Online searches for severe anxiety and 'panic attacks' hit record high in the US during Covid-19 pandemic: Study

Over the first 58 days of the coronavirus pandemic, there were an estimated 3.4 million searches related to severe acute anxiety in the US

                            Online searches for severe anxiety and 'panic attacks' hit record high in the US during Covid-19 pandemic: Study
(Getty Images)

There is a significant concern among health experts that the coronavirus pandemic could have an adverse and lasting impact on people’s mental health, but assessing these concerns is difficult without data. A research team now finds that online help-seeking for severe acute anxiety – which includes “panic attacks” and “anxiety attacks” – hit record highs in the US during the pandemic.

The analysis reveals that there were an estimated 3.4 million searches on the internet related to severe acute anxiety during the first 58 days of the Covid-19 pandemic in the US. The team says that searches for anxiety and panic attacks were the highest they have ever been in over 16 years of historical search data. 

The largest increases in queries took place between March 16, 2020, and April 14, 2020, “cumulatively increasing 17%.” According to the researchers, these increases coincided with the rollout of national social distancing guidelines (March 16) and their extension (March 29), the US surpassing China with the most reported cases (March 26), the Centers for Disease Control and Prevention (CDC) recommending facemasks (April 3), and the US surpassing Italy for most deaths (April 11).

“We found 3.4 million searches about panic attacks originating from the US in the one month following the US declaration of a national emergency. This is a record high for panic attack searches. The majority of these searches occurred during the first two weeks where we saw inconsistent messaging about protective measures while the US surpassed China and Italy in the number of cases,” study author Dr Alicia L Nobles, from the Center for Data-Driven Health at the Qualcomm Institute within the University of California San Diego (UCSD), told MEA WorldWide (MEAWW).

Led by Dr John W Ayers, also from the Center for Data Driven-Health, and Dr Nobles, in collaboration with Johns Hopkins University, Barnard College, and Institute for Disease Modeling, the study has been published in JAMA Internal Medicine.

“A panic attack is not to be taken lightly as it can land someone in the emergency room with shortness of breath, a pounding heart, chest pain, and an intense feeling of fear. Our results unquestionably warrant a need for increased mental health services,” suggests Dr Ayers.

The increases in severe acute anxiety-related searches coincided with the rollout of national social distancing guidelines (March 16) and their extension (March 29), and the US surpassing China with the most reported cases (March 26), among others (Getty Images) 

According to researchers, traditional population mental health surveillance, such as telephone surveys, medical records, lacks the agility to provide on-demand insights. They are time-consuming, expensive, and may miss persons who do not participate or seek care. Therefore, to evaluate the association of Covid-19 with anxiety on a population basis, the team examined internet searches indicative of acute anxiety during the early stages of the pandemic.

“Health experts hypothesize that people’s mental health will be adversely impacted by the Covid-19 pandemic, but currently there is very little data to confirm how people’s mental health is being impacted. Typically, public health experts measure a population’s health using surveys and medical records. But this type of data takes months or even years before it’s available. This is a huge problem when leaders are trying to figure out how to craft policy that can address co-occurring health problems. We need agile public health monitoring during the interim. One way to do this is by monitoring what people search for online about their health since most people search online about their health,” Dr Nobles told MEAWW.

The findings

The research team analyzed Google search queries that mentioned “panic attack” or “anxiety attack” emerging from the US from January 2004 through May 9, 2020. These included queries like “am I having a panic attack?” “signs of anxiety attack” or “anxiety attack symptoms.” The experts studied anxiety attacks because they are a common mental health problem, can lead to other mental health problems like depression, are triggered by outside stressors, and (especially relevant during a pandemic) are socially contagious.

When the authors evaluated trends after President Donald Trump first declared a national emergency (March 13), they discovered severe acute anxiety-related searches reached a record high. “All acute anxiety queries were cumulatively 11% higher than expected for the 58-day period that started when President Trump first declared a national emergency and ended with the last available date of data (May 9). This spike was a new all-time high for acute anxiety searches. In absolute terms this translates to approximately 375,000 more searches than expected for a total of 3.4 million searches,” the findings state. 

The largest spike in acute anxiety queries occurred on March 28, with 52% more queries than expected. “Moreover, most excess queries occurred between March 16 and April 14 when queries were cumulatively 17%. Queries returned to typical levels by April 15 through the end of the study,” shows analysis. 

According to the authors, while internet searches indicative of acute anxiety spiked early during the pandemic, they have since returned to typical levels, perhaps because Americans have become “more resilient to the societal fallout” from Covid-19 or because they had already received whatever benefit they could from searching the internet. They note that while this study cannot confirm that any search was linked to a specific acute anxiety event or panic attack, it provides evidence of the “collateral psychological effects” stemming from Covid-19, and motivates several data-driven recommendations.

“The pandemic and our public health response, while warranted based on early evidence, could have many unintended and collateral health impacts. Our results provide among the first insights into understanding those impacts,” says study co-author Dr Eric C Leas, an assistant professor in the UCSD Department of Family Medicine and Public Health. 

The team studied anxiety attacks because they are a common mental health problem, can lead to other mental health problems like depression, are triggered by outside stressors, and are socially contagious. (Getty Images)


The researchers recommend that surveillance should continue as changes during the pandemic may spark new increases in acute anxiety that necessitate a response. “The value of monitoring queries goes beyond acute anxiety. For instance, during the Covid-19 pandemic, we first detected spikes in shopping for unproven therapies and shopping for guns using similar methods, and these can be further extended across public and mental health topics,” explains study co-author Dr Mark Dredze, the John C Malone associate professor of computer science at Johns Hopkins University.  

In light of the pandemic, resource providers should better address acute anxiety, says the team. “More must be done to link those needing help with help. A “panic attack” Google query does not return any links to helplines, even though Google has pioneered the “OneBox” approach to mental health queries, highlighting life-saving results at the top of a user’s search results (including suicide and addiction hotlines) rather than hoping searchers find actionable information by chance alone. The Google OneBox should be expanded to promote resources for acute anxiety, like SAMHSA’s Disaster Distress Helpline, to meet potential increased demand during Covid-19 now and in the future,” the authors recommend. 

According to the investigators, time-sensitive decision-making during a pandemic underscores the importance of fostering an agile empirical approach that can continually monitor health threats. Mining internet searches may improve strategies to discover and subsequently address the collateral mental health consequences of Covid-19, they emphasize. As political and policy leaders debate where to spend health resources to address the mental health burdens of Covid-19, timely, empirical evidence like the one provided in the study can ensure that limited resources are allocated to the direst needs, explains the team. 

“We need a public health monitoring system that engenders time-sensitive data collection. This system should be able to shift instantaneously for data collection, especially in a crisis. One potential way to do this in the interim is by using internet searches to fill the gap and provide real-time data. Data and evidence are critical to crafting effective policy that will address collateral health effects of the pandemic,” Dr Nobles told MEAWW. She adds, “Public health experts can begin working with internet search engine companies to ensure that the public gets effective resources when they search for information about a health concern. Traditionally, public health messaging occurred on television, radio, or bus advertisements, for example. We live in a modern-day society where we need to meet people where they are at – and these days that is the internet for a majority here in the US.

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