Frontiers | Looking Back to Move Forward: Reflections on the Strengths and Challenges of the COVID-19 UK Mental Health Research Response

    As the coronavirus disease 2019 (COVID-19) pandemic unfolded, the mental health research community has wanted to contribute to rapid research response. A large number of research projects have been rapidly initiated and carried out by researchers, facilitated to some extent by the existing research infrastructure1.

    however, we do not yet know the extent to which these efforts have achieved the desired results, including advancing understanding of the impact of covid-19 and ongoing national/regional social distancing measures and lockdowns on mental health. As this rapid response will continue, it is important that we reflect on the initial activity to consider how we can apply any learning in the future. Here, we offer reflections on the initial COVID-19 mental health research response, with a focus on the UK (UK; March-October 2020). these capture the perspectives of the authors. we are a group of uk mental health researchers (including academics involved in the covid-19 research response), experienced experts and academics who monitor relevant journals and networks. we set out to focus on the processes through which the initial covid-19 research activity was carried out, using them to stimulate debate and reflection among the mental health research community as we continue and plan our next steps to respond to the pandemic and beyond. Unlike the work of Holmes, O’Connor and colleagues (1) and O’Connor and colleagues (2), the current perspectives article does not focus on what should be prioritized; rather, we consider the mental health response to covid-19 so far and offer suggestions on how what we have learned can be applied to ongoing covid-19 mental health research, future situations emergency and general investigative practice. . here, we offer discussion of four key insights. Boxes 1 to 4, offered throughout the text, summarize the main challenges and considerations moving forward.

    Table 1. Summary of reflection 1 and key considerations for moving forward

    systems have been streamlined to allow rapid response

    • Funders and HEIs must learn from streamlining covid-19 research, working to create sustainable models with simpler and more timely application processes.

    our research response shows fragmentation and an overlapping emphasis on specific priorities

    • Efforts should be undertaken to further develop and expand interdisciplinary and inter-institutional networks to support greater collaboration and more efficient deployment of resources.

    • There is a need for continued effort and research to find ways to bring our community together to create a more collaborative approach (eg, funders considering how their calls can directly foster cross-institutional collaboration).

    • Records can help coordinate activity, but these too must be carefully coordinated to avoid duplication.

    Our infrastructure has not been built for emergencies

    • Leaders and coordinators must further develop our infrastructure to better facilitate investigative responses to future emergencies, particularly given calls to do so more than a decade ago (3).

    Table 2. Summary of reflection 2 and key considerations for moving forward

    There are some concerns about the extent of co-production in covid-19 research, likely due to the rapid response and challenges brought by the pandemic

    • Researchers should consider ways they can engage people with lived experiences that might be more difficult to reach remotely [see, for example, tips on co-producing during covid-19; (4)].

    • Funders should ensure that more small-scale funding is available to specifically support the effort and costs of co-production: during the development of research proposals and to support training in around co-production, especially for research teams that lack the start-up funds or infrastructure to pull it off.

    • Researchers should be aware of co-production challenges that may have been magnified by the pandemic (eg, the time and effort required to build these relationships) and plan for more flexible collaboration with representatives of co-production and ppie. .

    Table 3. Summary of reflection 3 and key considerations for moving forward

    lived experience has been overlooked due to limited qualitative research

    • Future work should consider the adoption of mixed methods. where this is hampered by lack of experience, the research team should attempt to initiate collaborative interdisciplinary research with experts in this method.

    new covid-19 studies have relied heavily on less reliable sampling methods (non-probability samples via online surveys)

    • Future covid-19 work should consider the use of random sampling methods to reduce bias.

    • Researchers interested in exploring the specific effects of COVID should consider using existing cohort studies that include pre-COVID data.

    Much of the current work is based on general populations.

    • Future work should focus on establishing the long-term experiences of specific marginalized populations.

    some of the existing and new covid-specific measures used in covid-19 mental health research lack sufficient validation and measurement invariance

    • Researchers should provide transparent information about measurement practices (how they chose, quantified, validated, and/or modified a measurement) that will allow reproducibility and accurate interpretation of findings

    • Researchers should try to establish measurement invariance in their own sample before meaningful comparisons can be made.

    paper and pencil questionnaires and face-to-face interviews moved to a web or telephone mode.

