Thesis A thesis of clinical research and practice [psychology and Long Covid], 2023, Petker

Source: University of Surrey Date: September 29, 2023 URL: https://openresearch.surrey.ac.uk/e...hesis-of-clinical-research-and/99794064802346

https://openresearch.surrey.ac.uk/v..._INST&filePid=13187759600002346&download=true

A thesis of clinical research and practice: Part A: [Psychological Associations with Long Covid]; Part B: [Long Covid: Finding Resolution in a Dichotomised World]; Part C: Summary of clinical practice and assessments
----------------------------------------------------------------------
Saara Petker - School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, U.K.

Abstract

A significant proportion of the population that have previously contracted the Covid-19 virus have gone on to develop long lasting symptoms known as Long Covid. Despite its prevalence, Long Covid remains a poorly understood medical condition. Existing research has portrayed the role of psychological processes in similar medically unexplained illnesses such as chronic fatigue and pain. Therefore, this thesis aimed to explore the psychological component of Long Covid, specifically understanding the role of psychology in the onset and experience of Long Covid.

Part one of this portfolio presents an empirical paper investigating psychological risk factors for Long Covid using quantitative measures. The study was initially designed to gather cross-sectional and longitudinal data; however, due to ethical issues only the cross-sectional component was completed. The study received criticism from potential participants regarding its psychological outlook on Long Covid. This ultimately led to the discontinuation of the study, resulting in a significantly smaller sample size than planned (n=95) and no longitudinal component. The findings showed no significant associations between psychological factors and Long Covid. The null findings were likely impacted by the cross-sectional methodology and small sample size.

Part two of this portfolio presents a second empirical paper which qualitatively investigates the role of psychological processes in the lived experience of Long Covid. Due to the response to the first study, this paper additionally explores patients’ own beliefs about psychology’s role in their condition. The findings reveal themes of fear relating to the uncertainty of Long Covid, feeling disbelieved, and searching for a cause. They additionally suggest that while Long Covid patients reject claims that psychology plays a causal role in their illness, many recognise that the course of illness is impacted by psychological processes.

 

There were some major issues with this study. I have asked ChatGPT to remove the line breaks that came as a result of formatting issues when copying the text, but not alter the text in any other way. So I believe the text is preserved.

AI-aided summary:

The study initially received ethical approval for a two-stage research design exploring psychological risk factors for Long Covid. It aimed to collect cross-sectional and longitudinal data to assess the relationship between psychological factors and Long Covid symptoms. However, after a Facebook post advertising the study received backlash from users, formal complaints were made to the Research Integrity and Governance Office (RIGO). As a result, permission to recruit via social media was revoked by RIGO, limiting participant outreach and preventing the longitudinal component of the study. The researcher was only permitted to share the survey within personal contacts, significantly reducing the sample size and introducing pro-psychology bias.

The full story:

Planned Design & Ethical Limitations
The research proposal initially received full ethical approval from the University Ethics Committee (see Appendix A) to conduct a two-stage study consisting of both cross-sectional and longitudinal methods to explore the psychological risk factors for Long Covid. The study was advertised to recruit participants with either a previous or current Covid-19 infection, or no prior Covid-19 infection (see Appendix B). Stage one aimed to gather cross-sectional baseline data using an online survey containing measures on sense-making processes and social contacts (predictor variables) and whether participants had Long Covid (outcome variable). Cross-sectional analyses aimed to explore differences between groups with and without Long Covid in their sense-making processes and social contacts, providing initial data on the relationship between psychological processes and Long Covid. Stage two would have followed up with participants one-year post-survey and repeated the same measures with the assumption that many of those who had no prior Covid-19 infection would have contracted it in the following year, and those with a previous or current infection may have developed Long Covid. Outcome data would have explored the persistence of Long Covid (e.g., 12 weeks, 6 months, 12 months plus). Thus, outcome data gathered at stage two would have been explored for associations with predictor variables gathered at baseline and follow-up. Multiple Regression analysis would have then indicated whether psychological factors predicted the persistence of Long Covid symptoms.

Following the study launch, however, a Facebook post advertising the study received several comments from users expressing dissatisfaction with the study aim of understanding Long Covid from a psychological perspective. Comments on the post related largely to discontent with the biopsychosocial model of health and misconceptions that ‘psychosocial’ implied that Long Covid is ‘all in the mind’. Attempts were made to diffuse frustration via a Facebook comment addressing the concerns; however, this was unsuccessful and escalated into formal complaints to the Research Integrity and Governance Office (RIGO). The study was immediately paused at 90 responses, the Facebook post removed, and all research documentation including the recruitment advert, participant information form and consent forms were scrutinised by the researcher, RIGO and the ethics board. All forms were edited to make exceptionally clear the idea that Long Covid is a medical condition caused by a virus and that the researcher was interested in how thoughts, feelings and behaviours may impact the experience of Long Covid, as guided by a large body of existing literature.

Despite efforts to resolve concerns with the ethics committee and RIGO, the study did not receive ethical approval to continue recruitment on social media due to concerns around further complaints. The researcher received ethical approval to circulate the survey link amongst personal contacts only without the use of social media and analyse existing data (see Appendix C). Therefore, the researcher was unable to continue with the planned longitudinal component of the study.

The decision taken by the University Ethics Committee to cease recruitment precluded the researcher from continuing with their prospective, longitudinal cohort study design which would have aimed to test the hypothesis that psychological processes are involved in and can predict the onset of Long Covid. The withdrawal of ethical approval further prevented the study from appealing to a demographic who appeared to be less ‘pro-psychology’ and capturing their data to reduce bias in the sample and increase generalisability. This also resulted in a significantly smaller sample size than originally planned (n=95 rather than n=180-270).

The ethical challenges faced in this study raised questions around attitudes held by the Long Covid patient group towards psychological input for their condition. The process with ethics highlighted the power of the patient voice, in that research was terminated as a result of strong emotions expressed by patients with Long Covid, and additionally those with co-morbid chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME). Along with the recommendations for future research outlined above, it would be of clinical importance to seek to understand the resistance towards psychology that appears to exist within members of this patient group. Failure to understand and overcome this resistance could create barriers in reaching the patient group and implementing psychologically informed interventions.