Gaps and Opportunities in Global Mental Health Research: Disparities Across Geographic Regions and Income Levels

“There is no health without mental health.”

- United for Global Mental Health -

Global health, defined as a field of study, research, and practice aimed at addressing health challenges and human diseases that transcend national borders and create global social, political, and economic impacts [1], represents one of the most critical academic and scientific priorities today. To monitor and measure the specific impact of these needs, the World Health Organization (WHO) introduced strategies centered on defining global health indicators, documented in the Global Health Observatory [2] and the Global Observatory on Health Research and Development. 3 These indicators, categorized by geographic regions and country income levels, enable comparisons of disparities in health metrics and outcomes [2,3].

Global mental health issues, as outlined in World Mental Health Reports [4], are considered critical determinants for addressing barriers to healthcare access, economic consequences, universal prevention and health promotion strategies, and the prevalence and burden of mental disorders with the highest global impact. Ensuring the protection and promotion of global mental health remains a fundamental objective in closing gaps in equity and advancing health outcomes worldwide.

However, the most recent World Mental Health Report, issued by the WHO in 2022 [4], provides a comprehensive analysis of the epidemiological landscape and public health gaps, raising concerns about the slowing progress observed compared to the previous decade. Key areas of stagnation include gaps in data availability, limitations in governance, and deficiencies in resources and services [4].

One of the most significantly impacted indicators since 2014 involves incomplete and insufficient research data. Notably, substantial inequities have been reported in this area. Less than 5% of mental health research funding is allocated to low- and middle-income countries [4].

To address this knowledge gap, an exploratory scientometrics analysis was conducted using the Scopus database, recognized as the repository with the largest collection of peer-reviewed scientific literature. The aim was to examine the distribution of scientific evidence and its general characteristics within the field of global mental health research.

Since “Global Mental Health” is not indexed as a term in Medical Subject Headings (MeSH), the search relied on the title and abstract fields, using the phrase “Global Mental Health” to identify scientific articles focused on topics related to this field. A filter for original studies was applied to ensure the inclusion of documents that underwent the standard peer-review process, employed a specific epidemiological design, and addressed a research question related to global mental health. The search strategy implemented was TITLE-ABS (“Global Mental Health”), and the query was conducted on January 20, 2025. Previous studies have employed this methodology for similar purposes [5].

Once the results were retrieved, they were exported in .CSV format. Information on a reference country for each scientific document was collected using the corresponding author metadata, as this item is provided by default in the database. The reference country was then categorized based on the WHO’s geographic region classification [6] and the World Bank’s income group classification [7].

A total of 1,608 documents were initially identified, of which 934 (58.1%) were categorized as articles. However, only 789 documents included metadata on the corresponding author’s country, and the analysis was conducted on this subset.

The countries with the highest number of affiliations by country were the United States (n=726), the United Kingdom (n=392), and India (n=164) (Table 1). When categorized by geographic regions, it was determined that the region of the Americas (n=389, 49.3%) and the European region (n=226, 28.6%) together accounted for 77.9% of the literature on global mental health. In contrast, the Eastern Mediterranean region (n=23, 2.9%) and the African region (n=30, 3.8%) produced the fewest publications on this topic. By income groups, high-income countries (n=630, 79.8%) and upper-middle-income countries (n=91, 11.5%) collectively contributed 91.3% of the global literature. Meanwhile, low-income economies accounted for only 1.1% (n=8/789) of the total publications.

Table 1.

The top 50 countries with the highest scientific output in global mental health, categorized by authors’ affiliations, along with the publication distribution by geographic regions and income groups

Country	Frequency	Country	Frequency
1. United States	726	26. Colombia	21
2. United Kingdom	392	27. Mexico	20
3. India	164	28. Lebanon	20
4. Canada	131	29. Kenya	20
5. South Africa	118	30. Japan	20
6. Australia	94	31. New Zealand	18
7. Switzerland	79	32. Turkey	16
8. China	74	33. Norway	14
9. Netherlands	69	34. Hong Kong	14
10. Germany	69	35. Thailand	13
11. Italy	60	36. Poland	13
12. Brazil	51	37. Belgium	13
13. Nigeria	37	38. Singapore	12
14. Spain	36	39. Peru	12
15. Nepal	36	40. Malaysia	12
16. Uganda	29	41. Israel	12
17. Denmark	29	42. Ghana	12
18. France	27	43. Ukraine	11
19. Ethiopia	27	44. Russian Federation	11
20. Ireland	24	45. Iran	11
21. Chile	24	46. Bangladesh	11
22. Sweden	22	47. Zimbabwe	10
23. Portugal	21	48. Egypt	10
24. Pakistan	21	49. Austria	10
25. Croatia	21	50. Taiwan	9
Countries by WHO region (N=789)		Frequency
African region		30 (3.8)
Region of the Americas		389 (49.3)
South-East Asia region		38 (4.8)
European region		226 (28.6)
Eastern Mediterranean region		23 (2.9)
Western Pacific region		83 (10.6)
Countries by income group (N=789)		Frequency
High-income economies		630 (79.8)
Upper-middle-income economies		91 (11.5)
Lower-middle income economies		60 (7.6)
Low-income economies		8 (1.1)

Frequency has been presented as number only or number (%).

These findings highlight significant gaps and inequities in the availability of primary data needed to inform public policy. Decision-makers require such data to implement evidence-based strategies tailored to health needs, aiming to improve health indicators and outcomes [8]. Additionally, these results provide evidence for fostering equitable opportunities in resource allocation, aligned with health needs, opportunities, and capacities, to strengthen health systems and institutions capable of addressing global mental health challenges [5,8].

Scientometrics studies and meta-research analysis are urgently needed to delve deeper into trends, themes, alignment, and the quality of available evidence [9]. Future research should incorporate scientometrics and meta-research approaches to quantitatively assess knowledge gaps and evidence asymmetries in global mental health, especially in underrepresented regions. Inequities in global mental health research is an international concern, as they present opportunities for innovation and evidence-based solutions [10-12]. Advancing knowledge in psychiatric epidemiology and social psychiatry is essential to addressing these disparities and fostering progress in global mental health.