    • Researchers should consider potential mode effects in analysis, interpretation, and reporting. although a shift to remote data collection for psychosocial assessment was possible, this has been more challenging for biological data, especially in populations considered most vulnerable.

    in some cases suboptimal statistical methods have been used

    • When researchers are interested in bidirectional associations over time, they should ensure that up-to-date robust analytical methods (ie, random intercept panel model) are employed to ensure the accuracy of the results.

    • The collider, confounders, and mediators must be accounted for in the analysis to obtain accurate causal effects. expert knowledge can ensure that the appropriate variables are considered in a model.

    • Investigators designing new studies should ensure that appropriate confounders (eg, biological, social) are assessed, although we note that there are likely to be difficulties in collecting biomedical data. this requires interdisciplinary work and collaborations between different sectors and disciplines.

    Funders, researchers and the public placed more importance on open science practices than usual.

    • There has been an open exchange of research protocols and questionnaires between research teams, and increased publication of preprints, in an effort to allow rapid dissemination.

    • However, by comparison, prior registration of study designs and statistical analysis plans has been limited. therefore, researchers should ensure pre-registration of studies prior to data analysis (for example, on platforms such as the open science framework).

    • For future work, researchers should also ensure that they actively seek permission from participants to securely deposit their data for sharing and reuse. During this process, transparency around data sharing, privacy protection, and anonymity of sensitive mental health data must be ensured. the uk data service is an example of a platform for securely depositing, managing and sharing research data [eg see covid-19 data from the comprehensive society; (5)].

    Table 4. Summary of reflection 4 and key considerations for moving forward

    Researchers with precarious contracts are now in vulnerable positions

    • We urge that urgent action be taken and examined within the UK’s research infrastructure to create better support and stability for those on casual or precarious contracts.

    • heis should invest in de-casualizing their workforce, both to protect current investigators and to ensure we can hire and retain new investigators

    • Funding agencies should consider their role in facilitating better employment, such as creating conditions within grants to use open-ended contracts.

    The pandemic has created an uneven impact on our workforce, with some groups likely to be more affected than others

    • With women and ethnic minorities in the UK disproportionately on precarious contracts, HEIS and funders need to urgently consider the inequalities that are being exacerbated as a result of covid-19.

    • Our infrastructure must be developed to ensure support and opportunities for women and ethnic minorities in the UK given their over-representation in casual employment.

    • HEIS, funders, and networks should be aware of the barriers some face (eg, parents and people with mental and physical health conditions) and take steps to limit the consequences of publishing and sharing. Reduced funding during 2020.

    Reflection 1: Fragmentation in our infrastructure has challenged the efficient and equitable deployment of resources

    The pandemic has affected all spheres of life and has highlighted the value of work in all disciplines and sectors. we begin this section by acknowledging that networks and funding bodies that facilitate interdisciplinary work have come into their own, launching rapid funding opportunities due to their intrinsic flexibility [e.g. see examples of covid-19 research supported by networks ukri mental health; (6)]. Those calls were met by extraordinary organizational efforts by higher education institution (HEI) research services that expedited processes within institutional ethics review committees to enable rapid response. In particular, funding agencies have also streamlined systems, with shorter application processes and quicker decisions. That offers a critical lesson: Academics typically spend a lot of time and effort on funding requests, but given the over 80% rejection rate (7, 8), this is wasteful and contributes to burnout, reduced productivity and low well-being (9). During COVID-19, funders have shown that streamlined systems can reduce the burden on everyone involved, seemingly without compromising their decision-making ability. however, further analysis is required to determine whether certain research streams, such as mental health interventions, were harmed by this approach. however, we encourage funders and HEIs to develop sustainable models with simpler and more timely application processes, while maintaining quality and rigor in the review process.

