Global Mental Health Research Research Articles

Cross-Cultural Insights from Two Global Mental Health Studies: Self-Enhancement and Ingroup Biases

AbstractThis commentary highlights two cross-cultural issues identified from our global mental health (GMH) research, RECOLLECT (Recovery Colleges Characterisation and Testing) 2: self-enhancement and ingroup biases. Self-enhancement is a tendency to maintain and express unrealistically positive self-views. Ingroup biases are differences in one’s evaluation of others belonging to the same social group. These biases are discussed in the context of GMH research using self-report measures across cultures. GMH, a field evolving since its Lancet series introduction in 2007, aims to advance mental health equity and human rights. Despite a 16.5-fold increase in annual GMH studies from 2007 to 2016, cross-cultural understanding remains underdeveloped. We discuss the impact of individualism versus collectivism on self-enhancement and ingroup biases. GMH research using concepts, outcomes, and methods aligned with individualism may give advantages to people and services oriented to individualism. GMH research needs to address these biases arising from cross-cultural differences to achieve its aim.

“People are still living with pains of the war”: An assessment of long-term adjustment and consequences of war-related traumatic stress among Liberian refugees

A dearth of empirical research examines the adjustment and wellbeing of long-term refugees in the United States and globally. The goal of this hermeneutic phenomenological needs assessment study was to examine stakeholders’ perceptions of individual, relational, and community-level adjustment in one of the largest Liberian refugee communities in the U.S. Twenty 60–90-minute key informant interviews were conducted and analyzed using hermeneutic phenomenology coding protocols. Six themes emerged in key informants’ perceptions of long-term adjustment and wellbeing among war-affected Liberian refugees: 1) unresolved traumatic stress, 2) substance use, 3) mental health stigma, 4) adverse relational effects, 5) disrupted community dynamics, and 6) lack of access to culturally relevant services. This study expands on refugee and global mental health research by empirically documenting adjustment experiences in a long-term and underrepresented refugee community, which can inform prevention and intervention efforts with communities displaced from war. Clinical, research, and policy implications are also described alongside efforts to enhance support for refugees across their adjustment phases. (162 words)

Early developments of psychiatric epidemiology in Chile: a local history with global implications

Abstract This viewpoint discusses a conference paper titled: “Epidemiological research on mental morbidity in Chile”, which summarizes a handful of studies from 1950s in Chile covering conditions such as alcoholism, psychosis, epilepsy, and neurosis. These were the first psychiatric epidemiological population studies conducted in the Southern hemisphere, but they are largely unknown globally. We argue that the Chilean studies have important implications for modern psychiatric epidemiology, as well as for related fields such as global mental health and mental health services research. This piece starts by describing the general sociopolitical context and presenting the main methodological features of the studies. It focuses then on three specific implications for the field: 1) promoting decoloniality in psychiatric epidemiology; 2) ensuring methodological rigor and feasibility; and 3) informing the development of mental health policy and services.

Gender (in)equity in global mental health research: A call to action.

Gender (in)equity in global mental health research: A call to action.

Living the Process: Examining the Continuum of Coercion and Care in Tijuana's Community-Based Rehabilitation Centers.

In Mexico, community-based, non-biomedical treatment models for substance use are legally recognized in national drug policy, monitored by state-level Departments of Health, and in some cases publicly funded. Academic research on centers that utilize these forms of treatment have focused primarily on documenting their rapid spread and describing their institutional practices, particularly human rights abuses and lack of established biomedical efficacy. In Tijuana, these community-based therapeutic models are shaped by conceptions of health and illness from the local cultural context of the United States-Mexico border zone in ways that do not cleanly match western, biomedical notions of the illness "addiction." In this article, I examine treatment ethics by exploring the contextually understood need for coerced treatment (i.e., why centers are locked) along with experiences of compulsion in a women's 12 Step center. These discussions highlight the contested therapeutic value of coercion from multiple perspectives. Utilizing engaged listening around local care practices marks a path for global mental health researchers to understand and sit with difference in order to communicate across opposing viewpoints in the service of mental health equity and best care practices.

