Imagine a 7-year old boy living in India. One day, his father gets drunk and kills his mother. The boy is a witness to the homicide, and develops a high fever as a response. Imagine you’re the mental health professional who is called to support the boy. Some of the things you would want to know are how children in India respond to severe trauma, what words they use, and what helps them to recover.

Unfortunately, that information is virtually inexistent. Traditionally, trauma research has been conducted in high-income, Western countries. This does make sense from a resources perspective, but it does not make sense from a clinical perspective: we should know most about those who are most in need. Trauma from community violence, war, accidents, and natural disasters hits those in low income countries more than those in high income countries.

But is this imbalance actually still the case? Surely, we have known the above for a while and there has been a growing interest in global mental health. Therefore, with a number of colleagues, we thought it would be good to see whether recent research reflected the need for a global approach. We took a random sample of 1000 peer-reviewed journal articles on traumatic stress published in 2012 (out of about 3100 articles in total) and coded them for data collection in low/middle-income countries (LMIC) versus high-income countries (HIC).

We were also interested in empowerment of researchers in low resource settings: if research is conducted in LMIC, are local researchers involved and, ideally, leading?

Finally, our view was that research knowledge should be accessible to those in areas of need. Therefore we also looked at (official or unoffical) open access of the articles.

We found the following:

• While 83% of the world’s population live in LMIC, data for 87% of the papers were collected in HIC.
• Although the articles came from 56 different countries, 51% of all papers described studies in the United States (very few came from large LMIC countries such as India).
• 45% of the articles on LMIC studies published by a HIC corresponding author, did not involve any LMIC co-authors.
• Over half of the articles were not accessible without a subscription.

There are many things to discuss regarding these findings, but for me the most important lessons are:

1. We need to increase our efforts to build research capacity in LMIC and actively involve local researchers in projects conducted.
2. We need to publish our work in open access journals only, or at a very minimum ensure that pre-print versions of our papers are available via repositories.

Let’s measure again, say in 5 years, whether we’re doing better.

Reference to the article:
Fodor, K., Unterhitzenberger, J., Chou, C., Kartal, D., Leistner, S., Milosavljevic, M., Nocon, A., Soler, L., White, J., Yoo, S., & Alisic, E. (2014). Is traumatic stress research global? A bibliometric analysis European Journal of Psychotraumatology, 5 DOI: 10.3402/ejpt.v5.23269