Early in the pandemic, there was a rapid shift in the pace of research. With the situation evolving quickly, lockdowns coming into effect, and the massive loss of life that followed, researchers across academia were racing against the clock to produce papers.
This haste was unusual for most scientists, more used to detailed scrutiny, further investigations, and collaboration. As a result, some were concerned about the rigour of papers that would ultimately see the light of day. Early on, psychologist Vaughan Bell tweeted with regards to Covid research, “If it’s urgent, the urgency is to do it right”. Now, almost two years into the pandemic, we can begin to assess how robust our efforts were, and see where developments are leading us.
An imperfect world
There is no escaping the fact that some initial fears about the quality of Covid research (mentioned in our May 2020 piece) did come to pass. It was always going to be the case that an expedited timeline, as well as the torrent of Covid-related papers — some estimates have it at over 200,000 papers in 2020 — would bend traditional publication frameworks to breaking point.
As early as August 2020, a systematic review by Inés Nieto and colleagues highlighted that while the majority of mental health research pertaining to Covid did report the expected statistical and methodological information, the reliance on convenience samples, lack of power analyses, and lack of pre-registration called into question both their generalisability and validity.
And this was not by any means an issue unique to psychology. A systematic review from February 2021, published in Nature Communications, looked at the quality of published research on Covid during 2020 compared to papers from before the pandemic began. When compared with non-Covid articles published in the same journal before the pandemic, Covid papers generally achieved lower quality scores. They were also subject to substantially shorter turnaround times; on average, Covid papers had just 13 days from submission to acceptance, as opposed to a typical 110 days for pre-pandemic papers. Out of the 686 articles on Covid included in their systematic evaluation, Covid research generally achieved modest methodological quality scores, though low journal impact score and rapid turnarounds in particular were in many cases associated with significantly lower methodological quality.
The sheer speed at which research moved did lead to some questionable papers slipping through the net of peer review. As Michael Scheeringa notes in a blog post for Psychology Today, some researchers from outside of psychological disciplines also tried their hand at psychological research to varying success. Others from within psychological disciplines swiftly drew tenuous links between their work and Covid to ride the wave to swift publications and impact. Retraction Watch currently lists over 160 Covid papers that have been withdrawn or retracted from journals, many of which fall within the boundaries of cognitive sciences. What’s more, even though these papers were retracted, the potential damage done by many of the questionable findings within them continues. Thanks to other researchers scooping up Covid research as soon as possible, many will have already been cited in other articles before they were caught and retracted, leading to a proliferation of inaccuracies.
This particular problem spread beyond just peer reviewed work. In an effort to overcome delays imposed by peer review, masses of pre-prints were uploaded to repositories. And while this increased speed and access to novel findings, it also resulted in unchecked studies being treated similarly to peer-reviewed articles, and risky citations by both scientists and media. Tweaks that would come about during review were undoubtedly lost in many cases, which may prove difficult to correct in the coming months.
However, even though typical research and publication frameworks bent and broke in some places, that doesn’t mean that we dropped the ball — rather, the urgency with which we needed to move superseded the risk of letting a percentage of imperfect papers see the light of day. In an ideal world, every Covid-related paper would have been immaculate. But researchers are human, and the situation was unprecedented in the truest sense of the word. This is important to remember as we turn attention to how we managed to rapidly reconfigure our research processes into systems that met the moment.
In the wake of social distancing, formats such as letters to the editor and social media (particularly Twitter) became powerful ways to spotlight areas in need of urgent research and organise efforts to rapidly fill those gaps. For example, the Psychological Science Accelerator — a distributed network of labs that collaborate on studies to increase the generalisability of findings on chosen research projects — quickly created the Rapid Response Covid-19 Project, creating calls for collaboration via social media. The three chosen projects focus on loss gain, cognitive reappraisal, and self determination. As of writing, all have been submitted for peer review, and the study on cognitive reappraisal has been published in Nature Human Behaviour.
In a commendable move, several large journals, including Elsevier, also made all of their Covid-related publications Open Access. This effectively removed institutional access barriers from those seeking to contribute to Covid efforts, and reduced access issues caused by working from home. And in response to the tidal wave of pre-prints, many repositories got pickier about the types of submissions they allow in order to ensure things that absolutely required peer review (such as predictions about potential treatments) received it.
Following the flurry of papers in early 2020 that focused on the spread of Covid, research on the mental health impacts of the pandemic have more recently taken centre stage. According to analyses in Nature, from November 2020, papers on mental health and Covid outpaced PubMed publication rates from other disciplines such as public health, diagnostics, and even epidemiology.
Valuable psychological insights, new issues, and new approaches have begun to emerge from the chaos. Several topics are likely to be of great relevance in the coming years, both for clinicians and academics. Here are just a few of those research topics that we are beginning to cover in more depth now that some of the dust is settling.
Following Covid recovery, many people report experiencing a wide array of extended symptoms, which have collectively been dubbed Long Covid. Many of these symptoms are neuropsychological, and while theories exist as to what may be causing these symptoms, no single mechanism has been agreed upon yet.
