Designing Culturally and Contextually Sensitive Protocols for Suicide Risk in Global Mental Health: Lessons From Research With Adolescents in Kenya.

ABSTRACT

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.