PERSPECTIVE published: 28 August 2020 doi: 10.3389/fpsyg.2020.02160 Mitigating the Impact of the Novel Coronavirus Pandemic on Neuroscience and Music Research Protocols in Clinical Populations Efthymios Papatzikis 1,2* , Fathima Zeba 1 , Teppo Särkämö 3 , Rafael Ramirez 4 , Jennifer Grau-Sánchez 5,6 , Mari Tervaniemi 3,7 and Joanne Loewy 8 1 Department of Psychology, Canadian University Dubai, Dubai, United Arab Emirates, 2 Latifa Women and Children Hospital, Dubai, United Arab Emirates, 3 Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland, 4 Music and Machine Learning Lab, Universitat Pompeu Fabra, Barcelona, Spain, 5 Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Spain, 6 Escola Universitària d’Infermeria i Teràpia Ocupacional de Terrassa, Autonomous University of Barcelona, Terrassa, Spain, 7 Cicero Learning Network, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland, 8 The Louis Armstrong Center for Music and Medicine, Mount Sinai Beth Israel, Icahn School of Medicine, New York, NY, United States The COVID-19 disease and the systemic responses to it has impacted lives, routines and procedures at an unprecedented level. While medical care and emergency response present immediate needs, the implications of this pandemic will likely be far-reaching. Edited by: Most practices that the clinical research within neuroscience and music field rely on, Andrea De Giorgio, eCampus University, Italy take place in hospitals or closely connected clinical settings which have been hit Reviewed by: hard by the contamination. So too have its preventive and treatment measures. This Tracey McConnell, means that clinical research protocols may have been altered, postponed or put in Queen’s University Belfast, complete jeopardy. In this context, we would like to present and discuss the problems United Kingdom Graham Frederick Welch, arising under the current crisis. We do so by critically approaching an online discussion University College London, facilitated by an expert panel in the field of music and neuroscience. This effort is United Kingdom hoped to provide an efficient basis to orient ourselves as we begin to map the needs *Correspondence: Efthymios Papatzikis and elements in this field of research as we further propose ideas and solutions on efp331@mail.harvard.edu how to overcome, or at least ease the problems and questions we encounter or will encounter, with foresight. Among others, we hope to answer questions on technical or Specialty section: This article was submitted to social problems that can be expected, possible solutions and preparatory steps to take Psychology for Clinical Settings, in order to improve or ease research implementation, ethical implications and funding a section of the journal Frontiers in Psychology considerations. Finally, we further hope to facilitate the process of creating new protocols Received: 28 May 2020 in order to minimize the impact of this crisis on essential research which may have the Accepted: 03 August 2020 potential to relieve health systems. Published: 28 August 2020 Keywords: COVID-19, music and neuroscience, music therapy, music and neuroscience research protocols, Citation: research crisis response Papatzikis E, Zeba F, Särkämö T, Ramirez R, Grau-Sánchez J, Tervaniemi M and Loewy J (2020) Mitigating the Impact of the Novel INTRODUCTION Coronavirus Pandemic on Neuroscience and Music Research The novel coronavirus disease (COVID-19) and the consequent systemic responses have impacted Protocols in Clinical Populations. lives, systems and procedures at an unprecedented level. While medical care and emergency Front. Psychol. 11:2160. responses are the need of the hour, the implications of this pandemic are more far-reaching doi: 10.3389/fpsyg.2020.02160 having direct consequences on health sciences and research. Neuroscience and music research, Frontiers in Psychology | www.frontiersin.org 1 August 2020 | Volume 11 | Article 2160 Papatzikis et al. COVID-19 on Neuroscience and Music Research Protocols and specially studies of music therapy, often take place in TABLE 1 | Breakdown of participants’ demographics. hospitals and health services. However, daily practices at these Argentina 1 Latvia 1 institutions have been reorganized to provide treatments for Brazil 1 Malaysia 1 patients diagnosed with COVID-19, as well as to prevent the Canada 16 Mexico 2 spread of the disease among professionals and patients with China 1 Myammar 1 other conditions. As a result, relevant to music and neuroscience Colombia 2 Netherlands 3 clinical research protocols have been subsequently temporarily Cyprus 2 Nigeria 1 suspended, put in jeopardy, or have been altered. Denmark 2 Poland 1 In this context, we would like to present and then address the Ecuador 1 Portugal 4 problems – related to methodological, technical, and potential Egypt 1 Qatar 1 psychosocial ramifications – that music and neuroscience Estonia 3 Russia 1 researchers in clinical settings may be facing. We do so by Finland 4 Singapore 1 consolidating the insights gleaned from an international online France 5 South Africa 4 forum attended by clinicians and researchers in the field of music Georgia 1 Spain 13 and neuroscience. It is hoped that this effort will provide ideas, Germany 4 Sri Lanka 1 answers to questions, and possible solutions to problems in the Greece 19 Switzerland 3 ongoing or anticipated impact of COVID-19 on active research Hong-Kong 2 Taiwan 1 