Internet-based search of randomised trials relevant to mental health originating in the Arab world

The Arab Region's Contribution to Global Mental Health Research (2009-2018): A Bibliometric Analysis

Background: Mental health research output in the Arab region is increasing, yet little is known about its recent landscape. This study provides a bibliometric analysis of mental health research in all 22 Arab countries over the past decade. Method: We used 760 journals and numerous keywords to search for articles published between 2009 and 2018 by individuals affiliated with institutions located in the Arab region. We analyzed data within Arab countries and between Arab and non-Arab countries. Results: We found that research output in the Arab world has increased by almost 160% in the past ten years, in comparison to 57% for the rest of the world. The quality of publications has also steadily improved, and so did international collaboration. Despite the progress, the number of articles per capita remains remarkably lower for the Arab world compared to the rest of the world. Also, the majority of articles continue to emanate from a limited number of countries (Egypt, Saudi Arabia, and Lebanon) and institutions within these countries. Mental health research topics in the Arab region are similar to those found in low- and middle-income countries of Africa, Asia, Latin America, and the Caribbean. Conclusion: The region needs to invest more in mental health research to close the gap with other medical and healthcare research areas and with the rest of the world. The region also needs to increase its international collaboration and research training to produce higher-quality studies, attract more funding, and publish more in top journals. As the region's population continues to face increasing trauma as a result of war and terrorism, among others, the field is afforded an opportunity to establish a major standing in the healthcare domain. Researchers are uniquely poised to use their body of research evidence to effectively help people reengage with their environments and return to daily life activities.

Meta-analysis of the efficacy and acceptability of cognitive-behavioural therapy for Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder

A meta-analysis of the literature of cognitive behaviour therapy (CBT) with Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder (PTSD) was conducted. Nine studies (n = 536) met the eligibility criteria. Three of the nine studies (33%) were randomised control trials using waitlist control groups. All studies (100%) reported a statistically significant reduction in psychological symptoms at post-treatment with large effect sizes for anxiety (effect size, 95% confidence interval) (1.44 [1.29, 1.59]), depression (1.26 [1.16, 1.35]) and PTSD (2.08 [1.94, 2.23]). Six out of the nine studies (67%) collated follow-up data and reported that reductions of psychological symptoms were maintained at follow-up. An average dropout rate of 26% indicated good overall acceptability. Five out of nine (55%) of the trials reported diagnostic remission rates and of those trials the mean remission rate was 31%). Five of the nine eligible studies (55%) delivered remotely via Internet or telephone were found to have similar effect sizes as face-to-face CBT. The current meta-analysis indicates the potential of CBT, delivered either face-to-face or via internet, as efficacious and acceptable interventions for the treatment of anxiety, depression and PTSD for Arab adult populations.

Facebook as an effective recruitment strategy for mental health research of hard to reach populations

Recent reports indicate that Facebook (FB) may facilitate recruitment of hard to reach participants into mental health research. The present study aimed to contribute to this emerging literature by exploring recruitment data from a recently completed trial of online treatment for symptoms of anxiety and depression that targeted Arab people. The present study compared traditional recruitment strategies such as media releases, emails, and print advertisements with Facebook strategies including boosting posts, promoting websites, events and FB public fan pages. The main outcomes of interest were the number of started applications and the time and cost per application associated with the FB and traditional recruitment strategies. A target sample of 350 was sought and a total of 81 participants applied to participate over the 42-week recruitment period. Overall, 86% of the resultant applications occurred via FB recruitment and a Poisson regression analysis indicated the FB strategies were more time-effective, recruiting participants 2.5 times faster than the traditional strategies. However, there were no differences in cost-effectiveness for FB ($US37 per participant) and traditional strategies ($US40 per participant). The findings of the current study add to existing literature detailing the value of FB recruitment strategies, alongside more traditional strategies, as a way of recruiting hard-to-reach populations for research. However, more research is needed to explore alternative and optimal strategies for the successful recruitment of hard to reach populations via FB and other online social media platforms.

