scholarly journals Social and ethical implications of psychiatric classification for low- and middle-income countries

2014 ◽  
Vol 20 (3) ◽  
pp. 6
Author(s):  
Jonathan K Burns
Keyword(s):  
Global Mental Health ◽  
Classification Systems ◽  
Societal Implications ◽  
Ethical Challenges ◽  
Psychiatric Classification ◽  
Middle Income ◽  
Middle Income Countries ◽  
Ethical Implications ◽  
Essentially Normal ◽  
Low And Middle Income

<p>With the publication of the <em>Diagnostic and Statistical Manual</em>, 5th edition, and the ongoing revision of the <em>International Classification of Diseases</em>, currently 10th edition, it is timely to consider the wider societal implications of evolving psychiatric classification, especially within low- and middle-income countries (LMICs). </p><p>The author reviewed developments in psychiatric classification, especially the move from categorical to dimensional approaches based on biobehavioural phenotypes. While research supports this move, there are several important associated ethical challenges. Dimensional classification runs the risk of ‘medicalising’ a range of normality; the broadening of some definitions and the introduction of new disorders means more people are likely to attract psychiatric diagnoses. Many LMICs do not have the political, social, legal and economic systems to protect individuals in society from the excesses of medicalisation, thus potentially rendering more citizens vulnerable to forms of stigma, exploitation and abuse, conducted in the name of medicine and psychiatry. Excessive medicalisation within such contexts is also likely to worsen existing disparities in healthcare and widen the treatment gap, as inappropriate diagnosis and treatment of mildly ill or essentially normal people has an impact on health budgets and resources, leading to relative neglect of those with genuine, severe psychiatric disorders.<strong> </strong></p><p>In an era of evolving psychiatric classification, those concerned for, and involved in, global mental health should be critically self-reflective of all aspects of the modern psychiatric paradigm, especially changes in classification systems, and should alert the global profession to the sociopolitical, economic and cultural implications of changing nosology for LMIC regions of the world.</p>

scholarly journals Stemming the tide: promoting mental health and preventing mental disorders in low- and middle-income countries

2015 ◽  
Vol 2 ◽  
Author(s):  
W. A. Tol
Keyword(s):  
Mental Health ◽  
Health Promotion ◽  
Mental Disorders ◽  
Global Mental Health ◽  
Action Plan ◽  
Mental Health Promotion ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

The first World Health Organization's global action plan for mental health recognizes the importance of mental health promotion and prevention of mental disorders, through the inclusion of one of four objectives focused on this crucial area of research and practice. This paper aims to provide an ‘aerial view’ of the field of mental health promotion and prevention of mental disorders with a focus on low- and middle-income countries. Starting with reasons why promotion and prevention need to take center stage in global mental health efforts, the paper provides a framework and four general principles to guide such efforts: a socio-ecological perspective (place); an inter-sectoral and interdisciplinary approach (collaboration), a developmental perspective (timing), and a participatory and empowerment approach (strengths), or PaCTS. Evidence-based examples of mental health promotion, universal, selective, and indicated prevention are described.

scholarly journals Mental Health in low-and middle income countries (LMICs): Going beyond the need for funding

2018 ◽  
Vol 17 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Folashade T Alloh ◽  
Pramod Regmi ◽  
Igoche Onche ◽  
Edwin Van Teijlingen ◽  
Steven Trenoweth
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Global Mental Health ◽  
Poor Mental Health ◽  
Health Issues ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mental Health Issues ◽  
The Impact ◽  
Low And Middle Income

Despite being globally recognised as an important public health issue, mental health is still less prioritised as a disease burden in many Low-and Middle-Income Countries (LMICs). More than 70% of the global mental health burden occurs in these countries. We discussed mental health issues in LMICs under themes such as abuse and mental illness, cultural influence on mental health, need for dignity in care, meeting financial and workforce gaps and the need for national health policy for the mental health sector. We highlighted that although mental health education and health care services in most LMICs are poorly resourced; there is an urgent need to address issues beyond funding that contribute to poor mental health. In order to meet the increasing challenge of mental health illness in LMICs, there is a need for effort to address cultural and professional challenges that contribute to poor mental health among individuals. We have a notion that mental health should be integrated into primary health care in LMICs. Creating awareness on the impact of some cultural attitudes/practices will encourage better uptake of mental health services and increase the ease when discussing mental health issues in these countries which can contribute to reducing the poor mental health in LMICs.