    However, the pandemic has also exposed weaknesses in our research infrastructure. specifically we see fragmentation in our response, along with an overemphasis on specific priorities. The prioritization and coordination framework developed by Holmes, O’Connor, and colleagues (1) has provided a critical starting point from which to coordinate and deploy efforts and resources, and we recognize that there has been significant national and international collaborative effort. however, our initial research response was relatively fragmented, as evidenced by the large volume of research studies with overlapping designs; for example, the records show many studies capturing quantitative data on depression, anxiety, and loneliness among people aged 16 and older (10, 11). Within a more advanced infrastructure, with expansive inter-institutional networks and fewer isolated research approaches, we could have done better: we could have identified potential synergies and initiated collaborations where priorities overlapped, producing fewer large-scale studies but with smaller teams. large and a more concentrated deployment of resources. Whether academic silos need to be fully broken down is a complex issue, not just for mental health research (12). what we are suggesting here is that we must find ways in which we can bring them together, at times like this, where collective effort may have been more effective. Of course, we are aware of the practical and motivational challenges behind collaborations between research teams, especially when they must compete for funding and scholarly publications. we hope that in the future there will be more effort and research to understand how to bring colleagues together. Given the competitive funding landscape for mental health research, funders can take an important first step forward by offering, for example, large-scale but equitable funding schemes with inter-institutional collaboration at their core.

    fragmented research response appears to reflect and perhaps exacerbate an emphasis on short-term impact and rapid response, as well as general population research; Although such efforts are critical (1, 3), we should avoid prioritizing them over long-term efforts and exploring impact for those at risk of acute and long-term effects (for example, UK ethnic minorities, children and young people, and those with existing mental health problems). Fragmentation has also placed an unnecessary burden on members of the public who are interested in participating in research, has led to services being bombarded with advertisements to share with users, and may have resulted in overlapping participants in research. samples, complicating meta-analysis efforts. It also revealed that, so far, interdisciplinary work has been limited: there has been a greater emphasis on self-reported psychosocial data, despite, for example, the benefit that biological data might offer [for example, understanding how social characteristics and biomedical may explain the burden of covid-19 among older people; (13)]. although this fragmentation is not exclusive to mental health research [for example, covid-19 medical research; (14)], unmasks the current weaknesses of our infrastructure and highlights that this infrastructure has not been built for emergencies, despite calls to do so more than a decade ago (3). leadership and coordination are needed in the future. Some good examples so far include coordination activities, such as the covid-minds network (10), the nihr covid-19 and mental health study registry (11), and the covid-19 suicide prevention research collaboration (15). ), but also caution against using multiple sharded records because it risks further duplication and inefficiency. Ultimately, if we are going to deploy vast amounts of time, energy, and funds to facilitate a rapid response, we must ensure that it is done in a strategic and coordinated manner. this is something that funders should take a more active role in. therefore, we recommend that our existing infrastructure (eg, existing networks and cohorts) be enriched, with an emphasis on collaboration, interdisciplinarity, and cross-sector partnerships. it is also important that we build longer-term mechanisms that allow the mental health research community to act proactively in the face of emerging crises.

    Thought 2: In responding quickly, we may have overlooked the role of experienced experts

    The need for rapid and reactive research has affected and reflected the state of co-production in mental health research. research for people struggling with their mental health in the covid-19 crisis is well-intentioned. however, it misses the richness and relevance that co-produced research can bring, where people with lived experience are essential and equal partners, and the aim is to do things with or for them (16, 17). co-production and patient and public participation and engagement (ppie) can strengthen research in a number of ways. it empowers groups that are rarely heard, thus challenging power dynamics within the research and allowing for more relevant and meaningful findings (16, 17).

    We note that several mental health projects have incorporated co-production and ppei with good results in response to the pandemic. These include, for example, a qualitative project by Gillard et al. (18) in which the research team included people with lived experience of mental health problems and a mixed method study exploring mental health and coping strategies among youth by dewa et al. (19) self-described as youth-led. As a result, these and similar projects have been able to prioritize and focus effectively and produce highly relevant and nuanced results with clear practical implications.

