The Arab world has struggled with conflict and political turmoil for several decades, rendering its already underdeveloped mental healthcare system unable to serve the psychiatric needs of victims of violence and trauma, with consequences that extend far beyond the cessation of hostilities. This role has become incumbent on international relief agencies, which have expanded mental health programmes in countries of conflict and refuge. Although their intervention has overall been positive, their mission is usually short term, leaving countries unable to maintain these advantages when the funding ends. The authors advocate for a sustainable framework that emphasises a larger role for regional and local actors. Expertise that is culturally and socially grounded could take the initiative in research, training and deployment in collaboration with non-governmental organisations, allowing for comprehensive development of the mental health sector.

Background: Low- and middle-income countries (LMICs) have been consistently under-represented in the pool of contributors to academic journals on health. For the past two decades, prominent voices within the psychiatric profession have called for better representation of LMICs in the interest of advancing the understanding of mental health globally and benefiting health systems in these countries. Objective: To investigate the absolute and relative representation of authors affiliated to institutes from LMICs in the most influential journals on mental health in 2019. Method: Thirty top-ranking journals on mental health based on Scimago Journal Rank were selected, and all papers other than correspondence and letters to the editor published in those journals in 2019 were examined to extract the country of affiliation of each of their authors and their position (corresponding author, first author, second author). Results: Of the 4022 articles examined, 3720 articles (92.5%) were written exclusively by authors from high-income countries (HICs); 302 (7.5%) featured one or more authors from a LMIC along with those from HICs; 91 (2.2%) featured authors only from one LMIC; and only 3 (0.07%) featured authors from more than one LMICs but without any co-author from a HIC. The ratio of articles by contributors from LMICs to all the articles published in 2019 in a given journal ranged from 0% to 19%. Of 1855 individual contributors from 45 LMICs, 1050 (56%) were from China. Conclusion: Despite the growth of the global health movement and frequent calls for academic inclusivity, LMICs were significantly under-represented among the authors of papers published in top-ranking journals on mental health in 2019.  

The explosion of 3,000 tons of ammonium nitrate on August 4, 2020, in the port of Beirut resulted in human tragedy and extensive property damage. As 1 of the largest man-made disasters to affect a population in peacetime, the explosion attracted global attention and support. The disaster happened in a complex socioeconomic context, even by the standards of Lebanon, a country that has witnessed challenging conditions throughout its modern history. Disasters of this scale, although fortunately rare, have major psychological consequences on affected communities that may extend into the distant future. An online survey was conducted 2 months following the explosion to assess rates and correlates of depression and posttraumatic stress disorder (PTSD) among population exposed to the August 4 explosion. Mental health was assessed using Arabic-validated scales, including the Patient Health Questionnaire and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Of the 2,078 participants that completed the survey, 37% met criteria for PTSD, and 80% were screened as having any depression, one fourth of whom (26.8%, n = 542) were screened as moderately-to-severely/ severely depressed at the time of the study. Most affected were those closest to the site of the explosion, especially those with lower socioeconomic status and women. Help-seeking following the explosion, in particular from mental health professionals, was limited. Documenting the mental health impact of the Beirut explosion is integral to advocating for an emergency mental health response that would better respond to similar disasters and ensure appropriate mental health care for those identified as most affect and at-risk of depression and PTSD.

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