Precision medicine and global mental health
Authors: Gunter Schumann, Vivek Benegal, Chunshui Yu, Sha Tao, Terry Jernigan, Andreas Heinz, Ricardo Araya, Le Yu, Vince Calhoun
Journal: The Lancet Global Health (2018)

By taking into account individual environmental exposure, lifestyle, and biological susceptibility, precision medicine promises to revolutionise the prevention and treatment of mental illness. However, since living conditions, sociocultural influences, and ethnic composition differ greatly between high-income countries and low-income and middle-income countries (LMICs), so do the determinants of mental illness. For example, environmental factors associated with urbanisation are the most rapidly growing cause of mental illness,1Galea S Uddin M Koenen K The urban environment and mental disorders: epigenetic links.Epigenetics. 2011; 6: 400-404Crossref PubMed Scopus (67) Google Scholar, 2Lambert KG Nelson RJ Jovanovic T Cerdá M Brains in the city: neurobiological effects of urbanization.Neurosci Biobehav Rev. 2015; 58: 107-122Crossref PubMed Scopus (74) Google Scholar with almost 700 million people predicted to reside in urban areas of India and China by 2050.3Department of Economic and Social AffairsWorld urbanization prospects, the 2011 revision. New York: United Nations.http://www.un.org/en/development/desa/population/publications/pdf/urbanization/WUP2011_Report.pdfDate accessed: November 26, 2018Google Scholar Although in many high-income countries, planned urbanisation results in improved infrastructure, in LMICs rapid urbanisation without planned infrastructure often leads to increased poverty and environmental adversity, and increased prevalence of anxiety, depression, and substance abuse.4Funk M Drew N Knapp M Mental health, poverty and development.J Public Ment Health. 2012; 11: 166-185Crossref Scopus (54) Google Scholar The development of precision medicine exclusively in high-income countries therefore runs the risk of ignoring the needs of LMICs, which have the greatest burden of mental disorders, thus contributing to the global gap in mental health treatment. To discuss the role of precision medicine for mental health in LMICs, the Centre for Population Neuroscience and Precision Medicine at the Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, hosted a conference in London in June 2018, with experts from China, India, Latin America, the USA, and Europe. The panel noted that economic growth and urbanisation, and the resulting social and regional disparities are among the greatest challenges for many LMICs. Identifying the risks for cognitive development and mental health in the different geographical locations and social conditions was considered essential. The adverse impact of these factors can best be prevented in childhood or adolescence, since 75% of the lifetime burden from mental disorders emerges by the age of 25 years.5Jones PB Adult mental health disorders and their age at onset.Br J Psychiatry Suppl. 2013; 54: 5-10Crossref PubMed Scopus (365) Google Scholar Precision medicine can help establish relevant risk and resilience factors and assess their effect on the brain and behaviour. Defining underlying mechanisms would result in earlier and more targeted prevention, and can contribute to reducing stigma, which is often a considerable obstacle to mental health care access. Additionally, the experts highlighted the need to obtain normative data in LMICs for comparison with measures in high-income countries. To address these challenges, the Global Imaging Genetics Initiative in Adolescence (GIGA) was established. GIGA is a consortium of several major cohorts in China, India, the UK, Europe, and the USA that investigates mental health outcomes in children and adolescents in different cultures, environments, and ethnic groups using behavioural and brain imaging genetic studies. GIGA is working towards harmonised data acquisition, retrieval, and data analysis of more than 195 000 individuals, including more than 20 000 neuroimaging scans. In addition to locally acquired neuroimaging, genetics, behavioural, and environmental data, GIGA will enable comparison of environmental measures by using mobile-phone-based technology, and analysing satellite information that measures, for example, features of urbanisation across geographical regions and across time. These measures will be integrated into a framework for adapted biomarker development aimed to improve prevention for mental disorders worldwide. We declare no competing interests.