As the Journal of Global Health Neurology and Psychiatry enters its second year of publication, we take stock not only of what has been accomplished but of the considerable challenges that lie ahead — challenges that are, in many ways, inseparable from the broader landscape facing all journals working at the intersection of neuroscience, psychiatry, and global health. This editorial reflects candidly on those challenges, in the belief that transparency about the difficulties of scientific publishing in this space is itself a contribution to the field.
The past year has reaffirmed the relevance of our founding mission. The global burden of neurological and psychiatric disorders continues to grow. The 2023 update of the Institute for Health Metrics and Evaluation confirmed that neuropsychiatric conditions remain among the leading causes of years lived with disability globally, with depressive and anxiety disorders, epilepsy, migraine, and dementia each contributing substantially to this toll.1 The need for a publication dedicated to generating and disseminating evidence that can guide equitable responses to this burden has not diminished — if anything, it has deepened.
The Challenge of Low Submission Volume from Low- and Middle-Income Countries
One of the defining ambitions of journals in our field is to centre the experiences and contributions of researchers working in low- and middle-income countries (LMICs). Yet a persistent structural challenge undermines this ambition: the submission landscape remains heavily skewed toward high-income settings. Investigators in LMICs face well-documented barriers to publication — limited access to writing support, underfunded research infrastructure, higher teaching and clinical loads, and the compounding disadvantage of writing in a language that is frequently not their own.2
The consequences are not trivial. When research agendas are defined primarily by investigators from high-income countries, the questions asked — and therefore the evidence generated — may not reflect the priorities of the populations bearing the greatest burden of disease. Closing this gap requires sustained editorial effort: waiver policies for article processing charges, active mentorship of early-career investigators from LMICs, and partnerships with regional academic networks. This journal remains committed to all three, but we acknowledge that progress has been slower than we would wish.
Open Access, Sustainability, and the Article Processing Charge Dilemma
Open access publishing is an ethical imperative in global health: research on conditions affecting populations in LMICs must be freely readable by the clinicians, policymakers, and researchers in those same countries. Yet the dominant business model of open access — the article processing charge (APC) — creates its own inequities. APCs in leading journals now routinely exceed USD 3,000–5,000 per article, a sum that is prohibitive for most investigators in low-income settings and a significant burden even in middle-income ones.3
This journal maintains a waiver programme for authors from low-income countries and offers discounted APCs for those from lower-middle-income settings. Nevertheless, the financial sustainability of open-access publishing without institutional subsidy remains a genuine tension. Calls for alternative models — diamond open access, whereby neither authors nor readers pay — have grown louder in recent years, with several consortia of learned societies and academic institutions exploring such frameworks.4 We are following these developments with close attention and remain open to structural evolution in our publishing model.
Peer Review: Quality, Speed, and Reviewer Fatigue
The peer review system is under strain across all of academic publishing, and journals in our field are not immune. The rapid growth in manuscript submissions globally, accelerated in part by increased research output during and following the COVID-19 pandemic, has placed enormous demands on the pool of qualified reviewers. Reviewer fatigue is real and well-documented: invitations are declined more frequently, turnaround times have lengthened, and the quality of reviews has become more variable.5
In a field as interdisciplinary as global health neurology and psychiatry, identifying reviewers with the appropriate combination of clinical, methodological, and contextual expertise presents particular difficulties. A manuscript reporting on task-sharing interventions for epilepsy in sub-Saharan Africa, for example, requires reviewers who understand both the neurology and the implementation science involved, as well as the specific health system context. We have invested in expanding our reviewer database and in training early-career investigators as peer reviewers, and we are grateful to the growing community of scholars who have given their time to this work.
Combating Predatory Publishing in the Field
A more troubling challenge is the proliferation of predatory journals targeting researchers in global mental health and neurology. These publications — which collect APCs while offering little or no genuine peer review, falsely claiming indexing in reputable databases, and sometimes fabricating editorial boards — pose a direct threat to the integrity of the scientific literature and to the careers of the investigators, particularly early-career researchers in LMICs, who publish in them.6
The consequences extend beyond individual careers. When systematic reviews and clinical guidelines are based partly on evidence drawn from journals that have not applied rigorous quality controls, patient care may be affected. We encourage authors to verify the credentials of any journal before submission using established resources, and we call on academic institutions and funders to develop clearer guidance for investigators navigating this landscape.
Scope Creep and the Coherence of an Interdisciplinary Journal
Interdisciplinarity is a strength of journals like ours, but it also carries a risk: scope creep, whereby the desire to be inclusive gradually erodes the coherence of the publication’s identity. As global health has expanded as a field, the range of topics plausibly relevant to a journal at its intersection with neurology and psychiatry has grown correspondingly broad. Papers on artificial intelligence in neuroimaging, climate change and mental health, conflict-related trauma, and the global genomics of psychiatric disorders have all been submitted to us — and all have legitimate claims to relevance.7
Managing this breadth while maintaining scientific and editorial focus is a continuous challenge. We have responded by developing a clearer internal framework for scope decisions and by expanding our section structure to accommodate distinct thematic areas without losing coherence. We will publish an updated scope statement and author guidelines later in 2023, and we welcome feedback from our readership on whether our current balance strikes the right note.
Looking Forward
None of the challenges described in this editorial are unique to the Journal of Global Health Neurology and Psychiatry. They are, in different configurations, the challenges of the entire ecosystem of journals committed to rigorous, equitable, and impactful science in global brain health. What distinguishes how journals respond to them is the degree of transparency, creativity, and commitment to their founding values they bring to bear.
We enter our second year with our founding values intact and with a clearer-eyed understanding of the structural barriers that complicate their full realization. We extend our deepest gratitude to our authors, reviewers, editorial board members, and readers — and we invite continued engagement, constructive critique, and above all, your science.