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Mental health promotion programs have included online strategies in their repertoire. Likewise, there has been an increasing utilization of online mental health information. Thus, there may be a need to explore the utilization of online information for depressive disorders. In doing so, it can reveal public expectations, needs, and online venues that can be used for depression information programs.
Methods
This infodemiological study explored the worldwide searches for major depressive disorder and persistent depressive disorder using relative search volumes (RSV) and top and rising related queries and topics from Google Trends. RSV is a value that represents the frequency or volume of searches normalized against the largest search volume in the study period and geography. Top and rising search-related queries and topics are terms and topics that online users also input into the Google search engine related to the keyword of interest. After describing the data, future RSVs were predicted using ARIMA.
Results
The findings revealed that searches for depressive disorders decreased and may further decrease in succeeding years. It also revealed increasing searches for diagnostics criteria, including DSM-5. There was also increased public interest in portraying depression. It also found a digital divide in searches for depressive disorders, where high-income countries searched for more online information for depressive disorders.
Conclusion
This study findings’ highlights the needs and opportunities in online information for depressive disorders. Nonetheless, further studies are needed to understand the utilization and effects of online information about depressive disorders in improving mental health promotion and literacy.
GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.
However, many individuals with depressive disorders may never receive specialized mental health care due to mental health stigma and limited mental health literacy, especially in low and middle-income countries.
Mental health promotion programs have been initiated throughout the globe to address the limited mental health literacy and stigma among populations. These programs have included online information dissemination and education strategies.
An online intervention to promote mental health and wellbeing for young adults whose parents have mental illness and/or substance use problems: theoretical basis and intervention description.
Since major depressive disorder and persistent depressive disorder are prevalent mental disorders, there may be a need to explore the utilization of online information for depressive disorders. In doing so, its findings may enable the advancement of mental health promotion programs and services since it can reveal public expectations, needs, and online venues that may be used.
Recent advances in big data analytics and infodemiological research are utilized to elucidate changes in online health information consumption and utilization.
Google Trends, a public repository of google searches, has been among the most popular and extensively used infodemiological tools to evaluate changes in the utilization of health-related information.
For example, it has been used in exploring changes in public perception and expectations regarding vaccination, HIV, COVID-19, epilepsy, mental health, and depression among populations.
Googling “mental health” after mental health legislation and during the COVID-19 pandemic: an infodemiological study of public interest in mental health in the Philippines.
Googling depression and major depressive disorder after mental health legislation and during the COVID-19 pandemic in the Philippines: an infodemiological study.
This is because Google is the leading and most prominent online search engine in the world since it accounts for about 90% of the total search engine global market share.
Given these, Google Trends can be used to explore public utilization of major depressive disorder and persistent depressive disorder.
1.1 Objectives and significance
This study described the online search volumes for major depressive disorder and persistent depressive disorders from Google Trends. Likewise, it predicted the future searches for online information for these depressive disorders using statistical forecasting analysis. It also determined the countries with the most searches relative to their total online searches. Finally, it also explored related search topics and queries for these disorders. In doing so, its findings may contribute to the advancement of online mental health promotion and literacy programs.
2. Methods
This infodemiological study explored online search volumes for major depressive disorder and persistent depressive disorder from January 2004 to December 2021 using data from Google Trends. This timeframe was selected since Google Trends’ data may vary slightly over time and the earliest data available is from 2004.
The data gathered were relative search volumes (RSV) and top and rising related queries and topics. This study does not necessitate local ethical approval since it does not involve human participants, and the data is available in the public domain.
2.1 Data and measures
This study utilized monthly RSVs to measure changes in online information utilization for major depressive disorder and persistent depressive disorder. RSV is a value that represents the frequency or volume of searches that has been normalized against the largest search volume in the specified time and geography.
Googling “mental health” after mental health legislation and during the COVID-19 pandemic: an infodemiological study of public interest in mental health in the Philippines.
Googling depression and major depressive disorder after mental health legislation and during the COVID-19 pandemic in the Philippines: an infodemiological study.
Google Trends automatically calculates RSV for selected keywords by anonymizing users' data, categorizing their search queries, and aggregating these searches into topics.
