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Galvanising mental health research in low- and middle-income countries: Role of scientific journals

The Department of Mental Health and Substance Abuse, WHO organized a meeting on Mental Health Research in Developing Countries: Role of Scientific Journalsin Geneva on 20 and 21 November 2003 that was attended by twenty-five editors representing journals publishing mental health research. A number of other editors reviewed and contributed to the background and follow-up material. This statement is issued by all participants jointly (see Appendix 1 for the list of journals/organizations and their representatives).

Research is needed to address the enormous unmet mental health needs of low- and middle-income (LAMI) countries. Scientific journals play an important role in production and dissemination of research. However, at present, only a minute proportion of research published in widely accessible mental health and psychiatric journals is from or about these countries. Yet over 85% of the world's population lives in the 153 countries categorized as low- and middle-income, according to World Bank criteria. Even more worrying is the observation that the gap between these and high-income countries may be widening in terms of their number of publications. The meeting was aimed at finding ways of resolving this unsatisfactory situation.

Responsibility of scientific journals towards international mental health

Science, in its quest to accomplish valid generalisations about nature, is inherently global. Researchers from all parts of the world should, desirably, contribute to new knowledge about mental health and mental illness, and publish their reports in widely accessible journals. This process is facilitated by a shared understanding of aims and scientific methods, formats of presentation and reference to previous published work. Mental health research from LAMI countries is needed for advocacy, policy development, establishment and expansion of clinical services and to educate investigators in research skills. A steady stream of information about mental health issues in these countries would also contribute to a greater international and multicultural understanding of mental health and ill-health.

Unfortunately, substantial barriers impede publication of mental health research from LAMI countries in widely accessible journals. Researchers from LAMI countries are often unable to meet the requirements of these journals because of limited access to information, lack of advice on research design and statistics, difficulty in writing in a foreign language, and overall material, financial, policy and infrastructural constraints. Limited appreciation of the research needs of, and realities in LAMI countries and the comparative anonymity of their researchers and research centres in editorial offices of journals may constitute additional barriers. Many researchers from LAMI countries are daunted by the seemingly insurmountable chasm between their research effort and its publication in international journals.

Supporting mental health researchers from low- and middle-income countries

We need to face the challenge of reducing the barriers to publication of mental health research by investigators working in LAMI countries. Time, skills, resources and commitment are needed to publish relevant studies from these countries. Editors' and reviewers' experience with and interest in LAMI countries could be an asset in facilitating publication. Meeting researchers from these countries on 'their home ground' could assist this process. International journals could also help researchers improve their submissions by diligent assessment, detailed recommendations for revision and sympathetic consideration of revised versions, even if it means requesting reviewers to 'take an extra round' to make papers suitable for publication. This is not to say that journals need to lower their standards in publishing papers from LAMI countries; rather, they should devise strategies to help authors attain those standards. Other approaches to support contributions from LAMI countries could be to launch 'starter' sections such as information pages and special columns or even dedicated issues of the journal.

Capacity building is the paramount factor in the long term. Training in research methodology and scientific writing is needed. This could be done through mentoring, personal encouragement, training courses and research collaboration. Increased access to mental health research publications would, by itself, help in capacity building.

Supporting mental health journals from low- and middle-income countries

A major impediment in accessing mental health research from LAMI countries is the lack of visibility of journals published in these countries. Most of them are not indexed in international databases and are often not available beyond their country or region of origin. These journals are published under strained circumstances, in that they often lack sound financial support and have a hard time becoming self-sufficient. They also have difficulty in obtaining suitable articles for publication because their author pool is limited; moreover, influential authors from this pool prefer to publish their best research in indexed journals. Some authors who submit their articles to LAMI country based journals may have limited skills in conducting research and/or in writing up their reports. However, it must be stressed that some excellent work does find publication in these journals.

The task of strengthening journals in LAMI countries begins from the recognition of their role as contributors to the enhancement of the mental health knowledge base and as partners in the international research community. Editors of LAMI country based journals require support to elevate standards in editorial procedures, peer review and overall journal management since sufficient expertise and experience may be lacking. This could be achieved through their participation in the publication process of established journals, mentorship, twinning arrangements and training workshops.