Outcomes of a community-based wellness screening tool administered by mental health professionals and religious leaders in the Ketu South Municipality in Ghana

IntroductionGhanaian community members with mental health conditions are usually not identified until their families cannot handle their care at home anymore, for example, due to mistrust in medical institutions. From community-based and global mental health research, we know why we should act (for example, early interventions improve the treatment outcomes) and what we should do (for example, task-sharing in community settings). How any of these activities can be implemented on the community level to decrease the delay of access to evidence-based care remains unclear.ObjectivesThe study explored the “how” for a specific identified problem (collaboration between mental health professionals and religious leaders) in the Ketu South Municipality in Ghana; additionally, the study explored the feasibilty and the results of a community-based wellness screening.MethodsWe used a human-centered design approach to tackle this challenge in the Ketu South Municipality in Ghana. We invited 80 mental health professionals, religious leaders, and service users to participate in this exercise. The participants innovated the so-called Brain Spirit Desk, which builds collaboration between mental health professionals and religious leaders. The participants also designed a 9-question wellness screening tool, including four validated screening scales in Ghana: PHQ-2, GAD-2, one question about suicidality, and CAGE-AID. The participating religious leaders were trained to use this screening tool and administer it by themselves or allow mental health professionals to administer it in their respective institutions. Referral pathways were established for community members who screened positive on the wellness screening tool.Results1065 community members (787 females, 278 males, mean age: 32.42 years) were screened using the wellness screening tool over five months (January - May 2022); 215 of these community members were already connected to mental health clinics in hospitals. 60 community members out of 203 who screened positive on the PHQ-2 were not receiving treatment at the time of screening and were referred for further assessment and treatment. Another 52, 53, and 142 community members were referred for further evaluation and treatment based on their answers to the GAD-2, suicidality, and CAGE-AID screening questions, respectively. Completed referrals across conditions averaged around 55%.ConclusionsOur activities explored, guided through principles of a human-centered design approach, how the delay in access to evidence-based mental health care in the Ketu South Municipality in Ghana can be decreased through a collaborative effort of mental health professionals and religious leaders. A developed screening tool identified potential cases of mental health conditions. Importantly, religious leaders’ involvement and endorsement built trust in the activities.Disclosure of InterestNone Declared

Applying Human-Centered Design in Global Mental Health to Improve Reach Among Underserved Populations in the United States and India.

Human-centered design (HCD) refers to a diverse suite of interactive processes that engage end users in the development of a desired outcome. We showcase how 2 global mental health research teams applied HCD to develop mobile health tools, each directed at reducing treatment gaps in underserved populations. CASE STUDY 1: Refugees face higher risks for mental health problems, yet these communities face structural and cultural barriers that reduce access to and use of services. To address these challenges, the Research Program on Children and Adversity at the Boston College School of Social Work, in partnership with resettled refugee communities in the northeastern United States, used codesign methodology to digitally adapt delivery of the Family Strengthening Intervention for Refugees-a program designed to improve mental health and family functioning among resettled families. We describe how codesign methods support the development of more feasible, acceptable, and sustainable interventions. CASE STUDY 2: Sangath, an NGO in India focused on mental health services research, in partnership with Harvard Medical School, designed and evaluated a digital training program for community health workers to deliver an evidence-based, brief psychological treatment for depression as part of primary care in Madhya Pradesh, India. We describe how HCD was applied to program development and discuss our approach to scaling up training and capacity-building to deliver evidence-based treatment for depression in primary care. HCD involves a variety of techniques that can be flexibly adapted to engage end users in the conceptualization, implementation, scale-up, and sustainment of global mental health interventions. Community solutions generated using HCD offer important benefits for key stakeholders. We encourage widespread adoption of HCD within global mental health policy, research, and practice, especially for addressing mental health disparities with underserved populations.

Maximising impactful, locally relevant global mental health research conducted in low and middle income country settings: ethical considerations.

Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection. Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect.

Opportunities for improving data sharing and FAIR data practices to advance global mental health.

It is crucial to optimize global mental health research to address the high burden of mental health challenges and mental illness for individuals and societies. Data sharing and reuse have demonstrated value for advancing science and accelerating knowledge development. The FAIR (Findable, Accessible, Interoperable, and Reusable) Guiding Principles for scientific data provide a framework to improve the transparency, efficiency, and impact of research. In this review, we describe ethical and equity considerations in data sharing and reuse, delineate the FAIR principles as they apply to mental health research, and consider the current state of FAIR data practices in global mental health research, identifying challenges and opportunities. We describe noteworthy examples of collaborative efforts, often across disciplinary and national boundaries, to improve Findability and Accessibility of global mental health data, as well as efforts to create integrated data resources and tools that improve Interoperability and Reusability. Based on this review, we suggest a vision for the future of FAIR global mental health research and suggest practical steps for researchers with regard to study planning, data preservation and indexing, machine-actionable metadata, data reuse to advance science and improve equity, metrics and recognition.

