Ethical issues in trauma-related research: a review

Research with women sexual assault survivors presenting for emergency care is safe: Results from a multi-site, prospective observational cohort study

A barrier to research with sexual assault survivors is the concern that research participation might be a negative experience for participants. We report the experiences with research of adult women sexual assault survivors participating in a large-scale, multi-site, prospective observational study that enrolled participants at the time of presentation for emergency care. Participants (n = 706, M = 28 years of age; 57% white, 15% Black) self-reported their experience with research 1 week, 6 weeks, 6 months, and 1 year post-assault. The vast majority rated the research experience as positive (95-97%), reported no drawbacks (84-89%), and felt that participating was worth it (93-95%). Positive experiences with research remained stable across the year, were generally consistent across demographic and clinical groups, and were reflected in qualitative comments. Given the tremendous morbidity experienced by sexual assault survivors and lack of progress in developing improved treatments for this population, ethically-conducted research with sexual assault survivors receiving emergency care should be encouraged.

"'I am a Man. How Could I Possibly Have Been Raped?' Men Making Sense of Their Experiences With Sexual Violence"

Sexual violence among college students is an enduring issue that can shape adverse outcomes for victim survivors. The gender dynamics of college sexual assault and rape include rates of women overrepresented as victims and men as perpetrators. Dominant cultural frames reinforcing the (hetero)normative gendered sexual scripts of masculinity often preclude men from being considered as legitimate victims of sexual violence, despite evidence documenting their victimization. The present study contributes to knowledge of men's experiences of sexual violence by sharing the narratives of 29 college men survivors and how they make sense of their experiences. Through open and focused thematic qualitative coding, findings revealed how men struggled to understand their victimization experiences within cultural frameworks that exclude men as victims. Participants engaged in complex linguistic processes (i.e., "epiphanies") to process their unwanted sexual encounter, in addition to altering their sexual behavior after experiencing sexual violence. Findings can inform programing and interventions to be more inclusive of supporting men as victims.

"I'm Going to Tell You Something I Never Told Anyone": Ethics- and Trauma-Informed Challenges of Implementing a Research Protocol with Syrian Refugees

As research subjects, refugees have numerous potential vulnerabilities. This study aimed to examine the ethics- and trauma-informed challenges of implementing a mental health research protocol with Syrian refugees living in Portugal. Guided by the integrated meaning-making model, the research project "Journeys in Meaning" employed a mixed-methods cross-sectional design to explore posttraumatic cognitive processing in refugees using two phases of data collection: two focus groups (Phase 1) to test the protocol and 39 in-depth individual interviews (Phase 2) to implement the protocol. Results examine the strategies used to address the following: methodological challenges related to protocol design, participant recruitment, and language; ethics- and trauma-informed challenges aimed at minimizing harm and maximizing benefit to participants that followed social justice principles; and perceived compassion fatigue on the part of the researcher following repeated empathetic exposure to traumatic content. Findings suggest the need for adaptive approaches to research with refugee populations that challenge strict compliance with the traditional principles of "do no harm" and researcher neutrality, and that accommodate individual and community complexities.

The association between recreational cannabis use and posttraumatic stress disorder: A systematic review and methodological critique of the literature

BACKGROUND

Given recent changes in the legal status of cannabis, the risks and benefits associated with its use have become an important public health topic. A growing body of research has demonstrated that posttraumatic stress disorder (PTSD) and recreational cannabis use (RCU) frequently co-occur, yet findings are inconsistent (e.g., direction of effect) and methodological variability makes comparison across studies difficult.

METHODS

We conducted a comprehensive systematic review of all studies (N = 45) published before May 2020 regarding etiologic models of co-occurring RCU and PTSD, as well as provided a methodological critique to inform suggestions for future research initiatives.

RESULTS

Findings indicate that a majority of studies (n = 37) demonstrated a significant association between RCU and PTSD. Findings provide evidence for the self-medication and high-risk models posited to explain co-occurring RCU and PTSD despite variability in assessment of RCU, which includes commonly used non-standardized self-report questions.

