INTRODUCTION

Scientific journals are the most trusted media for disseminating research with a view to providing better services to the community (Menon et al., 2020). Medical journals bring out the updates and generate evidence, based on which, policies are evaluated, amended or formulated that improve the quality of care for patients (Villanueva and Ravichandran, 2006). Like other disciplines, in psychiatry, there is an essential need to stay abreast of the updates of diagnosis, assessment, psychophysiology and psychopharmacology.

South Asia is a densely populated area consisting of eight countries - Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka ( World Bank, nd). As a region, it caters to a quarter of the world s population, 40% of the poorest people, and about 150-200 million psychiatric patients ( Thara and Padmavati, 2013). The countries in this region share similar social, developmental and health-related challenges including mental health problems ( Singh, 2010). Additionally, the population of South Asia is diverse with people from different backgrounds, cultures, socio-economic strata, and religions in comparison to the West (Trivedi and Tripathi, 2015; Kallivayalil, 2004). Nonetheless, these countries pose a lower research infrastructure and capability when compared to developed countries, especially in mental health. Perhaps, it is a representation of the global impetus needed behind mental health research as only 3-4% of the accessible health literature is about mental healthcare ( Saxena et al., 2006). Out of these mental health publications, research from lower and middle-income countries (LMICs) contribute only 6% (Saxena et al., 2006). Further evidence has supported the notion that there is a tremendous inequity in the representations of mental health research between high and low-income countries over the years, despite the burden of the disease being much higher in the latter (Razzouk et al., 2010; Patel and Kim, 2007;Saxena et al., 2006; Patel and Sumathipala, 2001). Also, it has been identified that the poorest Asian countries exhibit the greatest shortage of mental health research capacity (Tandon and Keshavan, 2019; Razzouk et al., 2010). The same pattern of a shortage of mental health professionals has also been found in most countries in this region (Arafat et al., 2021). In addition, there is a need for indigenous psychiatry journals focused on South Asian countries because there exist differences in culture, traditions, rituals, and practices in these nations in comparison to other parts of the world (Tandon and Keshavan, 2019). Therefore, the present study has made an attempt to identify and assess the academic journals and their publication status in psychiatry from the countries of this region. This might help in filling the gap of why such knowledge is scant. This information may be useful for future policymakers, researchers, editors, educational institutes, hospitals and psychiatric associations to take measures to enhance scientific inquiries - initiating journals exclusive to psychiatry so that scientific data will be readily available.

METHODS

Search strategy

We searched in Google in March 2021 to identify the currently functioning academic psychiatry journals from the eight South Asian countries (those published regular issues up to 2020). We used psychiatry journals in South Asia and mental health journals in South Asia as search terms. We also searched by individual country names (Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan and Sri Lanka). We also collected lists of psychiatry journals from authors of the countries. Journal information provided on the official websites was extracted. PubMed, Scopus, SCImago and Web of Science were also searched to identify relevant journals, and confirm their indexing status and journal metrics.

Inclusion criteria

We included currently functioning academic psychiatry journals in South Asian countries namely Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan and Sri Lanka. We only included the journals that are available through an online search, published in the English language, and published articles exclusively in the field of psychiatry. We considered general psychiatry journals which were run exclusively by local organisations.

Exclusion criteria

We excluded psychology journals and journals with only a minor scope in psychiatry, journals published in any vernacular l anguage, journals without an online presence, and journals managed by global organisations and/or organisations from more than one country. We dropped the Eastern Journal of Psychiatry and The Orissa Journal of Psychiatry due to missing issues. Additionally, we dropped the Indian Journal of Behavioural Sciences due to the absence of a proper website with relevant information.

Outcome variables

The following were extracted as outcome variables: name of the country, name of the journal, web link of the journal, starting year, number of volume in 2020, issues per year, publisher, affiliated society, indexation, the impact factor (IF), article categories, authorship criteria, any limit for the number of authors, submission process, submission charges, article processing fee refund policy, publication charges, reporting guidelines, referencing style, review process, number of reviewers per article, publication model (open access/subscription), publication style (continuous/issue wise), trial/other registrations, fast-track publication, students corner, subscription, copyright policies, and plagiarism policy.