protocols, thereby improving research implementation, ethical Hungary 2 Turkey 2 implications and subsequent funding considerations. We further India 17 United Arab Emirates 87 hope to facilitate the process of creating new protocols in order Ireland 1 United Kingdom 16 to minimize the impact of this crisis on essential research which Italy 8 United States 76 may have the potential to relieve health systems. Jordan 1 Unknown 78 THE DISCUSSION CONTEXT THE DISCUSSION THEMES The pandemic crisis has brought a myriad of new challenges The six themes presented below, roughly outline the COVID-19 to research practices in the international research community. crisis research situation, while also bringing to the forefront some It has also seemingly fostered the potential for a pioneering of crucial points to consider for future planning. new insights, beckoning professionals to examine how they can interact and solve problems in their respective scientific fields in novel ways. Many such insights were addressed during an online Factors Directly Affecting Protocols interaction held on April 15th, 2020. The forum, employing the Changed Timelines Webex platform, provided the opportunity for a discussion of Governmental policies facing the COVID-19 pandemic led to these issues and potential solutions related to active music and the cessation of many professional activities in the majority of neuroscience clinical research protocols during the COVID-19 countries, either because “essential activities” were the only ones crisis period. Live polls were also conducted through the Webex permitted to take place, or because restrictions interfered with platform, where participants could choose to answer questions the usual and customary development of these activities. In the posed by the organizers through an interactive platform. The field of music, music therapy and neuroscience research, these discussion panel was comprised of five clinicians and researchers governmental policies have a direct effect on data collection. in this specific field joining from Finland, the United States, Spain Researchers in this field may continue designing studies, and the United Arab Emirates. The discussion was attended by analyzing data and/or preparing their manuscripts, however, 392 participants from 41 different countries (for a breakdown on some on-going and about-to-start studies were forced to stop participants’ demographics please see Table 1). There was a mix their protocols as either researchers or participants are unable of academics, researchers and students of all levels. Among those to get to the lab, hospital or health service clinic. This is a who responded to the polls (60.15%) 35% were actively involved critical issue particularly for clinical trials which follow specific, in music and neuroscience research. Similarly, the polls reported pre-set protocols. Researchers are faced with difficult choices and that 29% were planning to research in the area, and another 43% fast decisions on questions such as “can the music intervention were contemplating researching in the areas of neuroscience and be altered so that it can be implemented through remote music. Each of the panelists presented their viewpoints, while communication” and “how does stopping and restarting the sharing their own distinct crisis reality each through a unique intervention later affect the design of the study.” lens. The themes that emerged were explored, categorized and expanded on by the authors who were also the panelists. Six Technological Challenges in Adapting to Changes major themes were revealed following an informal analysis of Music-based interventions are complex as they have several the discourse after the end of the teleconference. These were interacting components (Craig et al., 2008). Adaptation of based on the panel discussion, and the questions posed from the intervention protocols require a theoretical understanding of participants, as well as the live survey-polls. how these components contribute to the treatment success; Frontiers in Psychology | www.frontiersin.org 2 August 2020 | Volume 11 | Article 2160 Papatzikis et al. COVID-19 on Neuroscience and Music Research Protocols which components are essential; and how possible modifications socializing or traveling to attend research sessions if needed. to remotely implement the intervention would affect the It was also noted that especially research focusing on music group participants and the study outcomes. Further collaborations and interventions can no longer be conducted in many places around interaction with other fields such as engineering/information the world due to the restrictions on mobility and allowed size of technology are needed to effectively adapt interventions for their any type of group gathering. Tragically, in ongoing clinical trials virtual or remote implementation. Apart from the technical and longitudinal studies, it can also be anticipated that there will challenges, new ways of delivery also posit several ethical be participants who dropout of studies because of COVID-19, challenges, such as ensuring the safe and secure collection, and either directly because of illness or death or indirectly because storage of clinical data, as well as data potentially gathered at of changes in life situation. While further recruitment might be participants’ homes (Stanberry, 2006; Kaplan and Litewka, 2008). feasible later