CONCLUSION

The association between RCU and PTSD is likely bidirectional. Results inform clinicians and researchers working in the mental health and cannabis use fields how the variability in findings on the association between RCU and PTSD may be attributable, in part, to methodological issues that permeate the extant literature pertaining to RCU and PTSD.

Reimagining IRB review to incorporate a clear and convincing standard of evidence

This commentary is a critical response to the article written by David Resnik regarding the use of a standard of evidence for Institutional Review Board (IRB) decision making. Resnik suggests that IRBs should not only base decisions on evidence, but that this evidence should be sufficient to ensure a "clear and convincing" standard similar to that used by juries for legal proceedings. We agree that the increased use of evidence to meet this standard would be ideal since this provides clear guidance and could allow for a more transparent IRB review. However, to effectively meet this standard, significant modification would be required for researchers as well as for IRBs' processes. First, researchers would be required to identify, understand and include appropriate scientific and ethics evidence in support of their protocol. IRB members and IRB professionals would need to discuss the importance, value, and significance of evidence in order to come to a collective decision regarding each protocol. Such responsibilities are justifiable and could bring much needed rigor and transparency to the system but they would require time, training, research, and education. While Resnik's suggestion seems to incorporate a small change with respect to a standard, in application it would actually require a novel system.

The ethics of child maltreatment surveys in relation to participant distress: Implications of social science evidence, ethical guidelines, and law

Epidemiological surveys measuring the prevalence of child maltreatment generate essential knowledge that is required to enhance human rights, promote gender equality, and reduce child abuse and neglect and its effects. Yet, evidence suggests Institutional Review Boards (IRBs) may assess the risk of these studies using higher than normal thresholds, based on a perception they may cause high distress to participants. It is essential for IRBs and researchers to have an accurate understanding of the nature and extent of participant distress associated with these studies, and of the duties of researchers towards survey participants, so that meritorious research is endorsed and duties to participants discharged. Assessment by IRBs of the ethics of such research must be appropriately informed by scientific evidence, ethical principles, and legal requirements. This article adds to knowledge by considering participant distress in child maltreatment surveys and its appropriate ethical and operational treatment. We provide an updated overview of scientific evidence of the frequency and severity of distress in studies of child maltreatment, a review of ethical requirements including a focus on beneficence and participant welfare, and a new analysis of researchers' legal duties towards participants. Our analyses demonstrate that participant distress is infrequent and transitory, that researchers can satisfy ethical requirements towards participants, and that legal liability does not extend to emotional distress. Informed by these bodies of knowledge, we distil key principles of good epidemiological practice to provide solutions to operational requirements in these surveys, which both fulfil ethical requirements to participants, and demonstrate trauma-informed practice.

Developing Trauma-Informed Research Methods: Using Proxy Respondents to Assess Sexual Assault Survivors' Experiences Seeking Medical Forensic Exams

In research on sexual assault victims' help-seeking, proxy data sources are often utilized because outreach to survivors immediately postassault may increase a study's risk-to-benefit ratio. Victim advocates and services providers are common proxy respondents, but empirical research comparing the accuracy of their information is needed. We collaborated with seven sexual assault nurse examiner (SANE) programs to collect de-identified, paired data from nurses and advocates regarding the help-seeking experiences of N = 744 adult victims. Using pairwise McNemar tests, we found statistically significant agreement on victim demographics, assault characteristics, and victims' decisions regarding medical forensic exams, sexual assault kit (SAK) collection, and release of SAKs for forensic DNA testing. Nurses and advocates had different information regarding victims' disclosure histories and their reasons for seeking SANE care.

Trauma-informed qualitative research: Some methodological and practical considerations

