Table 1.

Summary of ethical challenges and potential solutions for global mental health survey research

Ethical challenge	Guiding principle(s)	Questions for investigators and IRBs to ask of new research	Questions for communities to ask of new research and researchers	Potential solutions
Ensuring research findings are useful and novel	Beneficence	•Will the research produce unique findings that can impact mental health policy or services? •Does answering this question necessitate burdening new participants?	•How likely is it that the research will result in changes for the communities from which participants are drawn?	•Ensure a thorough literature review has been done to identify studies of mental health in similar populations. Only proceed if no substantial research exists on the topic that is generalizable to the population of interest. •Look for other data sets already in existence that could be used to answer new research questions before beginning a new study.
Including and protecting vulnerable participants	Justice and beneficence	•Has risk and vulnerability been appropriately assessed and addressed in the study context? •Is the likelihood of direct benefit proportional to the degree of participant vulnerability?	•Do the researchers have an understanding of the problems of participants and/or a plan for receiving ongoing feedback? •Do the researchers have a plan for sharing findings with the participants and their communities? Who will ‘own’ the results?	•Use community-based advisory boards and participant input to ensure protection of individuals, adequate assessment of risk, a full understanding of vulnerability, and threats to identifiable communities. •Embed surveys into ongoing mental health service provision. •If not possible, find a government group or community-based organization interested in providing mental health services with whom to partner. Build capacity and share ownership of results. •Together use the results to advocate for funding for an intervention or for policy/legal reform. •If no organization is interested, conduct participatory research so participants can provide input and put findings to use locally.
Accurately communicating benefits and managing expectations of research	Autonomy	•Will the community's expectations of research be fairly managed? •Will potential participants recognize this mental health issue and be able to assess risks and benefits of the research?	•Do the researchers know what community members and participants expect to happen as a result of the research? •Will participants and their communities understand the purpose and nature of the study as explained by the researchers?	•Solicit input from community and participant advisory boards on research expectations and how to clearly communicate the purpose, limits, and potential benefits of the research to stakeholders and participants. •Conduct initial formative exploratory research to elicit local understandings, terminology, and relevance of the problem of interest. Use findings together with knowledge of context, adherence to ethical guidelines, and ethical review structures to create an appropriate informed consent procedure and to accurately assess and explain potential benefits.