Towards Horizon 2020: challenges and advances for clinical mental health research – outcome of an expert survey

Abstract

Background

The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders.

Methods

The research was conducted as an expert survey and expert panel discussion during a scientific workshop.

Results

Eighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The “subjectivity gap” between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required.

Conclusion

Innovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs.

Keywords:

• clinical research
• mental health
• randomized clinical trials
• Horizon 2020
• expert survey
• challenge
• research agenda
• Europe

Supplementary material

Search terms for experts Delphi survey

Web of Science

Search History – “ROAMER Delphi survey”

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Refined by: Document Types=(REVIEW) AND Web of Science Categories=(PSYCHIATRY OR PHARMACOLOGY PHARMACY OR PSYCHOLOGY CLINICAL OR PSYCHOLOGY OR FAMILY STUDIES OR PUBLIC ENVIRONMENTAL OCCUPATIONAL HEALTH OR PSYCHOLOGY DEVELOPMENTAL OR HEALTH POLICY SERVICES OR PSYCHOLOGY MULTIDISCIPLINARY OR PSYCHOLOGY BIOLOGICAL OR REHABILITATION OR PSYCHOLOGY APPLIED OR HEALTH CARE SCIENCES SERVICES OR PSYCHOLOGY PSYCHOANALYSIS) AND [excluding] Publication Years=(2013)

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TS=(clinical* OR trial OR psychiatry OR psychology OR psychiatr* OR psychol*)

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TS=((“drug abuse” OR “drug addict” OR “drug addicts” OR “drug addiction” OR “drug addicted” OR “drug dependent*” OR “drug dependence*” OR “drug withdrawal” OR “drug abuse”) OR (“addictive disease*” OR “addictive disorder*”) OR (“alcoholic patient*” OR “alcoholic subject*” OR alcoholism OR “alcohol dependent*” OR “alcohol dependence*” OR “fetal alcohol*” OR “prenatal alcohol*” OR “chronic ethanol*” OR “chronic* alcohol*” OR “alcohol withdrawal” OR “ethanol withdrawal”) OR (“caffeine dependent*” OR “caffeine dependence” OR “caffeine addiction” OR (caffeine AND addict*) OR “caffeine withdrawal”) OR (((cocaine OR heroin OR cannabis OR MDMA OR ecstasy OR morphine*) AND (abuse OR depend* OR dependent* OR dependence* OR addict* OR addicts OR addicted OR addiction* OR withdrawal)) OR methadone) OR (addiction OR addictive OR “substance abuse” OR “withdrawal syndrome” OR psychoactive*) OR ((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR (((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression) OR “suicide attempt*” OR suicidal* OR cyclothymia OR Dysthymia) OR (((anxiety OR panic OR “Obsessive-compulsive” OR adjustment OR conversion OR dissociative OR Somatoform OR Somatization OR neurotic) AND disorder*) OR (“hypochondriasis*” OR “body dysmorphic disorder*” OR “pain disorder*”) OR agoraphobia OR “social phobia*” OR “Post-traumatic stress” OR “stress disorder*”) OR (“Eating disorder*” OR “Anorexia nervosa” OR “Bulimia nervosa” OR “sleep disturbance” OR (sexual AND (disorder* OR dysfunction)) OR ((postnatal OR postpartum) AND depression) OR ((antidepressant* OR laxative* OR analgesic* OR psychotropic* OR vitamin* OR steroids OR hormone*) AND abuse)) OR (((insomnia OR sleepiness OR “sleep disturbance”) NOT (apnea OR “side effect*” OR parkinson* OR alzheimer OR neurodegenerat* OR cancer OR obesity OR obese*)) OR (hypersomnia NOT narcolepsy) OR ((sleep OR night) AND terror*) OR nightmare*) OR ((disorder* AND (personality OR identity OR impulse* OR impulsive* OR impulsivity)) OR asocial OR antisocial OR psychopathic OR anxious OR narcissi* OR “Pathological gambling” OR pyromania* OR Trichotillomania OR Psychosexual OR (“Munchhausen syndrome”)) OR (“Pervasive developmental disorder*” OR autism OR autistic* OR “Rett* syndrome” OR “Asperger* syndrome”) OR (((Hyperkinetic OR Conduct OR Emotional OR tic) AND disorder*) OR (anxiety AND (separation OR phobic OR social)) OR (hyperactivity AND (disorder* OR syndrome)) OR “Tourette syndrome” OR “Tourette’s syndrome”) OR ((Mental AND (disorder* OR illness OR health)) OR “psychological distress” OR “psychiatric disorder”) OR (Nervousness OR “nervous tension” OR Irritability) OR anorexia OR (neurosis OR neuroses OR psychoses) OR ((“mental confusion*”) OR (“mental disability*”) OR (“mental capacity*”) OR ((psychiatric OR mental) AND (comorbidity OR comorbid)) OR psychiatry OR psychology))

