Quantifying the Effects of COVID -19 on Mental Health Support Forums (2020)

Abstract: The COVID-19 pandemic, like many of the disease outbreaks that have preceded it, is likely to have a profound effect on mental health. Understanding its impact can inform strategies for mitigating negative consequences. In this work, we seek to better understand the effects of COVID-19 on mental health by examining discussions within mental health support communities on Reddit. First, we quantify the rate at which COVID-19 is discussed in each community, or subreddit, in order to understand levels of pandemic-related discussion. Next, we examine the volume of activity in order to determine whether the number of people discussing mental health has risen. Finally, we analyze how COVID-19 has influenced language use and topics of discussion within each subreddit.

## introduction the implications of covid-19 extend far beyond its immediate physical health effects. uncertainty and fear surrounding the disease and its effects, in addition to a lack of consistent and reliable information, contribute to rising levels of anxiety and stress @xcite . policies designed to help contain the disease also have significant consequences. social distancing policies and lockdowns lead to increased feelings of isolation and uncertainty @xcite . they have also triggered an economic downturn @xcite , resulting in soaring unemployment rates and causing many to experience financial stress. therefore, in addition to the profound effects on physical health around the world, psychiatrists have warned that we should also brace for a mental health crisis as a result of the pandemic @xcite @xcite . indeed, the literature on the impact of past epidemics indicates that they are associated with a myriad of adverse mental health effects. in a review of studies on @xcite @xcite @xcite found that anxiety, fear, depression, anger, guilt, grief, and post-traumatic stress were all commonly observed psychological responses. furthermore, many of the factors commonly cited for inducing these responses are applicable to the covid-19 setting. these include: fear of contracting the disease, a disruption in daily routines, isolation related to being quarantined, and uncertainty regarding the disease treatment process and outcomes, the well-being of loved ones, and one's economic situation. while disease outbreaks pose a risk to the mental health of the general population, research suggests that this risk is heightened for those with preexisting mental health concerns. people with mental health disorders are particularly susceptible to experiencing negative mental health consequences during times of social isolation @xcite . further, as @xcite warn, they are likely to have a stronger emotional response to the feelings of fear, anxiety, and depression that come along with covid-19 than the general population. given the potential for the covid-19 outbreak to have devastating consequences for mental health, it is critical that we work to understand its psychological effects. in this work, we use reddit, a popular social media platform, to study how covid-19 has impacted the behavior of groups of users who express mental health concerns. we analyze the content of discussions (covid-related discussions, psycholinguistic categories, and topics) as well as the volume of communication (daily user count) and find notable changes in each category. some of these changes appear in multiple mental health subreddits, but some are more specific to individual communities that relate to specific diagnoses. we believe that our findings can help us better understand and potentially alleviate the negative mental health effects of the pandemic; for instance, this type of analysis could help moderators to more effectively support users through future crises. to the best of our knowledge, the method that we propose has not been used previously to study changes in mental health subreddits, and could be applied to understand the effects of other major events like political elections and natural disasters. ## data we collect reddit posts from three mental health subreddits using the pushshift api foot_0 (baumgartner et al., 2020): r/anxiety, r/depression, and r/suicidewatch, from january 2017 to may 2020. the reasons for analyzing these three subreddits are twofold: first, over the three and a half years represented in our data, these subreddits have a significant amount of activity (≥ 40 posts every day), making it feasible to treat daily values as a time series. second, because the subreddits provide support for different mental health disorders, their users may have been affected differently by covid-19. we separate the data into two time periods: pre-covid (january 1, 2017 -february 29, 2020) and post-covid (march 1, 2020 -may 31, 2020), roughly delineating when covid-19 began to have a serious impact on those in the united states, where the majority of reddit users are concentrated. 2 this choice of dates was informed by our analysis of the rates at which covid-19 related words were discussed in each subreddit (see section 5.1), which we found hovered around 0-5% before rising sharply near the beginning of march. we exclude posts where the author or text is marked as '[removed]' or '[deleted]', because posts with deleted authors offer no value for user count metrics, and deleted content means that we are unable to capture linguistic signals (see section 4.1 for more details on these metrics). figure 1 shows the average number of daily posts for r/anxiety, r/depression, and r/suicidewatch. ## methodology our goal is to identify how mental health subreddit activity has changed during the pandemic. we first create time series for a number of metrics that could be affected by the pandemic, encompassing activity levels and text content (section 4.1). we then use a time series intervention analysis technique to determine whether there are significant changes in our metrics during the pandemic (section 4.2). ## conclusions in this study, we examined how covid-19 has influenced the online behavior of individuals who discuss mental health concerns by analyzing activity within the r/anxiety, r/depression, and r/suicidewatch communities on reddit. we found substantial evidence of increases in anxiety; we observed an increase in user activity in r/anxiety, as well as significant increases in discussions of anxiety and the symptoms associated with it. interestingly, we observed a decrease in activity within the r/depression and r/suicidewatch subreddits. the literature on the impact of disease outbreaks on depression rates contains somewhat contradictory findings; we therefore believe that this is an interesting area for future work. we also observed interesting changes in the content of discussions within each subreddit. our results suggest that concerns related to covid-19, such as health and family, have become more prominent discussion topics compared to other common concerns, such as work and school, which have generated relatively less discussion since the outbreak. while our findings largely confirm the warnings offered by psychiatrists regarding the potential for covid-19 to have an adverse effect on mental health, we also found some reason for optimism; increases in the usage of we as well as the information sharing topic (associated with words such as "story" and "hope"), suggest a heightened sense of community and shared experience, which may help individuals cope with these stressful times.