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ProtocolKatie Seaborn ‍ ‍,1 Mark Chignell ‍ ‍,2 Jacek Gwizdka3

To cite: Seaborn K,
Chignell M, Gwizdka J.
Psychological resilienceduring COVID-19: a meta-­
review protocol. BMJ Open
2021;11:e051417. doi:10.1136/
bmjopen-2021-051417►► Prepublication history forthis paper is available online.
To view these files, please visit
the journal online (http://​dx.​doi.​
org/​10.​1136/​bmjopen-​2021-​
051417).

Received 18 March 2021
Accepted 04 June 2021

© Author(s) (or theiremployer(s)) 2021. Re-­use
permitted under CC BY-­NC. No
commercial re-­use. See rights
and permissions. Published by
BMJ.
1

Department of Industrial
Engineering and Economics,
Tokyo Institute of Technology,
Tokyo, Japan2
Department of Mechanicaland Industrial Engineering, The
University of Toronto, Toronto,
Ontario, Canada
3
School of Information, The
University of Texas at Austin,
Austin, Texas, USA
Correspondence to
Dr Katie Seaborn;​seaborn.​k.a​ a@​m.​titech.​ac.​jp

ABSTRACTIntroduction The global COVID-19 pandemic continues
to have wide-­ranging implications for health, including
psychological well-­being. A growing corpus of researchreviews has emerged on the topic of psychologicalresilience in the context of the pandemic. However, thisbody of work has not been systematically reviewed for its
quality, nor with respect to findings on the effectivenessof tools and strategies for psychological resilience. To
this end, a meta-­review protocol is proposed with thefollowing objectives: (1) identify review work on the topicof psychological resilience during COVID-19; (2) assess
the quality of this review work using A MeaSurement
Tool to Assess systematic Reviews; (3) assess the riskof bias in this work; (4) generate a narrative summary of
the key points, strengths and weaknesses; (5) identify
the psychological resilience strategies that have beenreviewed; (6) identify how these strategies have been
evaluated for their effectiveness; (7) identify what
outcomes were measured and (8) summarise the findings
on strategies for psychological resilience so far, providing
recommendations, if possible.
Methods and analysis A systematic meta-­review will
be conducted in accordance with the Preferred Reporting
Items for Systematic Reviews for Protocols and Joanna
Briggs Institute umbrella review guidelines. Electronic
searches of general databases, especially Web of Science,
Scopus and PubMed, will be conducted. Only results fromJanuary 2020 onwards will be considered, coinciding
with the COVID-19 pandemic. Only results in English will
be included. Descriptive statistics, thematic analysis andnarrative summaries describing the nature of the reviewed
work and evaluation of psychological resilience strategies
will be carried out.
Ethics and dissemination Ethical approval is not needed
for systematic review protocols. The results of the meta-­
review will be published in an international peer-­reviewed
journal. The raw and summarised data will be shared in
the journal or other open venues.
PROSPERO registration number CRD42021235288.

INTRODUCTION
The COVID-19 global pandemic has beena disruptive force across many areas of life.
In healthcare, mental health and psychological well-­being has emerged as a key topic.1–4
Most nations have strongly recommended orenforced social distancing, self-­quarantine
and physical isolation, all interventions
that have known or predicted impacts on

Strengths and limitations of this study►► The protocol was crafted according to the Preferred

Reporting Items for Systematic Reviews and Meta-­
Analyses for Protocols guidelines.
►► The protocol was designed to be replicable and comprehensive, involving keywords and descriptors thatare highly similar or relevant to psychological resilience so that multiple disciplines can be searched
and a variety of measures can be assessed.
►► The protocol was designed to evaluate the quality of review work conducted during COVID-19,
and so is not limited to systematic reviews andmeta-­analyses.
►► Limiting the inclusion criteria to papers that include
the key term ‘psychological resilience’ in the abstract may lead to potentially relevant papers being
missed.
►► Limiting the inclusion criteria to English papers maylead to language bias.