Ethical Considerations in Global Mental Health Research: Lessons Learned From Binational U.S.–Mexico Collaborations

Binational research is critical to better understand the health, mental health, and health outcomes of immigrant communities. Binational studies are often difficult to conduct, however, due to cost, challenges with participant recruitment and data collection, lack of appropriate cross-cultural instruments, and challenges ensuring ethical reviews and approval in both counties. This research note discusses ethical issues navigating institutional review board (IRB) procedures while striving to maintain the highest ethical protection for participants when engaging in binational behavioral sciences research between México and the United States. We discuss the need to clarify requirements for international research between México and the United States and navigating differences that may exist or emerge between IRBs in México and the United States. We provide some recommendations to assist researchers in ensuring IRB approval for their research protocols and ethical protection for their participants.

Lola Kola: developing mHealth for mental health in west Africa

Lola Kola's passion is global mental health research that harnesses the potential “of psychological interventions for improving outcomes for patients when delivered by trained lay health-care workers” and “the use of technology to support the delivery of such interventions”, she says. Based in Ibadan, Nigeria, Kola is Senior Research Fellow at the University of Ibadan's WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse in the Department of Psychiatry, College of Medicine, and Adjunct Associate Professor at the Department of Sociology and Psychology at the Lead City University. Kola is also affiliated with the Behavioral Research in Technology and Engineering (BRiTE) Center at the University of Washington (UW), Seattle, WA, USA, and the University of Ibadan's Centre for Child and Adolescent Mental Health in the College of Medicine. With colleagues at the BRiTE Center, and supported by an NIH Global Emerging Leader grant, Kola has led the design and development of a mobile phone app for the self-management of perinatal depression in adolescent mothers as an adjunct intervention to WHO's Mental Health Gap Action Programme (mhGAP) within routine antenatal and perinatal services in primary care. This population has “a greater risk of depression and anxiety than their adult counterparts, which in turn predisposes them to serious physical health complications”, she says. These “young mothers did not like going for treatment in primary care because of self-stigma and social stigma”, Kola explains, and “the app brings care closer to them”. The app uses short, age-appropriate animated videos to deliver mental health and wellbeing messages, including encouraging treatment attendance. Kola and her colleagues have recently completed the field trial of the app and she is now working with a colleague in Kenya to explore funding for use of the app in other African countries, starting with Kenya.

What are the expectations and experiences of a GMH research programme delivered in Bosnia-Herzegovina, Colombia and Uganda? A prospective longitudinal qualitative study.

ObjectivesGlobal health research collaborations between partners in high-income countries and low-income and middle-income countries (LMICs) aim to generate new evidence, strengthen research capacity, tackle health inequalities and improve outcomes. Previous evaluations of such programmes have identified areas for improvement but consisted only of retrospective experiences. We conducted the first prospective study to assess the initial expectations as well as the final experiences of participants of a global health research programme.Design, settings and participantsThis study adopted a prospective longitudinal qualitative study, 38 participants of a global mental health research programme with partners in Bosnia-Herzegovina, Colombia, Uganda and the (UK). The interviewees included senior investigators, coordinators and researchers. Framework analysis was used to analyse the data.Outcome measuresParticipants were interviewed about their initial expectations at the inception of the research programme and their final experiences at the end.ResultsMany of the original expectations were later reported as met or even exceeded. They included experiences of communication, relationships, developed research expertise, further research opportunities and extending networks. However, other expectations were not met or only partially met, mainly on developing local leadership, strengthening institutional research capacity and opportunities for innovation and for mutual learning. Around equity of partnership and ownership of research the views of participants in the UK tended to be more critical than those of partners in LMICs.ConclusionsThe findings suggest that global health research programmes can achieve several of their aims, and that partners in LMICs feel equity has been established in the partnership despite the imbalance of the funding arrangement. Aims of global health research projects should have a realistic focus and be proportionate to the parameters of the funding arrangement. More resources and longer time scales may be required to address sustainable structural capacity and long-standing local leadership sufficiently.

Implementation of a Community-Based Psychosocial Support Focal Point Response for Internally Displaced Persons in Myanmar During COVID-19.

