Key Issues in Conducting Mental Health Research in Traditional

Communities:Examples from Sri Lanka

Gaithri A. Fernando, Ph.D.

California State University,

Los Angeles

Objectives

Identify some issues relevant to conducting socially responsible mental health research with traditional communities

Provide some recommendations for conducting long term programs of research that is sustaining for both researcher and communities where research is conducted

Global Mental Health: What is it?

DefinitionOverall mental health of an individual

Sum of all knowledge about mental health in all countries and cultures

Conversations and discourses around mental health issues

Typically by people in countries with resources

About people in countries without resources

[Measureable?]

Key Issue 1: Etic-Emic Tension

Etic – culture-general

Emic – culture-specific

Pseudo-etic – assuming an etic position that is actually emic

E.g. PTSD

Key Issue 1: Etic-Emic Tension

TrainingTraining is often conducted in developed countries, using etic or pseudoetic perspective

Training often changes or solidifies the perspective of trainee

Examples

Clinical work with bomb blast survivors

“PTSD” work ended after 3 weeks

Rest of the time – women supporting each other

“Renuka” and her husband

Clinical work with torture survivorHow reincarnation impacted coping

Examples

PTSDIntrapsychic vs. external and psychosocial

SLIPSS-A

Predictors of Life Satisfaction

SLIPSS-A Scores

Life Concerns(Finances,

Education)

p = .000)

(p = .000) R2 = .41, p < .000

Life Rating

Key Issue 1: Etic-Emic Tension

Data gatheringWhat data are gathered are now colored by trainee’s trainingValue of qualitative vs. quantitative dataIf data remains emic, researchers and editors of journals consider that ‘regional’ and reject papersIf data become pseudoetic they are of no value to the local communities (can be harmful)Researcher has to navigate between two sometimes competing agendas

Example: Trauma and PTSD

PTSD is the model that was being used by many researchers after tsunami

Emic understanding: psychosocial vs. PTSD

Emic understanding: daily stressors vs. trauma exposure

Traumatic Event

Negative Outcomes

‘Black Box’ Model

c

Example: Trauma and PTSD

Traumatic Event

Negative Outcomes

Daily Stressors

Mediation Model

a

c′

b

c

Example: Resilience ResearchResilience in Sri Lanka: “Aathmashakthiya” – strength of will; “hitha hadaagaththa” – mending one’s heart

Psychosocial gratitude an important component of resilience

Key Issue 2: Classification

“Western”/“Non-Western”Looking for a new language

HIC-LIC – doesn’t capture cultural aspects

“EA-17”, E. European, Asian, Hispanic, African (where does Russia fall)?

“Euro-American/Developed” vs. “Asian/ Developed” vs.“Non-EA-Asian/Developing?

Resistance to changing classification

Why is it an issue?Precision of scientific language

Identification of players/agendas

Key Issue 3: Identifying Stakeholders

Funder

Researcher’s institution

Researcher

Funder’s stakeholders – research organizations, national institutions, individual donors

Key Issue 3: Identifying Stakeholders

Local organizations/liaisonsLocal community

Gatekeepers and community leadersMembers of community

Research communityThe “premier” or pioneering researchersEditors of journalsPeer reviewersReaders

Researchers’ co-workers/students

Key Issue 4: Tying Goals and Outcomes of Research to Stakeholder Expectations

Educating others (including other researchers) to the complexities of the lived experience of communities

“What is needed, even in the poorest countries, are robust evaluations of innovative programs” – Kleinman, 2003

Key Issue 4: Tying Goals of Research to Stakeholder Expectations

Educate the funder/funder’s stakeholders about the community being studied

Policy implications of the research (e.g. daily stressor project)Establishing funding prioritiesEnsuring that the resources sent match the reality of the receiving community

Persuade funders to invest in communities and facilitate that process

Introduce local organizations to funders and making local communities ‘visible’Persuade funders to include outcomes they may not have considered (those that communities consider important)

Key Issue 4: Tying Goals & Outcomes of Research to Stakeholder Expectations

Standing with local organizations to empower and educate communities

Use the findings of the research to enhance quality of life of communities

Encourage community members to step up as community leaders

Build capacity for both research and intervention

Key Issue 4: Tying Goals & Outcomes of Research to Stakeholder Expectations

Educate the researcherReflecting on whether/how the research changed the researcher in some wayInform future research of the researcherReflect on context – historical, psychological, current realities

Increase the credibility of the researcherIncrease the fundability of the researcher

Key Issue 4: Tying Goals & Outcomes of Research to Stakeholder Expectations

Enhance the profile of the researcher’s institution

Provide data for the funder to keep funding mandate alive; generate reports that justify keeping funder in business

Key Issue 5: Evaluating the Effort

Who benefits?Researcher – publications, presentations, credibility

Institution – prestige, attracting important faculty

Funder – further funding, credibility

Community – greater understanding from others? Resources from researchers and funders?

Recommendations

Be aware of your prejudicesAsk others to hold up the mirror!

Watch out for the power differential

Be open to feedback (be humble)

Learn from the communities in which you work

Be creative in how you can bring resources to the communities you study