The algorithm's results for each month are a relative number scaled from 0 to 100, normalized against the highest search volumes in the specified period and location. On this scale, 100 corresponds to the highest search volume, while 0 corresponds to the lowest search volume.
Over the study period, top and rising search-related topics and queries were used to determine other public interests related to major depressive disorder and persistent depressive disorder. Top search-related queries and topics are the terms and topics that Google search engine users most frequently search for concerning the keyword of interest in the specified period and geography.
Googling “mental health” after mental health legislation and during the COVID-19 pandemic: an infodemiological study of public interest in mental health in the Philippines.
Googling depression and major depressive disorder after mental health legislation and during the COVID-19 pandemic in the Philippines: an infodemiological study.
Likewise, rising related topics and queries are the topics and terms that Google search engine users searched for with the keyword of interest, which had the highest increase in search volume in the studied period.
Googling “mental health” after mental health legislation and during the COVID-19 pandemic: an infodemiological study of public interest in mental health in the Philippines.
Googling depression and major depressive disorder after mental health legislation and during the COVID-19 pandemic in the Philippines: an infodemiological study.
The keywords “Major depressive disorder (Mental Disorder)” and “Persistent depressive disorder (Mental Disorder)” were inputted in the Google Trends' Explore feature to aggregate all related searches for major depressive disorder and persistent depressive disorder, respectively (available at: http://www.google.com/trends, accessed 5 July 2022). As Mavaragani and Ochoa have noted,
using “topic” keywords in Google Trends can represent and aggregate all the terms and idioms that share the same concept in any language related to the keywords of interest. As such, the present study utilized topic keywords for mental disorders to represent all the terms and idioms used to search for major depressive disorder and persistent depressive disorder. After, Google Trends’ Region filter was set to “Worldwide” to determine global searches for the aforementioned disorders. The Time Range filter was set from January 2004 to December 2021 to specify the study period.
The RSVs and the ranking of countries for both keywords were described and compared. After, the pattern of changes in RSVs was noted. Then, further analysis of RSVs was conducted using autoregressive integrated mean averaging (ARIMA). By doing so, ARIMA smoothened autocorrelations, addressed seasonality, and predicted future RSVs. Next, the methodology suggested by Schaffer et al.
Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions.
for ARIMA models was followed. Transformation of RSVs was conducted using seasonal differencing to address non-stationarity, seasonality, and changes in variance over time.
Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions.
Then, the ARIMA models fit was determined using the R Square and Ljung-Box test. Lastly, the top and rising related topics and queries were descriptively compared.
3. Results
3.1 RSVs for major depressive disorder and persistent depressive disorder
Fig. 1 shows that the RSVs for major depressive disorder generally decreased. These started at 83 and dropped by the end of 2021 to 69. The RSV for persistent depressive disorder also has a decreasing trend. These began at 81 and closed at 44. Hence, it decreased by almost half (see Fig. 2).
Fig. 1Graph depicting the worldwide search volumes for major depressive disorder from 2004 to 2021 and its predicted values until 2025.
ARIMA models were used to predict the future RSVs for these disorders. Table 1 shows that the models used for this have moderate to high correlation and have a good fit (p > .05) for predicting future RSVs for both major depressive disorder and persistent depressive disorder. Based on the ARIMA models, RSVs for major depressive disorder are predicted to decrease further from 69 in 2021 to 65 by the end of 2025. Likewise, the RSVs for persistent depressive disorder was predicted to decrease from 44 in 2021 to 40 in 2025. This finding indicates that Google search volumes for major depressive disorder and persistent depressive disorder are decreasing and will further decrease.