Data extraction

A total of 20 journals were reviewed from the five South Asian countries; one each from Bangladesh, Nepal, Pakistan and Sri Lanka, and 16 journals from India. No journal was identified from Afghanistan, Bhutan and the Maldives.

Statistical analysis

Frequency and percentages were used to express the categorical variables and binomial responses. Descriptive statistics were used to analyse the data.

Ethics statement

The study was conducted in accordance with the ethical standards of the Helsinki Declaration of 1964. As the study reviewed publicly available information on online journal platforms, no formal ethical clearance was sought for conducting the study.

RESULTS

Distribution of the journals

A total of 20 journals were identified from eight South Asian countries. Most of the journals are from India (f=16, 80%) and one each from Bangladesh (5%), Pakistan (5%), Nepal (5%), and Sri Lanka (5%). The oldest journal is the Indian Journal of Psychiatry (IJP) which started publishing in 1949, and perhaps the latest journal is the Indian Journal of Mental Health and Neurosciences which was started in 2018 (Table 1).

Scope of the journals

Twelve journals (60%) cover the general psychiatry field exclusively, two (10%) cover general psychiatry and allied sciences, two (10%) cover psychiatry and neuroscience, and one each covers social and community psychiatry, geriatric psychiatry, child and adolescent psychiatry, and psychiatry and organisational behaviour (Table 1).

Indexation

Among the 20 journals, only three (15%) are indexed in PubMed on a regular basis and one has PubMed indexation for selected citations; four journals (20%) are indexed in Scopus, one in Web of Science, and nine journals (45%) in the Directory of Open Access Journals (DOAJ), (Table 1, Table 2). All the indexed journals are identified from India. None of the journals in other countries have major indexations.

Journal metrics

Only two journals - IJP and the Indian Journal of Psychological Medicine (IJPM) - have IF reported in journal citation reports from clarivate analytics. The IF information for the IJP is available from 2010 onwards; its initial IF in 2010 was 0.56 and the latest IF in 2020 was 1.78. The IF for IJPM in 2020 was 1.07. SCImago Journal Ranking (SJR) was available for three journals - IJP (SJR = 0.49), IJPM (SJR=0.42), and the Journal of Indian Association for Child and Adolescent Mental Health (JIACAM) (SJR = 0.13). The percentage of international collaboration (i.e. the document ratio whose affiliation includes more than one country address) as reported by SCImago in 2020 for the IJP, IJPM, and JIACAM were 14.6%, 10.4%, and 0, respectively. IJP appeared to be the leading journal in the region on several grounds such as the earliest initiative, having a reputed publisher, indexed in PubMed and Scopus, IF, publishing regular issues, the number of issues and the number of special issues.

Frequency of publications

Fifteen journals (75%) publish two issues within a year on a bi-annual basis. Two of the journals (10%) focus publication on a bimonthly basis and three publishes (15%) on a quarterly basis (Table 1).

Publishers

Among the psychiatry journals from India, MedKnow publishes seven journals (35%), Sage one (5%), Jaypee Brothers Medical Publishers one (5%), IP Innovative Publication Private Limited one (5%), Academy Publisher one (5%), Indian Psychiatric Society Tamil Nadu chapter one (5%), Delhi Psychiatric Society one (5%), Indian Association for Child and Adolescents Mental Health one (5%), and Desousa Foundation publishes one journal (5%) (Table 1). For Bangladesh, Pakistan, Sri Lanka, and Nepal publishing agents are the Bangladesh Association of Psychiatrists, Pakistan Psychiatric Society, Sri Lanka College of Psychiatrists, and Psychiatrists Association of Nepal respectively (Table 1).

Authorship limit and peer review process

Fourteen journals mention the authorship criteria and seven journals have a limit of a maximum number of authors in different types of articles (Table 2). All the journals follow a double-blind peer-review process.

Submission process

Three (15%) journals required submissions via email, 15 (75%) journals have their online platforms for submission, one journal (5%) accepts both (via email or online mode) and the Delhi Psychiatric Journal (5%) does not provide any information regarding its submission process.

