Designing Culturally and Contextually Sensitive Protocols for Suicide Risk in Global Mental Health: Lessons From Research With Adolescents in Kenya - 26/08/22
, Akash R. Wasil, MA d, Tom Lee Osborn, AB b, Eve S. Puffer, PhD e, John R. Weisz, PhD, ABPP a, Christine M. Wasanga, PhD b, cRésumé |
In cross-cultural psychological treatment research, investigators must ensure that protocols for addressing risk are culturally tailored and feasible, while also protecting against harm. Guidelines including the Belmont Report1 and the Declaration of Helsinki2 emphasize respecting participants’ autonomy and right to equitable treatment, minimizing harm and maximizing benefit, while considering unique circumstances, local laws and regulations, and cultures. They highlight the importance of supervision from qualified health professionals,2 and special protections for children.1 Suicide risk poses distinctive challenges for cross-cultural research; actions that protect participants in one cultural context may harm participants in another. For example, because suicide attempts are illegal in many countries (eg, Kenya, Gambia, Nigeria), involving law enforcement, or others who may report to them, can generate penalties and incriminate those at risk. Upholding the Belmont and Helsinki principles can therefore require adapting strategies for different cultural contexts. This Commentary outlines strategies for applying principles of ethical risk management3,4 that prioritize sensitivity to context. We focus on addressing participant suicide risk during clinical research in low-resource and high-stigma settings, presenting the example of risk among adolescents in Kenya.5,6
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| This article is part of a special series devoted to addressing bias, bigotry, racism, and mental health disparities through research, practice, and policy. The series is edited by Assistant Editor Eraka Bath, MD, Deputy Editor Wanjikũ F.M. Njoroge, Associate Editor Robert R. Althoff, MD, PhD, and Editor-in-Chief Douglas K. Novins, MD. |
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| Research reported in this article was supported by a grant from the Templeton World Charity Foundation (TWCF0509). The funding agency had no involvement in this study; the content is solely the work of the authors and does not necessarily represent the views of the funding agency. |
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| Author Contributions |
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| Conceptualization: Venturo-Conerly, Wasil, Osborn, Puffer, Weisz, Wasanga |
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| Supervision: Puffer, Weisz, Wasanga |
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| Visualization: Venturo-Conerly |
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| Writing – original draft: Venturo-Conerly, Wasil |
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| Writing – review and editing: Venturo-Conerly, Wasil, Osborn, Puffer, Weisz, Wasanga |
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| Disclosure: Dr. Puffer has reported being a member of the Shamiri Institute Science Board. Dr. Weisz has received funding from the National Institute of Mental Health (NIMH; 1R01 MH124965-01), the Institute of Education Sciences (R305A140253-17), School Mental Health Ontario, and the Marriott Foundation. He has reported being a member of the Harvard EMPOWER Science Council, the Global Mental Health Harvard Advisory Group, the Steering Committee for Re-STAR (King’s College London), and the Scientific Advisory Boards for Aim for Youth Mental Health, the Shamiri Institute Science Board, and TEAM UP (Smith Family Foundation). Dr. Wasanga, Ms. Venturo-Conerly, and Mr. Osborn have declared their affiliation with the Shamiri Institute, Inc., a non-profit dedicated to increasing access to mental health care for youth in sub-Saharan Africa. Mr. Wasil has reported no biomedical financial interests or potential conflicts of interest. |
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| All statements expressed in this column are those of the authors and do not reflect the opinions of the Journal of the American Academy of Child and Adolescent Psychiatry. See the Guide for Authors for information about the preparation and submission of Commentaries. |
Vol 61 - N° 9
P. 1074-1077 - septembre 2022 Retour au numéro
Article précédent
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