3.2 Ranking of countries based on search volumes for major depressive disorder and persistent depressive disorder
The ranks of countries based on their search volumes were analyzed. For major depressive disorder, the top five countries with the highest search volume were Japan, Finland, Australia, Norway, and Ireland. On the other hand, Argentina, Venezuela, South Korea, Indonesia, and Russia were the lowest-ranked countries. Thus, all highly-ranked countries were high-income countries,
For persistent depressive disorder, the top five countries based on their search volumes were Netherlands, Chile, Mexico, Honduras, and Spain. On the other hand, Egypt, Ukraine, Thailand, Iran, and Indonesia were the lowest-ranked countries. This indicates that almost half of the top-ranked countries were from high-income countries,
3.3 Top and rising search-related topics and queries for major depressive disorder
Table 2 shows that the top search-related topics for major depressive disorder revolved around its related concepts such as “depression”, manifestations such as “Symptom”, treatment such as “Therapy” and “Pharmaceutical drug”, diagnostics such as “International Classification of Diseases”, etiology such as “Cause” and other-related disorders such as “Bipolar disorder” and “Anxiety disorder”. The rising related topic with the most increase over the years was “Ketamine”. Other rising topics related to major depressive disorder were similar to the top topics with notably higher ranked diagnostics and manifestations such as “International Classification of Diseases” and “Symptom”, respectively. This indicates that, over the years, the public increasingly search for online information to understand the treatments, manifestations, and diagnostics, especially the newly classified antidepressant drug, Ketamine.
Table 2Top and rising search-related topics and queries for the major depressive disorder from 2004 to 2021.
Top related topics
RSV
Rising related topics
% increase
Top related queries
RSV
Rising related queries
% increase
Depression
100
Ketamine
5000%
depression
100
reddit depression
>5,000%
Symptom
15
International Classification of Diseases
950%
うつ
18
depression tumblr
>5,000%
Disease
12
ICD-10
650%
うつ 病
10
depression wiki
>5,000%
Anxiety
8
Sadness
300%
depressão
9
อาการ โรค ซึม เศร้า
>5,000%
Medical sign
7
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5
300%
depression symptoms
7
icd 10 code for depression
>5,000%
Therapy
6
Feeling
250%
anxiety
7
symptoms of depression in women
>5,000%
Pharmaceutical drug
4
Symptom
190%
depresion
6
ツレ が うつ に なり まして
>5,000%
Bipolar disorder
3
Cause
170%
depressed
5
trầm cảm
>5,000%
Anxiety disorder
3
Anxiety
140%
depression test
5
depression meaning in hindi
>5,000%
Antidepressant
3
Disease
130%
depressione
4
depresja test
>5,000%
Mental disorder
3
Anxiety disorder
120%
depressive
4
แบบ ทดสอบ โรค ซึม เศร้า
>5,000%
Suicide
2
Medical diagnosis
90%
depressionen
4
depresyon stayla
>5,000%
Cause
2
Medical sign
80%
depression and anxiety
4
i have crippling depression
>5,000%
Sadness
2
Cure
60%
depression signs
4
新型 うつ
4200%
Medical diagnosis
2
what is depression
3
ตรวจ โรค ซึม เศร้า
4050%
Cure
2
depressao
3
dsm 5 depression
4000%
Feeling
1
signs of depression
3
depresija simptomi
3700%
Psychology
1
depression help
3
high functioning depression
3350%
Mental health
1
symptoms of depression
3
depression symptoms in women
3050%
International Classification of Diseases
1
鬱
3
is depression a mental illness
2300%
ICD-10
1
depressie
3
depresja objawy
2300%
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5
Similar to the top related topics, Table 2 also shows that the top related queries for major depressive disorder inputted by online users were about its related concepts such as “depression”, manifestations such as “depression symptoms”, diagnostics such as “depression test”, and treatment such as “depression treatment”. While English was the most used language, two highly-ranked queries were also in Japanese. Other languages used were Portuguese, Italian, Chinese, Afrikaans, Spanish, Polish, and Turkish. The rising related queries were similar to the top queries. These include searches about major depressive disorder-related concepts, manifestations, treatment, and diagnostics. Notably, the highest-ranked queries were social media platforms in conjunction with depression, such as “reddit depression” and “depression tumblr”. There were also rising queries regarding the depression Wikipedia website such as “depression wiki”. Television shows such as the Japanese show about depression “ツレ が うつ に なり まし (Tsure ga Utsu ni Narimashite/My S. O. Has Got Depression)” was also popular. Similar to the top queries, languages aside from English were used for queries, including Japanese, Turkish, Polish, Latvian, Thai, and Vietnamese. These indicate that, over the years, there might be an increasing searches for social media platforms, depression Wikipedia website, and mainstream media for major depressive disorder information.
