A Network for Studying Psychological Resilience in Low and Middle-Income Countries (NESP)

Vulnerability to or resilience to the commonest mental health disorders (depression, anxiety, drug and alcohol misuse) is related to the combination of genetic susceptibility, early life factors and an individual's current environment. Studies, over 95% of which have been confined to high income countries (HICs), have confirmed the importance of genes, development and adult environment. However, very little is known of these factors in low and middle-income countries (LMICs), where the burden of such common mental health disorders is even more substantial than in HICs.

Here we propose a powerful network of global leaders to analyse the key factors in three contrasting LMIC settings in three regions of the world, Nepal, Malawi and Costa Rica. This will enable us systematically to determine the processes leading to vulnerability or resilience to common disorders of mental health and exploit this knowledge, enabled by globally-leading data sciences and within-country expertise, to develop specific approaches to reinforce resilience and support prevention, diagnosis and treatment.

Our approach is highly multidisciplinary, combining genetic, clinical and social sciences expertise to provide a comprehensive view of an individual's genetics, development and environment. We will combine this expertise with world-leading informatics capacity to create a network for the study of psychological resilience across diverse environments and economies.

Vulnerability or resilience to common mental health disorders is related to the combination and interaction of genetic susceptibility, early life factors and an individual's current environment. Over 95% of studies addressing these factors have been confined to High income countries (HICs) however, very little is known of these factors in low and middle-income countries (LMIC), where the burden of such common mental health disorders is even more substantial.
Here we propose to develop a network of global leaders to analyse the key factors in three contrasting LMIC settings. This will enable us systematically to determine the processes leading to vulnerability or resilience to common disorders of mental health and exploit this knowledge, enabled by leading data sciences and in-country expertise, to develop specific approaches to reinforce resilience and support prevention, diagnosis and treatment. Our approach is highly multidisciplinary, combining genetic, clinical and social sciences expertise to provide a comprehensive view of an individual's genetics, development and environment. We will combine this expertise with world-leading informatics capacity to create a network for the study of psychological resilience across diverse environments and economies.
The long term aims of this pump-priming grant are to conduct high quality multidisciplinary research into the epidemiology and aetiology of resilience and mental disorders with our partners - extending awareness of risk factors, knowledge of illness and preventative protective systems. We also seek to build a linked community in each country with local leadership to lead a mental health research programme over the coming decades and establish connections between these three different regions (each with their different economic, social, and cultural systems). This will help position our partner countries as centres of mental health research within regional and wider international networks.

Our ambition is that this programme will Our research proposal will pave the way for future research opportunities by

1) engaging researchers in a network of LMICs across a gradient of differing macroeconomic environments
2) engaging with future research participant and families within the partner countries
3) establishing that there are ethical and quality assured processes for local research data collection.

The anticipated impacts of our programme are linked to our future outputs of new data resources on resilience and risk and newly connected communities of practice. The impact of our enhancement of the research skills, confidence and capacity of the group of researchers working together which has the capacity to shape the way that psychiatry is understood in each country and increase its prominence in the academic and health service sector.

The anticipated increase in the knowledge base on genetic and environmental risk factors associated with mental health and resilience in each of the 3 communities and their comparison across the 3 regions will impact on training of psychiatry and lead to novel programmes being developed from the evidence that has been generated singularly and separately from the three programmes. The data resources on risk factors and resilience opportunities and on what constitute risk environments and protective environments will be made available in each country for other researchers in other fields to work with. A stronger community of researchers connected together with the purpose of empowering researchers to engage in mental health research. The development of innovative methodologies of research is a key impact of the programme

This will be the first time (to our knowledge) that these 3 countries have shared ideas and research knowledge which focuses on collectively understanding issues of risk and resilience. We anticipate that this will create a strong central body of science in this area which will encourage bright young science, medical and nursing graduates to enter a career in psychiatry and mental healthcare which will improve the overall numbers within the service and begin to turn mental health around from a forgotten, sometimes despised discipline.

The current call for funding is pump-priming and preparatory to larger-scale hypothesis drive research. nevertheless, the experience of the researchers involved, any lessons learned, and any outputs from the resulting research will be submitted for publication. In addition, we will publicise our activities through the University of Edinburgh's Global Health Academy where we will share any outputs from our research. Particularly newsworthy outputs from the activities, teaching and research facilitated by this pump-priming award will be submitted as a news release by the University's Press Office.