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<p class="title-left"><span class="bold">Association Between the COVID-19 Outbreak and Mental Health in India:</span></p>
<p class="subtitle">A Google Trends Study</p>
<p class="byline-regular">N. A. Uvais, MBBS, DPM</p>
<p class="drop-cap-with-body-text"><span class="bold-14pt-for-cap"><span class="bold">A</span></span>s a result of the emergence of novel coronavirus disease 2019 (COVID-19), socioeconomic crisis and psychological distress rapidly occurred across the world.<span class="htm-cite"><a href="#ref1">1</a></span> Although, there is growing concern regarding the impact of the pandemic on mental health, little is known regarding how the psychiatric needs of the population have evolved along with the spread of COVID-19 across India. The internet is an important source of information, and Google search trends can inform public interests related to mental health.<span class="htm-cite"><a href="#ref2">2</a>,<a href="#ref3">3</a></span> The objective of this study was to use the Google Trends search volume index (SVI), a normalized value from 0 to 100, to understand whether changes in the number of COVID-19 cases and deaths are associated with SVI of contents associated with mental health in India.</p>
<p class="subheads-subhead-2">Methods</p>
<p class="body-text">Google Trends (<a href="https://support.google.com/trends/" target="_blank"><span class="hyperlink">https://support.google.com/trends/</span></a>) was searched in India for the following keywords: <span class="italic">suicide</span>, <span class="italic">depression</span>, <span class="italic">anxiety</span>, and <span class="italic">insomnia</span>. Google Translate (<a href="https://translate.google.com" target="_blank"><span class="hyperlink">https://translate.google.com</span></a>) was used to convert keywords to Hindi. The SVI was retrieved for the period between March 12, 2020, and June 13, 2020. The Spearman rank correlation coefficients were analyzed in SPSS version 21 (IBM, Armonk, New York). Results were considered significant if the <span class="italic">P</span> value was less than .05.</p>
<p class="subheads-subhead-2">Results</p>
<p class="body-text">There were significant positive correlations between the SVI for all keywords in English and the number of COVID-19 cases and deaths in India: <span class="italic">depression</span> (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.405, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.000; <span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.405, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.000<span class="italic">), anxiety (r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.668, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.000; <span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.668, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.000), <span class="italic">insomnia</span> (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.374, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.000; <span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.374, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.000), and <span class="italic">suicide</span> (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.240, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.020; <span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.240, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.020) (<span class="callout"><a href="#" onclick="createFigure('T1'); return false;" title="">Table 1</a></span>). Moreover, there were a higher number of searches for the terms <span class="italic">suicide</span> and <span class="italic">depression</span> compared to other search terms (<span class="callout"><a href="#" onclick="createFigure('F1'); return false;" title="">Figure 1</a></span>).</p>

                <div id="figure-2"> <a href="#" onclick="createFigure('F1'); return false;"><img src="20br02778F1.gif" alt="Figure 1" id="F1" border="0" /></a>
      <p class="click-to-enlarge">Click figure to enlarge</p>
    </div>

<div id="figure" class="right">
<a href="#" onclick="createFigure('T1'); return false;"><img src="20br02778T1.gif" alt="Table 1" id="T1" border="0"></a>
<p class="click-to-enlarge">Click figure to enlarge</p>
</div>
<p class="body-text">There was also a significant positive correlation between the SVI for <span class="italic">depression</span> in Hindi and the number of COVID-19 cases and deaths (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.214, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.039; <span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.213, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.039). Whereas there was a significant negative correlation between the SVI for <span class="italic">anxiety</span> in Hindi and the number of COVID-19 cases and deaths (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>−0.268, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.009; <span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>−0.268, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.009), there were no significant correlations for <span class="italic">insomnia</span> (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.059, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.571; <span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.059, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.573) or <span class="italic">suicide</span> (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.004, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.969; <span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.004, <span class="italic">P</span><span class="thinspace"> </span>=<span class="thinspace"> </span>.966) in Hindi.</p>
<p class="subheads-subhead-2">Discussion</p>
<p class="body-text">In this study, a significant positive correlation was found between the SVI for all of the English search terms: <span class="italic">depression</span>, <span class="italic">anxiety</span>, <span class="italic">insomnia</span>, and <span class="italic">suicide </span>and the number of COVID-19 cases and deaths in India. These study findings are in agreement with the emerging scientific literature suggesting a significant increase in psychiatric morbidity among the Indian population following the COVID-19 pandemic.<span class="htm-cite"><a href="#ref4">4</a></span> Moreover, media reports<span class="htm-cite"><a href="#ref5">5</a></span> also indicate a significant increase in suicide rates among the Indian population following the COVID-19 pandemic. However, a discrepancy in interests in Google Trends keywords between English and Hindi users was found in the present study. Hindi users have shown a significantly higher interest in the term <span class="italic">depression</span>, but their interest in the keyword <span class="italic">anxiety</span> showed significant reduction with respect to the number of COVID-19 cases and deaths in India. Google users in Hindi also showed no significant increase in interest in the terms <span class="italic">insomnia</span> or <span class="italic">suicide</span>. These findings might indicate that Google users searching in Hindi are more resilient and have better adaptive coping strategies compared to Google users searching in English in India.</p>
<p class="end-matter"><span class="bold-italic">Received:</span> August 6, 2020.</p>
<p class="end-matter"><span class="bold-italic">Published online:</span> November 5, 2020.</p>
<p class="end-matter"><span class="bold-italic">Potential conflicts of interest: </span>None.</p>
<p class="end-matter"><span class="bold-italic">Funding/support:</span> None.</p>
<p class="references_references-heading"><span class="bold">REFERENCES</span></p>
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<p class="references-references-text-1-9"><a name="ref5"></a><span class="htm-ref"> 5.</span> Stress, self-injuries and suicide: India battles mental health crisis as COVID tally spikes. The Economic Times Sep 13, 2020. <a href="https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/stress-self-injuries-and-suicide-india-battles-mental-health-crisis-as-covid-tally-spikes/articleshow/78087743.cms" target="_blank"><span class="hyperlink">https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/stress-self-injuries-and-suicide-india-battles-mental-health-crisis-as-covid-tally-spikes/articleshow/78087743.cms</span></a>. Accessed October 13, 2020. </p>
<p class="front-matter-rule"><span class="superscript">a</span>Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India</p>
<p class="front-matter"><span class="asterisk">*</span><span class="italic">Corresponding author:</span> N. A. Uvais, MBBS, DPM, Iqraa International Hospital and Research Centre, Malaparamba, Calicut, Kerala 673009, India <span class="hyperlink">(<a href="mailto:druvaisna@gmail.com">druvaisna@gmail.com</a>)</span>.</p>
<p class="front-matter"><span class="italic">Prim Care Companion CNS Disord 2020;22(6):20br02778</span></p>
<p class="front-matter-rule"><span class="bold-italic">To cite:</span> Uvais NA. Association between the COVID-19 outbreak and mental health in India: a Google Trends study. <span class="italic">Prim Care Companion CNS Disord</span>. 2020;22(6):20br02778.</p>
<p class="doi-line"><span class="bold-italic">To share:</span> https://doi.org/<span class="doi">10.4088/PCC.20br02778</span></p>
<p class="front-matter"><span class="italic">© Copyright 2020 Physicians Postgraduate Press, Inc.</span></p>
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