on, at the very epicenter of the pandemic, it is Moreover, implementation of adapted interventions requires quite difficult to proceed with it at present. If the pandemic and piloting and testing procedure feasibility, processes that take the state of emergency continue for long, it may also negatively time and can delay a rapid response to this situation. For affect the general willingness and motivation of people, especially on-going studies, adapting an intervention protocol would force the high risk groups most affected, to participate in research as researchers to analyze the data of those participants who received subjects, as it may be seen as unsafe or abortive. the intervention in an adapted form, separately from those who In parallel, it was noted that the sample recruitment participated under normal clinical conditions. difficulty will most definitely affect the context of music and neuroeducation, too – a closely related field with challenges Loss of Control Over Confounding Variables similar to those met in music rehabilitation. Its importance Prolonged breaks in interventions and treatments if the study is intrinsic in those studies which aim at revealing brain is interrupted and restarted later may have direct consequences bases for the development of music skills, and which also on research quality. One of the main challenges when restarting explore the existence of transfer skills influenced by music a protocol will be to ensure that the conditions related to activities. These studies recruit participants from newborns until the setting, professionals and procedures remain as similar as adolescence mostly in longitudinal paradigms, and they face possible to the conditions set before the crisis. However, it is similar constrains and uncertainties in the current situation. uncertain how hospitals and health services are going to operate in the future. Researchers will have to analyse these contexts and Factors Due to the Setting control their changes to avoid potential confounding variables. Music, music therapy and neuroscience research most frequently Confounds can also occur due to the nature of the populations occurs in clinical settings. With some hospitals placing that are usually involved in neuroscience and music studies. restrictions on “non-essential” services, research for many has Research in music, music therapy and neuroscience often involve come to a grinding halt. For example, neonatal intensive care vulnerable populations. These populations are inevitably prone units (NICUs) are a common setting in which to conduct music, to being affected by isolation, and the lack of activity and music therapy and neuroscience research on infants. In adult rehabilitative treatments during this period, as well as by the neurological and neurodegenerative disorders, such as stroke predicted future economic crisis. There may be long-term and dementia, much research takes place in the context of negative physical, cognitive and psychosocial consequences in rehabilitation units and care homes. In the COVID-19 pandemic, these vulnerable populations, which will force researchers to these facilities are now among the most isolated units as their redefine music-based interventions and protocols in the future. clinical populations are highly vulnerable and at high risk for Researchers may be asked to address new needs that may contagion, and are therefore out of bounds when it comes to arise, consequently changing how protocols for treatment are participating in music intervention research. The cruel irony is instituted and measured. that especially in this situation, music could actually be a most valuable tool for many to cope with the stress, loneliness, and Factors Directly Affecting the Sample social exclusion caused by the quarantine-like isolation measures While the domain of neuroscience and music promotes imposed by COVID-19 management. With the ICUs being filled exploratory studies on brain development (for example up and overloaded, there is no longer the time or patience to Papatzikis, 2017; Putkinen et al., 2019; for a review see do music research, even though music-based intervention might Tervaniemi et al., 2018), quite a lot of research in the field is improve not only patients but also professionals’ well-being. rehabilitative in nature (Särkämö et al., 2016; Cheever et al., Regarding the methodological side, music and neuroscience 2018). The rehabilitative studies in the field include recovery research typically utilizes neuroimaging equipment and facilities, from stroke and brain injury as well as other neurological and such as electro- or magnetoencephalography (EEG/MEG) and neurodegenerative disorders. Additionally, the specific field deals magnetic resonance imaging (MRI). This equipment is often with neurodiverse research population paradigms focusing on located within the hospital setting. Therefore, physical access to autism, ADHD and pre-term infants (Loewy et al., 2013). these facilities by researchers is now not only limited by more One apparent element of the discussion was that populations stringent hospital safety policies but also because in most affected with high vulnerability to the disease cannot physically countries available resources are devoted to patients diagnosed participate in active research at the moment, due to possible with COVID-19. Also, performing the measurements entails coronavirus exposure, while