Mental health nurses who engage in research are likely to undertake research on sensitive topics, related to experiences of illness, care delivery and treatment. With recognition of the high prevalence of trauma in the lives of people who interact with mental health services, it is likely that many research participants will have experienced trauma in their lives and that while this may not be the focus of the research, sensitivity and awareness are required. Reference to 'trauma-informed' approaches in research design and practice is emerging in fields such as trauma-focused research and social sciences; however, it has not yet been applied to nurses. Trauma-informed approaches can build upon existing ethical and methodological frameworks to inform how mental health nurses go about qualitative research and what they need to consider when doing so. This discursive paper explores some of the implications of awareness and sensitivity to trauma for research undertaken by mental health nurses, including practical and methodological considerations. Recommendations include training and structural supports for nurse researchers, collaborative research designs, consideration of the environments where research occurs, awareness of approaches to distress and inclusion of trauma sensitivity within research policies, frameworks and leadership, alongside vigilance to interpersonal approach and the establishment and protection of psychological safety throughout. Continuing to undertake research on topics, and with people, where trauma is present, is essential to ensure ongoing awareness. Many of the existing skills held by mental health nurses can also support research to be undertaken in trauma-informed ways.

Reactions to Laboratory-Based Trauma Research in a Sample of Incarcerated Women

An evidence-based approach to research ethics is critical to ethical research but little is known about how trauma survivors-especially those from vulnerable populations-respond to laboratory-based trauma research. One hundred four incarcerated women (N = 64 rape survivors) reported their traumatic life experiences, listened to and responded to an audio recording of a dating interaction that culminates in a completed rape, and then reported their responses to their participation. Compared to the control group (N = 40), rape survivors (N = 64) had more posttraumatic stress disorder symptoms and these symptoms were associated with more emotional responding. Both groups showed a positive benefit-cost ratio with regard to their participation did not differ on their overall reactions to research participation. These findings suggest that laboratory-based trauma research methods are associated with consistently positive experiences, which can help inform researchers and institutional review boards about the risks and benefits of such research.

A scoping review of recommendations in the English language on conducting research with trauma-exposed populations since publication of the Belmont report; thematic review of existing recommendations on research with trauma-exposed populations

OBJECTIVE

To identify recommendations for conducting public health research with trauma-exposed populations.

METHODS

Researchers searched Embase, PubMed, Scopus, Web of Science, Open Grey, and Google Scholar for recommendations. Trauma that causes psychological impact was our exposure of interest and we excluded clinical articles on treating physical trauma. We reviewed titles and abstracts of 8,070 articles and full text of 300 articles. We analyzed recommendations with thematic analysis, generated questions from the existing pool of recommendations, and then summarized select gaps.

RESULTS

We abstracted recommendations from 145 articles in five categories: community benefit, participant benefit, safety, researcher well-being, and recommendations for conduct of trauma research.

CONCLUSIONS

Gold standards to guide the conduct of trauma-informed public health research do not yet exist. The literature suggests participation in trauma research is not inherently harmful, and current recommendations concern using research to benefit communities and participants, protecting participants and researchers from harm, and improving professional practice. As public health researchers increasingly analyze trauma as a determinant of health, gold standards for the conduct of trauma-informed public health research would be appropriate and timely.

Immediate and Delayed Reactions to Trauma-related Laboratory Research Among Rape Survivors and Controls

Ethical implications of laboratory-based experimental trauma research are not well studied. Female rape survivors (N = 62) and controls (N = 79) listened to an audio recording of a sexual assault and completed mental health measures and the Reactions to Research Participation Questionnaire-Revised in the first session and again several weeks later. In the first session, mental health symptoms were associated with stronger emotional reactions and personal benefits from participation. Rape survivors also reported stronger emotional reactions than controls, but also more personal benefits, more satisfaction, and fewer perceived drawbacks from participation. Several weeks later, both groups reported diminished posttraumatic stress disorder symptoms and rape survivors' reports of stronger emotional reactions and greater satisfaction with their participation remained significant. Benefit-cost ratios indicate positive responses to participation across groups and time. Findings suggest significant benefits to laboratory trauma research for participants.

Disclosure of non-recent (historic) childhood sexual abuse: What should researchers do?