    Although there are so many good examples, it seems that in many cases co-production and ppie have unfortunately fallen by the wayside due to the rush of our response. Already, research ethics committees report that the inclusion of co-production and ppie appears to have been substantially lower in covid-19 rapid health research, relative to “normal” research (20). however, that need not be the case in the future. The existence of established networks has supported aspects of the practice, including ppie and co-production within covid-19 research (for example, ukri networks and organisations, such as the mcpin foundation). Thus, in organizations and networks where people with lived experiences are already seen as equal partners, (21), and where resources are available to support engagement, good-quality research can still turn around relatively quickly, with the ability to deliver stronger, more relevant results. . co-production should not be seen as “another thing to do”, but as a way to achieve relevant and meaningful research (22). now more than ever, mental health research must be driven by all who are likely to be affected by the pandemic (23). indeed, the pandemic has the potential to allow for the possibility of greater inclusion and broader relevance, and may create space for people with lived experiences to participate (24). while we cannot directly assess the extent to which lived experience of covid-19 has been incorporated or ignored within work, others have noted concerns about less attention to this (25). in the future, we urge research groups to find, recruit and train [p. eg, check out the campaign training ground; (26)] people with direct life experience relevant to your research goals, to play an active role in all stages of the research, both during the pandemic and after.

    When including people with lived experience in future research, researchers must also take into account practical issues and, in particular, the current challenges that have arisen due to the pandemic. for example, the new normal of working from home and remote participation methods can facilitate greater participation by people who are often overlooked in co-produced research, for example because they cannot easily leave home. this demonstrates that so-called “hard-to-reach” populations can, in fact, be reached with the appropriate adaptations. still, we must not forget those who may find it difficult to participate virtually, for example, hospitalized patients, frontline workers, or those with unstable living conditions (27). given that co-production with such populations is often based on face-to-face meetings, researchers should consider other ways to engage all people with lived experiences, ensuring, for example, that those without internet access have access to a number free phone ( 28, 29). Researchers need to be aware of other practical issues, such as the costs associated with co-producing research and the availability of funds to accommodate this. in fact, researchers without funding or established networks were less able to meaningfully incorporate such perspectives at speed (30). this highlights the need to develop suitable ppie and co-production groups within our research infrastructure, and to offer fast and light funding streams to support such efforts, such as the small-scale funding provided by nihr’s research design services (4 ). Finally, researchers should take into account the time and effort required to build relationships with people with lived experience (31) and plan for a flexible partnership, as this may be more difficult to maintain virtually, especially as co-production and ppie representatives they may have more responsibilities during this time (32). As restrictions are lifted, mental health research must encompass the ability, but also the responsibility, to work with people with lived experiences of COVID-19 and mental health difficulties.

    Thought 3: Strong and open methods may have been compromised by quick responses

    the thirst for information can threaten the credibility of our work. findings based on inappropriate methods, samples, and untenable evidence risk misinforming the public and, more importantly, policymakers. it is our responsibility to be open and transparent about the methodological strengths and difficulties of our work, and we argue that this should be a strong driver for good research practice and open science. here we reflect on how these have been applied in the covid-19 effort so far.

    limited qualitative research

    In particular, the rapid initial research response to the pandemic was overwhelmingly quantitative. At the time of writing this report, only one in five of the studies registered in the nihr covid-19 and mental health study register reported the use of qualitative and/or mixed methods (11). Encouragingly, these predominantly explore experiences among specific subgroups, such as adolescents (33), mental health service users (34), and foster carers and children in care (35), facilitating a deeper understanding of differential impact. however, the limited number of qualitative studies raises concerns. Despite the growing recognition that qualitative research can uniquely inform mental health policies and services (36, 37), statistical analyzes are overwhelmingly favored over lived experience, and many journals treat qualitative studies as low priority. or they discourage submissions outright (37-39). We are currently facing complex circumstances around the world, with stark disparities in disease and morbidity rates, loss of mourning and bereavement rituals, widespread economic loss and anxiety, repeated changes in restrictions, and school closures, to name a few. we question how effectively we can understand statistical associations or translate knowledge into meaningful action without a deeper understanding of what those issues mean in people’s lives. valuing different methodological approaches and developing an integrated evidence base for mixed methods in mental health is key to facilitating a nuanced and meaningful approach to policy and practice (36, 37).

