OBJECTIVE: To systematically identify mental health research and researchers in Pakistan. Subsidiary objectives were to identify methodologies of studies published in the indexed journals along with their country wide mean impact factor.
METHODS: A systematic search strategy using key words related to neuropsychiatry was carried out to identify various studies published in Indexed and Non-indexed databases.
RESULTS: We identified 108 studies from Indexed data bases (77.8% Medline; 22.2% PsychInfo). Beside these, 51 studies were also identified from non-indexed databases. Among the indexed articles, 97 (89.8%) were Journal articles while 10 were other type of documents--there were 3 clinical trials of which only one was a randomized controlled trial. The mean Impact Factor (IF) of these studies was 2.75 (Range; 2.21-3.29). The median IF was 2.90. The most preferred journal for publication was the Journal of Pakistan Medical Association (JPMA; N = 33) followed by British Journal of Psychiatry (B J Psych; N = 11) and Journal of College of Physicians and Surgeons, Pakistan (JCPSP; N = 9). From the indexed and non-indexed publications we identified 43 researchers. Among these 34 (80%) were psychiatrists.
CONCLUSION: The key finding of this mental health research mapping exercise is that mental health research output from Pakistan is low both in numbers and quality, with very few studies making it to high impact international journals. There is an urgent need to strengthen research capacity in areas of mental health at individual, organizational and macro-system levels

