Ethics in global mental health research: enhancing theory, policy, and practice.

在冲突或地震等紧急情况发生后，经历心理健康状况不佳的人数，包括压力，抑郁，焦虑和创伤反应增加。然而，在全球环境中，精神卫生服务往往有限，或无法为有这种困难的人提供。为了发展适当和可获得的服务，可靠的研究证据对于指导政策制定者将有限的资源投入有效和文化上适当的精神卫生服务至关重要。研究伦理促进研究行为，优先保护参与者免受伤害，并产生可靠的证据。然而，我的研究表明，道德监督的程序系统，以及研究人员在实践中实施的道德原则，并不总是导致预期的道德研究行为。这可能导致研究质量低下，这意味着经历心理健康困难的人被剥夺了支持他们康复的循证服务。因此，该奖学金的目的是改善全球心理健康研究的道德行为方法。在我的博士学位期间，我与在南亚冲突后环境中进行心理健康研究的研究人员进行了交谈。这揭示了伦理研究程序旨在实现的目标与研究人员实际上如何将伦理原则应用于全球心理健康研究之间的脱节。这提出了一个需要解决的重大问题，因为当研究不符合道德时，风险就会增加。在我的博士论文中发现的风险包括：研究人员拒绝支付参与者承诺的时间或旅行费用;伪造数据。除了这些不道德行为的例子之外，研究人员还描述了应用伦理原则时面临的挑战，例如，当受人尊敬的宗教领袖或医学专业人士建议参与时，参与者对参与研究的自主决定不自信。除了这些实践中的伦理问题，研究人员还将研究伦理审查的程序系统描述为扼杀伦理研究。出现这种情况的一个原因是，在程序性伦理审查过程中，研究人员简化了他们的研究可能提出的伦理问题，以加快和确保批准，从而忽视了实践中可能出现的伦理挑战。这表明，旨在促进伦理研究的程序可能产生相反的影响，导致研究人员基于理想而不是现实世界的研究环境来规划研究。正如这些例子所示，有必要审查程序伦理体系对伦理研究实践的影响;以及对研究人员进行全球心理健康研究的支持。我将通过开发一个概念框架来解决这些知识差距，以帮助我们理解伦理研究程序和研究人员在实践中实施伦理之间的脱节。我还将主持一个研讨会，根据我的研究和我的研究伙伴的经验制定证据简报。这些证据简报将传达给在支持伦理研究方面发挥作用的利益相关者-如政策制定者，伦理审查委员会，研究资助者和研究人员本身-以告知未来的研究伦理政策，程序，在这个奖学金结束时，我的目标是提高利益相关者对伦理研究程序与研究人员的伦理经验之间脱节的认识。全球心理健康研究。这种敏感性将为进一步了解和促进重要的全球精神卫生伦理研究提供机会，以支持循证精神卫生服务，支持人口的康复。

Following emergencies such as conflict or earthquakes, the number of people experiencing poor mental health including stress, depression, anxiety, and trauma reactions increases. However, in global settings mental health services are often limited or inaccessible to people experiencing such difficulties. To develop appropriate and accessible services, reliable research evidence is critical for guiding policy makers to invest limited resources in effective and culturally appropriate mental health services.Research ethics promotes research conduct that prioritises protecting participants from harm, and generating reliable evidence. However, my research has shown that procedural systems of ethical oversight, and researcher in-practice implementation of ethical principles, do not always result in the intended ethical research conduct. This may lead to poor quality research meaning people experiencing mental health difficulties are denied evidence-based services to support their recovery. Therefore, the aim of this fellowship is to improve approaches to the ethical conduct of global mental health research.In my PhD I spoke to researchers conducting mental health research in post-conflict settings in South Asia. This revealed a disconnection between what ethical research procedures aim to achieve, and how researchers actually apply ethical principles to global mental health research. This presents a significant problem that requires addressing, as when research is not conducted ethically the risks increase. Examples of risks identified in my PhD include: researchers witholding participant compensation promised for time or travel expenses; and falsifying data. Beyond these examples of unethical conduct, researchers described challenges when applying ethical principles, such as not being confident that participants made autonomous decisions about research participation when respected religious leaders or medical professionals recommended participation.Beyond these in-practice ethical issues, researchers described the procedural system of research ethics review as stifling ethical research. One reason this arose was because during the procedural ethical review process researchers simplified the ethical issues potentially raised by their research to speed up and secure approval, thereby ignoring the ethical challenges that could arise in practice. This suggests that the very procedures designed to promote ethical research may be having the opposite impact, leading researchers to plan research based on an ideal rather than real-world research setting.As these examples show, there is a need to examine the impact of the procedural ethics system on ethical research practice; and the support for researchers carrying out global mental health research. I will address these knowledge gaps by developing a conceptual framework to aid our understanding of the disconnect between ethical research procedures and researchers' in-practice implementation of ethics. I will also host a symposium to develop evidence briefings containing recommendations based on my research and the experiences of my research partners. These evidence briefings will be communicated to stakeholders with a role in supporting ethical research - such as policy makers, ethical review boards, research funders, and researchers themselves - to inform future research ethics policy, procedures, and practice.By the end of this fellowship I aim to have raised the awareness of stakeholders to the disconnect between ethical research procedures and the ethical experiences of researchers carrying out global mental health research. This sensitisation will provide opportunities for further understanding and promoting vital ethical global mental health research to underpin evidence-based mental health services that will support populations in their recovery.