3.4 Top and rising search-related topics and queries for persistent depressive disorder
Table 3 shows that the top search-related topic for persistent depressive disorder was “Major depressive disorder”. This was followed by persistent depressive disorder-related concepts such as “Disease”, treatment such as “Therapy”, manifestations such as “Symptom”, diagnostics such as “ICD-10”, and other related disorders such as “Bipolar disorder”. The rising related topics were similar to the top related topics. About half of them increased by more than 5,000%.
Table 3Top and rising search-related topics and queries for the persistent depressive disorder from 2004 to 2021.
Top related topics
RSV
Rising related topics
% increase
Top related queries
RSV
Rising related queries
% increase
Major depressive disorder
100
Emotion
>5,000%
dysthymia
100
persistent
>5,000%
Disease
90
Psychological testing
>5,000%
distimia
68
persistent depressive disorder
>5,000%
Depression
69
Catatonia
>5,000%
depression
44
dsm 5
>5,000%
Chronic condition
53
Apathy
>5,000%
dysthymic
36
дистимия
>5,000%
Therapy
21
Postpartum period
>5,000%
dysthymic disorder
29
persistent depression
>5,000%
Symptom
20
Heart arrhythmia
>5,000%
chronic
18
distimia significado
>5,000%
Bipolar disorder
15
Behaviour therapy
>5,000%
dysthymie
17
dysthymia icd 10
>5,000%
Mood
14
Hypochondriasis
>5,000%
chronic depression
16
dsm 5 dysthymia
>5,000%
Mental disorder
13
Lithium
>5,000%
depression dysthymia
15
persistent depressive disorder dsm 5
>5,000%
Cyclothymia
12
Dyslexia
>5,000%
persistent
11
dysthymia vs depression
>5,000%
Medical sign
11
High-functioning autism
>5,000%
persistent depressive disorder
10
distimia pdf
>5,000%
Anxiety
11
International Classification of Diseases
1350%
dysthymia disorder
10
agoraphobia
>5,000%
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5
10
ICD-10
750%
depresion
9
chronic depressive disorder
>5,000%
Personality
9
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5
Table 3 also shows that the top related queries for persistent depressive disorder inputted by online users were about its related concepts such as “dysthymic”, diagnostics such as “dsm”, and other related disorders such as “bipolar”. Notably, there were top Portuguese, Japanese, and Romanian queries. All the rising related queries increased by more than 5,000% and were similar to the top queries. Most rising queries were in English, but some were in Bulgarian, Turkish, Spanish, and Portuguese. Aside from concepts, diagnostics, and other disorders, there were also rising queries regarding its manifestations, such as “persistent depressive disorder symptoms.” Likewise, there were notably highly-ranked queries related to diagnostics, such as “dsm 5”. These indicate that there might be increasing public concerns about information regarding diagnostics evaluation, including the DSM-5 diagnostic criteria of persistent depressive disorder.
4. Discussion
The findings showed that Google search volumes for major depressive disorder and persistent depressive disorder are decreasing and will further decrease in the future. This can be because online users might use other websites to inform themselves about depressive disorders. For instance, the rising queries for major depressive disorder showed that searches for social media platforms and Wikipedia alongside depression were among the most popular search for queries. Thus, the public may search for online information about major depressive disorder from social media platforms or Wikipedia. Hence, the findings support previous notions that online utilization of information may be increasing,
albeit on different online platforms. Nonetheless, further research is necessary to ascertain any change or increase in the public utilization of these online platforms for information about major depressive disorder and persistent depressive disorder.
Another medium that programs can consider partnering with is the film industry. For example, this study found that searches for depressive disorders are related to some films, such as Tsure ga utsu ni narimashite, a film about a man suffering from depression whom his wife helped.
Since there are rising queries regarding this film, there might be opportunities for mental health promotion in films that portray hopeful stories of recoveries from depressive disorders. Likewise, there were a high number of queries for the new FDA-Approved antidepressant, Ketamine, which offers a rapid antidepressant effect and anti-suicidal properties in patients with treatment-resistant depression.
