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      ‘Global mental health’: systematic review of the term and its implicit priorities

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          Abstract

          Background

          The term ‘global mental health’ came to the fore in 2007, when the Lancet published a series by that name.

          Aims

          To review all peer-reviewed articles using the term ‘global mental health’ and determine the implicit priorities of scientific literature that self-identifies with this term.

          Method

          We conducted a systematic review to quantify all peer-reviewed articles using the English term ‘global mental health’ in their text published between 1 January 2007 and 31 December 2016, including by geographic regions and by mental health conditions.

          Results

          A total of 467 articles met criteria. Use of the term ‘global mental health’ increased from 12 articles in 2007 to 114 articles in 2016. For the 111 empirical studies (23.8% of articles), the majority (78.4%) took place in low- and middle-income countries (LMICs), with the most in Sub-Saharan Africa (28.4%) and South Asia (25.5%) and none from Central Asia. The most commonly studied mental health conditions were depression (29.7%), psychoses (12.6%) and conditions specifically related to stress (12.6%), with fewer studies on epilepsy (2.7%), self-harm and suicide (1.8%) and dementia (0.9%). The majority of studies lacked contextual information, including specific region(s) within countries where studies took place (20.7% missing), specific language(s) in which studies were conducted (36.9% missing), and details on ethnic identities such as ethnicity, caste and/or tribe (79.6% missing) and on socioeconomic status (85.4% missing).

          Conclusions

          Research identifying itself as ‘global mental health’ has focused predominantly on depression in LMICs and lacked contextual and sociodemographic data that limit interpretation and application of findings.

          Declaration of interest

          None.

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          Most cited references18

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          Global mental health: a new global health field comes of age.

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            Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being.

            Large-scale community studies of the prevalence of mental disorders using standardised assessment tools are rare in sub-Saharan Africa. To conduct such a study. Multistage stratified clustered sampling of households in the Yoruba-speaking parts of Nigeria. Face-to-face interviews used the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). Of the 4984 people interviewed (response rate 79.9%), 12.1% had a lifetime rate of at least one DSM-IV disorder and 5.8% had 12-month disorders. Anxiety disorders were the most common (5.7% lifetime, 4.1% 12-month rates) but virtually no generalised anxiety or post-traumatic stress disorder were identified. Of the 23% who had seriously disabling disorders, only about 8% had received treatment in the preceding 12 months. Treatment was mostly provided by general medical practitioners; only a few were treated by alternative practitioners such as traditional healers. The observed low rates seem to reflect demographic and ascertainment factors. There was a large burden of unmet need for care among people with serious disorders.
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              Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care.

              To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders. A cross-sectional sample selected by two-stage sampling. Primary health care facilities in 14 countries covering most major cultures and languages. A total of 25,916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response). Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers. The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability.
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                Author and article information

                Journal
                BJPsych Open
                BJPsych Open
                BJO
                BJPsych Open
                Cambridge University Press (Cambridge, UK )
                2056-4724
                May 2019
                31 May 2019
                : 5
                : 3
                : e47
                Affiliations
                [1]Doctoral Candidate, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , USA
                [2]Program Director, Neuropsychiatric Genetics of African Populations-Psychosis Study, Harvard T.H. Chan School of Public Health , USA
                [3]Assistant Scientist, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , USA
                [4]Research Associate, Department of Epidemiology, Harvard T.H. Chan School of Public Health , USA
                [5]Professor, Department of Epidemiology, Harvard T.H. Chan School of Public Health , USA
                Author notes
                Correspondence: Supriya Misra, Harvard T.H. Chan School of Public Health , Department of Social and Behavioral Sciences, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, MA 02115, USA. Email: supriya@ 123456mail.harvard.edu
                Author information
                https://orcid.org/0000-0003-0389-1227
                Article
                S2056472419000395 00039
                10.1192/bjo.2019.39
                6582218
                31530316
                d2cdade9-c0dd-48b5-aa60-14981a63da4a
                © The Royal College of Psychiatrists 2019

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

                History
                : 24 September 2018
                : 28 April 2019
                Page count
                Figures: 5, Tables: 1, References: 38, Pages: 8
                Categories
                Review

                global mental health,global health,mental health,depression,psychosis

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