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GP=(Europe* OR “EU-27” OR Nordic* OR Austria* OR Belgium OR Belgian OR Flemish OR Bulgaria* OR Cyprus OR Cypriot* OR Czech* OR Denmark OR Danish OR Estonia* OR Finland OR Finish OR France OR French OR German* OR Greece OR Greek OR Hungary OR Hungarian OR Ireland OR Irish OR Italy OR Italian OR Latvia* OR Lithuania* OR Luxembourg OR Malta OR Maltese OR Netherland* OR Dutch OR Holland* OR Poland OR Polish OR Portugal OR Portuguese OR Romania* OR Slovak* OR Slovania* OR Spain OR Spanish OR Sweden OR Swedish OR “United Kingdom” OR “Great Britain” OR British OR Britannic OR England OR English OR Wales OR Welsh OR Scotland OR Scottish OR Croatia* OR Macedonia* OR Iceland* OR Montenegr* OR Turkey OR Turkish OR Albani* OR Andorra OR Armeni* OR Azerbaijan* OR Azerbaidzhan* OR Belarus* OR Byelarus* OR Bosnia* OR Georgia* OR Liechtenstein OR Moldova OR Moldovan OR Monaco OR Monacan OR Monegasque OR Norway OR Norwegian OR Russia* OR “San Marino” OR Serbia* OR Switzerland OR Swiss OR Ukrain* OR Vatican*)

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CU=(Europe* OR “EU-27” OR Nordic* OR Austria* OR Belgium OR Belgian OR Flemish OR Bulgaria* OR Cyprus OR Cypriot* OR Czech* OR Denmark OR Danish OR Estonia* OR Finland OR Finish OR France OR French OR German* OR Greece OR Greek OR Hungary OR Hungarian OR Ireland OR Irish OR Italy OR Italian OR Latvia* OR Lithuania* OR Luxembourg OR Malta OR Maltese OR Netherland* OR Dutch OR Holland* OR Poland OR Polish OR Portugal OR Portuguese OR Romania* OR Slovak* OR Slovania* OR Spain OR Spanish OR Sweden OR Swedish OR “United Kingdom” OR “Great Britain” OR British OR Britannic OR England OR English OR Wales OR Welsh OR Scotland OR Scottish OR Croatia* OR Macedonia* OR Iceland* OR Montenegr* OR Turkey OR Turkish OR Albani* OR Andorra OR Armeni* OR Azerbaijan* OR Azerbaidzhan* OR Belarus* OR Byelarus* OR Bosnia* OR Georgia* OR Liechtenstein OR Moldova OR Moldovan OR Monaco OR Monacan OR Monegasque OR Norway OR Norwegian OR Russia* OR “San Marino” OR Serbia* OR Switzerland OR Swiss OR Ukrain* OR Vatican*)

