A call for greater diversity and representativeness within countries in psychiatric research: lessons and challenges from a systematic review of schizophrenia research in Brazil.

Abstract

Objective: To systematically review studies on schizophrenia in Brazil, addressing geographical coverage as an indicator of sampling representativeness - an essential precondition for inferences regarding the generalizability of findings - and, secondarily, of variation in research funding across different regions.

Methods: We searched for studies carried out until July 2023. The inclusion criteria were studies of patients diagnosed with schizophrenia (or its spectrum) recruited in Brazil. The following parameters were extracted: geographic region of the first and last authors, recruitment setting, research subfield, and funding sources. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Of 296 studies reviewed, most (63.18%) took place in the Southeast region, particularly the state of São Paulo (48.98%). Clinical trials comprised the majority (41.6%); genetic studies were primarily conducted in the Southeast or South (81.5%). Funding was reported in 64% of papers. The Northeast region was less likely to receive study funding compared to the Southeast.

Conclusion: Schizophrenia research in Brazil shows a clear geographic concentration, with significant disparities in funding allocation and underrepresentation of certain regions. Broadening research coverage through equitable distribution of funding opportunities and fostering collaborations with local institutions are of utmost importance to enhance the understanding and treatment of schizophrenia within Brazil's diverse socioeconomic and ethnic landscape.