In early 2020 the Coronavirus disease 2019 (COVID-19) emerged and affected almost every country, resulting in over 100 million confirmed infections and over 3 million deaths globally. The most common approach governments use to contain the spread of the virus has been Shelter in Place Orders (SIPOs) [[1], [2], [3], [4]]. SIPOs seek to limit transmission of COVID-19 by restricting population movement and social interaction so that the possibility of infections can be reduced, preventing national health services from being overwhelmed. SIPOs, while effective in reducing transmission of the virus, regrettably also have been found to impact economic activity negatively [5,6] It has also been associated with higher rates of business failure [5] and unemployment [6], increasing social isolation, and worsening mental health [7,8].

These events have spurred increasing research on the psychological outcomes of COVID-19 [[9], [10], [11]]. Research has shown a prevalence of psychological distress and depression [12], anxiety, and post-traumatic stress disorder, particularly among the vulnerable and those directly impacted by the virus, such as youth and front-line workers [13]. Higher levels of suicide, domestic violence, child abuse, and increasing use of alcohol and substance abuse are additional problems identified during the pandemic [14,15]. Past research found persons with specific affective temperament types (depressive, cyclothymic, hyperthymic, irritable, and anxious) prone to adverse clinical outcomes such as higher suicide behavior [16,17]. For these reasons, the impact of COVID-19 on mental health is becoming an increasing concern among policymakers and health practitioners, particularly in the face of multiple waves of infections and longer and more intensive SIPOs measures adopted by Governments [[18], [19], [20]]. Equally important but not fully explored in terms of research is understanding coping strategies (positive and negative) used by citizens to manage the social isolation and distress that come with prolonged lockdowns [21,22]. By understanding how people cope, new programs, and interventions can be designed and rolled out, which can be particularly useful for at-risk groups and communities during lockdown periods.

The study of the impact of COVID-19 on mental health is particularly relevant among Caribbean Small Island Developing States (SIDS). Island states share a common set of environmental, economic, and social vulnerabilities due to their relatively small size, geographical remoteness, and concentrated economic structures that make adjustments to external shocks such as COVID-19 difficult to mitigate [23,24]. Past research has shown that mental health disorders are a leading cause of disability and a major contributor to the burden of non-communicable diseases in the region [25,26]. Indeed, mental and neurological disorders account for 22.2% of the total burden of disease in the region (measured in disability-adjusted life years) [25]. The treatment gap for mental disorders in the Caribbean region is overwhelming and ranges from 37.4% (non-affective psychoses) to 64.0% (bipolar disorder)

Moreover, Caribbean countries have been found to be vulnerable to economic and climate shocks with severe mental health consequences [26]. In the past Caribbean countries have also had to deal with several epidemics, such as Dengue, Zika, and Chikungunya [27]. The Global Health Security Index (GHS Index) shows that small island economies have poorer health capabilities regarding prevention, detection, and rapid response to epidemics. The problem is also compounded by the high prevalence of non-communicable diseases such as diabetes, asthma, cardiovascular diseases, and obesity, which make people living in small island economies particularly vulnerable to developing severe symptoms from COVID-19 [23].

Caribbean countries have encountered notable disparities in infection rates, fatalities, and community transmission of COVID-19. 10.13039/100014337Furthermore, there is significant diversity among Caribbean governments in terms of the policy measures implemented to mitigate the spread of the virus and the level of support provided to impacted communities. Some island economies have adapted by creating “island bubbles,” becoming increasingly isolated from the mainland economies but simultaneously increasing interisland trade [28]. Additionally, Caribbean countries have had to rely largely on implementing varied SIPO measures, ranging from restrictions on the size of social gatherings, closure of schools, non-essential businesses, and curfews, frequently extending into months in some locations. These measures have significantly reduced community mobility within and across Caribbean countries and contributed to relatively low infection rates relative to comparator locations [23]. Despite the length and intensity of these measures, there remains little research focusing on the impact of COVID-19 on mental health conditions among Caribbean countries. Little research has also examined strategies people utilize to cope during major extended lockdowns. Like many emerging economies, Caribbean islands are plagued by a scarcity of timely data on key development issues, making policymaking during a crisis complex [[29], [30], [31], [32]]. This paper, therefore, seeks to examine the impact of major lockdowns on mental health among key English-speaking Caribbean SIDS.1 We do this by utilizing high-frequency near real-time data sources, based on internet search patterns during COVID-19 generated from Google Trends data analytics. The intuition of the approach is premised on the idea that the information-seeking behavior of individuals on the internet would reflect areas of interest, perception, and concern that are engaging their attention at the time of the search. Indeed, search patterns reported by Google Trends have been used to predict stock market trends [26,27] accurately, electoral outcomes [33,34], and tourism patterns [35]. Recent research has also linked internet search patterns to persons experiencing negative mental health crises in a given location. These people may increasingly search the internet to find information for support or end their suffering in the case of suicide [[36], [37], [38], [39]].

In terms of our approach, we apply several robust estimation techniques Difference-in-Difference (DiD), Dynamic Difference-in-Difference (DDD), and Regression Discontinuity Design (RDD) models to empirically assess differences in daily search patterns of key search terms related to mental health and coping both before and after the implementation of key lockdown measures among countries in the Caribbean. Unlike previous studies that utilize cross-sectional datasets, we compare search patterns during each country's main lockdown period to the same period in the prior year. In this regard, this paper closely follows Brodeur, Clark [40] and Knipe, Evans [22] by utilizing data gathered on keyword searches reported by Google Trends to assess mental health patterns among populations in key countries before and after the implementation of major lockdowns. However, we extend the mental health literature by examining strategies utilized by these communities to cope with SIPOs during COVID-19 lockdowns.

In terms of our contribution, to our knowledge, this is the first paper to seek to assess mental health and coping strategies utilized during COVID-19 in the English-speaking Caribbean. More importantly, access to timely, accurate, and reliable data to support policy development and decision-making remains a crucial challenge among Caribbean countries [23,41]. This issue becomes even more pressing during periods of national crisis. This paper aims to introduce a new alternative data source with supporting estimation techniques that can be used to robustly assess mental health conditions and coping strategies among key English-Speaking Caribbean countries during a national health crisis such as COVID-19. In this way, it is hoped that information can better support policy and key decision-makers in providing social and community support during similar health and national crises in the future.

The remainder of this paper is structured as follows; Section 2 provides the data and methodology used for the study. Section 3 outlines the results, while section 4 provides concluding remarks.