psychological well-­being.5 This has subsequently raised the issue of how to measure,manage and prevent, if possible, negative
outcomes, ranging from anxiety to depression to suicide.1–3 6–9 Psychological resilience
is defined as positive adaptability or theability to ‘bounce back’ when confronted
with new and especially negative situations
involving adversity, stress and trauma.10–12
In a global pandemic such as COVID-19,
the degree to which populations achieve
psychological resilience, and how, may beessential for combating comorbidities related
to psychological well-­being. In assessing theimpact of psychological resilience on theimpact of COVID-19 on mental stress andmental well-­being, results of different studies
may be systematically biased by the target
populations they observe. Socioeconomic
status13 and cultural factors,14 among others
may all impact the role of psychological resilience in moderating the impact of COVID-19
stressors.
One way to assess the state of affairs while
taking account of factors such as quality andbias in review work is through a meta-­review
process. Meta-­
reviews, also called umbrella

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Psychological resilience during
COVID-19: a meta-­review protocol

Open access

METHODS AND ANALYSIS
Objectives
The goal is to assess the nature and quality of survey workon the topic of psychological resilience, and to summarise
findings on the strategies that have been deployed toassess, maintain and encourage psychological resilienceduring COVID-19. Two research questions follow fromthis: (RQ1) What is the nature and quality of the survey
work published on this topic? (RQ2) What consensus
can be derived from the survey work on strategies used
to assess, encourage and/or maintain psychological resilience during COVID-19? In answering these questions,the following objectives will be met: (1) identificationof review work on the topic of psychological resilience2during COVID-19; (2) assessment of the quality of thisbody of work; (3) assessment of the risk of bias in thisbody of work; (4) generation of a narrative summary of
the key points, strengths and weaknesses revealed by thisbody of work; (5) identification of the psychological resilience strategies that have been reviewed; (6) assessing
the effectiveness of these strategies; (7) identification ofoutcomes and (8) summarisation of the findings so far,with recommendations where possible.
Study design
The meta-­review protocol will be conducted in line with
the Preferred Reporting Items for Systematic review
and Meta-­
analysis Protocols (PRISMA-­
P) guidelines,20
with additional guidance for meta-­reviews according to
Aromataris et al.15
Search strategy and information sources
Scopus, Web of Science and PubMed, the standard
general and broad-­indexing databases, will be searched
in June 2021. Only peer-­reviewed English language publications (eg, not papers posted to archival websites or grey
literature) will be included. Preliminary searches wereconducted on 16 and 19 January 2021 to test the initialqueries and keywords as well as to generate a first look at
the state of affairs. See table 1 for the full search queries.
Eligibility criteria
Study design
All types of systematic research surveys will be included.
Relevant terms are included in the search keywords basedon the typology created by Grant and Booth.21 Unpublished papers will be excluded.
Condition or domain being studied
Survey work on psychological resilience during COVID-19,
involving the general population or specific subsets, andreporting on strategies for assessing, encouraging and/or maintaining psychological resilience during COVID19, will be included. Survey work before COVID-19 or
excluding COVID-19 will not be included. All strategies, whether proposed or evaluated, whether during
COVID-19 or prospectively applied to COVID-19, will be
included. Survey work that does not feature psychological resilience or adjacent topics, for example, personal
strengths, positive functioning, coping strategies, etc, will
be excluded.
Setting
Only work conducted on the COVID-19 pandemic will be
included. However, we will evaluate whether or not thesurveyed reviews include work from before the pandemic.
Time frame
A date range of January 2020 and June 2021 will be set,coinciding with the start of COVID-19 up until the start ofthe planned query searches.
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reviews or overviews of reviews, are systematic reviewsof existing survey work that aim to generate clarity andconsensus on a certain topic or research question.15 16 A
key aspect of meta-­reviews is an assessment of quality of
the review work conducted.15 17 18 The intended beneficiaries are the academic community, the public at large
and especially decision-­makers. Typically, meta-­
reviews
summarise survey work that represents the highest level ofevidence achievable: systematic reviews and meta-­analysesof primary studies.15 Yet, COVID-19 has created a special
situation in which there is an urgent demand for answers
as well as greater flexibility in what gets published.19 This
‘paperdemic’ is raising serious questions about scientificintegrity during COVID-19.19 We expect that the body ofreview work on psychological resilience is no different:
that it has and will be subject to the same pressures oftime and demand. Indeed, a cursory review of the literature that purports to synthesise prior research showsthat much of the work cannot be classified as systematic
reviews or meta-­analyses. Yet, as citation counts and news
coverage indicate, we are relying on this body of work tounderstand the state of affairs and make decisions about
healthcare. As such, the effects of the COVID-19 situation
on research practice need to be acknowledged and integrated into meta-­review protocols. This means expanding
the purview of meta-­review protocols to include otherkinds of survey work beyond systematic reviews and meta-­
analyses. Additionally, protocols must assess the qualityof the methods used, summarise the state of the art andgenerate consensus for healthcare decision-­making.
To this end, the goal of this meta-­review protocol is toprovide a means of systematically surveying the previous
and emerging review work, broadly defined, on psychological resilience published during COVID-19. The
following two-­pronged approach is provided: (1) describe
the nature and quality of this body of work and (2)summarise the findings on the strategies that have been
deployed to assess, maintain and encourage psychologicalresilience during COVID-19. The results of conducting
this protocol will help us understand the state of the literature methodologically as well as summarise the findings
for building knowledge and taking action.

