Maximising impactful, locally relevant global mental health research conducted in low and middle income country settings: ethical considerations

Clara Calia; Amit Chakrabarti; Emmanuel Sarabwe; Anna Chiumento

doi:10.12688/wellcomeopenres.18269.2

Maximising impactful, locally relevant global mental health research conducted in low and middle income country settings: ethical considerations

Wellcome Open Res. 2023 Jan 5:7:240. doi: 10.12688/wellcomeopenres.18269.2. eCollection 2022.

Authors

Clara Calia¹, Amit Chakrabarti², Emmanuel Sarabwe³, Anna Chiumento⁴

Affiliations

¹ Clinical Psychology, University of Edinburgh, Edinburgh, EH8 9AG, UK.
² ICMR-Centre for Ageing and Mental Health, Division of Non-Communicable Diseases, Indian Council of Medical Research, Salt Lake, Kolkata, 700091, India.
³ Quality Assurance, Community Based Sociotherapy, Kigali, Rwanda.
⁴ Primary Care and Mental Health, University of Liverpool, Liverpool, L69 7ZA, UK.

Abstract

Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection. Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect.

Keywords: Bioethics; Community engagement; Global Mental Health; Impact; International partnerships; Low and middle income countries; Research ethics.

Grants and funding

This work was supported by Wellcome through funding to the Global Forum on Bioethics in Research (GFBR). GFBR funding is provided by The Wellcome Trust, the National Institutes of Health and the UK Medical Research Council. Amit Chakrabarti’s work on c-VEDA is jointly funded by the Indian Council of Medical Research (ICMR/MRC/3/M/2015-NCD-I) and the Newton Grant from the Medical Research Council (MR/N000390/1), United Kingdom, and the case study presented here arises from a 2020 project. Clara Calia’s work is funded by a SFC-GCRF Covid-19 urgent call “From the FIELD: impacts of COVID-19 on lives and livelihoods of Syrians living in the Levant”. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.