This study also found that there is increasing public utilization of online information regarding diagnostics tests, especially the DSM-5 diagnostic criteria. Previous studies showed that the public use of diagnostic criteria could result in depression symptoms and diagnosis overestimation, especially in women and the elderly.
Thus, there is a need to inform and caution the public about overestimating their depressive disorder diagnosis and symptoms by using the diagnostic criteria alone.
The top-ranked countries for major depressive disorder were high-income countries, while the lowest-ranked were mainly upper and lower-middle-income countries. For persistent depressive disorder, almost half of the top-ranked countries were also from high-income countries, while those with the lowest ranks were mostly from upper and lower-middle-income countries. These may be explained by the overall higher mental health promotion programs in high-income countries compared to upper and lower-middle-income countries. According to the WHO,
only about 51.5% and 71% of responding countries in upper and lower-middle-income countries have functioning mental health promotion and prevention programs, compared with 84% in high-income countries.
Aside from English, there were rising queries inputted using Japanese, Bulgarian, Turkish, Polish, Latvian, Thai, Vietnamese, Spanish, and Portuguese. This indicates a rising utilization of online information for depressive disorders among the speakers of these languages. Changes in online information utilization among these individuals can be explored through future analysis and research.
4.1 Limitations
As with other infodemiological studies, the present study comes with several limitations. First, online Google search volumes were utilized. Thus, the findings do not reflect those who use other search engines and directly utilized other websites such as Wikipedia. Second, the demographic characteristics of online users cannot be determined due to Google Trends’ automated anonymization features. Thus, whether the findings were more representative of specific population groups, such as the youth, cannot be ascertained. Third, RSVs are relative values rather than absolute. Thus, changes in exact search volumes cannot be determined or observed. Given these, traditional measures such as surveys can comprehensively understand population-level online information utilization for depressive disorders within and among countries and regions. Likewise, exploring public utilization of other search engines, social media, and specific websites can be done to gain a broader understanding of online information utilization for depressive disorders. Additionally, since the COVID-19 pandemic may affect the search volumes for depressive disorders,
Googling depression and major depressive disorder after mental health legislation and during the COVID-19 pandemic in the Philippines: an infodemiological study.
further analysis (i.e., interrupted time series) can be done to determine the effects of the pandemic on search volumes for major depressive disorder and persistent depressive disorder.
5. Conclusion
This study found that online searches for major depressive disorder and persistent depressive disorder have decreased over the years and may further decrease in the coming years. It also revealed an increasing global utilization of online information regarding the diagnostics criteria, especially the DSM-5. It also found a digital divide in online searches for depressive disorders that runs parallel with socioeconomic inequality among the top and lowest-ranked countries in Google Trends, where high-income countries searched for higher online information for depressive disorders than upper and lower-middle-income countries.
Given these findings, this study highlights the needs and opportunities in online information dissemination for depressive disorders. Nonetheless, further studies are needed to understand online information utilization for depressive disorders comprehensively. For instance, since searches for Wikipedia and social media platforms were observed among Google-related searches, future studies can explore the utilization of online information on these platforms and their effects on improving mental health promotion and literacy. Likewise, since this study revealed that searches for films portraying hopeful stories about depressive disorders seem to be highly searched for, future research can explore the possible effects of films portraying hopeful stories about depressive disorders on mental health promotion and literacy. Moreover, since there was variation in search volumes among countries, future research can also explore the variations in search volumes and related queries and topics among and between countries in different regions.
Ethics approval and consent to participate
The study does not necessitate ethical approval and consent forms since the data is publicly available and there was no human participant.
RA contributed to the conceptualization, methodology, data curation, formal analysis, writing – original draft, and writing – review and editing.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Declaration of competing interest
None.
Acknowledgments
None.
References
GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.
An online intervention to promote mental health and wellbeing for young adults whose parents have mental illness and/or substance use problems: theoretical basis and intervention description.
Googling “mental health” after mental health legislation and during the COVID-19 pandemic: an infodemiological study of public interest in mental health in the Philippines.
Googling depression and major depressive disorder after mental health legislation and during the COVID-19 pandemic in the Philippines: an infodemiological study.
Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions.
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