“Our goal is to nurture research and build capacity among young researchers in the sphere of mental health,” said Renier Steyn of the Graduate School of Business Leadership at the University of South Africa. “The aim is also to work on something meaningful and make a contribution to mental health knowledge – hence the focus on post-traumatic stress and COVID-19.”
Along with Erhabor Idemudia of the Faculty of Humanities at North-West University and Jürgen Becker of the Department of Industrial Psychology at the University of the Western Cape, Steyn was outlining plans for a long-term, multi-level, focused research project involving students and researchers from multiple institutions and countries. (The other member of the group is Ugasvaree Subramaney of the Department of Psychiatry at the University of the Witwatersrand.)
“This project is aimed at managing the psychological impact of communicable diseases on mental health,” said Steyn. “The assumption is that the COVID-19 pandemic is not an isolated case, and that strategies can be developed to manage current and future epidemic outbreaks. We will propose a model to identify individuals at higher risk, and also assess the effectiveness of preventive and treatment interventions.”
“Big problems need big research and big solutions,” added Becker. “This is not a new idea but has not always been done well. It needs to be run as a project not a research study with multiple layers of participation. The project will be structured in such a way that several investigators contribute to the study, focusing on different dimensions and settings.”
They explained that they will use the DSM-5 diagnostic criteria for post-traumatic stress which includes aspects like exposure to the threat of death, repeated exposure to adverse events and direct experience of trauma – all of which are clearly likely to be experienced by individuals as a result of the COVID-19 pandemic. Symptoms outlined in the DSM-5 include severe alterations in cognition and moods as well as disturbance to social, occupational or other aspects of life.
Idemudia indicated that the studies will incorporate both the individual, which includes looking at age, gender, socio-economic status, pre-existing conditions and underlying illnesses, as well as the context, which includes the relationship between culture and aspects such as social support, and the disease. “Individual and community capacity for psychological well-being, the psychological and social capital available, induces resilience and acts as a coping mechanism for dealing with adversity. These can act as moderators of PTSD,” he explained.
“We also hope to understand the effects of the pharmacological and psychotherapy history of the participants – for example, their present use of antidepressants and other mood stabilisers, to get a grasp of the disease. This is where Subramaney will make a valuable contribution.”
A long road
Becker stressed the need for long-term research and also research with an understanding of the compound nature of PTSD due to COVID-19 in addition to other underlying stressors. “Descriptive research is by nature cross-sectional, a snapshot, often with small sample sizes and therefore low statistical power,” he said. “This is a big event which affects the whole population. You need bigger data, longitudinal work with multiple data points, and sophisticated analytical techniques. We want to tick all the boxes.”
He pointed out that it’s about understanding initial symptoms but also their development over time. “We know there will be a long-term impact. The effect on the economy – on par with that of the Great Depression –means a potential fall out for at least six years.”
“The real effects will only emerge in time,” added Steyn.
Becker pointed to two major criteria for the work – how best to respond comprehensively and how to test variations in recovery. “It’s definitely not a shot-gun approach,” he continued. “We need to understand the impact of all factors and get to treatment with the lowest cost and highest impact.”
He also pointed to the need for more objective data. “Mental health is sensitive,” he said. “It’s a research subject riddled with biases, and strongly influenced by language and cultural values. We are working with current partners from the University of Los Angeles, well versed in such research. The data also have the potential to be used in cross-cultural studies, and, to be comparable, datasets must be set up in a standardised way.”
“We need to ensure we can integrate the variables in an intelligent manner,” said Steyn.
Describing the research as also “a study in education using COVID-19 as the case study”, Steyn emphasised the importance of developing young scientists and research capacity in mental health in South Africa. The project will incorporate careful design to empower young investigators to improve their research skills and academic agendas.
The presenters stressed that joining a ‘projectivised’ research project, can help students to focus on clear research objectives early in their careers and assist them to align their efforts with those of seasoned academics – while at the same time contributing towards solving important research questions. The overall strategy is to make available this COVID-19/PTSD research proposal to a diverse pool of students and supervisors, each taking ownership of a part of the research project. The smaller projects will be hosted by several universities and supervised by an experienced cohort of supervisors. It’s hoped that this will increase collaboration, as well as knowledge exchange between universities.
“It’s a large enough project to provide many opportunities,” added Idemudia. “We are setting up the laboratory for different but interdependent research projects, at different levels of complexity.”
“It’s about building institutional strength and momentum,” continued Becker. “The work should be relevant to the education of the next generation of researchers, and for any traumatic event beyond COVID-19.”
“If we can pull off one tenth of what we have in mind, it will have a huge impact.”
Michelle Galloway: Part-time media officer at STIAS
Photograph: Anton Jordaan