having even more difficulty safely being in close physical proximity with the participant (e.g., when Frontiers in Psychology | www.frontiersin.org 3 August 2020 | Volume 11 | Article 2160 Papatzikis et al. COVID-19 on Neuroscience and Music Research Protocols attaching EEG electrodes or the MRI head coil) which is not research dealing directly or indirectly with COVID and its public possible due to the need to keep the minimum physical distance, health outcomes. typically specified as 2 meters in the COVID-19 guidelines.While Over a longer period, the economic crises that may be remote or online data collection, for example with e-forms or imminent could lead to a general reduction on the level through various video chat apps, is an option in many fields of of science funding, which, in turn, may affect prioritization research, it is unfortunately not possible in applied neuroscience. of where the reduced funding is allocated. In the ensuing funding competition, smaller, more niched areas of research, Interfering Research Variables including music neuroscience, may take the heaviest tolls. In Like all experimental research, research in music, music therapy, the meantime, considerations arise for any data collection delays and neuroscience is carefully structured to ensure the reliability, as research timelines are severely affected. This situation would integrity, and stability of findings. This includes controlling for force researchers to negotiate with institutions, decision-makers various intervening factors pertaining to individual variability, and funding agencies for new timelines and extended access to stimuli characteristics, music delivery and environmental context protocol resources. (Hunt, 2015) which may affect the results and their interpretation The funders and policy-makers need to be convinced and generalizability. With ongoing research, these factors have regarding the special relevance for this research during this time, been controlled and planned in advance, especially in pre-post and how instituting and advocating for music as a meaningful design models, where the pre-assessment provides a baseline and and most of all easy, accessible tool to implement in the clinical any changes (outcomes) are then considered attributable to the settings, is necessary. Now more than ever, people need the effects of the music intervention or activity. kind of support provided by music since it can alleviate the In ongoing clinical trials or other longitudinal studies, the impact of isolation and address its cognitive, emotional (Ramirez COVID-19 situation, and the mobility and social restrictions et al., 2015) and social consequences. Those who may be more posed by it, do not only affect the protocol and sample vulnerable to isolation such as children with neurodevelopmental characteristics (see above) but can also have a broader personal disorders and older adults with neurodegenerative disorders are and social impact, which introduces a number of factors that apt to suffer the most, and therefore might benefit the most from can potentially interfere or bias the longitudinal results of such research (Grau-Sánchez et al., 2020). the outcome measures, such as questionnaires on mood and On another note, some clinical trials, more particularly quality of life and cognitive tests measuring attention and those involving a longer intervention period, may benefit memory. For example, the pervasive fear of contracting the from resources and treatment adaptation. Maintaining subject COVID-19 virus can increase anxiety. Being socially isolated treatment strategies may afford subjects and researchers from friends and family and facing uncertainty about the future achievable, sustainable status when adaption to a web-based can cause stress, rumination, and depression. Restriction from forum can be accomplished. Notably, any intervention that is usual participation in social activities and hobbies (including altered in any way needs to be accounted for and ultimately group musical hobbies, such as singing in a choir or playing in identified in the data collection process and approved by the a band) induces social deprivation or impoverishes one’s personal IRB (Internal Review Board). For example, the findings of music environment and lifestyle, which has broad psychological effects therapy forums involving groups that sing – addressing the on the individual. impact of community on outcomes such as aphasia, mood and Moreover, the economic crisis expected as a consequence of quality of life – may offer some surprises in the data analyses this pandemic will stress the role of social determinants on health, when outcomes are finally calculated. which should be taken into account as interfering variables. In One might suspect that a pandemic involving social distancing studies comparing intervention and control groups, all of these might reinforce isolation for older adults, an adaption of our factors of course affect both groups and thus balance out, but usual and customary protocols might reflect that web-based the problem is that they can be so pervasive and strong that groups may afford subjects the comfort of being alone in their they mask out any potential intervention effects. Understanding homes, or rooms, while at the same providing for time together that the mental state of the population may have changed, with others, personal and professional carers, in the