Qualitative analyses of posts revealed twenty second-order themes (Table 1). For parsimony, we discuss the top five themes that emerged in our qualitative analyses. Approximately 16% of the posts were either satirical, deleted, unrelated, duplicated, or unintelligible comments and, as a result, were excluded from further examination. Users primarily discussed some of the serious consequences of COVID-19 on their mental health (13%). Some users reported experiencing exacerbated mental health issues, including depression, anxiety (both social and generalized), phobia, thoughts of suicide and self-harm, and heightened fear of death or another pandemic. For example, a user indicated how COVID-19 aggravated their agoraphobia – “I have agoraphobia and the lockdowns knocked me out of my routine of going out and made me afraid to leave the house again.”
Others discussed their friends’ experiences or made observations and predictions on how COVID-19 have or might impact people. For example, a young professional stated that “many of the people in my circle (friends, acquaintances etc) are also professionals - in the last ~ 18 months, I have personally known 7 people who have committed suicide likely because they are (in no particular order) [1] overworked, [2] isolated, [3] feeling trapped. Make sure to check in on your friends - and if YOU need help, there are lots of resources.”
A substantial number of users directed their attention to discussions regarding direct and indirect deaths resulting from COVID-19 (10%). Discussions on direct deaths focused on vulnerable groups such as children, people from low socioeconomic status, nursing home residents, and older adults. For example, a user who stated that they were pediatrician highlighted that they “have had multiple babies and toddlers brought to the hospital by police for “found alone in the home with caregiver deceased.” Discussions on indirect deaths implied collateral damage such as delayed treatment resulting in death or decline from isolation resulting in death. A user responded, “Dementia and Alzheimer’s patients have died at higher rates due to their brains not being exercised by human contact. They're calling them “collateral deaths.”
Some users also voiced concerns about growing social and political divisions among couples, families, relationships, friends, and work colleagues (6.8%). For instance, a user mentioned that “the darkest effect [imo] is the levels of dishonesty about everything and the divisions it has caused.” Another user stated that “the rifts/divides it’s causing families and friends; people being cut out of others’ lives due to believes and support.” Users of online communities often respond with satirical remarks. A user, for example quipped that it is a “good way to thin out your friends list.” Vaccination debate was also a prominent part of the discussion on how Covid19 was creating a rupturing society and how people celebrate death of people not agreeing with their opinions. For example, a user stressed – “Division.... People dehumanising populations for varying stances on covid. I see redditors casually celebrate every death of an unvaccinated person. Really morbid, especially considering how mainstream it is, depressing.”
Six percent of responses focused on work-related issues such as burnout, thoughts of changing professions, insufficient staffing layoffs, furloughs, unemployment, and attrition among a variety of sectors such as health care, education, service industry. Writing about their bartending experiences, a user shared how they feel disassociated with their job – “People who were furloughed had time to realize they hate their job. I can only speak in service industry, but it feels like a soul crushing job more than ever. Guests are worse and more entitled than ever, and staff shortages have made shifts harder and longer.
Another user stated how burnout led experienced professionals to leave their job, creating a gap which is being filled by inexperienced people in healthcare – “the over work and over stress of health care providers making a lot of them leave the line of work. We are talking about experienced people leaving and never looking back. Means a lot of the people replacing them aren't being trained properly.” Discussing their personal experience, a user supported the burnout experienced by healthcare providers – “From housekeepers to physicians, every functional employee of the hospital system is burned out. They've been treated like garbage- like this was the job they signed up for, and how dare they expect a shred of respect or help. I left my job as an RN in December and would sooner work at Wendy's than put on a pair of scrubs ever again.”
