This rapid review was conducted to synthesize the current evidence on mental health and disability research activities in or on Ghana over a 10-year period between 2010 and 2020, in order to identify any research gaps and implications for future research. Overall, the review points to an increasing trend in both mental health and disability research output. The review also highlights the fact that one-quarter of the research studies were conducted without the collaboration of Ghanaian institutions, employed observational study designs, were concentrated in the southern regions of Ghana, and the research funding support has been limited and not commensurate with the research output over the period of the review.
Our findings in terms of the increasing trends in mental health and disability research output are consistent with the observed increases in mental health and disability research output globally [19]. The advent of Global Mental Health [20] and the United Nations Convention on the Rights of Persons with Disabilities (2006) [21] appears to have sparked a surge in research into mental health and disability rights globally and Ghana has been no exception. The impact of the field of Global Mental Health has been enormous and is linked to increased investments in mental health research in low and middle-income settings [20]. Similarly, it is possible that the Mental Health Act 846 passed in 2012 may have contributed to an increase in mental health research in Ghana by raising the profile of mental health and disabilities in the country [5].
Whilst our review points to an increase in the absolute numbers of mental health and disability research studies in Ghana, this should be interpreted with caution. As reported elsewhere, when looked at as a proportion of total health-related research publications in Ghana, the trend suggests a decline in the number of mental health and disability reported studies [22]. Based on our review, the role of funding could partly explain this observation. There has not been a substantial increase in the amount of funding over the same period relative to the total volume of research. This is not entirely surprising given Ghana spends less than 1% of the country’s gross domestic product on research and development [23]. The technical capacity to design rigorous studies is an important determinant of research output and this may be a challenge in Ghana. The technical capacity to conduct mental health and disability research was rated as weak in a recent study on setting research priorities in Ghana [22].
Aside from the observation that peer-reviewed mental health and disability research output relative to the amount of health research may not have increased since 2010, our review also identified some challenges with the type and approach to the research conducted in Ghana. Overall, it was noted that most of the studies conducted in both mental health and/or disability are observational quantitative or qualitative studies, with very few intervention studies. Read’s literature review on mental health research in Ghana in 2012 [6] reported similar observations, suggesting the trend has also not improved since 2010. Although observational studies are useful in establishing the burden of disease and inform possible prevention measures, they do not provide data on the effectiveness or efficacy of interventions. Inadequate funding and technical capacity could explain this observation, as conducting intervention studies is expensive and requires training in advanced epidemiology and trial design [24].
Our review also highlights important imbalances within the country. Majority of the research on mental health and/or disability is concentrated in the southern regions of Ghana. This observation aligns with the skewed distribution of specialist mental health services in Ghana wherein all the three psychiatric hospitals are located in the southern sector, with none in the northern sector [25]. The northern regions of Ghana are among the poorest and likely to present increased risk of mental health conditions; the social determinants theory of mental health conditions supports this assertion [25]. Arguably, these are the settings that will be benefit from well-designed epidemiological and intervention research. Despite this unequal distribution of studies across Ghana, the studies reviewed showed a reasonably equal representation of study participants in terms of age, gender, educational background, profession, income, and socioeconomic status.
As noted by other scholars, research-generated information helps establish the health needs in a given setting [26], provides evidence on culturally appropriate and cost-effective individual and collective interventions [27], including their implementation [28], and very importantly explores the obstacles that prevent recommended strategies from being implemented [29]. Ghana may not be benefiting from these advantages of research as our review clearly highlights the ‘research gap’ [30] in Ghana.
Our findings have several implications for the way forward. First, the observation that peer-reviewed mental health and disability research output may not have significantly improved since 2010 means there must be a deliberate effort to promote more research on mental health and disability in Ghana. Second, efforts should be made to improve and/or build research capacity nested within a supportive research culture. The weak capacity to conduct high-quality research in LMICs has been previously reported [22], [31].
Third, for a period of 10 years, there has been very little increase in the amount of funding available for mental health and/or disability research in Ghana. Even the little funding available came from external funders. We also observe in our review that the least researched mental health conditions were dementia, post-traumatic stress disorder and substance abuse disorders; ageing-related mental health conditions and substance use disorders are becoming common in LMICs and this requires urgent attention [32]. Finally, the fact that one quarter of all research within the period of this review was conducted without the involvement of a Ghanaian institution hints of the undermining effects of colonialist structures that have too long been part of global health research. This requires urgent action and as argued elsewhere, to improve on the past in global mental health, institutions in high-income countries (HICs) must champion equity, solidarity, and true partnerships between people with different experiences, knowledge, and needs from around the world [33].
Recommended strategies by Thornicroft and colleagues [30] to address these challenges are worth mentioning: training mental health professionals in research methods and scientific writing; making mental health research attractive to young researchers; promoting strategies for acquiring research grants and for developing and sustaining researchers’ careers; increasing the level of networking among research teams; enhancing research dissemination; and fostering dialogue between research teams and policymakers. Building this capacity will ensure an increase in the profile of well-designed intervention studies to help address critical questions on epidemiology and culturally appropriate interventions that work in our setting. This could be done by increasing the financial capacity of the three Ghana Health Service health research centers, strategically located across the three main ecological belts of Ghana viz. Savanah, Middle, and Southern. This will also help to address the uneven mental health and disability research activity in Ghana.
Aside from the research centers, universities, particularly schools of public health could take up interest and convene formal training programmes and courses in mental health and disability research. To address the issue of funding in mental health and disability research, there is need for more local funding of mental health and disability research. One way to address this is for the Ministry of health to prioritize research funding and implement Section 81, 2 d of Mental Health Act 846 [5]. Other strategies for generating funds for research include South-South or North-South partnerships [34].
Limitations
Our rapid review has some strengths, including the fact that the approach is useful for providing rigorous and timely information for decision-making, particularly when resources to conduct a full systematic review are limited [35]. Further, our approach to review both mental health and disability research together is novel in our setting. The wide scope also allowed us to include all peer-review studies conducted on mental health and/or disability in Ghana.
These notwithstanding, we recognize some limitations. First, due to time constraints, specific mental health conditions and disabilities (e.g., schizophrenia) were not included in the search terms and grey databases were not searched. It is therefore possible that including more search terms and grey literature databases would have produced additional relevant material. Despite this, the search retrieved a substantial number of studies which was adequate to meet the aims of the research and contained a good range of citations written from different perspectives and over a ten-year period. Second, we were unable to assess the rigor or quality of studies included.