JMIR Publications

ABSTRACT

Background:

In the United States, one in every three people lives in a Mental Health Professional Shortage Area (MHPSA). Shortage areas tend to be rural, have higher levels of poverty, and poor mental health outcomes. Past work has demonstrated that these poorer outcomes may arise out of interactions between a lack of resources and a lack of recognition of mental illness by medical professionals.

Objective:

We aim to understand differences in how people in shortage areas and non-shortage areas search for information around mental health online.

Methods:

We analyze search engine log data of queries related to health from 2017-2021 and examine the differences in mental health search behavior between shortage and non-shortage areas. We analyze along several axes of difference, including shortage/non-shortage comparisons, urban/rural comparisons, and temporal comparisons.

Results:

We find specific differences in search behavior between shortage and non-shortage areas. In shortage areas, broader and more general mental health symptom categories tend to be searched significantly more often (Q<.0003), namely Anxiety (mean = 2.03%, SD = .44%), Depression (mean = 1.15%, SD = .27%), Fatigue (mean = 1.21%, SD = .28%), and Headache (mean = 1.03%, SD = .23%). On the other hand, specific symptom categories and mental health disorders such as Binge Eating (mean = .02%, SD = .02%), Psychosis (.37%, SD = .06%), and Attention Deficit Hyperactivity Disorder (mean = .77%, SD = .10%) are all searched significantly more (Q<.0009) in non-shortage areas. Although rates of suicide are consistently known to be higher in shortage areas and in rural areas we see that rates of suicide-related searching are lower in shortage areas (mean = .05%, SD = .04% vs. non-shortages’ mean = .10%, SD = .03%, Q<.0003), and more so when a shortage area is rural (mean = .024%, SD = .029%, Q<2*10^-12).

Conclusions:

This work demonstrates differences in how people from geographically marginalized groups search online for mental health. One main implication of this work is the influence that search engine ranking algorithms and interface design might have on the kinds of resources that individuals make use of when in distress. Our results support the idea that search engine algorithm designers should be conscientious of the role structural factors play in expressions of distress, and design search engine algorithms and interfaces to close gaps in care.