Open access

Database

Metadata

Query

Filters

Web ofScience

Topic (TS)Year (2020,(AB=resilien* AND TS=(resilien* OR psycholog* OR personal* OR positiv* OR “cope” OR“coping” OR “personal strength”) AND TS=((covid OR covid OR coronavirus OR Sars-­
2021),
Cov-2) AND (“literature review” OR “systematic survey” OR “systematic review” OR “rapid Language
review” OR “literature survey” OR “review article” OR “survey article” OR “meta-­analysis”(English),
OR “living review” or “mapping review” or “qualitative evidence synthesis” or “scoping
Doctypereview” or “state-­of-­the-­art review” or “systematized review” or “narrative review” or(Article, Book,“comprehensive review”))) AND LANGUAGE: (English) AND DOCUMENT TYPES: (Article OR Book Chapter,
Book OR Book Chapter OR Early Access OR Proceedings Paper)
Early Access,Proceedings
Paper)

Scopus

Article title, (TITLE-­ABS(resilien*) AND (TITLE-­ABS-­KEY(psycholog*) OR TITLE-­ABS-­KEY(personal*)
abstract,
OR TITLE-­ABS-­KEY(positiv*) OR TITLE-­ABS-­KEY(cope) OR TITLE-­ABS-­KEY(coping))
keywords OR TITLE-­ABS-­KEY(“personal strength”)) AND (TITLE-­ABS-­KEY(covid) OR TITLE-­ABS-­
KEY(covid) OR TITLE-­ABS-­KEY(coronavirus) OR TITLE-­ABS-­KEY(sars-­cov-2)) AND(TITLE-­ABS-­KEY(“literature review”) OR TITLE-­ABS-­KEY(“systematic survey”) OR TITLE-­
ABS-­KEY(“systematic review”) OR TITLE-­ABS-­KEY(“rapid review”) OR TITLE-­ABS-­
KEY(“literature survey”) OR TITLE-­ABS-­KEY(“review article”) OR TITLE-­ABS-­KEY(“survey
article”) OR TITLE-­ABS-­KEY(“meta-­analysis”) OR TITLE-­ABS-­KEY(“living review”) OR
TITLE-­ABS-­KEY(“mapping review”) OR TITLE-­ABS-­KEY(“qualitative evidence synthesis”)
OR TITLE-­ABS-­KEY(“scoping review”) OR TITLE-­ABS-­KEY(“state-­of-­the-­art review”) OR
TITLE-­ABS-­KEY(“systematized review”) OR TITLE-­ABS-­KEY(“narrative review”) OR TITLE-­
ABS-­KEY(“comprehensive review”)))