Informed consent for controlled human infection studies in low‐ and middle‐income countries: Ethical challenges and proposed solutions

Bioethics ◽  
2020 ◽  
Vol 34 (8) ◽  
pp. 809-818
Author(s):  
Vina Vaswani ◽  
Abha Saxena ◽  
Seema K. Shah ◽  
Ricardo Palacios ◽  
Annette Rid
Keyword(s):  
Informed Consent ◽  
Human Infection ◽  
Ethical Challenges ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Towards Ethical International Research Partnerships in Gender-Based Violence Research: Insights From Research Partners in Kenya

2021 ◽  
pp. 107780122110357
Author(s):  
Sanne Weber ◽  
Margaret Hardiman ◽  
Wangu Kanja ◽  
Siân Thomas ◽  
Nicole Robinson-Edwards ◽  
...  
Keyword(s):  
International Research ◽  
High Income ◽  
Ethical Challenges ◽  
Gender Based Violence ◽  
Research Partnerships ◽  
Middle Income ◽  
Safety Concerns ◽  
Middle Income Countries ◽  
Gender Based ◽  
Low And Middle Income

Research with survivors of gender-based violence in low- and middle-income countries is important to improve understanding of experiences of violence and the policies that can help combat it. But this research also implies risks for survivors, such as re-traumatization, safety concerns, and feelings of exploitation. These risks are magnified if research is undertaken by researchers from high-income countries, whose positionality produces power inequalities affecting both participants and research partners. This article describes the ethical challenges of international gender-based violence research from the perspective of Kenyan researchers and organizations and identifies recommendations about how to prevent them.

scholarly journals Placental histopathology in preterm birth with confirmed maternal infection: A systematic literature review

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255902
Author(s):  
Aung Myat Min ◽  
Makoto Saito ◽  
Julie A. Simpson ◽  
Stephen H. Kennedy ◽  
François H. Nosten ◽  
...  
Keyword(s):  
Systematic Review ◽  
Preterm Birth ◽  
Parasitic Infection ◽  
Preterm Births ◽  
Classification Systems ◽  
Diagnostic Methods ◽  
Middle Income ◽  
Histopathological Classification ◽  
Middle Income Countries ◽  
Low And Middle Income

Four in five neonatal deaths of preterm births occur in low and middle income countries and placental histopathology examination can help clarify the pathogenesis. Infection is known to play a significant role in preterm birth. The aim of this systematic review is to explore the association between placental histopathological abnormality and preterm birth in the presence of confirmed infection. PubMed/Medline, Scopus, Web of Science and Embase were searched using the keywords related to preterm birth, placental histopathology and infection. Titles and abstracts were screened and the full texts of eligible articles were reviewed to extract and summarise data. Of 1529 articles, only 23 studies (13 bacterial, 6 viral and 4 parasitic) were included, and they used 7 different gestational age windows, and 20 different histopathological classification systems, precluding data pooling. Despite this, histopathological chorioamnionitis, and funisitis (when examined) were commonly observed in preterm birth complicated by confirmed bacterial or viral, but not parasitic, infection. The presence of malaria parasites but not pigment in placenta was reported to increase the risk of PTB, but this finding was inconclusive. One in three studies were conducted in low and middle income countries. An array of: definitions of preterm birth subgroups, histological classification systems, histopathologic abnormalities and diagnostic methods to identify infections were reported in this systematic review. Commitment to using standardised terminology and classification of histopathological abnormalities associated with infections is needed to identify causality and potential treatment of preterm birth. Studies on preterm birth needs to occur in high burden countries and control for clinical characteristics (maternal, fetal, labor, and placental) that may have an impact on placental histopathological abnormalities.

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