In an attempt to reverse this trend, WHO and 42 editors representing mental health and public health journals such as the British Journal of Psychiatry, Acta Psychiatrica Scandinavica, British Medical Journal, the Lancet, and others, have agreed a Joint Statement aimed at reducing the substantial barriers that impede publication of mental health research from lowû and middleûincome countries.
"There is very limited research written from and about lowû and middleûincome countries and we need to change this trend," said Dr Benedetto Saraceno, WHO’s Director of Mental Health and Substance Abuse. "Scientific journals can play a fundamental role in encouraging the production and dissemination of research findings. Mental health research in these countries is needed to better inform governments in planning the various aspects of care."
Substantial barriers impede publication of mental health research. Researchers from developing countries are often unable to meet the requirements of indexed 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. They usually work in research centres or universities that are perceived as not prestigious enough to attract the attention of international editorial boards. The result is that the bulk of research from developing countries is published in journals that are not widely distributed and do not figure in the international databases.
"Journals have an important role to play in developing the research capacity of lowû and middleûincome countries, especially in a neglected area like mental health," said Kamran Abbasi, Deputy Editor, British Medical Journal. "For journals to ignore or fail to publish work from these countries is also a failure to recognize the demographics, burden of diseases, and longûterm economics of the shrinking world we live in. There is also much that scientists and doctors from richer countries can learn from their counterparts in poorer countries û this is far from being a oneûway process."
The editors and WHO technical staff have drawn up a catalogue of ideas to guide followûup actions by individual journals to support the publication of mental health research from developing countries. Suggestions included that international journals help the researchers from developing countries improve their submissions by diligent assessment and detailed recommendations for revision, to make papers suitable for publication. Training in research methodology and scientific writing is also 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 capacityûbuilding.
"This has been a worthy attempt to oblige editors to confront the uneven representation of the global burden of mental health disorders in their respective journals. With some effort, and much good will, these recommendations should help to redress the balance of proportionate representation; a task that looms for all medical specialities," said Laragh Gollogly, Senior Editor, the Lancet.
The importance of online access as a costûeffective technology was also stressed, since little additional expenditure is required to provide access to new users apart from the initial costs of posting material on a web site. Free access to many categories of electronic resources is provided by many journals through initiatives such as the WHOûled Health InterNetwork Access to Research Initiative (HINARI). This offers institutions in developing countries electronic access to thousands of journals at no or very low cost.
"Mental health research in lowû and middleûincome countries is not a luxury, it is a necessary component of any effective mental health service and should be supported both locally and internationally," said Professor Robin Emsley, Scientific Editor, South African Journal of Psychiatry.
"The task of strengthening journals in developing 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," said Dr Catherine Le GalèsûCamus, WHO’s Assistant DirectorûGeneral, Noncommunicable Diseases and Mental Health. "They need support to elevate standards in editorial procedures, peer review and overall journal management since sufficient expertise and experience may be lacking. The vast majority of the mental health burden is in lowû and middleû income countries. Sharing knowledge and information globally will strengthen our ability to respond to it."