context of a baseline assessments may no longer be indicative of current screen. Where there are re-routings of this sort, however, there circumstances. Therefore, even if research could go forward, it can be surprises in the data. There are spaces for alteration. is at the risk of contamination from confounding variables. Finally, bringing the reality of the COVID 19 pandemic into our research thinking may call upon us as a global community Resources of music, music therapy and neuroscience researchers to expand With focus on the immediate health and economic outcomes our domains and cohorts types, directing our protocols to address of the pandemic, the shift for hospitalists and most health care novel or under-researched topics, such as the impact of music on providers is now seemingly on managing and coping with the pulmonary function. Recent music-based protocols for children pandemic, rather than on resource-building, per se. There may be and adults with chronic respiratory diseases, for example, show a lack of empathy from governing bodies for research at this time, promise (Canga et al., 2015; Loewy et al., 2020) despite the because the decision-makers may not see the value of research scarcity of clinical trials on the topic. Since breath control is in the face of more pressing immediate matters. As a result, reliant on a brainstem neuronal network that can be strengthened funding is likely to be – and is already being – redirected toward with predictability and rhythmic reinforcement, perhaps landing Frontiers in Psychology | www.frontiersin.org 4 August 2020 | Volume 11 | Article 2160 Papatzikis et al. COVID-19 on Neuroscience and Music Research Protocols ourselves in projects involving music and pulmonary function been a welcome opportunity to catch up on those secondary might gain traction and align opportunities for innovative research tasks, such as analyzing old data and finishing up funding support. old manuscripts, for which time under usual circumstances, may be difficult to find. Overall, this exceptional period can Response to Limitations give us a moment to become creative and adjust current Several studies point out that researchers are at high risk of projects, or to slow down and reflect, and in all cases, to suffering anxiety and depression (Levecque et al., 2017; Evans consolidate and understand nuances that may have perhaps been et al., 2018; Duffy et al., 2019). The pandemic forces us to stop otherwise missed. most research projects, and this has a subsequent negative impact As music researchers, we can study closely what pandemics on productivity. This is particularly relevant for young scientists do to people, how they have reacted, what kind of problems that are pursuing their Ph.D. studies or are on a path leading they have faced, what resilience they have shown, and what role toward a tenure-track position. On the other hand, quite a few music and its related technological, biological and psychological researchers in the music, music therapy and neuroscience field extensions might play in this situation. During the COVID-19 are still going forward resiliently. Along with the rest of the world, crisis, news images and videos from Italy, Spain and elsewhere they seem to have embraced technology and cell-phone based featured people quarantined to their homes playing music and modes of communication, as they have transitioned feasible singing together from their open windows and balconies to help interventions from in-person to online modes of delivery. cope with the emotional distress and social isolation; a testament Luckily, music is a mode of communication with some aspects to the emotional and social power of music. that can be easily transferred to the virtual domain. For example, Importantly, in these times, new music intervention projects gamification of interventions and home-based interventions and also new target groups requiring support can be identified. administered through apps (Benveniste et al., 2008; Benveniste, One such group are the frontline workers and medical staff 2010; Boulay et al., 2015; Bégel et al., 2018; Ramirez et al., 2020) who face unparalleled stress and burn out from shouldering are currently being used with more acceptance and may be a staggering responsibility. In New York city, for example, the viable solution for certain kinds of interventions moving forward. trend for virtual “music rooms” for staff is a tradition renewed Nevertheless, while during the pandemic this approach has from 9 to 11, which showed the impact of music therapy on certainly involved a learning curve for many, with collaboration another kind of trauma (Loewy and Frisch-Hara, 2002). The and some effort it has proved to be a valuable tool. This kind of treatment of trauma is a growing discipline, and is beginning adaptation or modification may not only help maintain research to be embraced in the music neuroscience world. Pandemics momentum but can provide much needed relief during this are fertile ground for the continuance of such important difficult period. work (Porges and Rossetti, 2018). Another important group to turn our research efforts upon are the elderly isolated in their homes, for whom online music interventions could be THE WAY FORWARD explored as tools to lift mood, soothe anxiety, and provide social contact. As research continues for some in its adapted state, and/or when Moving forward with hope rests