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Acknowledgments

This study was performed as part of the ROAMER project: A road-map for mental health research in Europe. Coordination and Support Action, Objective Theme (HEALTH.2011.3.3–4). This project has received funding from the European Union Seventh Framework Program (FP7/2007–2013) under grant agreement number 282586, and from the National R&D Internationalisation Programme of the Spanish Ministry of Science and Technology under reference ACI-PRO-2011-1080. Our thanks are extended to: Jacques Demote-Mainard for providing input and supporting the work of the Clinical Research Task Force; Harold Pincus for providing suggestions on how to conduct the survey; Mario Maj, Istvan Bitter, and Patrick Boyer, for acting as ambassadors for the survey in their countries; Rebecca Kuepper for her work on selection of experts for the survey; Rosanna Wendel for her work on setting up the survey questionnaire; and Anna Forsman for her advice regarding the Webropol analysis. We also thank the 89 experts who participated in the survey, including the following who agreed to be identified: Cecilio Álamo, Peter Allebeck, Alfredo Carlo Altamura, Celso Arango, Zerrin Atakan, Jose Luis Ayuso-Mateos, Ccorrado Barbui, Aartjan TF Beekman, Istvan Bitter, Filippo Bogetto, Peter Bower, Wim van den Brink, Wiepke Cahn, Somnath Chatterji, David Coghill, Francesco Colom, Pim Cuijpers, David McDaid, Daniel David, Jacques Demotes, Frank van Dijk, Guy Goodwin, Heinz Grunze, Beate Herpertz-Dahlmann, Lieuwe de Haan, Andreas Heinz, Marc de Hert, WJG Hoogendijk, Luigi Janirir, Ad JFM Kerkhof, Dimitrios Kontis, Ralph Kupka, Albert FG Leentjens, Francisco López-Muñoz, Mario Maj, Laura Mandelli, Donatella Marazziti, Massimo Carlo Mauri, Harm van Marwijk, CL Mulder, David Nutt, Ketil J Oedegaard, MJ Owen, Kirsi Peltonen, Andreas Reif, Aribert Rothenberger, Aart HSchene, Robert ASchoevers, Alessandro Serretti, Michael Sharpe, Wolfgang Soellner, Dollfus Sonia, Philip Spinhoven, Jan Spijker, David Taylor, Robert JM Vermeiren, Jan Walburg, Nick JA van der Wee, Jaap van Weeghel, and Mathias Zink. We are also grateful to the following experts who participated in the invitational conference on the results of round one of the expert survey: Istvan Bitter, Matthias Brunn, Jan Buitelaar, David McDaid, Louise Gallagher, Mario Luciano, Marta Miret, Szilvia Papp, and Siegfried Weyerer.

Author contributions

This research is published on behalf of the ROAMER consortium. The Clinical Research Task Force was led by CMFC. CMFC, JvO, and SK designed the survey. JvO provided input for the first part of the survey. SK and CMFC devised the predefined challenges in the second part of the survey, and DL and JvO provided input for this part as well. SK and IE analyzed the survey data in duplicate. CMFC presented the data at the Scientific Workshop. CMFC wrote the paper, and JvO, EV, SK, GS, H-UW, JMH, SWL, CO-T, DL, IE and KW contributed and approved the final version.

Disclosure

CMFC has received unrestricted grants for investigator-initiated research and unrestricted grants for lectures from Eli Lilly. JvO has received unrestricted investigator-led research grants or recompense for presenting his research from Eli Lilly, Bristol-Myers Squibb, Lundbeck, Organon, Janssen-Cilag, GlaxoSmithKline, AstraZeneca, Pfizer, and Servier, companies that have an interest in the treatment of psychosis. SWL has been a consultant or made educational presentations for Janssen-Cilag, Abbvie and AstraZeneca. EV has received grants and served as consultant, advisor, or speaker for the following entities: Alexza, Almirall, AstraZeneca, Bristol-Myers Squibb, Cephalon, Elan, Eli Lilly, Ferrer, Forest Research Institute, Gedeon Richter, GlaxoSmithKline, Janssen-Cilag, Jazz, Johnson and Johnson, Lundbeck, Merck, Novartis, Organon, Otsuka, Pfizer, Roche, Sanofi-Aventis, Servier, Schering-Plough, Shire, the Spanish Ministry of Science and Innovation, the Seventh European Framework Programme, the Stanley Medical Research Institute, Sunovion, Takeda, Teva, United BioSource Corporation, and Wyeth. JMH has been a consultant or made educational presentations for Eli Lilly and Company and Lundbeck, and has served on advisory boards for Eli Lilly and Company, Lundbeck, AstraZeneca, and Hoffman-La Roche, Inc. The other authors report no conflicts of interest in this work.