JMIR Publications

ABSTRACT

The COVID-19 pandemic and associated restrictions have been a major stressor that has exacerbated mental health worldwide. Qualitative data play a unique role in documenting mental state, via both language features and content. Within an online longitudinal study on mental health during the early COVID-19 pandemic, we analyzed free responses to the question: “Is there anything else you would like to tell us that might be important that we did not ask about?” We applied text analysis methods to ask whether individuals who responded to the item differed from non-responders, whether there were associations between language use and psychological status, and to characterize the content of responses and how responses changed over time. 3,655 individuals enrolled in the study and were asked to complete self-reported measures of mental health and COVID-19 pandemic-related questions every two weeks for 6 months. Of these, 2,497 participants provided at least one free response (9,741 total responses). Response likelihood was influenced by demographic factors and health status: those who were male, Asian, Black, or Hispanic were less likely to respond, and odds of responding increased with age and education as well as a history of physical health conditions. Although mental health treatment history did not influence the overall likelihood of responding, it was associated with more negative sentiment, negative word use, and higher usage of first-person singular pronouns. Responses were dynamically influenced by psychological status, such that distress and loneliness were positively associated with an individuals’ likelihood to respond at a given time point and were associated with more negativity. Finally, responses were negative in valence overall and exhibited fluctuations linked with external events. The responses covered a variety of topics, with the most common being mental health and emotion, social/physical distancing, and policy and government. Our results identify trends in language use during the first year of the pandemic, and suggest that both the content of responses and overall sentiment are linked to mental health.