Non-recent (historic) childhood sexual abuse is an important issue to research, though often regarded as taboo and frequently met with caution, avoidance or even opposition from research ethics committees. Sensitive research, such as that which asks victim-survivors to recount experiences of abuse or harm, has the propensity to be emotionally challenging for both the participant and the researcher. However, most research suggests that any distress experienced is usually momentary and not of any clinical significance. Moreover, this type of research offers a platform for voices which have often been silenced, and many participants report the cathartic effect of recounting their experiences in a safe, non-judgemental space. With regard to the course of such research, lines of inquiry which ask adult participants to discuss their experiences of childhood sexual abuse may result in a first-time disclosure of that abuse by the victim-survivor to the researcher. Guidance about how researchers should respond to first-time disclosure is lacking. In this article, we discuss our response to one research ethics committee which had suggested that for a qualitative study for which we were seeking ethical approval (investigating experiences of pregnancy and childbirth having previously survived childhood sexual abuse), any disclosure of non-recent (historic) childhood sexual abuse which had not been previously reported would result in the researcher being obliged to report it to relevant authorities. We assess this to be inconsistent with both law and professional guidance in the United Kingdom; and provide information and recommendations for researchers and research ethics committees to consider.

Understanding the vicarious trauma and emotional labour of criminological research

The psychological cost of exposure to traumatic events is receiving greater recognition in recent years, especially in terms of its impact in helping professions and emergency services. However, the costs to researchers remain relatively unexplored. In this article, we will discuss the nature and impact of vicarious trauma using two criminological research projects as case studies: one a qualitative project engaging with survivors of childhood sexual abuse, and the other, a quantitative analysis of police hate crime reports. In addition to considering the trauma elicited in fieldwork such as interviews, we interrogate the costs imposed on researchers during the coding and analysing processes. We suggest that the cost is potentially greater when the researcher has a personal connection with the issues being researched, but that this personal experience also provides the researcher with important skills for responding to new or compounded trauma. The costs of engagement with trauma may be compensated by the productive outputs and impact on policy and practice that this type of research may elicit. Understanding the impact and costs of engaging with close analyses of trauma is critical in developing more robust and ethical research processes to ensure that this trauma is appropriately managed so as to avert the long-term damage this work can inflict on researchers and participants.

The Child Life Challenges Scale (CLCS): Associations of a Single-Item Rating of Global Child Adversity with Children's Total Life Stressors and Parent's Childhood Adversity

BACKGROUND

Although many existing measures tabulate specific risk factors to yield cumulative risk indices, there is a need for low-burden strategies to estimate general adversity exposure.

AIMS AND METHODS

This study introduces a brief, new measure of lifetime adversity, the Child Life Challenges Scale (CLCS), and examines its validity in a sample of parents and children residing in emergency housing. The CLCS comprises a single global item for rating cumulative life challenges utilizing either a paper-pencil scale or a sliding scale on a tablet. Parents are provided with anchor examples of mild and extreme challenges and asked to mark a location along the scale reflecting number and severity of challenges in their children's lives to date. Study participants included 99 parents and their 3- to 6-year-old children.

RESULTS

CLCS scores were moderately associated with children's parent-reported total life stressors, and these associations were robust to controls for parental history of adversity, parental distress, and family demographics. Control variables also did not moderate associations between CLCS scores and total life stressors, suggesting that the CLCS functions similarly across a range of sociodemographic risk. Paper-pencil and tablet versions showed similar convergent validity.

CONCLUSION

The CLCS shows promise as an efficient measure for estimating children's lifetime adversity with minimal parent or administrator burden.

A Trauma-Informed Approach to Sexual Violence Research Ethics and Open Science

The practice of ethics in social science research is a reflexive process of self-review to define a profession's collective responsibility in the face of changing norms and expectations. In recent years, we have seen transformative changes in how society thinks about supporting sexual assault survivors, and how the scientific community thinks about our obligations to society. Decades of research on trauma and its impact has raised awareness about the needs of victimized individuals, giving rise to the trauma-informed practice movement, which emphasizes that service providers must center survivors' well-being in all interactions, decisions, and program practices. The field of sexual assault research helped give rise to this movement and provides empirical support for its guiding tenets, and in this article, we explore how to bring these ideas full circle to begin articulating trauma-informed principles for research. A trauma-informed perspective on research challenges scientists to go beyond the requirements of the Belmont Report (1979) and institutional review boards' (IRB) regulations to develop research procedures that fully support survivors' choice, control, and empowerment. Such reflection on participants' rights is particularly important given the open science movement sweeping academia, which calls on scientists to share their data publicly to promote transparency, replication, and new discoveries. Disseminating data could pose significant safety, privacy, and confidentiality risks for victims of sexual assault, so we need to evaluate what open science means within a trauma-informed framework. In this article, we examine three key stages of the research process-participant recruitment, data collection, and dissemination-and consider how trauma-informed principles could help, but also could complicate, research practices. We explore these tensions and offer potential solutions so that research on sexual trauma embodies trauma-informed practice.

