A Q&A with Dr Daisy Fancourt
The COVID-MINDS Network launched just over 18 months ago as the pandemic took hold across the globe. Below, we’ve put together a Q&A with our Director and Founder, Dr Daisy Fancourt, who alongside colleagues at University College London foresaw the dramatic effects the pandemic would have on our lives. Dr Fancourt, an Associate Professor of Psychobiology and Epidemiology, describes the early days of the Network, how it emerged alongside a major longitudinal study that continues to run across the UK, and how her team was uniquely positioned to examine the pandemic’s psychological effects as countries began to isolate their populations in response to COVID-19. She also offers her insights into the pandemic’s future toll on mental health, as well as its surprising positive influences on mental health research.
The COVID-MINDS Network was founded in April 2020, soon after the United Kingdom and other countries implemented lockdowns and other measures. What sparked the Network’s creation?
DF: COVID-MINDS grew out of a new study on COVID-19 that we launched at the start of the pandemic. Early on it became clear to a number of scientists that the closures and social restrictions that we started to see happening around the world were inevitably going to come to the UK. We started hearing a lot about cases and deaths but my concern was that if we just focused on these aspects of the pandemic, we'd miss the much broader societal implications of COVID-19. Whilst a proportion of people would actually catch or die from COVID, everybody was going to be affected by the restrictions that were coming in. So we at University College London had the idea of running the COVID-19 Social Study. It arose on a Sunday afternoon when I called Professor Andrew Steptoe, Co-Founder of the study, and asked should we be doing something more to look at COVID given our expertise in other social issues and behaviours like social isolation, which was likely to be a big issue as soon as any types of social restrictions came in. So we had the fastest and most intense turnaround I've ever had. Within six days we had the full study designed, ethically approved and launched.
At the same time I was also aware that certain countries like the UK would probably have the resources to establish studies like this really quickly by building on existing infrastructure and having funders ready to provide emergency COVID funds. I became concerned that were we going to end up with an unrealistic picture of the global mental health impact, which would be biased towards these higher income countries. So that's what prompted the COVID-MINDS Network. We wanted to pool expertise between countries, making sure that we weren't all reinventing the wheel in our study designs. How could we make sure that data captured could actually be compared between countries to see if some fared better or worse than others? And how could we look at pooling expertise and knowledge to enable studies to expand to those countries that otherwise would be less likely to have data?
"That's what prompted the COVID-MINDS Network. We wanted to pool expertise between countries, making sure that we weren't all reinventing the wheel in our study designs."
How did you manage to launch the COVID-19 Social Study and the COVID-MINDS Network so quickly?
DF: We actually moved ahead without funding initially. We had existing funding from UKRI who generously announced that any of their funded scientists could second themselves onto COVID work immediately as a matter of national interest. So we got the study up and running. And it was only when we had been running for a couple of weeks that we then started to look for research funding, which the Wellcome Trust and the Nuffield Foundation generously provided later on. So initially all we knew was that we wanted to move as fast as possible to capture people's experiences right from when the lockdown first came in. We were just in time – we launched the study and then 48 hours later the country went into lockdown.
Has this set a precedent? Do you think research should happen this quickly?
DF: Nobody wants to have to do science that fast because naturally there are things that you look back on that you wish you'd tweaked or changed but didn’t have the bandwidth for at the time. When there is a global emergency like COVID you obviously have to make sacrifices along the way. So we had to be pragmatic about what we included in our study. We were very lucky that funders were so responsive and quick in reviewing applications, but again that's normally a process where scientific scrutiny can really enhance the science that's being carried out.
Fortunately, we were in the unusual position of actually being quite prepared to take on this work because we already had a massive national mental health network focusing on social factors and mental health, the March Network. And we also already had substantial expertise in carrying out citizen science experiments and cohort studies within the team, which is why we felt very well placed to undertake the COVID-19 Social Study. But moving forwards, proper preparation for future pandemics could mean that we actually have research units set up knowing exactly how to respond as soon as there is evidence of something like this happening again—perhaps without the same feeling of pressure and panic that there was at the start of COVID.
Why did you want the Network to focus on mental health specifically?
