Context: preprints in health care
A preprint is a scientific manuscript uploaded by its authors into a public server
prior to peer review or publication. The preprint contains the complete information
of a scientific article and can be described as an ‘interim research product’ because
it has not yet gone through the back-and-forth edits that typically occur during peer
review. Rather, after a brief quality-control inspection by the preprint server to
ensure that the work is scientific in nature and meets ethical standards, the manuscript
is posted promptly (usually within a day or two) and can be viewed online for free
by anyone. This allows for authors to receive prompt feedback from a far larger community
of colleagues than the two or three experts who might typically review their manuscript.
It also increases the visibility and speed with which research findings are disseminated
and can help to counterbalance the effects of publication bias. Work posted as a preprint
is frequently the same exact manuscript being submitted to a traditional, peer-reviewed
journal, often simultaneously. In this way, preprints (which are efficient and rapid,
but not validated through peer-review), can work in tandem with journal publications
(which are slow, but provide validation through peer-review) as a communication system
seeking to improve scientific research [1].
Preprints have been standard fare in physics and other hard sciences for the past
three decades. In fact, publication in traditional venues is at times viewed as a
late formality in these disciplines, where the bulk of the intellectual exchange can
happen long before publication, through commentary around the preprint. Much of that
exchange happens through email and social media, rather than through the preprint
server itself, which is in essence but a virtual repository providing a public ‘time
stamp’ to the work. Compared to the preprints’ immediacy in jump-starting dialogue,
the traditional peer-reviewed approach can feel painfully slow to scientists eager
to get their work out into the public discourse arena.
Compared to physics, the biological sciences have been slower on the preprint uptake,
but a groundswell began in 2013, when the Cold Spring Harbour Laboratories launched
bioRxiv. A further boost came in early 2017, when funding agencies encouraged applicants
to include their preprint works in grant proposals. This invitation was supported
both in the UK by the Medical Research Council [2] and the Wellcome Fund [3], and
in the US by the National Institutes of Health [4] and the Howard Hughes Medical Institute
[5]. The first repository specific for the health sciences, medRxiv, was started in
2019 [6, 7]. Concerns over the potential harm of faulty clinical studies, balanced
against the possibility of making critical information available as soon as possible,
may explain the lag in medical preprint servers, compared to those in other fields.
The Table summarizes a representative sampling of preprint servers relevant to child
and adolescent mental health (Table 1).
Table 1
Selected pre-print archives relevant to child and adolescent mental health
Archive
Homepage
Disciplines
Inception
Formats for submission
Formats published
Owned/operated by
bioRxiv
http://biorxiv.org
Biology
2013
PDF, Word
PDF
Cold Spring Harbor Laboratory
IACAPAP ArXiv
http://arxiv-iacapap.org/
Child psychiatry
2015
PDF
PDF
IACAPAP
OSF preprints medRxiv
https://osf.io/preprints/
https://www.medrxiv.org
All
Health sciences
2016
2019
Any
Any
Any
Any
Open Science Framework
Cold Spring Harbor Laboratory, BMJ, Yale
PeerJ preprints
https://peerj.com/preprints-search/
Biological Sciences, Medical Sciences, Health Sciences and Computer Sciences
2013
PDF
PDF and HTML
PeerJ
Preprints.org
http://www.preprints.org
All
2016
Word, LaTeX
PDF
MDPI
PsyArXiv
https://psyarxiv.com/
Psychology
2016
Any
Any
Open Science Framework
ResearchGate
https://www.researchgate.net
All
2008
Any
Any
ResearchGate
All archives use DOI (digital object identifier) as unique identifiers, and CC-BY
(Creative Commons) for licensing purposes
Despite the availability of a number of preprint services, uptake remains low and
uneven: for example, only 1.3% (1200) of the 93,000 papers added to PubMed in August
of 2017 had been deposited as preprints [8]. This rate is likely to increase over
time, particularly in light of emerging evidence that articles with a preprint received
higher Altmetric attention scores and more citations than articles without a preprint
[9]. Although preprints were not well cited in that study, 18% had Altmetric scores
in the top 5th percentile, and 48% were estimated to reach peer-reviewed publication
within 1 year. For context, Altmetric scores provide a weighted count of all of the
online attention for an individual research product, including mentions in the ‘gray
literature’ of public policy documents, references in Wikipedia, the mainstream news,
social networks, blogs and more.
Perspectives on preprints
The researcher’s raison d’être is to answer questions worthy of being asked, design
methodologically sound ways of answering those questions and sharing the answers with
those who may benefit from them. At each step of the process, the researcher depends
immensely on peers, both present and past. While some have pointed out that this idyllic
set of processes is not reflected in actual practice [10], it remains important that
academics aspire to these ambitions.
There are several considerations that can inform a prospective author’s decision to
upload a manuscript into a preprint archive:
Location
With the rapid expansion of journals in the past three decades [11], particularly
of open-access journals, it is hard to imagine that any particular niche of academia
is unserved. However, with this immense diversification comes a challenge of choice
and a diffusion of responsibility. Highly specialized journals may not be receptive
to publications that fall slightly outside their areas of focus, resulting in the
rejection of submissions not because of quality but because of an imperfect fit. This
diversification and increased selectivity may mean that authors struggle to find an
optimal place for their article, especially problematic for early career researchers
who are still developing their academic identity and expertise. Although preprint
archives can also be selective, they may be less so than specialized journals. Therefore,
they may serve as a convenient temporary space for a manuscript that has yet to find
a suitable journal, not by fault of its quality, but by virtue of its specialization.