PubMedTitle/
abstract,
text word

Year (2020,2021),
Language(English)((resilien*(Title/Abstract)) AND (resilien*(Text Word] OR psycholog*(Text Word] ORYear (2020,
personal*(Text Word] OR positiv*(Text Word] OR cope(Text Word] OR coping(Text Word] OR 2021),“personal strength”(Text Word)) AND (SARS-­CoV-2(Text Word] OR covid(Text Word] OR
Language
Coronavirus(Text Word)) AND (“literature review”(Text Word] OR “systematic survey”(Text(English)Word] OR “systematic review”(Text Word] OR “rapid review”(Text Word] OR “literature
survey”(Text Word] OR “review article”(Text Word] OR “survey article”(Text Word] OR “meta-­
analysis”(Text Word] OR “living review”(Text Word] OR “mapping review”(Text Word] OR“qualitative evidence synthesis”(Text Word] OR “scoping review” [Text Word] OR “state-­of-­the-­art review”(Text Word] OR “systematized review”(Text Word] OR “narrative review”(TextWord] OR “comprehensive review”(Text Word]))Selection process
One researcher will run the search queries. The
researcher will then extract the results to Zotero, areference management software. Two researchers will
screen the results by applying the inclusion/exclusion
criteria based on the title and abstract. Two researchers
will then independently rate the quality of the surveys
using A MeaSurement Tool to Assess systematic Reviews(AMSTAR-2).22 Inter-­rater reliability testing using
Cohen’s Kappa statistic will be used. Disagreements will
be discussed and re-­assessments will take place until a
Kappa value of ≥0.80 is achieved between the ratings ofthe two researchers. A third researcher will be involved
as a tiebreaker in the case of unresolvable disagreements
between the two researchers. Papers that were mistakenly
included in the first step or are of poor quality (three orless) will be excluded. Google sheets, Covidence and/or SRDR+ will be used to track and record decisions andratings and their analysis.

demographics, setting and context, number of databases sourced and searched, date range of databasesearches, publication date range of studies, number ofstudies, types of studies, country of origin of studies, study
quality assessment tool used, quality ratings of studies,outcomes reported, method of synthesis/analysis/narrative, measures and instruments related to RQ2, assessment of these measures, effect sizes with CIs, thematic orcontent frameworks and major findings. Missing data will
be marked with a dash. Google sheets, Covidence and/or
SRDR+ will be used to record the data.

Data collection and extraction process
Three researchers will divide the corpus of papers andextract the data independently, but within the same
shared spreadsheet/database. Extracted data will include
citation details, objectives, type of survey, participant

Outcomes
Several outcomes are expected for RQ1. A descriptionof the nature of surveys conducted will be produced.
An assessment of the quality of the body of work using
the AMSTAR-2 tool22 will be provided. An assessmentof the risk of bias across studies identified will be generated using a funnel plot of effect size over standardisedmean differences plus a measure of heterogeneity, as per
the Cochrane PRISMA guidelines.23 Finally, a narrative
summary of key features, including strong points andweaknesses across the body of work, will be derived. Next
steps will be presented in the form of a research agenda.

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Table 1 Search queries

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Risk of bias (quality) assessment
The ratings resulting from the application of the
AMSTAR-2 tool22 during the study screening phase will be
used to assess the quality of each included survey and theoverall quality of the body of survey work. The ratings will
be processed in line with Natto and Hameedaldain,24 thatis, converted to numbers and summed. Where discrepancies in ratings occur, the average (mean) score between
raters will be used.
Data analysis and synthesis
In line with Aromataris et al,15 we will analyse and synthesise the quantitative and qualitative data separately, pereach of our meta-­review research questions.
To answer RQ1, we will provide descriptive statistics on
the nature of the surveys, including mean values, medians,
SD and interquartile ranges for all quantitative variables.
We will use t-­tests to check if gender and other key demographics or variables were equally distributed. For quality,
we will categorise the scores from the AMSTAR-2 toolaccording to the quality categories provided by Shea et al.22
We will then take a random selection of other pre-­COVID
meta-­reviews that used the AMSTAR-2 and compare the
distribution across categories with our dataset.
To answer RQ2, we expect diverse research data, so wewill divide the findings by quantitative and qualitative
data reported. Quantitative data will then be summarised
based on variable, measures, effect sizes and outcomes.
Where possible, we will do meta-­
analyses. Qualitative
data will be summarised in narrative form based on
phenomena of interest.
Patient and public involvement
No patient or public involvement is planned. However,
the raw and summarised data will be made available after
publication.

