Background: Low- and middle-income countries (LMICs) have been consistently under-represented in the pool of contributors to academic journals on health. For the past two decades, prominent voices within the psychiatric profession have called for better representation of LMICs in the interest of advancing the understanding of mental health globally and benefiting health systems in these countries. Objective: To investigate the absolute and relative representation of authors affiliated to institutes from LMICs in the most influential journals on mental health in 2019. Method: Thirty top-ranking journals on mental health based on Scimago Journal Rank were selected, and all papers other than correspondence and letters to the editor published in those journals in 2019 were examined to extract the country of affiliation of each of their authors and their position (corresponding author, first author, second author). Results: Of the 4022 articles examined, 3720 articles (92.5%) were written exclusively by authors from high-income countries (HICs); 302 (7.5%) featured one or more authors from a LMIC along with those from HICs; 91 (2.2%) featured authors only from one LMIC; and only 3 (0.07%) featured authors from more than one LMICs but without any co-author from a HIC. The ratio of articles by contributors from LMICs to all the articles published in 2019 in a given journal ranged from 0% to 19%. Of 1855 individual contributors from 45 LMICs, 1050 (56%) were from China. Conclusion: Despite the growth of the global health movement and frequent calls for academic inclusivity, LMICs were significantly under-represented among the authors of papers published in top-ranking journals on mental health in 2019.