Timeliness
Journals have sought to reduce as much as possible the lag between submission and
dissemination, providing rapid editorial decisions and early access to proofs and
electronic copies. But the review and publication process does take time, and some
have argued for time-to-publication bias in the selection of articles [12]. Offering
a timely avenue to public distribution is one of the main selling points of so-called
‘predatory journals’. Definition of that term remains somewhat nebulous, but in general
denotes a periodical seeking to publish articles for a fee rather than for scientific
merit [13]. But it should be noted that timeliness is likewise a virtue of preprint
archives. Therefore, if time is of the essence and timeliness the main reason an author
would consider a fee-for-service journal that boasts blistering processing times (at
a potential cost of journal reputation), it may be more reasonable to seek to register
the preprint while submitting to a suitable journal with its longer processing time.
Indeed, moving from referring to an unpublished manuscripts as ‘personal communication’
to the more robust ‘available online at’ represents not just a less eyebrow-raising
designation. It provides a direct way to access the material and to make it available
for dialogue, critique and further refinement en route to publication. In this way,
the preprint ‘developmental stage’ of a scientific manuscript represents an opportunity
for the maturing of its scientific content, and allows investigators to make their
material widely available during the often lengthy path through ‘in press’ and into
final appearance in print and pixel.
Predatory journals
Predatory journals have taken advantage of the growing popularity and demand for open-access
publication. This puts academia at risk because it offers a compromised avenue to
the literature. In the journal ecosystem and its overabundance of titles, an ill-informed
consumer might be forgiven for massing reputable and disreputable journals together,
taking information provided at face value and trusting the peer review process. One
could argue that the ecological niche populated by predatory journals would not be
as viable if authors were able to secure a legitimate place in the literature for
their unreviewed work. Expanding free archiving services may help undercut the predatory
journal business model.
Cultural and linguistic diversity
A special area of medical and psychiatric research, particularly in child and adolescent
psychiatry, is that cultural context can strongly influence the clinical practices,
and even the effectiveness of treatment. This is especially true when considering
non-pharmacological treatments. As most peer-reviewed scientific journals only consider
papers written in English [14, 15], editors can also be reluctant to accept publications
dealing with strong cultural or linguistic specificities. This is based on the idea
that cultural specificity limits generalisability. Over time, there is a significant
risk that effective treatments developed in remote, linguistically underrepresented,
or impoverished [16, 17] cultures will not be recorded. Preprint archives provide
a unique opportunity to preserve and expand cultural diversity in etiology and therapeutics,
including of culture-bound conditions.
Access
Access is the main issue that justifies devoting resources to preprint archives. Why
bother at all? These archiving services are not heavily accessed and are not currently
indexed on the main sources of academic literature. While Digital Object Identifiers
(DOIs) are assigned to each archived manuscript, currently they are only retrievable
by means of actively informed search strategies. Therefore, while a manuscript may
be archived, it may not be as widely accessed as articles that appear in peer-reviewed
indexed journals. But as the practice becomes more widely adopted—as has been the
case in many other branches of science– we can anticipate that it will become as natural
to search a centralized preprint archive as it is to search multiple sources of peer-reviewed
articles today. Additionally, searching preprint archives will offer researchers a
glimpse into ongoing research, something not easily accomplished without the proper
connections. It therefore benefits researchers to adopt the habit of searching preprint
archives, as they offer an idea of what is to come and consequently what remains unanswered.
Trustworthiness
The idea of registering intellectual property with a publicly accessible server is
appealing, but without the scrutiny of an independent third party the degree of trustworthiness
of the content may be called into question. Those supporting the practice can justifiably
point to the number of articles appearing as preprints that then go on to be published
in peer-reviewed journals: about 55% after 24 months [18]. This rate of transition
indicates that the use of preprint services, at least currently, is not a repository
of articles that are not up to the same standard of peer-reviewed articles, but simply
that they have been placed in the registry to be disseminated as expeditiously as
possible. It is possible that as the popularity of preprint archives grows the number
of unscrupulous researchers seeking to disseminate unworthy content will grow as well.
But if disciplines adopt preprint practices and integrate them into their publishing
process, we can anticipate that the sophistication of the vetting process will improve,
reducing the risks associated with simply accepting submissions with a low degree
of scrutiny.
Preprints in Child and Adolescent Mental Health
Biomedical journal publishers are warming to the idea of preprint archives [19], which
should assuage worries about preprints compromising the potential for future publications.
Despite the recent expansion in preprint interest in biomedicine, psychiatric and
psychological sciences have not yet fully adopted the practice. Some have justifiably
tempered their enthusiasm for adopting preprints in the medical fields, notably by
citing the risks involved when sharing unreviewed medical advancements [20]. These
risks are noteworthy, and judgement may be necessary to vet the inclusion of potentially
dangerous content. However, establishing discipline-specific archives can help reduce
the risk, as discipline-specific curators can provide more reliable vetting of submissions.
The International Association of Child and Adolescent Psychiatry and Allied Professions
(IACAPAP) has developed a preprint archive specific to child and adolescent psychiatry
(http://arxiv-iacapap.org/). This repository gives child and adolescent mental health
professionals the opportunity to upload clinical or research documents in their own
language (with an abstract in English) that becomes freely available online. The quality
of the articles is assured by formal approval of the national child and adolescent
mental health organization to which the authors belong, and/or by IACAPAP. The IACAPAP
ArXiv is one of several preprint services that investigators may consider when uploading
their work for circulation and dissemination. Most peer-reviewed journals, though
not all, have policies specifically allowing the use of preprint servers prior to
submission. In some instances, journal submissions from the preprint server can even
happen directly. Authors are advised to check with the specific journal to which they
intend to submit to before uploading their work to a preprint repository.
CAPMH and its editorial team certainly welcome, and indeed encourage, the use of preprint
archives. We believe that any avenue that allows a researcher easy and timely access
to sharing and disseminating findings should be encouraged and welcomed, as early
access helps researchers better fulfil their raison d’être.