Advancing Global Mental Health: Lessons from an International Research Project on Adolescent Suicide Attempts

Background and purpose. Interest in global mental health research has increased in the past decades. Pediatric female suicidal behaviors have been identified by the WHO, the U.S. NIMH, and Canada’s Grand Challenges as priority research areas in global mental health. This is in part because suicide attempts are on the rise among adolescent girls living in developing countries. This study describes the challenges faced by an international team conducting research on adolescent girls’ suicidal behaviors across five Latin American countries.

Methods. Our pilot, mixed-method study examined the sociocultural, developmental, and familial dynamics that shape adolescent females suicide attempts in Argentina, Chile, Colombia, Mexico, and Peru. In each country, we proposed to interview fifteen adolescents receiving medical and mental health services in the aftermath of a suicide attempt (N = 75). Girls were between the ages of 13 and 17.

This study was coordinated by a Latina U.S.-based investigator in collaboration with local researchers and institutions in the participating countries. The team included at least two members in each country, all of them licensed mental health providers with varied levels of experience conducting research.  A diverse selection of medical and mental health services was identified as potential recruitment sites (i.e., private in-patient psychiatric clinics, outpatient psychiatric services, large public hospitals). Six institutional review committees oversaw the participating academic and clinical sites, totaling eight individual sites across five countries. 

Parallel to designing and implementing the study, all research team members kept systematic records documenting the study development and implementation process. These data were complemented by documents issued by the participating institutions, and emails exchanged among team members and others involved in the project (e.g., IRB members). The data was analyzed in three primary steps: data reduction (i.e., identifying themes), data display (i.e., creating a code book), and conclusion drawing.

Results. The research team faced several development and implementation challenges during the first 24 months of the project. We grouped challenges into categories associated with the initial start-up of the project (e.g., consensus of critical variables, identification of institutional partners); working with multiple agencies and providers transnationally (e.g., collaborating remotely); human subject protections in the United States and across participating countries (e.g., meeting research guidelines); and recruiting suicidal adolescents (e.g., tensions with local providers and researchers). Local cultural constructs modeled research and management practices (e.g., time management), and professional networks were vital for research implementation.

Conclusion and implications. From this experience, we learned several lessons that may be helpful to other social workers interested in international suicide research. We applied a democratic research implementation model that cultivated true collaboration among researchers from different national settings. Although the U.S.-based principal investigator designed the study and provided the funds to conduct it, critical input from the research team members improved the protocol and made possible its successful implementation.