Chiumento Anna, Rahman Atif, Frith Lucy, Snider Leslie, Tol Wietse A
University of Liverpool, Institute of Psychology, Health and Society, 2nd Floor, Block B, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
Independent Consultant, Peace in Practice, Amsterdam, The Netherlands.
Global Health. 2017 Feb 8;13(1):8. doi: 10.1186/s12992-017-0231-y.
Research in emergencies is needed to understand the prevalence of mental health and psychosocial problems and strengthen the evidence base for interventions. All research - including operational needs assessments, programme monitoring and evaluation, and formal academic research - must be conducted ethically. While there is broad consensus on fundamental principles codified in research ethics guidelines, these do not address the ethical specificities of conducting mental health and psychosocial support (MHPSS) research with adults in emergencies. To address this gap, this paper presents a review of multidisciplinary literature to identify specific ethical principles applicable to MHPSS research in emergencies.
Fifty-nine sources meeting the literature review inclusion criteria were analysed following a thematic synthesis approach. There was consensus on the relevance of universal ethical research principles to MHPSS research in emergencies, including norms of participant informed consent and protection; ensuring benefit arises from research participation; researcher neutrality, accountability, and safety; and the duty to ensure research is well designed and accounts for contextual factors in emergency settings. We go onto discuss unresolved issues by highlighting six current debates relating to the application of ethics in emergency settings: (1) what constitutes fair benefits?; (2) how should informed consent be operationalised?; (3) is there a role for decision making capacity assessments?; (4) how do risk management approaches impact upon the construction of ethical research?; (5) how can ethical reflection best be achieved?, and (6) are ethical review boards sufficiently representative and equipped to judge the ethical and scientific merit of emergency MHPSS research? Underlying these debates is a systemic tension between procedural ethics and ethics in practice. In summary, underpinning the literature is a desire to ensure the protection of participants exposed to emergencies and in need of evidence-based MHPSS. However, there is a lack of agreement on how to contextualise guidelines and procedures to effectively maximise the perspectives of researchers, participants and ethical review boards. This is a tension that the field must address to strengthen ethical MHPSS research in emergencies.
开展紧急情况研究有助于了解心理健康和社会心理问题的普遍程度，并加强干预措施的证据基础。所有研究，包括业务需求评估、项目监测与评价以及正规学术研究，都必须遵循伦理规范进行。虽然对于研究伦理准则中编纂的基本原则已达成广泛共识，但这些原则并未涉及在紧急情况下对成年人开展心理健康和社会心理支持（MHPSS）研究的伦理特殊性。为填补这一空白，本文对多学科文献进行综述，以确定适用于紧急情况下MHPSS研究的具体伦理原则。
采用主题综合法对符合文献综述纳入标准的59篇文献来源进行了分析。对于普遍的伦理研究原则与紧急情况下MHPSS研究的相关性达成了共识，包括参与者知情同意和保护的规范；确保研究参与能带来益处；研究者的中立性、问责制和安全性；以及确保研究设计合理并考虑紧急情况下背景因素的责任。我们接着通过突出当前与紧急情况下伦理应用相关的六场辩论来讨论未解决的问题：（1）什么构成公平的益处？；（2）应如何实施知情同意？；（3）决策能力评估是否有作用？；（4）风险管理方法如何影响伦理研究的构建？；（5）如何最好地实现伦理反思？；以及（6）伦理审查委员会是否有足够的代表性并具备评判紧急情况下MHPSS研究的伦理和科学价值的能力？这些辩论的背后是程序伦理与实践伦理之间的系统性紧张关系。总之，文献的基础是希望确保保护面临紧急情况且需要循证MHPSS的参与者。然而，对于如何将指南和程序因地制宜以有效最大化研究者、参与者和伦理审查委员会的观点，尚未达成一致。这是该领域为加强紧急情况下符合伦理的MHPSS研究必须解决的一种紧张关系。
