Elsevier

Health Policy

Volume 94, Issue 3, March 2010, Pages 211-220
Health Policy

Scarcity and inequity of mental health research resources in low-and-middle income countries: A global survey

https://doi.org/10.1016/j.healthpol.2009.09.009Get rights and content

Abstract

Objective

To map mental health research capacity and resources in low-and-middle-income countries (LAMIC) for the years 1993–2003.

Method

Mental health researchers from 114 LAMIC in three continents were identified through their publications in two databases (Medline and PsycInfo) and from local grey literature. A questionnaire was developed and sent to authors to elicit information about researchers’ background, available resources and details of up to three recent projects.

Results

4208 researchers from 83 countries were identified through 6340 mental health indexed-publications and 3598 publications from the grey literature. 912 researchers from 52 countries completed the questionnaires. Researchers and publications were concentrated in 10% of the countries. Respondents reported participation in 1847 projects, most of which were devoted to depression and anxiety disorders, substance misuse and psychoses. Epidemiologic studies, social, psychological and clinical research accounted for 80% of all projects. Two-thirds of projects had received external funding, and less than one-third of them were conducted in collaboration with other countries.

Conclusion

Mental health research capacity is scarce and unequally distributed in LAMIC. Global agencies for health research as well as LAMIC with higher concentrations of researchers and scientific output should play a more decisive role in strengthening the capacity of other LAMIC enhancing South–South partnerships and networks.

Introduction

Mental health research is critical to guide rational policy development, program planning and the provision of mental health services. Evidence-based action can reduce the social impact and economic costs of mental disorders to tackle health inequity, to prevent disability and mortality, and ultimately to foster country development [1], [2], [3], [4], [5], [6], [7]. Recently, The Lancet Series on Global Mental Health identified a number of research priorities to inform the scaling-up of mental health service development in low-and-middle-income countries (LAMIC) [8]. However, low levels of investment and the scarcity of resources and capacity in mental health research constitute the main barriers to achieving the above goals [8], [9], [10].

On average, LAMIC invest less than 1% of their GDP in research and development, compared to 2.3% in high-income countries [11]. Moreover, developing countries account for only 29% of world researchers, with a ratio of fewer than 0.5 scientists per 1000 population, in contrast to 2 per 1000 in developed countries [11]. The low priority given to mental health research in these countries is one of the reasons for the lower ratio of qualified mental health researchers and lower research output in comparison to other non-communicable diseases [12], [13], [14], [15]. Compounding the situation is the “brain drain” (especially in India, Pakistan, the Philippines, and most African and Caribbean countries), whereby well-trained researchers leave their countries in search of better work conditions in high-income countries [11], [16], [17].

In 2004, the Global Forum for Health Research and the World Health Organization (WHO) launched an international study aimed at mapping mental health research capacity in 114 LAMIC during the period from 1993 to 2003 [18], [19], [20]. A central aim of this study was to build a case for action, including the identification of the main barriers to be addressed in the promotion of mental health research (e.g., scarcity, inequity and inefficiency) [21], based on an analysis of mental health publications in the indexed and grey literature as well as survey data on researchers’ background and available resources.

Section snippets

Method

In 2004, the Global Forum for Health Research and WHO, Department of Mental Health and Substance Abuse, Mental Health: Evidence and Research, initiated a project entitled: ‘Mental health: Mapping of research capacity in low- and middle-income countries’ [2]. Six proposals from Latin America and Caribbean (LAC), Africa and Asia (two from each region) were selected based on their scope and the capabilities of the teams to carry out this project [2], [18]. The 114 selected countries included 52

Results

Together, searches by the six teams identified 4208 mental health researchers in 83 LAMIC from 6340 mental health publications indexed in Medline and PsycInfo databases and from 3598 publications in grey literature/local databases sources (Table 1). No mental health researcher was identified through Medline and PsycInfo databases in 37 countries. These 37 countries comprised 5.7% of the population of the 114 LAMIC and included 21 countries from Africa, 8 from LAC and 8 from Asia. Low-income

Discussion

Our results reveal a severe scarcity of mental health research resources in LAMIC, their inequitable distribution and inefficient utilization—three challenges typical of other mental health resources as well [21]. The greatest shortage of mental health research capacity was among the poorest African and Asian countries, where the number of publications and researchers identified was much lower than other continents. The same pattern of shortage of mental health professionals has also been found

Role of the authors

  • D. Razzouk: Drafting the manuscript; acquisition, analysis, and interpretation of data.

  • P. Sharan: Study concept and design, analysis and interpretation of data, critical review of manuscript.

  • C. Gallo: Study concept and design; regional coordination/principal investigator; acquisition, analysis and interpretation of data; critical review of manuscript.

  • O. Gureje: Study concept and design; regional coordination/principal investigator; acquisition, analysis and interpretation of data, critical

Funding/support

This project was supported by the Global Forum for Health Research and the World Bank through its grant facility to the Global Forum for Health Research, and was implemented under the overall coordination and technical guidance of the Global Forum for Health Research and World Health Organization, Department of Mental Health and Substance Abuse, Evidence and Research.

Role of the sponsors

The Global Forum for Health Research was involved in the study design; data collection, analysis, and interpretation; and draft preparation. The World Bank was not involved in any stage of this study. No other sponsor played any role.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Acknowledgements

The authors thank the following institutions for their contribution to the study:

  • The Global Forum for Health Research for funding, overall coordination and technical guidance of the original research project.

  • The World Health Organization for technical guidance.

  • FAPESP for funding equipments for Brazilian's team.

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