Tracking Population-Level Anxiety Using Search Engine Data: Ecological Study

Anxiety disorders are the most prevalent mental disorders globally, with a substantial impact on quality of life. The prevalence of anxiety disorders has increased substantially following the COVID-19 pandemic, and it is likely to be further affected by a global economic recession. Understanding anxiety themes and how they change over time and across countries is crucial for preventive and treatment strategies. The aim of this study was to track the trends in anxiety themes between 2004 and 2020 in the 50 most populous countries with high volumes of internet search data. This study extends previous research by using a novel search-based methodology and including a longer time span and more countries at different income levels. We used a crowdsourced questionnaire, alongside Bing search query data and Google Trends search volume data, to identify themes associated with anxiety disorders across 50 countries from 2004 to 2020. We analyzed themes and their mutual interactions and investigated the associations between countries' socioeconomic attributes and anxiety themes using time-series linear models. This study was approved by the Microsoft Research Institutional Review Board. Query volume for anxiety themes was highly stable in countries from 2004 to 2019 (Spearman r=0.89) and moderately correlated with geography (r=0.49 in 2019). Anxiety themes were predominantly long-term and personal, with "having kids," "pregnancy," and "job" the most voluminous themes in most countries and years. In 2020, "COVID-19" became a dominant theme in 27 countries. Countries with a constant volume of anxiety themes over time had lower fragile state indexes (P=.007) and higher individualism (P=.003). An increase in the volume of the most searched anxiety themes was associated with a reduction in the volume of the remaining themes in 13 countries and an increase in 17 countries, and these 30 countries had a lower prevalence of mental disorders (P