    methodological concerns

    On the other hand, early efforts to quantify the impact of the pandemic on mental health relied on online surveys using convenience samples, often recruited through social media. however, surveys tend to undersample groups (eg, older people, homeless people, men, minorities) and oversample people who are committed to the issue at hand. furthermore, from a theoretical perspective, it is not possible to correct for non-probability sampling for sampling bias (since the probability of someone being in the sample is unknown), and statistical tests on these samples require more complex modeling and more complex assumptions. strict ( 40, 41). therefore, while non-probability samples allow for quick and cost-effective results, they provide less reliable prevalence estimates (42); drawing inferences from them is problematic, requiring caution when interpreting and incorporating covid-19 findings into policy.

    We acknowledge the important efforts of those involved in rapidly initiating longitudinal surveys of covid-19 (10); indeed, those studies will provide useful insights into people’s ongoing experiences and needs during the pandemic. But, without proper pre-Covid-19 data, these studies tell us little about whether changes in mental health are pandemic-specific. existing cohorts may be valuable in addressing this (43), but many focus exclusively on general populations, highlighting the urgency of establishing new research with marginalized populations, such as nursing home residents and staff.

    issues with measures used in covid-19 research (eg, gad-7, ucla, used in about 36% of covid-minds studies) should also be considered. First, researchers must ensure that the chosen measures are valid by evaluating what they are supposed to evaluate. This is especially the case for measures that have been validated with convenience samples, such as the UCLA Loneliness Scale (44), covid-specific measures that have been hastily developed but lack detailed validation (45), and, more generally, measures that have been developed without input from the intended audience (46), as is often the case with children and youth (47). Now, more than ever, the validity of the measures must be considered, especially across groups, as COVID-19 has a disproportionate impact on the health of older people and ethnic minorities in the UK (48, 49). lockdown approaches have also varied around the world, immediately creating scientific interest in considering age, cross-cultural, and transnational differences. As simple as it sounds, often the measures are not invariant and evaluate different things between samples and/or groups, as is the case, for example, with gad-7 (50). therefore, it is urgent to establish measurement invariance, before meaningful comparisons can be made. Finally, we highlight potential comparability issues with mental health measurement before and after the pandemic. paper-and-pencil questionnaires and face-to-face interviews were moved to a web or telephone mode (51). that they can affect how individuals respond to the same questions, giving different answers in different modes [also known as mode effects; (52)]. investigators should consider that issue in analysis, interpretation, and reporting (53).

    robust methods may still be insufficient if the analyzes are not appropriate. First, when investigating the possible causal effects of COVID-19, researchers must carefully consider which variables to include in their models. inclusion of a collider (i.e., a third variable caused by the independent and outcome variables) (54), and failure to consider key biological and psychosocial mediators or confounders (54, 55), can lead to spurious causal effects (although we note there may be challenges in collecting biological data at this time, particularly with high-risk groups). for example, given the increased focus on loneliness during the pandemic, researchers evaluating this should also consider social anxiety as a potential confounder given previous evidence (56, 57) and recent qualitative evidence from covid-19 ( 58). however, this has been generally absent from current work. this is one of the areas where interdisciplinarity and interinstitutional collaboration would be most useful, as some of these confounders can only be identified through expert knowledge (54). Second, given the wealth of longitudinal studies, we anticipate greater use of crossover panel models. however, some of the covid-19 studies are already employing the traditional panel model, which does not consider “trait-like” differences (between-person effects) and thus does not represent true within-person relationships. over time (59). ). therefore, we urge adopting an appropriate method (for example, random intercept panel models) to avoid inaccurate conclusions about causal processes.

