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The Pros, Cons and In-betweens:

Dr Praveetha Patalay on where we are with mental health research and COVID-19

This month, the COVID-MINDS Network registered a total of 160 longitudinal studies since the start of the pandemic. They range in size, measures, location, and duration. The majority were launched during the pandemic, whilst others were existing cohort studies. For some researchers, the volume of publications and the increased attention on mental health have been positive outcomes of the pandemic. For others, the pandemic has highlighted how mental health research could be improved.

The COVID-MINDS Network is asking researchers to comment on what they think are the main lessons of the last year and a half, and how the mental health community could move forward in light of its findings on the effects of the pandemic on mental health.

This month we spoke to Dr Praveetha Patalay, Associate Professor at University College London. In our interview, Dr Patalay describes her work with the Covid-19 Longitudinal Health and Wellbeing National Core Study and what she thinks are the positive and negative aspects of mental health research in the last year.

COVID-MINDS: The National Core Study is a tremendous example of longitudinal collaboration and data sharing. Tell us about the project and your role leading its mental health focus.

Patalay: The Study is examining several themes, some of which are directly related to COVID, such as vaccinations and Long COVID, and some which are more broadly related to the wider impacts of the pandemic. We are examining the impact of COVID on both population mental health and on particular groups that were most impacted. We are also looking at what might have helped maintain good mental health and the mental health consequences of Long COVID.

The project is exciting because it involves over a dozen longitudinal cohorts and uses electronic health records, which give us a high coverage of the population but also allows us to triangulate data and account for different kinds of biases across data sources. The goal is to examine the electronic health records over the long-term to see whether people who suffer from COVD have higher or distinct mental health difficulties, while the population-based cohorts will give us a better idea of the whole distribution of distress, as well as the social and economic determinants of these.

COVID-MINDS: What do you think are the main lessons that we've learned about how the pandemic has affected population mental health?

Patalay: I think it's probably safe to say we don't know—and we can't know—all the impacts of the pandemic on mental health because it hasn't finished.

And we also don't know what the mental health consequences in the medium and long-term will be. However, what societies and governments do moving forward will help determine these, and there's a lot we should do to minimise mental health difficulties as much as we can. Many consequences will be indirect effects such as financial recession which we know has been associated with poorer mental health in the past. Income inequalities have massively widened, and we know inequalities are not good for mental health. So governments, societies and policymakers need to think about financial inequalities and hardship and how to mitigate their effects on mental health in the long-term.

COVID-MINDS: It is thought that the pandemic has brought increased attention and resources to mental health. In your opinion, how has the trajectory of mental health research and investment changed in response to the pandemic?

Patalay: Mental health research and services have been underfunded and have absolutely no parity with other health issues, which has been very obvious for a long time. Many people have been fighting to get mental health the attention it needs especially given its immense global burden of disease. I'd like to think progress was being made before the pandemic but very slowly. Too slowly. Mental health research and services are still not funded enough. It is a tiny proportion of the NHS budget and completely misaligned with the health consequences it has for both individuals and for society even in high income countries. And there's even greater disparity in low- and middle-income countries. And it's hard to know if the pandemic will change this because the focus could shift away again as other public health concerns come to the forefront.

"A side effect of COVID has been more efforts to improve the way we do science, more open science and willingness to share code and data across the board. And that’s how it should have always been.”

COVID-MINDS: Some researchers have commented that the speed of research in the last year has compromised its quality. What do you think?

Patalay: Yes in some cases speed compromised quality of research, and it is easy to be critical but I think it’s also important to acknowledge that speed was necessary. We didn’t have the luxury of time to plan for long periods given the nature of the pandemic.

That said, if I could rank three wishes for the last year, it would be that we as a research community had prioritised greater population representatives in studies, more involvement of people with lived experience, and less duplication of efforts. There have been myriad online studies with large convenience samples that result in quick findings, but which always attract a certain demographic of the population. I think it's very dangerous when precise seeming findings (i.e. with large N’s and small confidence intervals) may not actually apply to the population. Many researchers have been very upfront about those caveats, but sometimes those limitations were lost, and from a population health perspective, representativeness and ensuring data on all groups is considered and analysed is really important.

The community could have also involved a wider network of people including those with lived experience of mental health and people from a variety of demographic backgrounds. These aspects were dropped probably because of the pace of research but could have improved the quality of the data. Finally, there has been a lot of duplication of effort, but I don’t know how we could have avoided that. We couldn’t read other people's minds and plans nor could have known that they were doing ethics applications at the same time.

COVID-MINDS: In contrast, has the pandemic helped to strengthen mental health research in any way?

Patalay: It has been very impressive to see people mobilising so quickly and putting their skills they have developed over years into action very efficiently. In particular, the National Core Study has been a wonderful way to bring together everyone’s skills and intelligence. Normally you sit there and you think ‘how can I make this study as strong as possible’? But if you have 20 co-authors who know the datasets really well, you collectively can come up with the best possible methodology.

This is one of the positives of COVID – more collective, robust science. There are over a dozen UK cohorts in the National Core Study. These cohorts have existed for a long time, but I think this is the first time we are working on papers that use a dozen cohorts to answer one question. That's absolutely brilliant because rather than each cohort publishing different papers answering the same question and then pulling them together subsequently, we're analysing the data together, making the same decisions and using the same code. The hope is that where there are inconsistencies in findings, at least we know it's not because we all ran different types of models.

So a side effect of COVID has also been more efforts to improve the way we do science, more open science and willingness to share code and data across the board. And that's how it should have always been. So we can talk about speed versus quality and sometimes quality has been compromised for speed, but equally the pandemic has kickstarted and accelerated many good ways of doing science.

COVID-MINDS: Looking forward, if you could have the best goodie bag of treats that a mental health researcher could ask for, what would that include?

Patalay: The goodie bag of treats would obviously be more funding, more resources, etc. But in terms of things that are in our control, I think we could continue to work towards more collaboration and take advantage of the skillsets and expertise in our research community. The National Core Study is a really nice example. In the long-term, if we can carry on doing research in 12 cohorts instead of in one, considering limitations of different data sources and triangulating evidence and sharing data and code, it will make science better. This is in our control – more open data, more collaborative science.


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