Mental health in Africa — bridging genomics discovery and clinical delivery

The burden of mental disorders is increasing in Africa due to increased life expectancy and population growth.¹ Global mental health researchers have advocated for closing the treatment gap, given the cost-efficiency of scaling up evidence-based interventions.² Simultaneously, in discovery science, geneticists have emphasized gaps in understanding the genetic architecture of mental disorders in Africa, the consequent risk of widening health inequities, and the opportunity for work on African genetics to advance psychiatric science. Greater engagement between global mental health and neurogenetics in the African context is therefore timely. Here we discuss key synergies, opportunities, and challenges at their intersection.

First, neurogenetics and global mental health both have a strong focus on person-centered care. Global mental health has emphasized contexutally relevant interventions, while neurogenetics has highlighted personalized medicine. Precision public health is an important aspiration, and requires better understanding of both neurobiological and psychosocial variation. Second, global mental health and neurogenetics both have a strong focus on human rights and ethics. Human rights and principles of equity are key pillars of global mental health, while genetics research has emphasized ethical, legal and social implications. Third, as emerging scientific fields, global mental health and neurogenetics share other features, such as multidisciplinary approaches, employment of digital tools, and the aim of global impact.^2,3

Global mental health research has important foundations on which neurogenetics can build. Global mental health has emphasized understanding the full spectrum from well-being to severe mental illness, and intervening across this continuum. It would be useful for neurogenetics in Africa to address not only key mental disorders, but also resilience and wellbeing, identifying biological and behavioural intervention targets along the mental-health-to-illness spectrum. Global mental health has emphasized the early onset of mental disorders, and understanding neurodevelopment in the context of key social determinants.² Neurogenetics is well placed to delineate mechanisms underlying neurodevelopment, including gene-environment interactions, and work on early gene programing might help identify critical periods for intervention. Birth cohorts that maximize the integration of neurobiological and psychosocial knowledge in Africa might be particularly useful.⁴ Global mental health argues that for mental health, all countries are developing, and work done in under-resourced countries might be useful in high income countries.⁵ For example, the friendship bench, developed in Zimbabwe for depression, has been exported to the USA.⁶ Analogously, genomic diversity in Africa might help characterize genes relevant to mental health globally.

Neurogenetics has conversely provided key foundations which might be useful for global mental health. Neurogenetics has emphasized the potential value of its discoveries for precision medicine. Global mental health has focused on broad-spectrum and transdiagnostic intervention, but there is growing attention to precision public health. With the development of mobile-health and person-centered tools, greater individualization of care is possible globally, including a role for genetic testing in global mental health trials.⁷ Second, neurogenetics has demonstrated the heritability of mental disorders, as well as genetic overlap across some psychiatric and medical disorders (e.g. migraine), supporting the conceptualization of mental disorders as medical conditions. Global mental health research on collaborative care may further contribute to clinicians addressing mental disorders as non-communicable disorders.⁸ Third, neurogenetics has emphasized user perspectives, and is funded by family advocates. Global mental health is increasingly emphasizing user participation in research and advocacy, and can usefully lobby for both discovery and delivery research priorities.⁹

Engagement of global mental health and neurogenetics may however face impediments. Scale-up of efficacious interventions might have immediate benefits, but the path from genetic discovery to clinical utility is long. Genetic testing is used in neuropsychiatry in resource-rich clinical settings; extension of such work to African populations might be facilitated by combining discovery, clinical genetic testing, return of results, and genetic counselling.¹⁰ Comorbidity of mental disorders is challenging for both global mental health and neurogenetics. Research in under-resourced countries on interventions for comorbid conditions is at an early stage, and while neurogenetics has shown genetic overlap across mental disorders pleiotropic effects are incompletely understood. Both global mental health research and neurogenetics are cognizant of translation challenges. In global mental health, for translation from efficacy trials to scale-up, multiple issues need to be addressed, including buy-in, training and supervision, quality maintenance, monitoring, and finance. Analogously, there are m ultiple challenges for translation from bench to bedside in neurogenetics. Both fields must advocate that mental health research is underfunded and that greater investment will significantly pay-off over time.

Discovery research has emphasized that the story of humans begins in Africa, and with population growth delivery research on the continent will become increasingly crucial. There has, however, been an imbalance in health research with 90% of all research emerging from high-income countries in which only 10% of the world live. Greater engagement between global mental health and neurogenetics in Africa (Fig 1) may be valuable in redressing this research imbalance.

Figure 1.

Global Mental Health Research Sites and Mental Health Genetic Research Sites from H3 Africa and NeuroGAP