on an assumption that there it resumes for others, we will need to be mindful and sensitive. will always be support for improving the human condition. As We need to have an understanding of how time and temporary researchers working in this exceptional situation, we need to cessation, as well as limited mobility and social restrictions have be patient and open in our views and also perhaps a bit more affected our projects. At the same time, we need to discover permissive when it comes to meeting our own deadlines and mechanisms for accurate analysis and best reporting of these achieving goals. For instance, we may have to make addendums disruptions, as well as markers that will inevitably determine for reporting confounding variables in the pursuit of our research when to begin research, and/or resume and adhere to the original objectives as we think of new ways to implement our research. and/or alter the interventions and data collection in our projects. We also need to understand that people react differently to crisis. Do we perhaps need to be more cautious in these times than We have to respect this and take it into account when working the general health and safety guidelines dictate, especially when together. On the other hand, it is important to keep pressing we deal with vulnerable populations and at-risk groups? Which forward, to be proactive, and make the necessary comprises when research takes priority within labs when measurement times get needed, rather than to bury our heads in the sand and simply wait bottlenecked? These are some critical questions to answer, and for things to change or get better. the only way to overcome these issues is through communication Finally, now more than ever, it is important to come within the scientific community, and with our clinical partners as together as a community, to interact, learn from each other, well. This occurs, most surely, with patience. and identify new research avenues where music could be During the COVID-19 lockdown, the time some researchers used to combat among others the emotional and social “lose” in data collection is time that fortunately can be used for burden caused by COVID-19. An instance of this coming in-depth literature review catch-up, for data analysis, reading together is the Musicovid network (which can be accessed and writing. As mentioned, for some the research continues at https://www.aesthetics.mpg.de/forschung/abteilung- in a temporarily altered format. For many others this period, musik/musicovid-an-international-research-network.html) while being in many ways stressful and demanding, has also that compiles and makes available to the public Frontiers in Psychology | www.frontiersin.org 5 August 2020 | Volume 11 | Article 2160 Papatzikis et al. COVID-19 on Neuroscience and Music Research Protocols domain research conducted in this area. This is an AUTHOR CONTRIBUTIONS exemplary model of community convergence, research communication and support, showcasing an effective way EP and FZ drafted the main body of the manuscript. TS, JG-S, RR, forward. Taking care of ourselves and of the people we MT, and JL contributed parts and commented on the manuscript. work with is and should be paramount in these difficult and EP, FZ, and JL edited and proofread the manuscript. All authors extraordinary times we live in, hence a must for our research approved the final submission. community, too. FUNDING DATA AVAILABILITY STATEMENT TS was funded by the Academy of Finland (grant number All datasets presented in this study are included in the 299044) and European Research Council (ERC, grant article/supplementary material. number 803466). REFERENCES Loewy, J., and Frisch-Hara, A. (2002). Caring for the Caregiver: The Use of Music and Music Therapy in Grief and Trauma. Silver Spring, MD: AMTA. Bégel, V., Seilles, A., and Dalla Bella, S. 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Potential benefits of music playing in stroke upper limb motor rehabilitation. Neurosci. Biobehav. Rev. 112, 585–599. doi: 10.1016/j.neubiorev. Conflict of Interest: The authors declare that the research was conducted in the 2020.02.027 absence of any commercial or financial relationships that could be construed as a Hunt, A. M. (2015). Boundaries and potentials of traditional and alternative potential conflict of interest. neuroscience research methods in music therapy research. Front. Hum. Neurosci. 9:342. doi: 10.3389/fnhum.2015.00342 Copyright © 2020 Papatzikis, Zeba, Särkämö, Ramirez, Grau-Sánchez, Tervaniemi Kaplan, B., and Litewka, S. (2008). Ethical challenges of telemedicine and Loewy. This is an open-access article distributed under the terms of the Creative and telehealth. Camb. Q. Healthc. Ethics 17, 401–416. doi: 10.1017/ Commons Attribution License (CC BY). The use, distribution or reproduction in s0963180108080535 other forums is permitted, provided the original author(s) and the copyright owner(s) Levecque, K., Anseel, F., De Beuckelaer, A., Van der Heyden, J., and Gisle, L. (2017). are credited and that the original publication in this journal is cited, in accordance Work organization and mental health problems in PhD students. Res. Policy 46, with accepted academic practice. No use, distribution or reproduction is permitted 868–879. doi: 10.1016/j.respol.2017.02.008 which does not comply with these terms. Frontiers in Psychology | www.frontiersin.org 6 August 2020 | Volume 11 | Article 2160