One of the more widespread and under-supported cognitive consequences of Long Covid is brain fog. Though it is not a diagnosis in itself, the condition is widely recognised by medical professionals, poses severe issues for those going through chemotherapy, and is prevalent among those with HIV, as well as other conditions. Despite this, misinformed associations between brain fog and malingering persist in the general population, creating extensive barriers to treatment.
To illustrate the difficulties faced by those suffering from post-Covid brain fog, researchers based at Oxford University recently published a qualitative study which takes a detailed look at brain fog sufferers’ lived experiences. Recruiting via online support groups, the discussions participants had during small focus groups detail the life changing impacts of cognitive impairment, from difficulties completing the weekly shop to extensive struggles with dismissive healthcare professionals. Several experienced issues conducting their jobs, and while some recovered over the course of the study, many did not, suggesting this may become a widespread longstanding issue for both patients and healthcare professionals going forward.
With research suggesting that around 81% of those with Long Covid may experience brain fog, there is an urgent need for specialised health and support services that are easily navigable by those suffering from the symptoms of brain fog, such as extremely low energy, confusion, and poor memory, to name a few.
Transitioning from the ICU
Through the course of the pandemic, there have been thousands of intensive care unit (ICU) admissions within the UK. A large number of these were older individuals, as may be expected, but a remarkable number were also younger, generally healthy individuals. For all patients, the shock of being admitted to ICU and their experiences while being treated are extreme, and for many can make readjusting to everyday life a struggle. Some researchers have wondered whether Post-Intensive Care Syndrome may pose a “crisis after a crisis“. Cognitive deficits and mood disorders are common in those who survive the ICU, with 47% suffering from depression or anxiety even two years post-ICU. Social factors stemming from physical injuries, such as financial instability or changes in identity may exacerbate this further in times of Covid.
Though research in this area with regards to Covid is still somewhat immature, psychologists such as Adam Guck and colleagues have drawn from extensive existing literature on the psychological consequences of ICU stays with different diseases to create a probable list of psychological issues Covid patients may face post-ICU.
Using existing publications on Covid, SARS, MERS, conditions requiring ventilation, and other considerable medical interventions, the team identified five broad areas of issues that commonly occur in post-ICU patients: medical trauma and post-traumatic stress, cognitive deficits, fatigue and depression, social stress and readjustment, and illness anxiety. Combining this with their own observations, the authors then provide treatment recommendations for each of these areas, with emphasis on those that can be delivered as outpatient or telemedical interventions.
These sorts of recommendations are a promising start, and several academics highlight the need for future research to verify the efficacy of suggested approaches, such as cognitive behavioural therapy and diaphragmatic breathing, in Covid populations. It may be the case that cognitive behavioural therapy’s effect may be lessened by cognitive difficulties particular to Covid recovery, or that typical breathing exercises may draw attention to negative emotions or lasting physical effects concerning the respiratory system. Similarly, ensuring that therapies are effective across cultures and socioeconomic backgrounds will be vital to the world’s recovery from Covid.
Prolonged Grief Disorder
Millions of families around the world have been faced with the sudden death of loved ones due to Covid. Beyond this tragedy, the shock of these losses, combined in part with the disruption of typical death and mourning rituals, appears to have given rise to Prolonged Grief Disorder (PGD).
PGD is a condition recently added to the DSM and ICD in response to ongoing mass death due to Covid, as well as other natural disasters and wars. Those with the condition experience bereavement difficulties which persist or grow, rather than diminishing over time, and can remain indefinitely without treatment.
Pre-Covid prevalence estimates sit at around 10 to 20% for the recently bereaved. However, some initial estimates of PGD’s prevalence during the pandemic within Chinese populations place this figure much higher. Using online versions of the International Prolonged Grief Disorder Scale and the Traumatic Grief Inventory Self Report, researchers Suqin Tang and Zhendong Xiang assessed grief in 422 Chinese participants who had recently lost a loved one to Covid. From this, they were able to arrive at an estimate that between 29 and 38% of participants were experiencing symptoms of PGD.
Study of this condition is still in its infancy, and more research is needed to establish its prevalence, factors associated with Covid that may be making it more prevalent — such as fear or disrupted mourning practices — and how it may vary between cultures. But, given the potentially high prevalence of PGD brought on by the pandemic, combined with the sheer number of people requiring support from bereavement services, continued attention should be paid to this sector.
Towards the future
Though it’s still too early to assess the quality of recent months’ research as a whole, several different psychological topics that still require urgent insights, such as the above, are emerging. This small list is by no means exhaustive; questions remain about Covid’s long term impacts on both physical and mental health, and it’s likely that new issues will come to light in the coming years.
The pandemic has shifted the ways in which we collaborate, and thoroughly tested the processes guarding the gates to publication. Efforts of the research community over the last two years of the pandemic have been incredible, and have helped us get our feet on the ground. From here, it’s unclear how quickly we’ll need to move in order to keep pace with Covid developments. However, it’s likely that the lessons we’ve learned in how to organise effectively and research as quickly as possible will help us return to some sort of normality when it comes to Covid research in the near future.
This feature appears in the December 2021 issue of The Psychologist
Emma L. Barratt (@E_Barratt) is a staff writer at BPS Biomedarticles