"Keeping Control": A user-led exploratory study of mental health service user experiences of targeted violence and abuse in the context of adult safeguarding in England

The situation for people with mental health problems as a group of disabled people who experience targeted violence and abuse is a complex one. Disabled people, particularly those with mental health problems, are at higher risk of targeted violence and hostility with few effective evidence-based prevention and protection strategies. Achieving effective safeguarding for adults with mental health problems is characterised by differential attitudes to and understandings of abuse by safeguarding practitioners, as well as systemic issues arising from multi-agency working. "Keeping Control" was a 16-month user-led, co-produced exploratory qualitative study into service user experiences of targeted violence and abuse that was examined in the context of Care Act 2014 adult safeguarding reforms in England. User-controlled interviews of mental health service users (N = 23) explored their experiences and concepts of targeted violence and abuse, prevention and protection. Preliminary findings from these interviews were discussed in adult safeguarding and mental health stakeholder and practitioner focus groups (N = 46). The data were also discussed via two facilitated Twitter chats (responses N = 585 and N = 139). Mental health service users' experiences and concepts of risk from others, vulnerability and neglect can be different to those of practitioners but should be central to adult safeguarding. Histories of trauma, multi-factorial abuse; living with fear and stigma as well as mental distress; the effects of "psychiatric disqualification" and individual blaming should be addressed in adult safeguarding in mental health. Fragmented responses from services can mean a person becomes "lost in the process". Staff can feel disempowered, afraid or lacking in confidence to "speak up" for individuals in complex service systems with poor communication and lines of accountability. Adult safeguarding practitioners and stakeholders need to be confident, accessible and respond quickly to service users reporting incidents of targeted violence and abuse particularly in closed environments such as wards or supported housing.

Lessons Learned: Conducting Research With Victims Portrayed in Sexual Abuse Images and Their Parents

Victims portrayed in sexual abuse images may be resistant to participate in research because of embarrassment or shame due to the sensitive nature and potential permanency of images. No studies we are aware of explore reactions to participating in research after this type of crime. Telephone interviews were conducted with convenience samples of parents ( n = 46) and adolescents who were victims of child sexual abuse ( n = 11; some of whom were portrayed in sexual abuse images), and online surveys were completed by adult survivors depicted in abuse images ( N = 133). The first lesson was that few agencies tracked this type of crime. This lack of tracking raises the question as to what types of data should be collected and tracked as part of an investigation. The second lesson was that few victims at the two participating agencies had been portrayed in sexual abuse images (4%-5%). The third lesson was that once possible cases were identified, we found relatively high percentages of consent to contact and interview completions. This implies that researchers and service providers should not be hesitant about conducting research after an investigation of child sexual abuse. The fourth lesson was that the vast majority of participants reported not being upset by the questions. We hope that the data presented here will encourage agencies to reconsider the types of data being tracked and will encourage researchers to conduct in-depth research with populations that are often difficult to reach to continue improving the professional response to child victimization.

Risk Perceptions for Trauma-Related Research: An Exploratory Study of Undergraduate Student Researchers in Psychology

The purpose of this study was to examine student researchers' perceptions of risks associated with trauma-related research. The participants were 92 students enrolled in an introductory Research Methods course. Students evaluated (a) trauma-exposed participants' ability to provide informed consent and (b) the potential consequences of participating in trauma-focused research. Risk perceptions were assessed at the beginning of the course, after completion of the Collaborative Institutional Training Initiative (CITI) ethics education, and at the end of the course. Results show that student researchers' perceptions of risk changed significantly across time. After completing the CITI ethics education, students perceived trauma-exposed individuals as less able to provide informed consent and also perceived greater potential for negative consequences from participation in trauma-focused research, perceptions that were relatively maintained throughout the remainder of the course.

