Global research challenges and opportunities for mental health and substance-use disorders
Open accessAbstract
The research agenda for global mental health and substance-use disorders has been largely driven by the exigencies of high health burdens and associated unmet needs in low- and middle-income countries. Implementation research focused on context-driven adaptation and innovation in service delivery has begun to yield promising results that are improving the quality of, and access to, care in low-resource settings. Importantly, these efforts have also resulted in the development and augmentation of local, in-country research capacities. Given the complex interplay between mental health and substance-use disorders, medical conditions, and biological and social vulnerabilities, a revitalized research agenda must encompass both local variation and global commonalities in the impact of adversities, multi-morbidities and their consequences across the life course. We recommend priorities for research — as well as guiding principles for context-driven, intersectoral, integrative approaches — that will advance knowledge and answer the most pressing local and global mental health questions and needs, while also promoting a health equity agenda and extending the quality, reach and impact of scientific enquiry. This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.
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The lack of valid and pragmatic assessments for implementation-related factors and outcomes has been noted in the health services and implementation science literature and echoed by researchers across health-related interventions.
“Furthermore, the lack of valid and pragmatic assessments for implementation-related factors and outcomes has been noted in the health services and implementation science literature [110, 111] and has been echoed by researchers across health-related interventions [112].”
From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [110]
The Health Delivery and Implementation Research section identifies gaps in knowledge about implementing mental-health interventions and calls for better diagnostic assessment and population surveillance. It does not say that valid, pragmatic assessments of implementation-related factors or outcomes are lacking; searches for that claim and for implementation measures found no supporting passage. (LLM, conf=0.73)
Experimental — accuracy not yet measuredThere is widespread consensus that integrating mental health services into primary and community healthcare settings and task-sharing are essential for addressing the global treatment gap.
“There is widespread consensus that integrating mental health services into primary and community healthcare settings and task-sharing are essential for addressing the global treatment gap.7,8”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [7]
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“labor, increased crime, poverty, unemployment, and early mortality, as well as the development of mental health disorders such as depression and schizophrenia [22].”
BackgroundInfluentialTreatments for people living with schizophrenia in Sub‐Saharan Africa: an adapted realist review
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“Very little of the content published in the most reputable psychiatric journals comes from countries outside the developed world and the proportion ‘from low- and middleincome countries is even lower (3.2%)’ (Patel & Kim 2007, p. 77; Baingana et al. 2015).”
BackgroundInfluentialDeterminants of substance use among young people attending primary health centers in India
Venkatesh, U., Aparnavi, P., Kaviprawin, M., Durga, R., Pearson, J., Kishore, S., Joshi, H. S., Nair, N., Nisha, B., Agrawal, R., et al. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.13 · Cited by 33 · see citing works
“Early substance use can lead to enduring physical, mental and cognitive impacts, elevating the risk of future substance use disorders and associated problems like educational underachieve-ment (Balyakina et al., 2014; Baingana et al., 2015).”
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Metabolic Enzymes of Cocaine Metabolite Benzoylecgonine
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Clinical Potential of an Enzyme-based Novel Therapy for Cocaine Overdose
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“This could favour the establishment of partnerships across sectors while preserving core values in global mental health.”
Reaching into the toolbox: Stem cell models to study neuropsychiatric disorders
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“Nine of ten C&A with MNSDs in LMICs lack adequate care [17,18].”
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“…another way of colonization (Mills, 2014); as well as the lack of evidence of the efficacy of “evidence-based” practices in LMICs, since most relevant clinical trials were conducted in high-income countries (Baingana et al., 2015; Kieling et al., 2011; Patel & Kim, 2007; Razzouk et al., 2010).”
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“Other authors focus on setting priorities for research, linking them with principles for context-driven, intersectoral and integrative approaches to change policy and systems in LMICs [146].”
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Toward a Global Roadmap for Precision Medicine in Psychiatry: Challenges and Opportunities
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“In 2010, 7.4% of the total global disease burden was attributable to mental and substance use disorders, and this burden is anticipated to rise (Whiteford et al., 2013), with the highest increases to occur in low- and middle-income countries (LMICs) (Baingana et al., 2015).”
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“In this context of scarce treatment resources, every opportunity for SUD treatment requires optimisation through providing appropriate and efective care [21–23].”
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“Furthermore, these comorbid difficulties may increase risk of relapse, infections and other complications, and social deprivation (Baingana, al ’ Absi, Becker, & Pringle, 2015).”
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“7 percent of the global disability-life years (YLDs) [1].”
BackgroundEffectiveness of a Cocaine Hydrolase for Cocaine Toxicity Treatment in Male and Female Rats
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Silencing synaptic MicroRNA‐411 reduces voluntary alcohol consumption in mice
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“Given the genetic complexity of AUD, it is not surprising that only a few pharmacotherapies have been identified for treating dependence and preventing relapse (World Health Organization 2014; Baingana et al. 2015).”
BackgroundPriorities for addressing substance use disorder in humanitarian settings
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Advancing Implementation Science Measurement for Global Mental Health Research
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“Challenges contributing to the severity and complexity of the mental health implementation gap include social determinants of mental health,(2) the impact of stigma,(3) limited engagement and participation of key stakeholders including service users,(4) and the need for improved mental health measurement and data coll…”
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“This activism and advocacy is arguably part of good mental health practice in all contexts [52, 53], but is possibly especially important in contexts, like South Africa, where resources are scarce [54].”