DISCUSSION
Meta-­
reviews are urgently needed as the COVID-19
global pandemic continues to play out. We must understand the state of affairs in research survey work as wellas the state of the art on healthcare topics. COVID-19
is the first global pandemic in the modern communications era, meaning that it is also the first where theimpacts of social distancing and other interventions havebeen moderated to some extent by digital technologies.
Many of the impacts of COVID-19 appear to be similar
across a broad range of countries, with responses suchas antimask and antilockdown protests occurring acrossdiverse societies and cultures. The stressors created by
COVID-19 have been many and varied, testing the resilience of people in different contexts. Examples include
people sheltering at home, young people who have
had their social lives curtailed or schooling impaired,older people who have become more isolated andperhaps even ‘imprisoned’ in residences or care homes,
essential workers who are exposed to COVID-19, long-­
haulers and front-­line workers. Each of these COVID-19
contexts offer unique, perhaps ‘once in a century’
opportunities to study resilience in different contexts
on a global scale.
The proposed overview of reviews we have describedin this article will capture a snapshot of how resiliencehas been studied in the time of COVID-19. It is characterised by a reproducible procedure, including descriptions of data sources, search strategy, and data extraction
methods. Thus, we have contributed a comprehensive
and replicable meta-­
review protocol on a timely andvital topic—psychological resilience—that will serve tocapture and critically evaluate the quality of review work
as well as generate a synthesis of health outcomes andpotentially recommendations across fields of study andmodes of practice. The meta-­review is expected to provide
consensus on outcomes and provoke a more comprehensive, critical view of survey work during the pandemic.
Twitter Mark Chignell @MarkChignell
Contributors All authors made substantial contributions to the work. KS: led thedesign of the protocol and drafted the paper. MC: contributed to the protocol design,
focusing on the data analysis portion and selection of the quality assessment
instrument. JG: contributed to the protocol design, focusing on the keywords andquery design. MC: critically reviewed and refined the draft. All authors sourced
references. All authors confirmed the article before submission.
Funding Open access fee was funded by an NSERC Discovery Grant awarded toMC.

Ethics and dissemination
No ethics review process was necessary for this work. We
do not foresee any safety issues related to this work. We
will publish the results of this protocol as a complete
meta-­
review paper in an international peer-­
reviewed
reputable academic journal. We will provide the extracted
and summarised data in spreadsheets or similar formats
through the journal and/or our institutional repositories, non-­for-­profit research archives and/or our personal
websites.

Competing interests None declared.

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Patient and public involvement Patients and/or the public were not involved in
the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Open access This is an open access article distributed in accordance with theCreative Commons Attribution Non Commercial (CC BY-­NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non-­commercially,and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the use
is non-­commercial. See: http://​creativecommons.​org/​licenses/​by-​nc/​4.​0/.

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For RQ2, any findings related to the evaluation of
psychological resilience strategies will be summarised
quantitatively or in narrative form. Measures could
include standardised mean differences (continuous variables), ORs (dichotomous variables), descriptive statistics
for tests of internal and external reliability (eg, Cronbach’s alpha), thematic or content analyses of qualitative
data, and more. We will use standard statistics software,such as SPSS, R and Microsoft Excel, to conduct theseanalyses.

Open access

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REFERENCESBMJ Open: first published as 10.1136/bmjopen-2021-051417 on 18 June 2021. Downloaded from http://bmjopen.bmj.com/ on June 18, 2021 by guest. Protected by copyright.

ORCID iDs
Katie Seaborn http://o​ rcid.​org/​0000-​0002-​7812-​9096
Mark Chignell http://​orcid.​org/0​ 000-​0001-8​ 120-​6905