    open science practices

    there has been a widespread and publicly stated commitment to ensure covid-19 related research and data is available, including from funding bodies (e.g. ukri), research journals, institutions (60) and researchers ( 10). At first, the researchers shared study protocols, questionnaires, and materials. Consequently, there may have been greater methodological consistency in the ongoing research than usual, which could allow researchers to better address important questions and triangulate results across samples.

    however, since rapid dissemination is needed when research has vital policy implications and when expert opinion is communicated to policymakers (61), covid-19 mental health research is being conducted and spreading at an accelerated rate. at the time of this writing, the covid-minds network had indexed 225 published articles (10), and a search for “covid and mental and health” found 726 preprints on medrxiv and 128 preprints on psyarxiv as of March 8, 2020 Both preprints and journal articles can work well as parallel means of communicating ongoing mental health research [see fraser et al. (62) for an in-depth discussion], although suboptimal methodological practices within covid-19 research warrant caution in basing policy decisions on preprints. for example, despite the large number of covid-19 preprints, we found only 93 previous records of analysis plans in the open science framework using the above search term. Among other benefits, prior registration is useful to differentiate between planned (confirmatory) and unplanned (exploratory) tests (63). Clearly, open science practices have not been abandoned, but the desire for more knowledge may mean that open science was not quickly applied with the same rigor. for example, it remains unclear to what extent current covid-19 studies have actively sought permission from participants to securely deposit their data for re-sharing and reuse. Sharing research data and code plays an important role in increasing the impact of mental health research, maximizing the value of contributions from participants and patients, reducing research waste, and can help treatment or service provision for others (64, 65).

    It is encouraging that in the wake of covid-19, mental health research has generally embraced the spirit of open science. it is crucial that researchers build on this, ensuring that this initial enthusiasm translates into new norms of openness and sharing in the future.

    Thought 4: This pandemic may exacerbate existing problems of inequality in our workforce

    The pandemic has also highlighted ongoing issues of inequality, not only within the research response, but also in academia more broadly. academia maintains inequality at best, due to hierarchical structures and continued reliance on doctoral students and the precarious roles disproportionately occupied by women and ethnic minorities in the uk (66). the pandemic has exacerbated that. Ph.D. students and precarious staff have already begun to experience research problems, increased stress, and worry about future plans since the pandemic began (67-69). many will be left with expired visas and no job prospects (70), in a system with limited opportunities for those without funds or integrated into established networks. others have faced intensified barriers and lower research productivity, including parents with increased caregiving responsibilities, particularly mothers (71, 72), and those with existing mental and physical health problems. this may have a long-term impact as academic incentives reward publication and funding (72).

    Ultimately, Covid-19 is likely to further widen inequalities within academia and potentially roll back the progress that was being made to address structural inequalities. it is ironic that we are losing and failing to support a significant part of our workforce in a time of need to produce rapid evidence on mental health (73). even before the covid-19 crisis broke out, research showed that casual academic employment is a separate, insecure secondary labor market within the academic workforce (74) as a result of universities relying on a business model that considers precarious academics, especially women, as non-citizens of the academy (75, 76). Failure to address these systemic issues may influence our ability to recruit and retain early-career researchers (77), thus affecting our ability to deliver a mental health research agenda both in “normal” times and in crisis situations. emergency. therefore there is an urgent need for a detailed examination of the uk’s research infrastructure and ways in which we can better support and provide greater stability to researchers on casual or precarious contracts. These include some of the union of university colleges’ long-term recommendations, such as that research funders make it a condition of grants to employ researchers on open-ended contracts, and that universities invest in decassualizing their workforce (75). .

    final remarks

    rapid efforts by funding institutions, heis and mental health researchers have enabled significant progress towards research into the mental health consequences of covid-19 in the uk. however, there are valid concerns that the speed may have compromised elements of quality. we have pondered and identified potential issues within the mental health research response thus far, which we observe may have relevance to mental health research even in non-emergency settings, and indeed to research in other fields . These include issues with fragmentation and duplication, focus (for example, unclear research questions), methods, co-production, and open science approaches taken by covid-19 mental health studies, and implications for equality in our workforce. . it is difficult at this stage to comment on the implications those issues will have had for the quality of our work, but we note the need for caution and care in reviewing the current evidence, especially when it is used to drive policy.