To some, it was impact on vulnerable population groups. As one user stated – “The majority of childcare and eldercare during the pandemic was done by women, and economists are estimating that this (along with them not returning to the same roles at the same capacity due to ongoing instability in other family needs, etc.) will set back women’s lifelong earnings and take a long time to climb back up to where we were.” Beyond health, there were discussions on educators who played a crucial role in adapting teaching and learning during the pandemic – “The hateful rhetoric I've witnessed accusing teachers of laziness, of not want to return to school, of not caring for students, is appalling. People attack teachers for quitting, too, claiming their hearts must be ice to leave so many children in the lurch. But did any one of the 4917 comments here spare a thought for teachers' physical and mental well-being? The endless 12-hour workdays? Being forced back into schools without mask or vaccination mandates for slashed pay and benefits?”
Table 2 presents an overview of the results of our topic modeling analysis, offering insights into key topical things and examples from users’ posts. Although the key topics that emerged prominently among users’ online conversations during this period were physical health, mental health, vaccinations, job losses, the impact on the young population, the loss of relatives, and suicidal thoughts, the primary focus of these conversations revolved around physical and mental health. Physical health-related discussions frequently centered on COVID-19 symptoms, such as the loss of the sense of smell, cognitive decline, and brain fog, among other related issues. Mental health was a recurring theme, including topics focusing on depression, anxiety, and suicidal thoughts.
Table 2
Results of Topic Modeling
Topic index | Topics | Label 2 |
0 | “felt like” “south africa” “getting sick” “grocery store” “passed away” “brain fog” “sense smell” “mild case” “cognitive decline” “committed suicide”', | Emotional and physical distress & suicide |
1 | “right wing” “family member” “social interaction” “pay attention” “taste smell” “vaccine available” “icu nurse” “small group” “mortality rate” “working remotely”', | Sociopolitical impact & Adaptations in Pandemic Lifestyle |
2 | “mental health” “immune system” “fully vaccinated” “dating apps” “couple month” “covid denier” “human being” “thank god” “meet new” “4 hour”', | Mental health & Vaccination |
3 | “5 year” “1 5” “4 5” “suicide rate” “6 7” “ 1k” “depression anxiety” “stuck home” “stayed home” “reading comment”', | Pandemic restrictions, age, mental health |
4 | “high school” “young adult” “age group” “buying car” “non emergency” “hazard pay” “meant behave” “idea meant behave” “feel like” “formative year”', | Youth & behavioral expectations |
5 | “cost living” “tested positive” “trust government” “medical field” “significantly worse” “raw material” “weve seen” “limited capacity” “wearing mask” “refuse accept”', | Distrust for institutions & resource scarcity |
6 | “past year” “leave house” “icu bed” “2 22” “work remotely” “anti mask” “hundred thousand” “elementary school” “feel comfortable” “past 2 year”', | Isolation & healthcare capacity |
7 | “pandemic began” “early 2 2” “anytime soon” “2 2” “case spiked” “smell taste” “didnt discover” “loved one” “video call” “horror story”', | Pandemic progression & associated loss |
8 | “year old” “3 4” “social skill” “covid related” “vaccine mandate” “1 x” “mental illness” “healthcare worker” “acting like” “1 th”', | Age-related specific issues |
9 | “week later” “short staffed” “god forbid” “piece shit” “phone call” “social security” “admitted hospital” “mass shooting” “loss taste” “store shelf”', | Staffing issues |
10 | “year half” “taken away” “middle night” “nurse doctor” “near future” “survivor guilt” “communication skill” “getting rejected” “wearing mask” “2 year”', | Career disruption and aftereffects |
11 | “good luck” “3 month” “young child” “lockdown restriction” “labor shortage” “eye opening” “bar owner” “young healthy” “nerve damage” “entire career”', | Childcare challenges & economic changes |
12 | “find peace” “lost job” “wore mask” “health issue” “feel guilty” “new hobby” “medical staff” “fall apart” “non urgent” “er visit”', | Job loss & health complications |
