The survey questions reported on here were part of a larger study “Mental Health: Mapping of Research Capacity in Low- and Middle-Income Countries” that aimed to develop regional maps of mental health researchers, and detail their research agenda and the research infrastructure (institutional, funding, policy on research, etc.) that supports them.23
This is the first article from that study and it is based on the section on priorities for mental health research.
The Global Forum issued a “Request for Proposals” that was distributed widely through a combination of electronic and postal methods to universities, research institutions and individuals in LAMI countries of Africa, Asia and Latin America and the Caribbean (henceforth termed the Americas). LAMI countries of Europe and the Middle East were not included. Six out of 18 distinct proposals (two from each region) were selected based on their scope (the extent to which they met the broad goals of the project) and the capabilities of the teams. Further project development occurred with coordination and support from Global Forum and World Health Organization (WHO), so the six teams addressed some common issues. A standardization workshop with project leaders (Global Forum, WHO and the six principal investigators) was conducted to agree on the common issues and the methods to approach them, e.g. the databases to be used, the time frame for the search for the enumeration of researchers, the documents and networks to be tapped to enumerate stakeholders, a shared understanding of terms and definitions use to help the teams in supporting their members and respondents who sought clarifications. A total of 114 LAMI countries from Africa (52), the Americas (30) and Asia (32) constituted the study universe (see Sharan et al, for the list of countries).23
Researchers were enumerated through a search of indexed (Medline and PsycInfo) and non-indexed literature (regional databases, online journals, other local journals, unpublished papers, presentations, and reports) for a 5-year period (1999 to 2003) for mega countries (population >100 million) and for a 10-year period (1993 to 2003) for less populated countries. All authors whose addresses could be identified in the literature search were invited by mail or e-mail to participate in this survey. Stakeholders were identified through websites and reports of organizations and associations, journals, regional databases, grey literature searches, ministries of health documents and snowball technique. Stakeholders included: (i) decision makers (legislators and officers of ministries of health, health insurance agencies, foundations, and research councils), (ii) university administrators, and (iii) officers of associations (office bearers of professionals associations, non-governmental organizations, and associations of users and carers). Survey respondents' addresses were obtained through local directories (e.g., professional organizations), resources like Google™ Scholar, and correspondence with affiliated institutions and colleagues.
The overall design of the postal survey was as follows: a letter of announcement was sent to explain the rationale of the study, and inform potential respondents about availability of choice in response formats (electronic- or paper-based) and confidentiality. One week later the questionnaire and a pre-addressed return envelope or information about the website where the questionnaire was available was sent. Non-respondents were sent up to four reminders (including a copy of the questionnaire) at 2-4 weeks intervals. The questionnaires could be answered in English or other international languages.
The draft questionnaire was developed by a core group (public health professionals of WHO and Global Forum with knowledge of mental health, health research priority setting, and health economics; and experience of working in and for LAMI countries) that compiled an initial list of items within the broad health research system framework.24
The options related to questions on priority were adapted from various sources: an unpublished WHO questionnaire on mental health research (critiqued by 12 public mental health experts from WHO, LAMI and high-income countries); a WHO-Research Policy and Cooperation study on health research in LAMI countries,3
and an Australian study on research priorities in mental health.16
This questionnaire was discussed in detail in the standardization meeting by the regional principal investigators (mental health professionals from diverse backgrounds with extensive experience of working in LAMI and high-income countries) who identified omitted issues and finalized the questionnaire.
The section on mental health research priorities began with the question -- “Over the next 5 years, what in your opinion are the most important mental health research priorities in your country?” Respondents were requested to indicate the top three for each of the following categories of research priorities by marking multiple choice boxes:
Type of mental health research
Epidemiological studies of burden and risk factors; health systems research (e.g., services evaluation, policy and economic studies); social science research (e.g., illness beliefs, measurement); clinical trials; and basic sciences research (e.g., genetics and neuro-imaging).
Depression/anxiety, substance use disorders, psychoses, disorders with onset in childhood and adolescence, suicide, dementia, personality disorders, learning disorders, epilepsy, eating disorders, others.
Children and adolescents, women, persons exposed to violence/trauma, the poor, elderly persons, disabled persons, minorities, refugees, prisoners, others.
Criteria for prioritizing
Burden of disease in the population, availability of funds, researchers' personal interests, policy-maker request, social justice/equity and others. The findings of the study with compared with two external (hard) indices that were available for the same countries: projects conducted by responding researchers,23
and the burden of neuropsychiatric diseases.25
As a part of the larger study (Mental Health: Mapping of Research Capacity in Low- and Middle-Income Countries) each researcher had to tick multiple choice boxes (with the same response options as in the survey on priorities) regarding the type of research, its focus on disorders and specific populations, and the motivation(s) for conducting the research; for three research projects carried out in the last 5 years (n=1847 projects).23
Though questions on the project preceded those on priorities, it was possible that researchers might have selectively reported projects that matched their subjective priorities. To check on this possibility, we compared the ranking of various response categories in the projects with the ranking of similar categories in indexed publications (Pubmed and PsycInfo, n=2397) from the same countries in one region (the Americas).23
The ranking for types of research, disorders, and specific populations was found to be identical (data available from the authors on request); suggesting that researchers had been reasonably objective in reporting on their projects.
The table on estimated total disability adjusted life years by cause and member states (December 2004 estimates) was used to compile the burden of 6 relevant neuropsychiatric categories for 111 of the 114 countries: depression/anxiety (unipolar depressive disorders, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder), substance use disorders (alcohol use disorders, drug use disorders), self-inflicted injury (including suicide), psychosis (schizophrenia), dementia (Alzheimer and other dementias), and epilepsy.25
The study methodology was approved by the Institutional Review Boards of the respective teams. No formal ethical approval was required in the Philippines because the 'Official and Formal Ethical Board' was not in existence during the conduct of the study. A formal ethical approval was also not required in Nigeria at the time of the study.