Enhancing dissemination of mental health research publications

Many high quality mental health journals have a wide distribution, but most of their subscribers are from high-income countries. Special attention to dissemination of research findings is needed urgently in order to maximize their impact on mental health policy and practice and advance relevant research in LAMI countries. Increasing online availability is cost-effective since little additional expenditure is required to provide access to new users apart from the initial costs of posting material on a website. Free access to many categories of electronic resources is provided by many journals. Initiatives such as the WHO-led Health InterNetwork Access to Research Initiative (HINARI) offer institutions in LAMI countries electronic access to thousands of journals at no or very low cost. The Open Access model provides free online access along with the possibility of unrestricted dissemination of research materials, but charges for publication may be prohibitive for authors from LAMI countries unless support comes from funding agencies and governments, e.g. the Scientific Electronic Library Online (SciELO) project in Latin America. Governments in other LAMI countries need to be made aware of the opportunities provided by information technology for dissemination and application of research knowledge.

The role of various stakeholders

Editors of journals, editors' associations and international organizations, including WHO could help achieve the aforementioned objectives. A catalogue of ideas is presented in Appendix 2 to act as a starting point for specific action. Although these ideas have been developed for the field of mental health, many of them may apply to other areas of health.

Appendix 1: Participants

Acta Psychiatrica Scandinavica(Povl Munk-Jorgensen), American Journal of Orthopsychiatry(Carlos Sluzki), Annals of General Hospital Psychiatry(George St. Kaprinis, Konstantinos N. Fountoulakis), Anthropology and Medicine(Sushrut Jadhav), Australian and New Zealand Journal of Psychiatry(Sidney Bloch), BioMed Central Psychiatry(Pritpal S. Tamber), British Journal of Psychiatry(Peter Tyrer), BMJ(Kamran Abbasi), Bulletin of World Health Organization(Hooman Momen), Child Abuse and Neglect, The International Journal(John M. Leventhal), Chinese Journal of Nervous and Mental Disease(Li Yingxi, Guan Jinli), Comprehensive Psychiatry(David L. Dunner), Culture, Medicine and Psychiatry(Mary-Jo Delvecchio Good), Epidemiologia e Psichiatria Sociale(Michele Tansella), L'Evolution Psychiatrique(Yves Thoret), Indian Journal of Psychiatry(Utpal Goswami), L'Information Psychiatrique(Thierry Tremine), International Journal of Social Psychiatry(Dinesh Bhugra), International Psychiatry(Hamid Ghodse), Journal of Child and Adolescent Mental Health(Alan Flisher), Journal of Nervous and Mental Disease(Eugene B. Brody, Kathy McKnight), Lancet(Laragh Gollogly), Primary Care Psychiatry(Sean Lynch), Psychiatry: Interpersonal and Biological Processes(Robert Ursano), Psychiatry Research(Monte Buchsbaum), Psychological Medicine(Eugene Paykel), Psychology and Psychotherapy: Theory, Research and Practice(Phil Richardson), Psychopathologie Africaine(Momar Gueye), Quarterly Journal of Pakistan Psychiatric Society(Amin A. Gadit), Revista Brasileria de Psiquiatria(Jair Mari), Salud Mental(Hector Perez-Rincon), Social Psychiatry and Psychiatric Epidemiology(Paul Bebbington), South African Journal of Psychiatry(Robin Emsley, Susan Hawkridge), Transcultural Psychiatry(Laurence J. Kirmayer), World Psychiatry(Mario Maj), Forum for African Medical Editors(James K. Tumwine), Global Forum for Health Research(Andres de Francisco), World Association of Medical Editors(Ana Marusic, Peush Sahni), World Health Organization(Shekhar Saxena, Pratap Sharan, Benedetto Saraceno, Barbara Aronson, Vladimir Poznyak, Izthak Levav, Edith Certain, R Srinivasa Murthy, Tikki Pang).

