(Editorial) Psychiatric research in Pakistan: Past, Present and Future
Psychiatric research in Pakistan: Past, Present and Future
Ahmed Waqas, Hamza Bukhari, AunsGhazanfar
Affiliation: CMH Lahore Medical College and Institute of Dentistry, Lahore Cantt
Corresponding author: Ahmed Waqas
In recent years, Pakistan has shown an encouraging improvement in its research output. In 2010, Pakistan ranked 43rd in publication output and by 2018, this rank is expected to improve to 27th.1There has also been a rise in biomedical journals in Pakistan working hard to earn their reputation. As of now, there are 76 indexed biomedical journals in Pakistan.2Out of these, only 5 journals are ISI Thompson and pubmed indexed.
The student section at JPPS is itself an achievement and it hopes to inspire the medical student community to invest their energies in psychiatric research. However, within this ray of optimism stands a very critical shadow of doubt especially from the community of mental health and psychiatry. What the ranking fails to show is the fact that while there have been numerous publications coming forth from various fields of medicine in Pakistan, those on mental health and psychiatry have been found wanting. There has not been a satisfactory number of publications found under the field of psychiatry, nor has the field itself gained a mainstream acceptance by the general public in Pakistan. There have been only 349 practicing psychiatrists in Pakistan according to a WHO report in 2009 and this number is unlikely to have raised much since then.3A huge number of Pakistani psychiatrists are working abroad. This seems like an appropriate decision for them considering burnout levels in psychiatrists in the USA rank amongst the second lowest.4And while they may not get the highest salaries, American psychiatrists have a higher amount of optimism and satisfaction with their wages compared to other medical professionals.5
Indeed with the advent of the internet and increasing ways of acquiring education, the public of Pakistan has certainty adopted a more positive health seeking behavior but the ability to seek or acquire help in mental health has still been found lacking. Even in the settings of education such as medical colleges and large universities, in major cities like Lahore, the concept of psychiatric illness is still deemed a stigma.6The public so far has adopted a fairly discouraging attitude towards the concept of mental illness. This is highlighted in a survey conducted among third year Pakistani medical students where only 7.6% of them chose psychiatry as a likely choice for their medical career for reasons like attractive life style and the subject being intellectually challenging and interesting.7
In the research department, again countries like USA have a systematic and organized approach towards allocating grants and funding towards medical research. The NIMH allocates around 1.4 million USD annually to fund researches of all kinds.8Pakistan may not even offer a fraction of such a sum if any to encourage researchers to take up projects concerning psychiatry.
To analyze the trends of publishing in Psychiatry in Pakistani biomedical journals, we took the mantle of auditing pubmedindexed journals of Pakistan. Currently, only 4/75 Pakistani medical journal are indexed in ISI Thompson and pubmed namely: JPMA, JCPSP, JAMC and PJMS. Details of Articles related to mental health and psychiatry published in these four journals from January 2005 and December 2014 were included in this audit. The task of auditing was conducted by three authors, AW, HB and AG separately and then the final data file was reviewed by the principle investigator (AW) to minimize errors in data entry.
Auditing was conducted in two phases. Firstly, the articles related to mental health and psychiatry were screened out by reading their titles and then their abstracts were read and following details were recorded: number of authors, corresponding authors' affiliation, number of citations, type of article and study design.
Data were analyzed in SPSS v 20. Frequencies of different variables were calculated and a line plot was created to analyze year wise publication trend of psychiatry related articles published from January 2005 to December 2014. Line graph revealed an increasing trend in publication output of articles related to Psychiatry (Figure 1).
478 articles related to mental health and Psychiatry have been published from January 2005 to December 2014. Most of the articles (205, 42.89%) were contributed from International medical institutes especially from Iran and Turkey followed by 89 (18.62%) articles from AKU and Dow University of Health Sciences (35, 7.3%) and the rest were contributed by other Pakistani institutes. Most of the articles were published in JPMA (248, 51.9%), PJMS (124, 25.9%), JCPSP (58, 12.1%) and JAMC (48, 10%).
Categories related to type of articles had following distribution: Original 306 (64.4%), Special Communication 70 (14.6%), Letter to editor 36 (7.5%), case report 26 (5.44%), Editorial 23 (4.8%), Review 16 (3.3%) and Systematic review 1 (0.2%). Original studies had following study designs cross-sectional 224 (73.2%), case control 29 (9.48%), RCT 17 (5.55%), prospective 12 (3.92%), retrospective 9 (2.94%), experimental 7 (2.29%) and Quasi-experimental 6 (1.96%), case series 2 (.65%).
Line graph revealed an increasing trend in publication output of articles related to Psychiatry (Figure 1)
We observed a very satisfactory and year wise improving trend in publication output in Psychiatry. However, it is interesting to note that most of the original studies had cross sectional designs and only a few RCTs and case control studies have been conducted in Pakistan so far. Also, only 273/478 (58.16%) of these articles were contributed by Pakistanis. These results are in consonance with the statistics reported by Naqvi and Khan from 1993-2004 out of which only 3/108 studies were clinical trials and 34% of the publications were contributed by only 5 Pakistani psychiatrists.9 However, from 2005 to 2014, we observed a rapidly increasing trend in publication output of Psychiatric research. This might be due to reasons such as promotion of research culture among the faculty by PMDC and HEC, Pakistan.
It is a need of the hour to improve the knowledge of study designs in Pakistani researchers and also NGOs and research organizations should step forward to support research in Pakistan. Another aspect that can improve the prospects of psychiatric research in Pakistan is mentorship initiatives by the Psychiatry faculty of Pakistan. Experienced researchers should introduce research methods and medical writing to young students and establish effective mentor/student relationships. As an example, we invited a few students from CMH Lahore Medical College and started a few research projects with them. Not only were they involved in all the steps of conducting a research project but also given workshops on literature review, medical writing and statistical concepts. Respected Editor in Chief of JPPS, Professor Dr. Rana also aims to establish such student/mentor projects in various medical colleges in Pakistan to promote research culture among medical students.
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FY 2016 Budget of National Institute of Mental Health (NIMH). (online) (Cited 2015 February 2) Available from URL: http://www.nimh.nih.gov/about/budget/cj2016_final_149031.pdf
Figure 1: Year-wise publication trend of articles related to mental health and psychiatry from 2005-2010 in JPMA, JCPSP, JAMC and PJMS.