Charges

There are no submission/processing charges for authors residing within the country and overseas authors in 16 (80%) journals; one journal (5%) from Pakistan has a non-refundable fee (6,000 Pakistani rupees/£25), and no data was available for two journals (10%). Out of 20, only one journal from India, charges (US$60/£45 for overseas authors and 3,000 Indian rupees/£13 for authors from India) an article acceptance fee from both authors residing within the country and overseas; 15 journals (75%) have no fee, four (20%) journals have no acceptance fee details mentioned on their website. From the available information, we couldn t understand the model of expense maintenance of the open access journals. Perhaps the affiliated societies arrange the money for running the journals.

Publication model and style

All the journals follow the open access model of publication and the online appearance of the journals varies from 2005 to 2018 (Table 2). Eleven

journals (55%) follow the continuous model and nine (45%)publish when the whole issue is ready.

Other information

Fast-track services are not available in any journal and only one journal (5.3%) has a post-graduate corner. All journals follow the Vancouver style of referencing.

DISCUSSION

South Asia caters to about a quarter of the global population with an immense mental health burden and treatment gap (Thara and Padmavati, 2013). This research aimed to identify and assess the academic journals in psychiatry from South Asia.

The main findings and current status

In the eight South Asian countries, only five (Bangladesh, India, Nepal, Pakistan and Sri Lanka) have at least one mental health journal of their own, while India outnumbers the others (Table 1 and Table 2). No local psychiatry journal was identified in Afghanistan, Bhutan and the Maldives. This probably reflects the lack of mental health research capacity in these countries. Presumably, not enough attention is paid to the discipline of psychiatry, which may impact on mental health services provided to patients and the development of psychiatry as a distinct discipline. This is in line with a review of psychiatric publications between 2011 and 2015 which revealed that only 0.16% of psychiatric research originated from low-income countries (Zhang et al., 2017).

Indexation is a major issue for most of the journals, as only three journals are indexed in PubMed regularly and except in India, none of the countries has indexed journals. Procuring indexation on bibliographic databases like PubMed has been a challenge for journals from LMICs (Szabo et al., 2018; de Jesus Mari et al., 2010). A task force of the World Psychiatry Association (WPA) observed that among indexed journals on mental health, 96% were from high-income countries and 4% were from middle-income countries; at the time, no Asian or African journal on mental health had been indexed, indicating the sheer lack of indexation for journals from LMICs (de Jesus Mari et al., 2009). The Indian Journal of Psychiatry therefore became the first South Asian journal to be indexed on Medline, and two other journals followed (IJPM and Industrial Psychiatry Journal). The potential reasons for the lack of indexation for South Asian journals may include the lack of timely and regular publications, dropped issues, inadequate peer-review process, lack of adequate and dedicated staff support, and the lack of funds to cover the expenses. The publication and sustainabilty of an academic journal needs consistent and dedicated funding, which is often a challenge in these countries where financial resources are prioritised towards other important factors (Henderson et al., 2020).There may be a lack of initiative among the editorial staff to enhance the quality of their journals to receive indexing. Among the reviewed journals, only five produce at least four issues per year, a criterion which was considered by the WPA task force earlier with regards to indexation (de Jesus Mari et al., 2009). The difficulty in finding appropriate reviewers is also a challenge faced by journal editors worldwide, leading to delays and irregularities in publishing (Henderson et al., 2020).

Only two mental health journals have an IF in the whole South Asian region. These two journals, both from India, have only a modest IF. This reiterates the notion that research conducted in South Asian countries is not adequately cited by other researchers.

