The ethical, social, and cultural dimensions of screening for mental health in children and adolescents of the developing world

Abstract

Despite their burden and high prevalence, mental health disorders of children and adolescents remain neglected in many parts of the world. In developing countries, where half of the population is younger than 18 years old, one of every five children and adolescents is estimated to suffer from a mental health disorder. It is then essential to detect these conditions through screening in a timely and accurate manner. But such screening is fraught with considerable ethical, social, and cultural challenges. This study systematically identifies, for the first time, these challenges, along with potential solutions to address them. We report on the results of an international multi-and inter-disciplinary three-round Delphi survey completed by 135 mental health experts from 37 countries. We asked these experts to identify and rank the main ethical, social, and cultural challenges of screening for child and adolescent mental health problems in developing nations, and to propose solutions for each challenge. Thirty-nine significant challenges emerged around eight themes, along with 32 potential solutions organized into seven themes. There was a high degree of consensus among the experts, but a few interesting disagreements arose between members of the panel from high-income countries and those from low-and middle-income nations. The panelists overwhelmingly supported mental health screening for children and adolescents. They recommended ensuring local acceptance and support for screening prior to program initiation, along with careful and comprehensive protection of human rights; integrating screening procedures into primary care; designing and implementing culturally appropriate screening tools, programs, and follow-up; securing longterm funding; expanding capacity building; and task-shifting screening to local non-specialists. These recommendations can serve as a guide for policy and decision-making, resource allocation, and international cooperation. They also offer a novel approach to

Conceptual framework for task shifting and task sharing: an international Delphi study

“…There are numerous Delphi variants, but most share design features such as purposive sampling, participant anonymity, iterative design, structured communication between participants and researchers, thematic analysis of expert responses, and statistical aggregation of group feedback [ 7 , 9 , 10 ]. Delphi methods add structure to the process of building group consensus and reduce biases that can arise in face-to-face meetings by limiting the social, psychological, and political aspects of conventional group interactions, improving the quality, efficiency, long-term accuracy and validity of panelists’ predictions and judgements [ 10 , 11 ].…”

Epidemiological Study on the Early Detection of Mental Disorders in Young Children in Russia

“…Screening for mental health in children is generally laden with ethical, social, and cultural quandaries [34].…”

Conceptual Framework for Task Shifting and Task Sharing: An International Delphi Study

“…7,9,10 Delphi methods add structure to the process of building group consensus and reduce biases that can arise in face-to-face meetings by limiting the social, psychological, and political aspects of conventional group interactions, improving the quality, e ciency, long-term accuracy and validity of panellists' predictions and judgements. 10,11 The Delphi panel and method were not intended to deliver consensus or nal approval for the speci c language, structure, and format of the conceptual framework. The Delphi process was intended to solicit and synthesize a broad range of knowledge and experience concerning TS/S and provide consensus on the elements included in the COATS Framework…”