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Internet searches regarding acute anxiety reached an all-time high between March and May 2020, new research shows.
Investigators used data collected by Google to monitor the daily percentage of all Internet searches originating in the United States that included the terms “anxiety” or “panic” in combination with “attack” between January 2004 and May 2020.
They found an 11% increase in all acute anxiety queries between March 2020, when President Donald Trump first declared the COVID-19 pandemic a national emergency, and May 2020. This translates into approximately 375,000 more searches than expected.
Most of the increase in inquiries occurred when specific developments in COVID-19 were reported.
“We found record levels of people potentially having panic attacks, as reflected by their online queries since early in the pandemic,” lead author John W. Ayers, PhD, associate adjunct professor of medicine, School of Health Sciences, University of California, San Diego (UCSD), told Medscape Medical News.
“There are two main take-home messages from our research — one is that we need to think about how to address acute anxiety during COVID-19, and the other is that we need to start thinking about how our messaging impacts acute anxiety,” said Ayers, who is also vice chief of innovation, Division of Infectious Diseases and Global Public Health, UCSD.
The study was published online August 24 in JAMA Internal Medicine.
“There has been a lot of speculation about collateral consequences of COVID-19, especially in mental health,” Ayers said.
Most of the research has been conducted via self-report survey, but these types of surveys may miss individuals who do not participate in the surveys or do not seek care, Ayers added.
“We need a strategy that can measure behavioral health in real time so we can design interventions to meet these needs,” he said.
He explained that he and his colleagues “looked at one case study — panic attacks — because it is the most prevalent form of mental health problem driven by your surroundings, and it is socially contagious, meaning that when someone you know is having a severe acute anxiety or panic attack, you’re more likely to have one yourself.”
The researchers turned to publicly available nonidentifiable data collected via Google Trends — a feature of Google that shows how frequently a given search term is entered into Google’s search engine, relative to the site’s total search volume, over a specific period.
They monitored all searches containing their keywords over a 15-year period (January 1, 2004, to May 4, 2020). Search volumes between March 13, 2020 (when the national emergency was declared) and the last date of available data (May 9, 2020) were compared to the expected search volumes that would have been found had COVID-19 not occurred.
Cumulatively, all acute anxiety searches were 11% higher than expected for the 58-day study period (95% CI, 7% – 14%). There was a dramatic increase in searches (375,000), or a total of 3.4 million searches, during that period.
Most of these searches took place between March 16, 2020, and April 14, 2020, when searches were cumulatively 17% higher than expected (95% CI, 13% – 22%).
Several COVID-19-related milestones took place during that period.
First imposition of social distancing guidelines occurred (March 16, 2020).
Extension of social distancing guidelines occurred (March 29, 2020).
The United States surpassed China with the most reported COVID-19 cases (March 26, 2020).
The CDC recommended use of face masks (April 3, 2020).
The United States surpassed Italy for having the most COVID-19-related deaths (April 11, 2020).
The largest spike in acute anxiety queries occurred on March 28, 2020, on which date there were 52% more searches than expected.
Queries returned to expected levels on April 15, 2020, and have fallen within expected ranges since then.
Ayers noted that although other stressors have affected people in the United States, including electoral and economic issues, “the headlines around COVID-19 were driving the anxiety, and those days with dramatic headlines were associated with large spikes in queries.”
“Our messaging surrounding how COVID-19 is reported may need to change to prevent this,” Ayers said. “Headlines that hit people in the head by reporting how many people died and bury in the article how we can slow the spread may increase anxiety more than headlines reporting strategies that work right up front.”
He noted that media reporting of suicide has begun to change; there have been fewer sensationalized headlines, and there has been an increase in referrals to suicide hotlines. “We need to be thinking about similar strategies when reporting COVID-19,” said Ayers.
He also suggested tapping existing resources, such as state suicide hotlines, by training staff to assist persons experiencing acute anxiety and panic attacks.
As an example of this model, the authors point to an Illinois-based hotline, Call4Calm, which helps people cope with acute COVID-19 anxiety.
Google queries concerning panic and anxiety do not yield any links to helplines, although OneBox, a Google feature, provides information to people inquiring about suicide and addiction. “This approach could be used to promote resources about anxiety and panic and COVID-19,” Ayers suggested.
Commenting on the report for Medscape Medical News, Elspeth Cameron Ritchie, MD, chair of the Department of Psychiatry, Medstar Washington Hospital Center, Washington, DC, said the study’s recommendations were “interesting and worth amplifying ” and that “headlines calling for calm” were “a good suggestion.” She was not involved with the study.
“A multifaceted, multimedia approach is needed — not only what’s on Google, but it would be helpful if politicians could acknowledge the anxiety and make available more mental health resources,” she added.
Ritchie, who is also vice chair of psychiatry at Georgetown University School of Medicine, suggested that it is a “simple option [during patient visits] to incorporate a question as to how your patient is being affected by the pandemic into your standard template, together with questions about sleep, appetite, sexual functioning, etc.”
Ayers said that the “call to action” that he and his colleagues are making is to use their methodology to “know what mental health needs are in the population” and to use existing frameworks and strategies to address them.
The study was supported by a grant from the University of California Office of the President and by intramural support from the Division of Infectious Diseases and the Center for Data Driven Health at the Qualcomm Institute, both with the University of California, San Diego. Coauthor Althouse was funded by Bill and Melinda Gates through the Global Good Fund. Ayers owns equity positions in Directing Medicine, Health Watcher, and Good Analytics, companies that advise on the use of digital data for public health surveillance. Ritchie reports no relevant financial relationships.
JAMA Intern Med. Published online August 24, 2020. Full text