BACKGROUND
Worldwide, the vast majority of people have been impacted by COVID-19. While millions of individuals have become infected, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggest this can lead to profound behavioral and mental health changes, but rarely are researchers able to track these changes with frequent, near real-time sampling or compare these to previous years of data on the same individuals.
OBJECTIVE
We seek to answer two overarching questions by combining mobile phone sensing and self-reported mental health data among college students participating in a longitudinal study for the past two years. First, have behaviors and mental health changed in response to the COVID-19 pandemic as compared to previous time periods within the same participants? Second, did behavior and mental health changes track the relative news coverage of COVID-19 in the US media?
METHODS
Behaviors such as the number of locations visited, distance traveled, duration of phone usage, number of phone unlocks, sleep duration and sedentary time were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported Ecological Momentary Assessments (EMAs) of the Patient Health Questionnaire-4 (PHQ-4). Participants were 217 undergraduate students, with 178 students having data during the Winter 2020 term. Differences in behaviors and self-reported mental health collected during the Winter 2020 term (the term in which the coronavirus pandemic started), as compared to previous terms in the same cohort, were modeled using mixed linear models.
RESULTS
During the initial COVID-19 impacted academic term (Winter 2020), individuals were more sedentary and reported increased anxiety and depression symptoms (P<.001), relative to the previous academic terms and subsequent academic breaks. Interactions between the Winter 2020 term and week of academic term (linear and quadratic) were significant. In a mixed linear model, phone usage, number of locations visited, and week of the term, were strongly associated with increased coronavirus-related news. When mental health metrics (e.g., depression and anxiety) were added to the previous measures (week of term, number of locations visited, and phone usage), both anxiety (P<.001) and depression (P=.029) were significantly associated with coronavirus-related news.
CONCLUSIONS
Compared with prior academic terms, individuals in Winter 2020 were more sedentary, anxious, and depressed. A wide variety of behaviors, including increased phone usage, decreased physical activity, and fewer locations visited, are associated with fluctuations in COVID-19 news reporting. While this large-scale shift in mental health and behavior is unsurprising, its characterization is particularly important to help guide the development of methods that could reduce the impact of future catastrophic events on the mental health of the population.
CLINICALTRIAL
Mental Health and Behavior During the Early Phases of the COVID-19 Pandemic: A Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study in College Students