CAN WE LEARN FROM EACH OTHER?

Many researchers in mental health would agree that the majority (if not all) of mental disorders are produced by a nature—nurture interplay, and that the aetiology, clinical picture, course, outcome, treatment and service effects of such disorders are heavily influenced by ethnicity and socio-cultural environment. To compare research carried out in different parts of the world is therefore of great academic and practical importance, as the benefits of evidence-based psychiatry in one part of the world can be applied elsewhere for the benefit of all.

In reality, however, such comparative exercises have been relatively few, particularly between East and West. The best way to assess this is to search the literature reporting this kind of research from the international psychiatric journals. Patel & Sumathipala (Reference Patel and Sumathipala2001, this issue) attempt to do so by analysing the representativeness of papers from Euro-American countries and the rest of the world (RoW) published in six leading international psychiatric journals in 1996, 1997 and 1998. The authors found much lower acceptance rates for papers submitted to four of the six journals from the RoW, resulting in a very low percentage (6%) of this work being published in the literature. The underrepresentativeness of RoW papers was more serious in American journals as compared to the European journals.

Historically, modern psychiatry has been developed in the West, and mental health services and research are much more advanced there. Most of the founders of psychiatric departments and their senior faculty members in the RoW received clinical and/or research training in Euro-America. The number of RoW mental health professionals is much smaller, and the research facilities and funding, information technology and numbers of support workers are much more limited compared to those in Euro-American countries. Moreover, the much heavier clinical duties of mental health workers in the RoW have considerably reduced their time and energy available for research. As Patel & Sumathipala have pointed out, language difficulties in manuscript preparation are another problem for RoW mental health researchers whose academic language is not English. All these negative factors have not only made it difficult for RoW colleagues to establish locally based peer-reviewed international journals, but also led to much smaller numbers of papers submitted to international journals and to lower rates of publication. In many RoW countries, the evaluation of academic achievement for a university faculty staff member or a researcher is mainly based on the number of scientific papers he/she has published in Science Citation Index (SCI) journals. In consequence, local journals in the RoW usually do not receive good papers submitted for publication.

All the scientific journals are concerned about their number of subscriptions, which reflects their market and, to a certain extent, their academic reputation and the evaluation by their readers and subscribers. It is therefore understandable that editors and reviewers of international journals tend to accept papers that the majority of their readers, who are from Western nations, would welcome. It is speculated that this might explain, at least in part, the lower rates of RoW articles published in American psychiatric journals when compared to those in European journals. It will be interesting to enquire into the correlation between the number of subscribers and the number of papers from different countries published in international journals. Another interesting enquiry would be to compare the proportion of papers in these journals to their country of origin. Perhaps Western readers need to be educated to appreciate work from the RoW.

The work by Patel & Sumathipala is mainly based on quantitative evidence. It would be relevant to conduct a comparative content analysis of review comments on representative Western and RoW manuscripts, provided that the editors of the journals would agree to supply such material without having to violate confidentiality. Such a study may be able to examine whether Western reviewers are holding a double standard in their assessment of manuscripts from RoW and Western countries, or whether papers from the RoW are indeed by and large lower in quality than those from Euro-America.

In their discussion, the two authors have mainly emphasised work concerning mental health service as they believe that there is a “growing emphasis on biological research in major journals, which is not only of less relevance to mental health in developing countries but is also limited in its appeal owing to restricted availability of research infrastructure”. Although it has been emphasised that service-combined research is the first priority for a newly established mental health centre in any community, this requirement does not necessarily exclude opportunities for crossethnic and cross-cultural research on aetiology and clinical characteristics of mental disorders. However, the benefit derived from such collaborative research should not be one-sided (e.g. mere export of DNAs from RoW to Western countries in exchange for co-authorship for RoW researchers on papers prepared by Western researchers).

For more than 10 years, I have served as a peer reviewer for international psychiatric journals, and am currently a reviewer for four of the six psychiatric journals included in the study by Patel & Sumathipala. They are correct to point out that Western reviewers sometimes criticise papers from the RoW as being only of local interest suitable for a local journal, while work done in Western society is “automatically deemed to be of international significance”. It is believed that to have competent reviewers from the RoW for papers submitted from both RoW and Western countries is equally useful. Such reviewers are generally more familiar with the society, culture, and health care system of the RoW than their Western counterparts and their review comments on work from Western countries can counterbalance Euro-Americanism in scientific thinking and can achieve a more objective evaluation of scientific work. However, most psychiatric journals have an extremely low representation of RoW researchers in their editorial committees.

In order to improve the situation, we need to facilitate mutually beneficial good-quality international collaborative research between East and West. Such activity may provide a good opportunity for mental health researchers from East and West to understand and to learn from each other, exploring methodology and cross-cultural and cross-ethnic differences. Any potential bias on the assessment of work from the RoW can then be expected to be considerably reduced. The World Health Organization has in the past initiated several international studies across East and West with significant contributions in this aspect (e.g. World Health Organization, 1973, Reference Ustun and Sartorius1995). Other funding organisations for research in Western countries are generally more interested in studies across Western nations (e.g. Reference Dowrick, Casey and DalgardDowrick et al, 1998; Reference CopelandCopeland, 1999). It is argued that there is still a need for more East—West collaborations, which might be initiated by international mental health societies/organisations if good research funds can be obtained.