PERSPECTIVES
Galvanizing mental health research in low- and middle-income countries: role of scientific journals
A joint statement issued by editors of scientific journals publishing mental health research, & Department of Mental Health and Substance Abuse, WHO, Geneva, January 20041
The WHO Department of Mental Health and Substance Abuse organized the following meeting: Mental Health Research in Developing Countries: Role of Scientific Journals in Geneva, on 20 and 21 November 2003, attended by 25 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 Box 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. Nevertheless, 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 aim of the meeting was to find ways of resolving this unsatisfactory situation.
Responsibility of scientific journals towards international mental health
Scientific research, in its quest to accomplish valid generalizations 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 previously 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 is published 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 urgently needed 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 web site. 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 Box 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. 
1 This joint statement may also be published in other journals