DF: While the COVID-19 Social Study was set up to look broadly at the psychological and social impact of the pandemic, the area that was of most immediate concern to me and my colleagues was the mental health impact. We wanted our international work to have more focus because we thought that would enable us to really scrutinize the choice in measures, the bespoke analyses cross-country, and we’d be able to provide more targeted support to other countries. Mental health was the obvious candidate given the forecasting that we started to see on how people might be affected by the pandemic.
"When we project forward what's likely to come in the aftermath of COVID, it’s not going to be a simple resolution of this virus but will be years of societal ramifications. Most of the predictions suggest that greater numbers of people will need mental health support."
Do you think a pandemic preparedness plan for mental health research would be useful for the research community?
DF: I don't think there's been much talk about it but I know that the mental health of many researchers working on COVID-19 was quite adversely affected by those early months of the pandemic in terms of the stress. I certainly know from my team that we had many 7-day working weeks and some of us were working overnight as well to get things done. It's obviously not a sustainable or sensible mental health strategy for research. It was something that had to be done this time but we'd love to have better infrastructure in place for next time.
What do you think is the most significant finding regarding the impact of the pandemic on mental health?
DF: It's been quite shocking to see the new Lancet Global Burden of Disease paper that came out in October, which has highlighted just how great the impact has been on mental health across every continent around the world. We predicted it would have adverse psychological effects but I think the endurance of these effects and how widespread they are is shocking. Also, we knew there were inequalities in mental health before COVID but these have been exposed and exacerbated by the pandemic. What's more, it's also highlighted how COVID has been different from previous epidemics. When we look at data from things like SARS, H1N1, Ebola, we see slightly different patterns of effects on mental health compared to during COVID. For example, we often see mental health deteriorating during lockdowns, but during COVID, the pattern has often been a deterioration in mental health in the lead up to lockdowns because people have seen the situation get worse and they've started to get scared. Often the measures coming in have played a role in stabilising mental health. We've also seen that repeated lockdowns have started to take a longer-term toll on some individuals. So I think it's important to recognise that we can't necessarily predict how people will be affected based on past pandemic experiences and that continuing research is needed.
Some say that aggregate data shows that on a global level, mental health has not changed much in response to the pandemic. Yet other evidence suggests this is not the case. How do we reconcile different viewpoints?
DF: I think as time goes by we're starting to gather these larger international comparative studies that are providing really high-quality representative data about dozens of countries at once and those are some of the papers that will define how we look back on the mental health experiences of COVID. That's not to say that everyone has experienced adverse psychological effects. Indeed when we look at country levels and we look at specific subgroups within countries we can see certain groups where there has been very fast recovery or actually low impact overall psychologically. But when we project forward what's likely to come in the aftermath of COVID, it’s not going to be a simple resolution of this virus but will be years of societal ramifications. Most of the predictions suggest that greater numbers of people will need mental health support.
There's also a note of caution which is that some of the data sources that have been used in COVID have been relatively new. Things like Google Trends, Twitter analytics, Facebook analytics. Some of the research we carried out looking at how accurate these kinds of data sources are highlighted that we have to be extremely cautious in how we use them as sometimes they don't correlate at all with more scientifically accepted data on mental health. Similarly even when we look at hospital statistics on things like self-harm, we can actually find quite confusing data because people's patterns of engagement with health services changed because of the pandemic. Often people were trying to stay away from crowded emergency departments. So some of the things that we have traditionally used as reliable data on things relating to mental health have actually been altered by the pandemic itself.
What do you think is the greatest challenge of collaborative global mental health research?
DF: One of the challenges is being able to make meaningful comparisons between countries. There’s a tension here: we can recommend specific scales that should be used across every study globally to enable those comparisons, but we also need to recognise the unique social definitions and constructs of mental health in different countries. So some scales might have greater resonance in some countries than others. During COVID there were a number of international groups that tried to set recommended scales and we promoted those through the COVID-MINDS network. For example, a lot of work in this space was led by the Wellcome Trust. At the same time, we've also tried to encourage countries to include their own measures on aspects of mental health and broader functioning that we felt were particularly helpful for their populations.
Has anything surprised you about mental health research in the last year and a half?
DF: I think one of the positives of the pandemic is the many new international collaborations in mental health research. We've seen researchers make new contacts and start new projects that are operating across multiple countries at once. That sort of enhanced networking and collaboration has been an example of science at its best. It was triggered by an emergency and it really responded to international need. It’s been really lovely meeting other scientists with similar interests working on similar topics around the world.