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“Psychiatric disorders have become the major contributors to overall morbidity and disability across the globe [1].”
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Global Child Mental Health Research: Time for the Children
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“The health burden of mental health disorders is exacerbated by the growing concurrent problems associated with substance misuse (Baingana et al., 2015).”
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“The burden of addiction and mental health problems continues to increase globally (1,2).”
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“In low-and-middle-income countries, it is vital to identify cost-effective models of adapted evidence-based practices for addressing substance use disorders [19, 20].”
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Heterogeneous Effects of Obesity on Life Expectancy: A Global Perspective
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The Development of Bacterial Carboxylesterase Biological Recognition Elements for Cocaine Detection
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Psychoactive substances for the treatment of neuropsychiatric disorders
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“Our fi ndings on extreme health burdens in Uganda and Belarus align with Baingana et al. ’ s (23)projection that low-and middle-income countries will experience the steepest rise in mental disease and SUDs burden due to increasing life expectancy, population growth, and under-resourced healthcare…”
Brain Theranostics and Radiotheranostics: Exosomes and Graphenes In Vivo as Novel Brain Theranostics
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Epigenetic Drugs for Mood Disorders
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Global mental health and the treatment gap: A human rights and neuroethics concern
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Health insurance expansion and family violence prevention: A conceptual framework
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“A bidirectional relationship exists between mental disorders and excessive social media use, substance use, and drug dependence, leading to a vicious cycle impacting youth across all communications and countries [4-7].”
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“In South Asia, including India, more than 50% of all the mental health related DALYs are related to depression (Baingana et al., 2015).”
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Patterns of Pulmonary Consultation for Veterans with Incident Chronic Obstructive Pulmonary Disease
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“The available evidence-base of efficacious and effective interventions for the treatment of SUDs and other MHDs derives from studies conducted in high-resourced settings (Baingana et al., 2015; Zielinski et al., 2020).”
BackgroundInfluentialChronic substance use and self-harm in a primary health care setting
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“…a robust understanding of the barriers and facilitators that contribute to implementation success and what these look like across diverse task-sharing mental health interventions and contexts, which is needed to fulfill the promise of task-sharing in addressing the mental health treatment gap [29].”
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“We also highlight mental health distress, which commonly co-occurs with, and can be a cause or a consequence of substance use [23, 24].”
Mental Health Promotion Through Collection Of Global Opinion Data
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“22 23 Several studies have also pointed out issues such as missed opportunities and delays in addressing NEET raised concerns around quality and affordable education in children and youth as promised by countries following global SDG commitment.”
BackgroundAn Empirical Analysis of Structural Neuroimaging Profiles in a Staging Model of Depression
Nogovitsyn, N., Ballester, P. L., Lasby, M., Dunlop, K., Ceniti, A. K., Squires, S. D., Rowe, J., Ho, K. T., Suh, J. S., Hassel, S., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.01.246 · Cited by 5 · see citing works
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Bioculture and the global regulatory gap in neuroscience, neurotechnology, and neuroethics
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“The challenges and opportunities ahead are significant [3, 12], but the scientific synergies created by networks, mentoring, and research collaborations have huge potentials to promote learning, growth and development, for all parties involved.”
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“The key components of personal networks include the following: (1) a focal node (respondent), (2) peers reported by the respondents, and (3) the ties between the respondent and their peers [3].”
SANTÉ PSYCHIQUE, MAL-ÊTRE, DÉPRESSION ET ANXIÉTÉ DES ÉTUDIANTS : DES CHIFFRES ET DES HUMAINS?
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“Several studies have demonstrated the potential for mHealth technologies to support mental health service delivery in LMICs [15].”
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“…a robust understanding of the barriers and facilitators that contribute to implementation success and what these look like across diverse task-sharing mental health interventions and contexts, which is needed to ful�ll the promise of task-sharing in addressing the mental health treatment gap (29).”
Background
- Authors
- Baingana, F., al'Absi, M., Becker, A. E., & Pringle, B.
- Affiliations
- Makerere University (UG)
- Harvard University (US)
- National Institute of Mental Health (US)
- Corresponding author
- Baingana, Florence
- Venue
- Nature
- Published
- 2015-11-18
- Volume
- 527
- Issue
- 7578
- Pages
- S172-S177
- ISSN
- 0028-0836 (ISSN-L)
- 1476-4687
- PMC
- PMC6368440
- OpenAlex
- W2176845058
- Cited by
- 138
- References
- 66
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 15 · 2023: 17 · 2022: 14 · 2021: 8 · 2020: 14 · 2019: 15 · 2018: 12 · 2017: 12 · 2016: 7 · 2015: 1 · 2014: 1
- FWCI
- 1.66
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Nature (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion, cc-by)
- PubMed Central (acceptedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Grand Challenges Canada
- National Institute of Mental Health
- National Institute on Drug Abuse (R21DA024626, R01DA016351, R01DA027232)
- Fogarty International Center
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
- Keywords
- global mental health, substance use disorders, low- and middle-income countries, implementation research, service delivery adaptation, research capacity building, multimorbidity, life course, health equity, multisectoral approach, integrative care, access to mental health care
- MeSH terms
- Delivery of Health Care, Humans, Mental Health, Substance-Related Disorders, Biomedical Research, Internationality
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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