BackgroundIn response to the COVID-19 pandemic, the Global Mental Health research group at Johns Hopkins School of Public Health worked with three local partner organizations in Myanmar to develop a psychosocial support (PSS) program that could be delivered by community-based focal points in internally displaced persons camps. This PSS program was designed to be delivered in communities with limited access to regional mental health services due to pandemic travel restrictions. The content of the PSS program was based on materials from an ongoing Common Elements Treatment Approach (CETA) mental health program; CETA counselors based in the three partner organizations were available to provide telephone-based CETA counseling. In April 2020, the partners organizations recruited and trained PSS focal points in 25 IDP camps to establish a multi-tiered system of MHPSS supports.ImplementationThe PSS program including psychoeducation handouts focused on stress and coping during COVID-19 and skills for cognitive restructuring (i.e., changing unhelpful thoughts) in simplified terms, audio recordings of the content of these handouts and referral opportunities for telephone-based services by CETA counselors located outside of the camps. PSS focal points distributed the handouts, had the recordings played via radio and loudspeaker, and were available to answer questions and provide access to a PSS program phones to connect with the CETA counselors. After 6 months of implementation, program monitoring logs were reviewed and a cross-sectional evaluation was conducted to assess the PSS program's reach, understanding, and perceived utility.EvaluationForty-one focal points implemented the PSS program in 25 IDP camps in Kachin and northern Shan States. From May to September 2020, the focal points distributed handouts to 5,725 households and reported 679 visits by IDPs, including facilitating 332 calls to a CETA counselor. Data from the program evaluation (n = 793 participants) found high levels of handout readership and perceived utility of the information, and good comprehension of the content and application of skills.DiscussionFindings suggest that provision of a multi-tiered MHPSS program, with PSS focal points providing direct information and linkages to further mental health services via telephone, was feasible despite the constraints of the pandemic. Utilizing camp-based focal points was acceptable and successful in delivering basic psychosocial supports to a broad population while serving as points of contact for individuals who wanted and needed telephone-based counseling services.

Considerations for supporting meaningful stakeholder engagement in global mental health research.

The need to ensure that research evidence is adopted by health systems and is informed by lived experience expertise has been increasingly recognised in mental health research. In the field of global mental health (GMH), though some progress has been made, the meaningful engagement of key stakeholders in research remains low. This editorial outlines recommendations to support the meaningful engagement of policy makers and people with lived or living experience of mental illness in GMH research. Recommendations include: increasing funding structures that are designed to support meaningful engagement; urging institutions to consider administrative structures that support engagement with lower resourced partners; promoting capacity development opportunities and resources to support researchers to promote meaningful engagement; developing research governance structures that include key stakeholders; and, taking steps to ensure the needs of diverse stakeholders are met through their engagement in research. Examples of good practice from these areas are provided. Though not an exhaustive list of recommendations, this editorial represents a call to the GMH research community to take a deliberate and proactive approach to prioritising meaningful stakeholder engagement in GMH research with the ultimate goal of improving accessible and appropriate mental health care.

Is everyone invited to the discussion table? A bibliometric analysis COVID-19-related mental health literature.

The COVID-19 pandemic has captured the mental health discussion worldwide. Examining countries' representation in this discussion could prove instrumental in identifying potential gaps in terms of ensuring a truly global conversation in times of global crisis. We collected mental health and COVID-19-related journal articles published in PubMed in 2020. We focused on the corresponding authors' countries of affiliation to explore countries' representation. We also examined these articles' academic impact and correlations with their corresponding authors' countries of affiliation. Additional journals and countries' indicators were collected from the Web of Science and World Bank websites, respectively. Data were analyzed using the IBM SPSS Statistics and the VOSviewer software. In total, 3492 publications were analyzed. Based on the corresponding author, high-income countries produced 61.9% of these publications. Corresponding authors from Africa, Latin America and the Caribbean, and the Middle East combined accounted for 11.8% of the publications. Europe hosted corresponding authors with the most publications and citations, and corresponding authors from North America had the largest mean journal impact factor. The global scientific discussion during the COVID-19 pandemic saw an increased contribution of academics from developing countries. However, authors from high-income countries have continued to shape this discussion. It is imperative to ensure the active participation of low- and middle-income countries in setting up the global mental health research agenda, particularly in situations of global crisis, such as the ongoing pandemic.

