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，精神健康状况不佳的人数增加，包括压力、抑郁、焦虑和创伤反应。然而，在全球环境中，遇到这种困难的人往往无法获得或获得有限的精神卫生服务。为了开发适当和可获得的服务，可靠的研究证据对于指导决策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。研究伦理促进优先保护参与者免受伤害和产生可靠证据的研究行为。然而，我的研究表明，伦理监督的程序系统，以及研究人员在实践中对伦理原则的实施，并不总是导致预期的伦理研究行为。这可能会导致低质量的研究，这意味着有精神健康问题的人无法获得基于证据的服务来支持他们的康复。因此，该奖学金的目的是改进全球精神卫生研究的道德行为方法。在读博士期间，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如何将伦理原则实际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规范时，风险就会增加。在我的博士论文中发现的风险例子包括：研究人员扣留了参与者承诺的时间或差旅费补偿；伪造数据。除了这些不道德行为的例子之外，研究人员还描述了在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疗专业人员建议参与者参与研究时，他们对参与者自主决定是否参与研究没有信心。除了这些实践中的伦理问题之外，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引起的伦理问题，以加快和确保批准，从而忽略了在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会产生相反的影响，导致研究人员根据理想而不是现实世界的研究环境来规划研究。正如这些例子所表明的，有必要考察程序伦理制度对伦理研究实践的影响；并支持开展全球心理健康研究的研究人员。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。我还将主持一次专题讨论会，以制定证据简报，其中包含基于我的研究和我的研究伙伴的经验的建议。这些证据简报将传达给支持伦理研究的利益相关者，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，以便为未来的研究伦理政策、程序和实践提供信息。在这个奖学金结束时，我的目标是提高利益相关者对开展全球心理健康研究的研究人员的伦理研究程序和伦理经验之间脱节的认识。这种敏感化将为进一步理解和促进至关重要的全球精神卫生伦理研究提供机会，以支持以证据为基础的精神卫生服务，从而支持人群的康复。

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.