Khan, Murad M

Naqvi, Haider A

English

eCommons@AKU

eCommons@AKUDepartment of Psychiatry Medical College, PakistanJanuary 2007Mapping exercise of mental health research andresearchers in PakistanHaider A. NaqviAga Khan UniversityMurad M. KhanAga Khan University, murad.khan@aku.eduFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_psychiatryPart of the Psychiatry CommonsRecommended CitationNaqvi, H. A., Khan, M. M. (2007). Mapping exercise of mental health research and researchers in Pakistan. Journal of Pakistan MedicalAssociation, 57(6), 294-298.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_psychiatry/107Original ArticleMapping exercise of mental health research and researchers in PakistanHaider A. Naqvi,  Murad M KhanDepartment of Psychiatry, The Aga Khan University, Karachi.AbstractObjective: To systematically identify mental health research and researchers in Pakistan. Subsidiary objectiveswere to identify methodologies of studies published in the indexed journals along with their country wide meanimpact factor. Methods: A systematic search strategy using key words related to neuropsychiatry was carried out to identifyvarious studies published in Indexed and Non-indexed databases. Results: We identified 108 studies from Indexed data bases (77.8% Medline; 22.2% PsychInfo). Beside these,51 studies were also identified from non-indexed databases.  Among the indexed articles, 97 (89.8%) wereJournal articles while 10 were other type of documents - there were 3 clinical trials of which only one was aRandomized Control Trial. The mean Impact factor (IF) of these studies was 2.75 (Range; 2.21-3.29). Themedian IF was 2.90. The most preferred journal for publication was the Journal of Pakistan Medical Association(JPMA; N=33) followed by British Journal of Psychiatry (B J Psych; N=11) and Journal of College of Physiciansand Surgeons, Pakistan (JCPSP; N=9). From the indexed and non-indexed publications we identified 43researchers. Among these 34 (80%) were psychiatrists. Conclusion: The key finding of this mental health research mapping exercise is that mental health researchoutput from Pakistan is low both in numbers and quality, with very few studies making it to high impactinternational journals. There is an urgent need to strengthen research capacity in areas of mental health atindividual, organizational and macro-system levels (JPMA 57:294;2007).IntroductionSeveral influential reports and papers have broughttogether data demonstrating that mental disorders arecommon and disabling. According to World Bank report(1993) mental illnesses contribution to the global diseaseburden is estimated to be 10.5%. This is projected toincrease to 15% by 2020.1 Less than 10% of globalspending on health is devoted to diseases or conditions thataccount for 90% of the global disease burden.2It is evident that research findings in high-incomecountries are not easily transferable or appropriate for use inlow and middle-income countries (LaMIC). In a recentpaper Patel and Sumithipala (2003)3 estimated that only 6% of articles in six leading psychiatry journals were fromregions other than Euro-America.  One of the reasons forthis low publication rates form LaMIC is low quantity andquality of submitted papers, poor research design,methodology and  language difficulties for authors fromcountries where English is not the academic language. Thismakes it imperative that critical mass of researchers shouldbe developed in LaMIC.3There is no objective data on the status of mentalhealth research from Pakistan. Most of the informationcomes from a handful of reports and editorial view points.4In an editorial Gadit, (2006) reports that there is "dearth ofscientific articles about mental health even in the local peer-reviewed journals" and "even if other journals that are notlisted in the Medline may also be considered, the list stillwould not go beyond over a hundred articles".5,6 Howeverthere is no objective data to back this statement. If mentalhealth research capacity programs are to be developed thisbe based on sound research evidence.    The aim of this study was to systematically identifythe mental health researchers in Pakistan, contributing tothe evidence on various topics related to psychiatry over thecourse of ten years (1993-2004). We had four specificobjectives viz.1. Identification of various types of studies published inthe indexed journals.2. Identification of preferred journal for publishingoriginal studies.  3. Identification of researchers contributing to mentalhealth research over the course of ten years. 4. Identification of the mean country wide impact factorof studies published in indexed journals.Material and MethodsA systematic search, using Boolean key wordsstrategy was undertaken by P.I in order to identify studies,published in Indexed data bases like Medline andPsychinfo. Non-Indexed articles (grey literature) weresearched through local data bases like PakMedinet.com andVol. 57, No. 6, June 2007 294Faculty of health science Library (FHSL), Aga KhanUniversity Hospital, Karachi. Parallel search was done byanother set of researchers using Caidionline software forinternational databases. These files were then compared andcleaned for ineligible articles. This study emanates from a larger mapping exercisestudy of mental health researchers and stake holders inSouth Asia, a collaborative project of Global Forum forhealth research and World Health Organization (WHO) andis being prepared for submission. In this paper we report thekey findings pertaining to Pakistan only Inclusion Criteria:  Any piece of work related tomental health issues including qualitative, epidemiological,and biomedical research was included in our study. Thiswould comprise original research, published articles,editorials, congress abstracts, reports, thesis anddissertations. Eligibility criteria for studies included;* Pakistani physician or psychiatrists as first or secondauthor* Study conducted in geographical boundaries ofPakistan (excluding studies on Pakistani immigrants)  * Ten year period (1993-2004).MeSH headings included in the study (Pub Med)were: Pakistan and 'Schizophrenia and psychotic disorders','Affective Disorders (including post-partum depression)','Anxiety Disorders', 'Alcohol Abuse and Dependence','Drug Abuse and Dependence', 'Dementias includingAlzheimer', 'Learning Disabilities', 'Childhood Mental andBehaviour Disorders', 'Stress Disorders and PTSD', 'EatingDisorders', 'Epilepsy', 'Suicide', `Parasuicide', `Deliberateself-harm', 'Mental co-morbidity of AIDS', 'Neuro-psychiatric disorders', 'Mental health'. Exclusion Criteria: Non mental health studies,studies on migrant populations living in developedcountries and animal studies, studies exclusively onpersonality traits or general psychology. ResultsMedline search using indexed publications retrieved158 articles after systematic search Among the 158 articleson various topics related to mental health 108 met ourinclusion criteria. Figure shows the year wise distribution ofthe studies. There has been a gradual increase in number ofpublished articles from Pakistan over the years. Among the108 studies found to be eligible 84 (77.8%) studies wereidentified from Medline while 24 (22.2%) were fromPsychInfo, 97 (89.8%) were journal articles while 10 wereother type of documents published in the peer reviewjournals. Among the journal articles 66 (61 %) were originalstudies. Table 1 shows the details of Publication-typespublished in Indexed Journals.  