Culturally sensitive protocols for suicide risk management in global research

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 Report and Declaration of Helsinki emphasize respecting participants' autonomy and right to equitable treatment, minimizing harm and maximizing benefit, while considering unique circumstances, local laws and regulations, and cultures. Actions that protect participants in one cultural context may harm participants in another. For example, because suicide attempts are illegal in many countries (e.g., Kenya, Gambia, Nigeria), involving law enforcement, or others who may report to them, can generate penalties and incriminate those at risk. This commentary outlines strategies for applying principles of ethical risk management that prioritize sensitivity to context, focusing on addressing participant suicide risk during clinical research in low-resource and high-stigma settings, presenting the example of risk among adolescents in Kenya.