The Relationship between Deteriorating Mental Health Conditions and Longitudinal Behavioral Changes in Google and YouTube Usages among College Students in the United States during COVID-19: Observational Study

Background: Mental health problems among the global population are worsened during the coronavirus disease (COVID-19). Yet, current methods for screening mental health issues rely on in-person interviews, which can be expensive, time-consuming, blocked by social stigmas and quarantines. Meanwhile, how individuals engage with online platforms such as Google Search and YouTube undergoes drastic shifts due to COVID-19 and subsequent lockdowns. Such ubiquitous daily behaviors on online platforms have the potential to capture and correlate with clinically alarming deteriorations in mental health profiles of users through a non-invasive manner. Objective: The goal of this study is to examine, among college students in the United States, the relationship between deteriorating mental health conditions and changes in user behaviors when engaging with Google Search and YouTube during COVID-19. Methods: This study recruited a cohort of undergraduate students (N=49) from a U.S. college campus during January 2020 (prior to the pandemic) and measured the anxiety and depression levels of each participant. The anxiety level was assessed via the General Anxiety Disorder-7 (GAD-7). The depression level was assessed via the Patient Health Questionnaire-9 (PHQ-9). This study followed up with the same cohort during May 2020 (during the pandemic), and the anxiety and depression levels were assessed again. The longitudinal Google Search and YouTube history data of all participants were anonymized and collected. From individual-level Google Search and YouTube histories, we developed 5 signals that can quantify shifts in online behaviors during the pandemic. We then assessed the differences between groups with and without deteriorating mental health profiles in terms of these features. Results: Of the 49 participants, 41% (n=20) of them reported a significant increase (increase in the PHQ-9 score > 5) in depression, denoted as DEP; 45% (n=22) of them reported a significant increase (increase in the GAD-7 score > 5) in anxiety, denoted as ANX. Of the 5 features proposed to quantify online behavior changes, statistical significances were found between the DEP and non-DEP groups for all of them (P<.01, effect sizes eta_{partial}^2 ranging between 0.130 to 0.320); statistical significances were found between the ANX and non-ANX groups for 4 of them (P<.02, effect sizes eta_{partial}^2 ranging between 0.115 to 0.231). Significant features included late-night online activities, continuous usages and time away from the internet, porn consumptions, and keywords associated with negative emotions, social activities, and personal affairs. Conclusions: The results suggested strong discrepancies between college student groups with and without deteriorating mental health conditions in terms of behavioral changes in Google Search and YouTube usages during the COVID-19. Though further studies are required, our results demonstrated the feasibility of utilizing pervasive online data to establish non-invasive surveillance systems for mental health conditions that bypasses many disadvantages of existing screening methods.