Table 1. Publications types published in indexed journals.  Publication type Frequency (%)Original articles published in the journalsEmpirical studiesEditorialsReview articlesJournal articles: Validation studiesJournal articles: Clinical trialJournal articles: Randomized clinical trialComments; lettersEvaluation studies  Research-review Lectures Others66 (61%)11 (10.2 %)4  (3.7 % )3  (2.8 %)2  (1.9 %)2  (1.9 %)1  (0.9 %)5  (4.6 %)1  (0.9 %) 1  (0.9 %)1   (0.9 %)11  (10.3 %)Total 108 (100 %) Table 2. Leading indexed journals in which articles from Pakistanwere published.Journals IF* Number ofarticlesJournal of Pakistan Medical AssociationBritish Journal of  PsychiatryJournal of College and Physicians and surgeons Pakistan. Acta Psychiatrica ScandinavicaCrisis Psychological Medicine Journal of Ayub Medical CollegeAmerican Journal of PsychotherapyLancetOthers Not available4.2Not available2.32.9Not available7.622-3312974432133Total 2.75 (2.21-3.29) 108Publication Year52236510152025303540umber of PublicationsFigure. Publication Year for studies related to mental health, published in Indexed Journals fromPakistan.295 J Pak Med AssocThe most preferred journal among the indexedliterature was Journal of Pakistan Medical Association(JPMA) followed by British Journal of Psychiatry (BJP).Journal of College of Physicians and Surgeons Pakistan(JCPSP) ranked third while Acta Psychiatrica Scandinavia(APS) ranked fourth as for number of articles on mentalhealth. Among these top four journals the Institute ofScientific Information Impact Factor (ISI IF) for BJP andAPS was 4.2 and 2.3 respectively.  Table-2 shows the studytypes and their journal wise distribution along with theirImpact Factor. The mean Impact Factor (IF) of these studieswas 2.75 (Range 2.21-3.29). The median IF 2.90.Greyliterature was gathered from local data-base searches.Among 338 articles on various aspects of neuro-psychiatry204 were published in last 10 years; among them 134 metour inclusion criteria. A local database (PakMediNet) that includedindexed and non-indexed journals from Pakistan was alsosearched for studies on neuro-psychiatric disorders. Amongthe 96 studies retrieved 84 were eligible for inclusion. After'cleaning' the local databases we were able to identify 51additional studies (complete list available from authors).  Full text articles of these studies were retrieved,which were hand searched for any other eligible studies.Searches were done by the two authors separately. They metregularly and discussed any conflicting issues in order tominimize any selection bias.  Table 1 shows the type ofdifferent methodological type of studies published inIndexed journals. After scanning through the articles fifty researcherswere identified through indexed literature. Additional 18researchers were identified through Grey literature; makingthe total tally to 68. This tally also contained six authorswho were primarily Westerners and had a Pakistani co-author.In order to identify the main researchers in mentalhealth research, we excluded Pakistani authors settledabroad. This reduced the total to 43 researchers. Amongthese 34 (80%) were psychiatrists while rest were from thevarious sub-specialties of medicine (Family Medicine, 3;Public health, 2; Emergency medicine, neurology, forensicmedicine, 1 each). Among the top five authors three werepsychiatrists while two were family physicians. . Togetherthese top five researchers accounted for 34 % of thepublications from Pakistan, which highlights the fact thatfew mental health professionals were involved in researchand is one of the key findings of this mapping exercise.Survey questionnaires were sent to all these individuals inorder to identify the status of mental health researchresources, Epidemiology/Bio-statistics support facilitiesand available funding. That survey is part of another projectwhich will be reported separately. DiscussionThe key finding of this mental health researchmapping exercise is that there is dearth of mental healthprofessionals engaged in research in Pakistan. This isreflected in the relatively small number of publications andpapers in indexed and non-indexed data bases. Besides thelow numbers, most of the studies were by handful ofpsychiatrists working in few centers. We could identify only34 psychiatrists contributing to mental health researchevidence from Pakistan. The mean Impact Factor (IF) of these studies was2.75 (Range 2.21-3.29). The median IF 2.90. There aresome controversies regarding Institute of ScientificInformation Impact factor (ISI IF). Originally IF wasintended as an objective measure of the reputability of ajournal, it is now being increasingly applied to measure theproductivity of scientists. IF have significant, butcontroversial, influence on the way scientific research isperceived and evaluated. It is calculated each year by theInstitute for Scientific information for those journals whichit indexes. The IF is calculated based on three-year period,and can be considered to be an average number of timespublished papers are cited up to two years after publication.Not all indexed journals have an ISI IF. Our literaturesurvey revealed that almost one third of the studies,published in indexed journals, had an ISI IF. A surprising finding was the negligible number ofclinical trials. We could identify only one randomizedcontrol trial (RCT) in our search. RCT is considered to be agold standard for efficacy of any intervention. In theabsence of RCTs it is extremely difficult to establishevidence-based treatments from developing countries,suited to the socio-cultural needs of the population. The low numbers may represent poor researchcapacity in Pakistan. There is an increasing emphasis inacademia all over the world on research and publications.Pakistan is no exception as clinicians find themselves in thedilemma to 'publish or perish'. There are other reasons to doresearch beside its unequivocal criteria for promotion andprogress in academic path, while others do research for thesake of learning. The American philosopher and educator,John Dewey (1859-1952) writes "learning is based ondiscovery guided by mentoring rather than on thetransmission of information." Research capacity can be strengthened throughmentorship. This requires a critical mass of trained and wellversed researchers. A systematic program is required whereyoung researchers are guided in identifying areas of theirresearch interest. This would result in sustained focus andVol. 