13 | “hearing aid” “blood test” “hearing impaired” “reading lip” “refuse vaccinated” “read lip” “fell apart” “suicidal thought” “wear hearing aid” “hard hearing”', | Hearing difficulties & vaccine refusals |
14 | “social medium” “best friend” “caught covid” “spend time” “loved one” “hit hard” “life saving” “online class” “darker effect” “feb 2”', | Personal loss and adaptation to online world |
15 | “pretty sure” “couple week” “quit drinking” “domestic abuse” “immediate family” “weight gain” “birthday party” “alcohol drug” “giving birth” “attempted suicide”', | Substance use |
16 | “wearing mask” “year ago” “social distancing” “mask mandate” “week ago” “lung cancer” “minimum wage” “8 hour” “far gone” “child abuse”', | Pandemic restrictions & Long-term impacts |
17 | “earlier year” “heart attack” “small business” “co worker” “large group” “nursing home” “saying goodbye” “entire generation” “bed available” “drug addiction”', | Heart health & financial impacts |
18 | “covid 19” “spanish flu” “7 8” “negative effect” “domestic violence” “extended family” “separation anxiety” “funeral memorial” “niece nephew” “sars cov”', | COVID-19 and historical pandemics & domestic violence |
19 | “death rate” “march 2” “big deal” “18 month” “month ago” “9 11” “able afford” “march 2 2” “real estate” “ask question”', | Pandemic timeline & Financial strain |
20 | “stay home” “24 7” “thank sharing” “beginning pandemic” “drug addict” “past 18” “dog cat” “able visit” “dog park” “animal shelter”', | Isolation, emotional sharing & pets |
21 | “2 year” “anti vax” “2 16” “friend family” “fucking suck” “panic attack” “hospital bed” “common cold” “12 hour” “5 6”', | Vaccine refusal |
22 | “mask wearing” “young kid” “december 2” “hard hearing” “virtual learning” “13 year old” “committing suicide” “year old” “allowed visitor” “lack access”', | Children’s experience in online world |
23 | “civil war” “multiple time” “april 2” “make wonder” “april 2 2” “anti science” “self harm” “daily basis” “suicide attempt” “violent crime”', | Increase in suicide and violent crime |
24 | “conspiracy theory” “act like” “break heart” “anti vaxxer” “turned away” “delta variant” “health care” “lack empathy” “death toll” “wealth gap”', | Conspiracy theoriesempathy deficit |
25 | “wear mask” “public school” “essential worker” “grinding teeth” “long hauler” “human history” “rich richer” “world wide” “hit hardest” “government overreach”', | Socioeconomic disparities |
26 | “long term” “anti vaxxers” “long term effect” “month later” “2 year old” “anti masker” “2 year” “lose mind” “mind blowing” “long distance”', | Attitudes and long-term pandemic effects |
27 | “sound like” “spending time” “get worse” “stimulus check” “major city” “memory issue” “human contact” “chronic pain” “emergency department” “mental health”', | Quality of life |
28 | “2 2” “2 19” “2 21” “united state” “public health” “didnt realize” “blood clot” “big pharma” “common sense” “look forward”', | Health issues |
29 | “feel like” “make sense” “working home” “grocery shopping” “mental health issue” “social anxiety” “supply chain” “mental health” “healthcare system” “pre pandemic” | Mental health and broader economic issues |
(Note: Models were trained with different number of topics, for combinations of unigram + bigram_trigram (UBT) and bigram_trigram (BT). The BT topic model with 30 topics provides higher coherence values for best representation.) |
[Insert Table 2 here]
Conversations also centered around the emotional and personal impact of losing loved ones due to the pandemic, highlighting the significant human cost of the crisis. Alongside these deeply personal narratives, user posts also discussed the sociopolitical consequences of the pandemic, particularly the measures taken to combat it. This included conversations around financial implications, vaccination efforts, insufficient healthcare resources, and the prevalence of misinformation and distrust toward systems and institutions. The polarization of opinions and beliefs became evident through these conversations, with the spread of low-credibility information in online discussions, reflecting the challenges in disseminating critical information and building trust among people during the pandemic. Furthermore, as a result of stay-at-home measures that kept families confined to their homes, users engaged into conversations that reflect signs of family stress and tension, particularly among the younger population.