JMIR Publications

ABSTRACT

Background:

The global COVID-19 pandemic's mental health impact was primarily studied in the initial year of lockdowns but remained underexplored in subsequent years despite evolving conditions. Utilizing Google Trends data and mediation analysis.

Objective:

This study examined the intricate interplay among COVID-19-related factors, stay-at-home behaviors, and mental health indicators.

Methods:

This investigation explored dynamics between national COVID-19 deaths, stay-at-home behaviors, and internet searches for "insomnia" and "suicide" across 45 countries during the initial three-year pandemic period (March 2020 to October 2022). Google Trends data assessed changes in search volumes for mental health indicators, while Google Location History data illuminated stay-at-home behavior effects through residence-based cell phone activity analysis. The study quantified the proportion mediated (PM) by stay-at-home behaviors in COVID-19's effects on insomnia and suicide ideation.

Results:

Findings revealed associations between COVID-19 deaths and "insomnia" searches. In high-income countries, a significant correlation emerged during the initial year, linking higher death counts to elevated "insomnia" searches, mediated by stay-at-home behavior (PM=31.9%). This trend diminished in subsequent years. Middle-income countries exhibited a distinct pattern with reduced "suicide" searches despite higher deaths in the first two years, influenced by factors beyond stay-at-home behaviors. Notably, in high-income countries, a tentative link between COVID-19 deaths and “suicide” searches emerged during the second year, which gained further significance in the third year, independently of stay-at-home behaviors.

Conclusions:

This study provided extensive insights into the evolving impact of the COVID-19 pandemic on mental health, informing interventions across diverse income-level countries.