RAMPing up a multidisciplinary understanding of Covid-19 impact

Since the outbreak of Covid-19, many of us have undergone major changes to our daily lives, such as staying away from friends and family, and limiting time outside of our homes. We don’t yet know what the psychological effects of this new situation will be; whether it will affect how we think, feel and act or the impact on our households, health and lifestyle. The Repeated Assessment of Mental health in Pandemics (RAMP) study aims to investigate the effect of the Covid-19 pandemic on the mental health and wellbeing of the UK population.

This is achieved through repeated online questionnaires (every two weeks) asking participants to report on symptoms of a range of mental health conditions, as well as their living and work situations, their physical health, and cognitive and behavioural factors that may impact on wellbeing. The goals of the RAMP study are to measure the short and long-term impact of the pandemic on mental health, as well as to understand factors that impact risk and resilience to mental health conditions during a global crisis.

There are a number of different studies currently aiming to explore the mental health impact of the pandemic. The RAMP study’s approach is distinctive in a few key aspects. First, the assessment of mental health in RAMP is broad, examining the impact not only on anxiety and depression, but also symptoms of other conditions that may be affected, such as psychosis, mania, OCD, PTSD, ADHD and eating disorders using clinically validated scales. Secondly, there is also a broad assessment of contextual, cognitive and behavioural factors that may moderate or mediate the impact of the pandemic on symptom levels. This will allow investigation of individual difference factors related to risk or resilience. Thirdly, RAMP includes measures of respiratory and neurological symptoms which will critically allow investigation of associations between physical and mental health symptoms longitudinally. Combining measures across research disciplines in this way allows for a comprehensive, multidisciplinary perspective on the psychological impact of Covid-19. 

Beyond measuring the degree of chance in symptoms of mental health conditions over the course of the pandemic, RAMP aims to further understanding of the impact of stress on mental health in two important ways. First, to assess whether factors typically linked to risk/resilience (e.g., loneliness, worries, self-care etc.) for mental health problems are also associated with changes in mental health during the chronic stress of a pandemic. Identifying the extent to which these factors impact mental wellbeing can inform guidance for future waves of Covid-19, other pandemics or global crises. Secondly, as the pandemic is a population level chronic stressor, there is a potential to understand risk and resilience to stress at large scale, accounting for many individual difference factors which may not be possible in smaller scale studies. However, understanding how representative responses to the chronic stress of a pandemic are to daily life experiences will be critical in using this information to improve the lives of those affected. This question is far from simple given the lack of a comparison group not currently experiencing the chronic stress of a global pandemic. RAMP aims to address this question in part through linking up with existing cohort studies (e.g., the Genetic Links to Anxiety and Depression; https://gladstudy.org.uk/) to try to understand how current experiences relate to pre-pandemic mental health. 

While it may be easy to assume that the pandemic will have a negative impact on mental health for all individuals, this may not necessarily be the case. The RAMP study design was reviewed by a panel of individuals with lived experience of mental health conditions, a process which highlighted the possibility for potentially unexpected positive impacts of the pandemic. For example, reductions in daily commuting and expectations for social interaction may provide temporary relief among those who find these experiences stressful. Others who may have learned coping skills through experiences of prior stress or trauma may also be well-equipped to adapt to the change in lifestyle induced by the pandemic. As described above, the RAMP study design includes assessment of contextual factors, including prior diagnosis of mental health conditions, allowing exploration of these possibilities.

RAMP is currently looking for participants and would like to hear from people from all across the UK. To take part, you must be a resident of England, Scotland, Wales or Northern Ireland and be over the age of 16. You will first be asked a series of questions about your current living situation, your wellbeing and your mental and physical health. You will then receive shorter follow up surveys every two weeks and very short questionnaires after major government announcements. You can find out more and participate at the RAMP website (https://rampstudy.co.uk). For researchers interested in learning more about the measures and procedures involved in RAMP, study materials are available through the Open Science Framework (https://osf.io/ux2rj/). 

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The RAMP study research team includes Dr Katherine Young (PI), Dr Kirstin Purves, Shannon Bristow MSc, Professor Gerome Breen, Professor Thalia Eley and Professor Matthew Hotopf. Several of the team are wholly or partially supported by the National Institute for Health Research (NIHR). This research was reviewed by a team with experience of mental health problems and their carers supported by the National Institute for Health Research Maudsley Biomedical Research Centre via King’s College London and South London and Maudsley NHS Foundation Trust. This study is in partnership with MQ, the UK’s leading mental health research charity. The researchers received funding for the study through the King’s Together Rapid Covid-19 call, a pilot funding scheme from King’s College London which aimed to engage rapid research on the disease.