Ipser, Jonathan C

Stein, Dan J

South African Medical Journal (SAMJ)

SCIENTIFIC LETTERS110Little mental disorder research in general medical journals in low- and middle-income countriesJonathan C Ipser, Dan J SteinTo the Editor: Research on mental disorders undertaken in low- and middle-income (LAMI) countries is rarely published in leading psychiatric journals published in high-income (HI) countries. An examination of the extent to which high-impact general medical journals provide an alternative forum for articles on mental disorders revealed that fewer of these articles are published in LAMI than HI countries.There is increasing recognition of the global economic and human burden imposed by mental disorders.1 This has resulted in a renewed appreciation of the importance of mental health research in both First-World countries and nations classified according to World Bank Criteria as LAMI countries. At the same time there is evidence that research on mental disorders undertaken in developing nations is rarely published in leading psychiatric journals.2  As part of an effort to correct the imbalance in the representation of mental health research from developed and developing nations, the World Health Organization (WHO) hosted a conference in 2003 entitled ‘Mental Health Research in Developing Countries: Role of Scientific Journals’.3 One of the recommendations made by the participating panel of mental health journal editors was that general medical journals in LAMI countries should encourage the publication of mental health-related articles.We decided to determine the extent to which high-profile general medical journals were publishing articles on mental disorders. The question of whether the proportion of articles on mental disorders in general medical journals differed between LAMI and HI countries was also investigated.MethodsLAMI journals of international standing were identified through searching the general and internal medicine category of the Science Citation Index database. A comparative group of HI journals was arbitrarily defined as those publications with an ISI impact factor of 2 or more. An estimate of the proportion of the articles published in LAMI and HI journals that focused primarily on mental disorders was obtained through using the mesh term ‘mental disorders’ as a filter in a PubMed search of all the articles published in the individual journals.Publication trends over time were detected by means of splitting the retrieved articles into those published within as well as before the last decade. A logistical regression analysis was performed to detect differences in the publication of mental disorder-related articles between journal categories and time periods, and to determine whether publication ratio varied between journal categories as a function of time. All statistical tests were performed using the R statistical package (version 2.2.0),4 and were 2-tailed with a significance level of p set to 0.05.ResultsPublication counts for 21 high-impact and 12 LAMI journals were included in the analysis (Table I). HI journals published a significantly greater proportion of psychopathology articles than LAMI journals (z = 15.74, p < 0.05). The ratio of such publications increased over time for both journal categories (z = 20.66, p < 0.05), from 4.66% to 6.27% and from 2.16% to 3.29% for HI and LAMI journals, respectively. There was evidence of an interaction between journal category and time period  (z = 2.31, p < 0.05). The mean impact factor was approximately 18 times higher for the HI than the LAMI journals (7.90 versus 0.43). The overall publication ratio among the LAMI journals was also significantly skewed, with psychopathology articles accounting for over 3% of all the articles published in only 3 of the 12 journals (Croatian Medical Journal, South African Medical Journal, West Indian Medical Journal). DiscussionThis report provides evidence that articles on mental disorders are being published in small but increasing quantities in high-profile medical journals. LAMI medical journals publish a significantly smaller proportion of psychopathology articles than their counterparts in HI countries, despite a reduction in this difference over time. This is consistent with the low proportion of the total health budget that LAMI countries allocate to mental health issues.5 ConclusionLAMI countries should be encouraged to increase their research on psychiatric disorders and to publish their findings in regional and international medical journals. By publishing articles describing the nature and scope of psychopathology Medical Research Council Anxiety and Stress Disorders Research Unit, Department of Psychiatry, Stellenbosch University, W Cape Jonathan C Ipser, MADepartment of Psychiatry and Mental Health, University of Cape TownDan J Stein, MD, PhDCorresponding author: J Ipser (jipser@sun.ac.za)February 2007, Vol. 97, No. 2  SAMJPg 110-111.indd   110 1/19/07   1:53:46 PMSCIENTIFIC LETTERS111within their regions, LAMI medical journals can make a unique contribution to the international mental health database. JI has no known conflicts of interest outside of his employment by the MRC Unit on Anxiety Disorders. DS has received research grants and/or consultancy honoraria from AstraZeneca, Eli-Lilly, GlaxoSmithKline, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, and Wyeth. He has participated in a number of ongoing trials, and has presented data from some of these trials on behalf of the sponsoring companies. 1. World Health Organization. World Health Report 2001. Mental Health: New Understanding, New Hope. Geneva: WHO, 2001.2. Patel V, Sumathipala A. International representation in psychiatric literature: Survey of six leading journals. Br J Psychiatry 2001; 178: 406-409. 3. Editors and Department of Mental Health and Substance Abuse, World Health Organization. Galvanizing mental health research in low- and middle-income countries: Role of scientific journals. Bull World Health Organ 2004; 82: 226-228.4. R: A Language and Environment for Statistical Computing. Version 2.2.0. Vienna: R Foundation for Statistical Computing, 2005. 5. Saxena S, Sharan P, Saraceno B. Budgeting and financing of mental health services: baseline information on 89 countries from WHO's project atlas. J Ment Health Policy Econ 2003; 6: 135-143.Table I. Summary statistics for HI and LAMI general medical journals Journals   Country   Impact factor*  Total†  Ratio (%)‡High-impact journals    N Engl J Med  USA   38.570   56 145  3.90JAMA   USA   24.831   56 634  6.32Lancet   England   21.173                 112 598  4.86Ann Intern Med  USA   13.114   23 944  3.82Annu Rev Med  USA   11.2     1 833  7.31Arch Intern Med  USA   7.508                  15 847  4.71BMJ   England   7.038                  40 985  6.41Am J Med  USA   4.179                  18 227  3.12Mayo Clin Proc  USA   3.746     7 975  2.98Medicine (Baltimore) USA   3.727     1 415  4.45Ann Med  Finland   3.617     1 456  9.00J Intern Med   England   3.590     2 851  3.26Am J Prev Med  USA   3.188     2 288  4.28Curr Med Res Opin England   2.928     2 139                11.59J Gen Intern Med  USA   2.821     2 929  8.40QJM-Int J Med  England   2.580     1 485  5.32Eur J Clin Invest  Germany   2.530     3 843  2.13Prev Med  USA   2.327     3 449  6.23J Pain Symptom Manage USA   2.187     2 042  8.28Br Med Bull  England   2.165     2 966  5.50Med J Aust  Australia   2.000   33 978  6.31    LAMI journals    S Afr Med J  South Africa  1.107                23 504  3.75Croat Med J  Croatia   0.690      901  6.55Natl Med J India  India   0.626   1 537  2.47Indian J Med Res  India   0.600   9 443  1.16Chin Med J (Peking) China   0.459   7 540  1.31J Formos Med Assoc Taiwan   0.453   2 841  1.94Medicina (B Aires)  Argentina  0.324   6 002  1.22Rev Invest Clin  Mexico   0.277   2 785  2.76Rev Med Chil  Chile   0.273   9 059  2.97West Indian Med J  India   0.209   2 434  3.41Ethiop Med J  Ethiopia   0.174   1 071  1.40Ter Arkh  Russia   0.100                16 944  1.58* ISI impact factor.† Total number of articles indexed by PubMed as of 27 September 2005.‡ Percentage of total number of articles indexed by PubMed under ‘mental disorders’.February 2007, Vol. 97, No. 2  SAMJPg 110-111.indd   111 1/19/07   1:53:47 PM

Little mental disorder research in general medical journals in low-and middle-income countries

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Little mental disorder research in general medical journals in low-and middle-income countries

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