    The covid-19 pandemic is evolving, which requires flexibility and the need to continuously review our research effort and apply learning in the future (78). We note that the reflections presented here are a snapshot of our prospects at the end of 2020, but continue to apply to more recent work, where the same ongoing strengths and challenges seem present. Going forward, research networks and organizations must make a conscious effort to minimize duplication and waste, facilitate collaborative and interdisciplinary work, and coordinate next steps, while identifying and retaining important advances. The response from the mental health research community has highlighted how crucial the right infrastructure is to enable rapid and efficient collaboration across disciplines and sectors, and with people with direct life experience. so far, it is a good sign that ukri’s funding programs continue as before (79), the wellcome trust has confirmed that its research support will continue for now (80), and nihr has committed to funding research exploring the effects of covid-19 beyond the acute phase (81). we have high hopes for further initiatives to develop interdisciplinary teams to address key mental health research challenges (82) and to encourage funders to sustain mental health research. major mental health initiatives put in place by the uk government during this crisis [eg addressing loneliness; (83)] should not be short-lived, and appropriate long-term financing plans should be considered even as the government comes under pressure to manage the national debt and respond to Brexit-related changes.

    As the situation continues to change, we must develop proactive ways to openly review, respond, and share information. with adequate funding, that could involve scoping exercises (eg rapid evidence reviews) to identify emerging trends, and more importantly, ongoing consultations to understand stakeholder needs. Whatever the approach, we must ensure that we conduct robust, open-ended research that builds a nuanced, meaningful, and robust evidence base to advance understanding of the mental health consequences of the pandemic. More broadly, this is a critical opportunity to reflect on new and ongoing issues within our infrastructure and community, engage in collective discussions, and encourage action that can develop and strengthen our field of research for the pandemic and beyond.

    data availability statement

    Original contributions presented in the study are included in the article/supporting material; further queries can be directed to the corresponding authors.

    author contributions

    od and mpa initiated the manuscript, analyzed covid-19 mental health databases, coordinated reflections, and wrote the first draft. od, mpa, sp, af, pq and mpi led to writing the specific sections. pq, la, and cc scanned the current covid-19 funding calls. all authors contributed to the writing of specific sections. all authors contributed intellectual content to the manuscript, edited early drafts, and read and approved the final manuscript.

    conflict of interest

    od is the principal investigator of the TELL study (Life Experiences of Locked-In Adolescents; partially funded by the University of Manchester Economic and Social Research Council Impact Account Fund). mpa is the principal investigator of covid-19, social media & Mental Health Study (unfunded), and participates in the Health and Wellness Survey: Monitoring the Impact of COVID-19 (led by Dr Michelle Lim, Iverson Health Innovation Research Institute, Swinburne University). sp is working on the “oxford study to achieve resilience during covid” (oxford arch study); This project is funded by the esrc [es/r004285/1]. pp participates in various mental health research activities in the context of covid-19. mpi published two articles on mental health and the covid-19 pandemic. this was not funded. cc is the principal investigator for co-space, which is funded by the uk research and innovation council. ro’c reports nihr grants, medical research foundation grants, scottish government grants, nhs health scotland/public health scotland grants, samaritans grants, scottish association for mental health grants, mindstep foundation grants , outside of the work presented ; and he is co-chair of the academic advisory group to the Scottish Government’s National Suicide Prevention Leadership Group. He is also a member of the National Institute of Health and Care Excellence Guideline Development Group for the New Pleasant Self-Harm Guidelines. pq participates in two covid projects: covid-19, social media & Mental Health Study (led by Dr. Margarita Panayiotou) and the Health and Wellbeing Survey: Monitoring the Impact of COVID-19 (led by Dr. Michelle Lim, Iverson Health Innovation Research Institute, Swinburne University) .

    The remaining authors declare that the research was conducted in the absence of commercial or financial relationships that could be interpreted as a possible conflict of interest.



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