68%

Mental Health and Behavior of College Students During the Early Phases of the COVID-19 Pandemic: Longitudinal Smartphone and Ecological Momentary Assessment Study

Huckins¹,

DaSilva²,

Wang³

et al. 2020

J Med Internet Res

596

473

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Background The vast majority of people worldwide have been impacted by coronavirus disease (COVID-19). In addition to the millions of individuals who have been infected with the disease, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggests that this can lead to profound behavioral and mental health changes; however, researchers are rarely able to track these changes with frequent, near-real-time sampling or compare their findings to previous years of data for the same individuals. Objective By combining mobile phone sensing and self-reported mental health data among college students who have been participating in a longitudinal study for the past 2 years, we sought to answer two overarching questions. First, have the behaviors and mental health of the participants changed in response to the COVID-19 pandemic compared to previous time periods? Second, are these behavior and mental health changes associated with the relative news coverage of COVID-19 in the US media? Methods Behaviors such as the number of locations visited, distance traveled, duration of phone usage, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments of the Patient Health Questionnaire-4. The participants were 217 undergraduate students, with 178 (82.0%) students providing data during the Winter 2020 term. Differences in behaviors and self-reported mental health collected during the Winter 2020 term compared to previous terms in the same cohort were modeled using mixed linear models. Results During the first academic term impacted by COVID-19 (Winter 2020), individuals were more sedentary and reported increased anxiety and depression symptoms ( P <.001) relative to previous academic terms and subsequent academic breaks. Interactions between the Winter 2020 term and the week of the academic term (linear and quadratic) were significant. In a mixed linear model, phone usage, number of locations visited, and week of the term were strongly associated with increased amount of COVID-19–related news. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, and phone usage), both anxiety ( P <.001) and depression ( P =.03) were significantly associated with COVID-19–related news. Conclusions Compared with prior academic terms, individuals in the Winter 2020 term were more sedentary, anxious, and depressed. A wide variety of behaviors, including increased phone usage, decreased physical activity, and fewer locations visited, were associated with fluctuations in COVID-19 news repo...

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“…Despite the fact that during the Measures period the temperature was warmer and there was more sunshine than usual, the analysis on weather data for Germany did not show a significant impact on the changed mental health symptoms. Our findings are supported by a growing body of evidence from ongoing studies [49] and recently published research [50], as well as anecdotal evidence reported in various mainstream media reports [51][52][53] which suggest that at least in the short-term the mental health effects of the COVID-19 measures may not be as negative as expected. One factor may be that the stress of everyday life and work/study is reduced during lockdown and home office/schooling.…”

Section: Principal Resultssupporting

confidence: 88%

Syndromic surveillance insights from a symptom assessment app before and during COVID-19 measures in Germany and the United Kingdom: results from repeated cross-sectional analyses

Mehl¹,

Bergey²,

Cawley³

et al. 2020

Preprint

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Background: Unprecedented lockdown measures have been introduced in countries across the world to mitigate the spread and consequences of COVID-19. While attention has focused on the effects of these measures on epidemiological indicators relating directly to the infection, there is increased recognition of their broader health implications. However, assessing these implications in real time is a challenge, due to limitations of existing syndromic surveillance data and tools. Objective: To explore the added value of mobile phone app-based symptom assessment tools as real time health insight providers to inform public health policy makers. Methods: A comparative and descriptive analysis of the proportion of all self-reported symptoms entered by users during an Ada assessment in Germany and the United Kingdom (UK) was conducted between two periods: before and after the implementation of Phase One COVID-19 measures. Additional analyses were performed to explore the association between symptom trends and seasonality, and symptom trends and weather. Differences in the proportion of unique symptoms between the periods were analyzed using Pearson's Chi-squared test and reported as Log2 Fold Changes (Log2 FC). Results: Between 48,300-54,900 symptomatic users reported 140,500-170,400 symptoms during the Baseline and Measures periods in Germany. Between 34,200-37,400 symptomatic users in the UK reported 112,100-131,900 symptoms during the Baseline and Measures periods. The majority of symptomatic users were female (Germany 68,600/103,200, 66.52%; UK 51,200/71,600, 72.74%). The majority (Germany 68,500/100,000, 68.45%; UK 50,900/68,800, 73.91%) were aged between 10 and 29 years, and about a quarter (Germany 26,200/100,000, 26.15%; UK 14,900/68,800, 21.65%) were between 30-59 years. 103 symptoms were reported either more or less frequently (with statistically significant differences) during the Measures as compared to the Baseline period, and 34 of these were found in both countries. The following mental health symptoms (Log2 FC, P-value) were reported less often during the Measures period: inability to manage constant stress and demands at work (-1.07, P<.001), memory difficulty (-0.56, P<.001), depressed mood (-0.42, P<.001), and impaired concentration (-0.46, P<.001). Diminished sense of taste (2.26, P<.001) and hyposmia (2.20, P<.001) were reported more frequently during the Measures period. None of the 34 symptoms were found to be different between the same dates in 2019. Fourteen of the 34 symptoms had statistically significant associations with weather variables. Conclusions: Symptom assessment apps have an important role to play in facilitating improved understanding of the implications of public health policies such as COVID-19 lockdown measures. Not only do they provide the means to complement and cross-validate hypotheses based on data collected through more traditional channels, they can also generate novel insights through a real-time syndromic surveillance system.

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Flattening the Mental Health Curve: COVID-19 Stay-at-Home Orders Are Associated With Alterations in Mental Health Search Behavior in the United States

Cited by 171 publications

References 26 publications

The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States

The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States

Mental Health and Behavior of College Students During the Early Phases of the COVID-19 Pandemic: Longitudinal Smartphone and Ecological Momentary Assessment Study

Syndromic surveillance insights from a symptom assessment app before and during COVID-19 measures in Germany and the United Kingdom: results from repeated cross-sectional analyses

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