Enduring challenges

A persistent low-level investment in mental health, resource constraints, and a low level of mental health research are the fundamental challenges in South Asian countries like other LMICs (Razzouk et al., 2010). There is a lack of adequate, trained, and dedicated staffing that makes the research article processing significantly delayed (Sharma and Razzaque, 2017). Additionally, psychiatry is not a priority in the region resulting in a meager amount of budget allocation for mental health (Thara and Padmavati, 2013; Kallivayalil, 2004). Many of the journals don t have linkages with the reputed publishers; they are run by the local psychiatric societies in the individual nation. These findings clearly depict that there is a lack of harmonious and timely interactions among the authors, editors, reviewers and publishers. It represents an overall system failure of the local academics. Other challenges include lack of a good local mental health research governance, limited mental health research capability, an inadequate trained psychiatry researcher, and low mental health literacy (Purgato et al., 2020), which often lead to very limited mental health researches in most of the nations of South Asia. Brain drain is another potential challenge for the countries in this region resulting in a fewer number of mental health professionals (Purgato et al., 2020; Alloh et al., 2018; Thara and Padmavati, 2013; Razzouk et al., 2010; Patel and Kim, 2007). Inadequate funds and fellowships, lack of training in research in the medical schools, lack of efficient research network hinder having good research skills (Arafat et al., 2021;Sharma and Razzaque, 2017).

Implications

Immediate attention is warranted from the local, national, and international stakeholders to improve the status quo, with a special focus on capacity building, adequate training in research, available funds, and collaborations with developed countries (Sharma and Razzaque, 2017; Patel and Kim, 2007). Country-wise and/or region-wise policy perspectives should be prioritised. Adequate funding of educational institutions for research and national psychiatric bodies for the successful running of national journals. Formulation of central bodies dedicated to journal management, regular training of editorial board members and reviewers, considering academic appreciations, getting reputed publishers are crucial things to implement (Thara and Padmavati, 2013). Students voices and critical opinions make up a special type of article and we recommend that journals include these. There needs to be workshops and research programmes to help psychiatrists to get oriented about editing, reviewing and running psychiatry journals. This again needs an inter-sectoral collaboration between the global psychiatric societies, editorial boards of the reputed journals, and the respective societies of South Asian countries.

Editorial members of the currently active psychiatry journals in South Asia should make efforts to achieve indexing for their journals, with the assistance of their respective psychiatric societies. Although the criteria used for indexing a journal vary among databases, the following criteria used by the WPA task force (de Jesus Mari et al., 2009) provides useful guidance for editors from South Asian journals to enhance their chances of receiving indexation: a) Geographical representativeness; b) Affiliation with a professional mental health society; c) Publication frequency i.e. to have published approximately four issues per year, on a regular basis, during recent years; d) Having a credible national and international editorial board; e) Language i.e. to have original articles publish in plain English, or at least abstracts in English; f) The level of regional and the present indexation in the main databases; g) The balance between original and review articles; and h) Having a user-friendly and free access of articles on their website.

Strengths and limitations

This is the first review assessing the mental health journals in South Asia to identify their strengths and limitations. We assessed the journals based on the available information on the journal websites, and such information may be biased and may not be updated regularly. We only included the currently running journals available online. Therefore, there is a chance of overlooking journals with only printed versions without any online coverage. We selected the journals which had an exclusive focus on psychiatry that also may exclude some journals with a wider focus in psychology and social psychiatry. We couldn t assess the readership status of the journals.

CONCLUSION

The review revealed that South Asia has a deficit in a high-quality mental health research publishing system on its own even though it caters to a quarter of the global population. Few South Asian journals have established themselves in global academia, but considering the unique psychosocial and geo-political landscape of this area, there need to be more additions in terms of research, training and publications in psychiatry. There is an urgent need to develop capacity, funding, and coordination for conducting research as well as the development of more psychiatric journals so that that this psychosocially unique and vulnerable region can lead to creating its own evidence-based psychiatric services. This warrants a global call for scientific cooperation, mutual hand-holding, and collaboration between publishers, editors, researchers and clinicians in psychiatry.

ACKNOWLEDGEMENTS

Conception and Design:

SMY Arafat.

Acquisition of data:

All authors.

Data analysis:

SMY Arafat & SAZ.

Drafting of the manuscript:

All authors.

Critical revision of the manuscript:

All authors.

DECLARATION OF ETHICS

The study was conducted in accordance with the ethical standards of the Helsinki Declaration of 1975, as revised in 2008. As the study reviewed publicly available information of online platforms of journals, no formal ethical clearance was sought for conducting the study.

CONFLICT OF INTEREST

None.

Funding

None.

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