Shekhar Saxena, Pratap Sharan, Hooman Momen and Benedetto Saraceno organized the WHO Meeting leading to this joint statement.

Appendix 2: Catalogue of ideas

Individual journals

Giving priority to relevant mental health research from low- and middle-income countries

• Educate editors and reviewers on research needs of and research infrastructure in LAMI countries;

• Use surveys of various stakeholders such as readers (including those from other regions) for shaping journals' priorities;

• Sensitize readers and other stakeholders to international mental health issues (e.g. through special sections and dedicated issues, guest editorship and the commissioning of relevant research from LAMI countries);

• Critically re-examine the use and limitation of measures such as citation rates and impact factors;

• Adopt a multilingual approach, such as translation of relevant articles and abstracts into other languages;

• Include reviewers and correspondents with a special interest and expertise in LAMI countries on editorial boards;

• Accept a higher proportion of submissions from LAMI countries for review; and

• Encourage general medical journals to publish mental health research especially in countries/regions where no mental health journal exists at present.

Supporting authors/researchers from low- and middle-income countries

• Familiarize researchers from LAMI countries with the peer review process;

• Provide constructive critical feedback/detailed recommendations for revision;

• Make provision for extra rounds of editing, assistance with language and use of technical editors;

• Pay attention to the educational goals of the review process (e.g. availability of reviewer's comments to readers or recruiting young researchers in LAMI countries to referee papers);

• Provide mentorship and support prior to submission;

• Organise training workshops for LAMI country researchers and students on scientific writing and research methodology;

• Facilitate the involvement of researchers in multi-centre projects and research groups;

• Accept and process submissions online; and

• Devise strategies to prevent economic exclusion of researchers from LAMI countries in author/input paying publishing models.

Supporting journals from low- and middle-income countries

• Support "twinning" or "pairing" arrangements, such as invited editorials, exchange of journals, cross-publication of contents/abstracts/summaries/articles and joint publications;

• Agree to serve on editorial boards or as reviewers;

• Agree to mentor reviewers and editors;

• Provide training workshops for editors and reviewers; and

• Support national/regional journals in developing their own websites and/or seeking inclusion in specialized websites on mental health

Enhancing Dissemination

• Participate in electronic dissemination initiatives or provision of free/open access through the journal's website;

• Participate in "buddy system"/peer sponsoring initiatives;

• Employ user-friendly technology for easier downloads;

• Subsidize journal subscriptions for LAMI countries; and

• Explore mechanisms for publication of selected papers in more than one journal for wider dissemination.

Editors' associations

• Develop guidelines for good editorial practice concerning publishing and research ethics and conflicts of interest;

• Facilitate access to literature and bibliographic services (e.g. through a directory of databases);

• Support authors to access appropriate specialized journals and specific audience (e.g. through a database of journals and instructions to authors);

• Facilitate mentoring for editors, reviewers and researchers;

• Organise training of editors, reviewers and researchers from LAMI countries; and

• Facilitate the multidirectional flow of articles, resources and expertise (e.g. translation of relevant articles and support with information technology).

International organizations

Supporting mental health research, research infrastructure and publications

• Influence other international institutions to give priority to mental health research in their agendas for LAMI countries;

• Support national institutions in LAMI countries to urge their governments to give higher priority to mental health research;

• Support inclusion of researchers/editors from LAMI countries in relevant decision-making forums; and

• Facilitate capacity building for researchers and journals from LAMI countries.

Enhancing Dissemination

• Assess information needs in LAMI countries and raise awareness of these;

Provide access to journals publishing mental health research (e.g. expansion of HINARI or enabling journals to be open access); and

• Encourage and facilitate the application of information technology.

Enhancing Collaboration

• Develop networks between editors, editorial organizations, professional bodies, publishers, funding agencies, national and international organizations and the media); and

• Adopt a systematic approach for follow up: statement of changes hoped for, development of outcome criteria, assessment of progress.

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Editors and WHO November 2003 Group. Galvanising mental health research in low- and middle-income countries: Role of scientific journals. Ann Gen Hosp Psychiatry 3, 5 (2004).

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