Impact of Covid-19 on Mental Health: A Bibliometric Assessment of Publications from India

<p style="text-align: justify;"><strong>Aim:</strong> The paper assesses the India&rsquo;s research output on &ldquo;Impact of Covid-19 on Mental Health&rdquo; indexed in Scopus database. <strong>Materials and Methods:</strong> The Scopus database was used to search for the articles published from India.<strong> Results:</strong> The search showed that since the onset of the pandemic upto 24th of April 2021, 1210 publications emerged from India, amounting to 6.87% share of the global output on the topic and averaged 5.97 citations per paper. India stood at 5th position in terms of number of publications on mental health, with highest number of publications emerging from United States (26.9%), followed by United Kingdom (13.35%), China (9.83%) and Italy (8.27%). About one-third (30.91%) of the publications involved international collaborations, with maximum number of collaborations were with United States, followed by United Kingdom, Australia, Italy, Canada, and Brazil. The most common keywords in the research included, &lsquo;mental health&rsquo;, followed by &lsquo;anxiety&rsquo; and &lsquo;depression&rsquo;. The research output came from 478 organizations, with maximum research coming from National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, All India Institute of Medical Sciences (AIIMS), New Delhi and Postgraduate Institute of Medical Education &amp; Research (PGIMER), Chandigarh. About three-fourth (76.85%) of the mental health research emerged from institute other than these 3 institutes. Five out of the 10 most productive authors and 5 out of the most impactful authors were from institutes other than the 3 major institutes.<strong> Conclusion:</strong> To conclude, this bibliometric analysis suggest that, researchers from India contributed to about 7% of the global mental health research on Covid-19 and India stood at 5th position among the various countries in terms of global mental health research on Covid-19. <p style="text-align: justify;"><strong> Key words:</strong> Covid-19, Mental health, Depression, Anxiety, Bibliometrics, India.

Gender inequality in the global mental health research workforce: a research authorship scoping review and qualitative study in Nepal

IntroductionAlthough women’s health is prioritised in global research, few studies have identified structural barriers and strategies to promote female leadership and gender equality in the global health research workforce, especially...

Evidence-based approaches for promoting gender equity in global mental health research: Study protocol for social network analysis of researchers in Nepal

There are increasing efforts for capacity building of researchers in low- and middle-income countries (LMIC) to foster local ability to conduct high quality research. However, female researchers remain underrepresented in scientific communities, particularly in LMIC where they have limited networking and mentorship opportunities. This protocol is for a Social Network Analysis (SNA) to evaluate if gender-sensitive, need-based capacity building can improve researchers' networking and mentorship opportunities in Nepal. The conceptual framework is informed by Social Cognitive Career Theory. Cross-sectional and longitudinal SNA are used to a) assess individual researchers’ network characteristics and their association with academic productivity; and b) examine if the association of network characteristics and academic productivity is mediated by self-efficacy and outcome expectations. Recruitment is designed to include early-career and senior researchers conducting mental health research, as well as students interested in pursuing a career in mental health research. The network characteristics will be mapped for approximately 150 researchers in working in Nepal. SNA characteristics in the network (individual density, homophily, and centrality) will be compared with academic productivity (total peer reviewed publications, h-index), including mediation effects via self-efficacy and outcome expectations. Ultimately, this study will generate information to design more evidence-based strategies for capacity building of a gender-equitable research workforce in global mental health.

Global Mental Health Research: Time to Integrate Basic Science

The Lancet Commission on Global Mental Health recommends the inclusion of research on the biological underpinnings of mental disorders as part of efforts to reduce the global burden of mental disorders. The search for defining features of mental disorders in non-Euro American settings is historically charged for the field. Yet, as illustrated by analysis of the NIMH objectives, the biological study of mental disorders cannot be scientifically sound without better inclusion of under-represented, globally diverse populations. It is time for global mental health researchers to take up the challenge and advance impactful research across the full translational spectrum.

Advancing Health Equity in Digital Mental Health: Lessons From Medical Anthropology for Global Mental Health.

Digital health engenders the opportunity to create new effective mental health care models—from substance use recovery to suicide prevention. Anthropological methodologies offer a unique opportunity for the field of global mental health to examine and incorporate contextual mental health needs through attention to the lived experience of illness; engagement with communities; and knowledge of context, structures, and systems. Attending to these diverse mental health needs and conditions as well as the limitations of digital health will allow global mental health researchers, practitioners, and patients to collaboratively create new models for care in the service of equitable, accessible recovery.