57, No. 6, June 2007 296development of knowledge, particular to a specific area. Inour survey we identified that, those who have an identifiedarea of research published more besides contributing to thescientific evidence in the field of mental health. On theother hand those who were driven by number ofpublications, as required for promotion, or donor agenciesagenda had fewer publications. In our survey we identified 41% of the studies werepublished in Pakistani journals. This is an interestingfinding. We can only speculate about the researchers' choiceof journal for publication. Whether they are driven by themotive to contribute more to the local evidence, journal'scirculation or other factors are open to question. There are other inherent difficulties in the peer-review process of scientific studies. Patel (2001)3,  hascommented: "Reviewers and editors (from high impactinternational journal) may judge papers from rest of theworld (RoW) as being less relevant to local readership andreject papers on this ground. Thus, any journal is likely topay attention to the needs of its readership. Other factorsmay include low quality of submitted papers, including poorresearch design and methodology, language difficulties forauthors from countries where English is not an academiclanguage".3Although health research is increasingly recognizedas one of the driving forces behind development,researchers in Pakistan, like other low-and middle-incomecountries continue to lag behind in the quality and volumesof scientific out-put. As a result, problems specific toMaLIC do not receive the attention they deserve. This isextremely relevant as with increasing globalization many ofthe communicable diseases prevalent in Pakistan and otherlower income countries also constitute a threat to globalhealth. It is imperative that research capacity strengthening(RCS) should move center stage in order to addresssustainable development7 Training and institutional development as keyelements in RCS were the subject of an extensive study bythe Wellcome Trust covering most of the agencies that fundresearch training both bilaterally and multilaterally.8 Thereport found that many funding organizations inindustrialized countries have been supporting broad-basedresearch training and institutional development in low-andmiddle-income countries. However, the study observed thatoverall investment in training by these agencies remainedmodest, with an aggregate expenditure of US$21 millionidentified in 1995-1997 for training in biomedical sciencesand health over the three-year period. Some of those trainedhad, for different reasons, not returned to their homecountries, thereby further contributing to the "brain drain"8Besides the classical distinction between country, regionaland global levels, there is growing consensus to look atcapacity strengthening at country level from three different,complementary perspectives or levels: individuals,institutions and systems levels. Recently Lansang (2004)9 has given a clearoverview of RCS at these various levels At individual levela critical mass of researchers competent in the basic,clinical, epidemiological, biostatistical, health systems andpolicy and social sciences, performing quality research ofnational relevance and of scientific importance, has to bedeveloped, maintained and retained. To maintain the interestand commitment of researchers, a research environment hasto be enhanced.9Nchinda (2002)10 has identified key elements neededfor successful RCS. These include a capable and committedscientific leadership, continuity of funding of research,ability to attract a core of dedicated young scientists,adequate and appropriate infrastructure for research,adequate equipment and supplies including moderncommunication facilities and scientific literature, scientificlinkage to other institutions and stable conditions of servicewith adequate remuneration. Most of these "success factors"refer to the institutional environment of individualresearchers and illustrate the critical importance ofinstitution building as a different component in RCS.  At macro-level health system research shouldinclude: strategic planning, research priority setting,knowledge management, advocacy and demand creation,consensus building and negotiation, resource generation andallocation, partnership building across many stakeholdersand communication, including virtual form of networking.  For countries like Pakistan, the critical question is:are we ready to address issues of RCS? For exampleepidemiology of mental illnesses in Pakistan is verydifferent when compared with the West. RCS should cometo forefront if we are to develop an evidence basedepidemiological map in Pakistan. No development inprogram and policy is possible without objective research. At individual level skills pertaining to researchmethodology needs to be developed. Training in scientificwriting, protocol development, epidemiology, biostatistics,data management and analysis needs to be incorporated inthe Psychiatry residency programmes. Mentorship in theseareas can effectively facilitate the learning for youngerclinicians. The dichotomy of researchers and cliniciansneeds to be dissolved. It has been demonstrated in the pastthat good research questions emanated form astute clinicalobservations. These however need to be developedsystematically, proven quantitatively, with robustmethodology. Gaussian ghost needs to be exercised duringthe clinical years of training.    297 J Pak Med Assoc

Mapping exercise of mental health research and researchers in Pakistan

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Mapping exercise of mental health research and researchers in Pakistan

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