A Qualitative Study of the Perceptions of Mental Health Care in Kuwait

Ten adult Kuwaitis (5 men and 5 women) participated in in-depth semistructured interviews regarding their perceptions of mental health care in Kuwait. The interviews were analyzed using grounded theory and the emergent theory identified stigma as being the overarching theme, supported by cultural factors, Islamic beliefs, and therapist characteristics. More specifically, participants described a relationship between the stigma of mental health care and prominent Kuwaiti cultural factors such as familialism, gossip, and the importance of reputation. Participants also discussed how Islam informs their perceptions of mental health care and ideal therapist characteristics that would possibly help reduce stigma. Implications for mental health care in Kuwait in light of the World Health Organization’s Mental Health Action Plan ( WHO, 2013 ) and directions for future research are also discussed.

Rivers of evidence

There has been too much of a one-way flow drift down a river of evidence. Researchers from rich countries have produced the primary evidence which they proceed to summarise within reviews. These summaries have directed care worldwide. However, things are changing and the river of evidence can flow in the other direction. The care of women with eclampsia has been changed or refined throughout the world because of a large low and middle income country trial. The global care of people with heart disease has been greatly modified by studies originating in China. The care of people who are acutely aggressive because of psychosis has to be reconsidered in the light of the evidence coming from Brazil and India. Healthcare is an issue everywhere and evaluation of care is not the premise of any one culture-the evidence-river must run both ways.

Mental health research in the Arab world

PURPOSE

To assess the progression of mental health research over four decades in the Arab world.

METHODS

Publications on mental health in 21 Arab countries from 1966 to 2006 were screened using PubMed and Psychinfo. Data were collected and analyzed for Arab authors and affiliations, publication year, topic and type of journal.

RESULTS

In 40 years (1966-2005), the Arab world published 2,213 articles on a vast variety of topics, most common being mood, anxiety and substance use disorders, and mostly in international journals. By the last decade, the total yearly publications increased about eightfold since the first two decades, and nearly doubled from the third one. The disparity of output was high across countries. The highest yearly output was from Egypt, Saudi Arabia, Kuwait and Lebanon. Per million population, the top four producing countries were Kuwait, Bahrain, Lebanon and United Arab Emirates.

CONCLUSIONS

Over a decade, the Arab world produced approximately 17% of the global output of mental health publications/million population and was comparative to Latin American and Caribbean countries. There is a wide gap in comparison with the industrialized world, with a fertile ground for cross-cultural and genetic studies.

Treatment of mental disorders and pathways to care in Arab countries

INTRODUCTION

The available studies on the treatment of mental disorders in the Arab world are uncommon.

METHODS

A literature review was conducted aiming at identifying studies related to the rate and type of treatment of mental disorders in Arab countries from the Middle Eastern Mediterranean region.

RESULTS

A total of 23 articles were included in this review. These articles focused mainly on type of services used and/ or the rate of treatment. Findings from several articles showed a paucity of treatment of mental disorders, and when present, individuals were more likely to receive it from the general medical than from the mental health sector. Only two studies have assessed patterns of treatment of mental disorders on a national level from the Arab Middle Eastern countries (Lebanon and Iraq).

CONCLUSION

The need for national studies on mental disorders in this part of the world and the improvement of public awareness in this field were highlighted.

Randomised trials relevant to mental health conducted in low and middle-income countries: a survey

BACKGROUND

A substantial proportion of the psychiatric burden of disease falls on the world's poorest nations, yet relatively little is known about randomised trials conducted in these countries. Our aim was to identify and describe a representative sample of mental health trials from low and middle-income countries.

METHODS

6107 electronic records, most with full text copies, were available following extensive searches for randomised or potentially randomised trials from low and middle-income countries published in 1991, 1995 and 2000. These records were searched to identify studies relevant to mental health. Data on study characteristics were extracted from the full text copies.

RESULTS

Trials relevant to mental health were reported in only 3% of the records. 176 records reporting 177 trials were identified: 25 were published in 1991, 45 in 1995, and 106 in 2000. Participants from China were represented in 46% of trials described. 68% of trials had <100 participants. The method of sequence generation was described in less than 20% of reports and adequate concealment of allocation was described in only 12% of reports. Participants were most frequently adults with unipolar depression (36/177) or schizophrenia (36/177). 80% of studies evaluated pharmacological interventions, a third of which were not listed by WHO as essential drugs. 41% of reports were indexed on PubMed; this proportion decreased from 68% in 1991 to 32% in 2000.

CONCLUSION

In terms of overall health burden, trial research activity from low and middle-income countries in mental health appears to be low, and in no area adequately reflects need.