Perceived Risks and Benefits in IPV and HIV Research: Listening to the Voices of HIV-Positive African American Women

African American women living with HIV were asked to reflect on the perceived risks and benefits of research participation after completing a study examining socially sensitive issues in their lives, including intimate partner violence (IPV) and HIV. Administration of standardized quantitative instruments yielded positive responses to the research experience. However, qualitative assessments of perceived risks and benefits revealed more nuanced responses. For example, confidentiality concerns were more prominent in open-ended responses as was participants' positive attitudes toward monetary compensation. In addition, some women reported that study participation provided them with new insights about their experiences with IPV. Findings suggest that empirical studies on research protections involving potentially distressing and socially sensitive experiences with vulnerable populations require both quantitative and qualitative assessments of perceived risks and benefits. We discuss implications of our findings for ethics practices in trauma-related research among populations with multiple social vulnerabilities.

Predictors of Individual Resilience Characteristics Among Individuals Ages 65 and Older in Post-Disaster Settings

OBJECTIVE

Literature explores which factors most impact resilience and how these factors impact an individual and communities' ability to cope with disaster. Less research has focused on how age impacts resilience. This research adapts several previous conceptual models used to investigate resilience. To investigate the unique vulnerabilities faced by older individuals in post-disaster settings, this analysis was undertaken to investigate predictors of individual resilience.

METHODS

Data for the study were derived from the Centers for Disease Control and Prevention (CDC) Gulf States Population Survey (GSPS). The final sample included 5,713 adult residents from 4 gulf-coast states. Multiple linear regression was used for the analysis.

RESULTS

All models (demographic, health, social, and combined) acted as significant predictors of individual resilience. Health and social resilience models accounted for more of the variance in resilience scores. In all models, age was negatively associated with resilience scores. Being female was protective across all models. The results of the model testing indicate inequitable disaster mitigation, with social and health indicators explaining the most variance in the resilience levels.

CONCLUSION

This research provides practitioners with the knowledge they need to focus their interventions on the areas where it is most needed to empower resilient individuals. (Disaster Med Public Health Preparedness. 2019;13:256-264).

Assessing the subjective experience of participating in a clinical trial (AVATAR)

This study assessed the subjective experience of participating in a clinical trial, specifically positive and negative experiences and the experience of audio recording assessment sessions. The study was cross-sectional from a single blinded randomised controlled trial. Forty participants with a primary diagnosis of non-organic psychosis completed baseline and 12-week follow-up questionnaires assessing their experiences. Participants rated research interviews as moderately helpful in facilitating their therapy and talking to the interviewer as moderately helpful at baseline and 12-week follow-up. Self-report ratings of the degree of self-realisation promoted by the research questionnaires were significantly higher at 12-week follow-up compared to baseline. Participants adjusted quickly to being audio recorded and rated interviews as not at all disruptive and not at all to slightly intrusive. On average there were neutral emotional reactions, positive gains and minimal inconveniences as a result of participation. The main reasons for taking part were: 'To help myself', 'I was curious' and 'To help others'. The findings offer support to previous research reporting that individuals with mental health problems find participating in clinical trials a beneficial experience. This may alleviate concerns that participation in similar studies may be personally intrusive or harmful.

Unraveling the Mobilization of Memory in Research With Refugees

In this article, we explore how narrative accounts of trauma are co-constructed through the interaction between researcher and participant. Using a narrative multiple-case study with Kurdish refugee families, we address how this process takes place, investigating how researcher and participants were engaged in relational, moral, collective, and sociopolitical dimensions of remembering, and how this led to the emergence of particular ethical questions. Case examples indicate that acknowledging the multilayered co-construction of remembering in the research relationship profoundly complicates existing deontological guidelines that predominantly emphasize the researcher's responsibility in sensitively dealing with participants' alleged autobiographical trauma narratives. Instead, our analysis invites qualitative researchers to engage in a continued, context-specific ethical reflection on the potential risks and benefits that are invoked in studies with survivors of collective violence.

Complicating Narratives: Defining and Deconstructing Ethical Challenges in Community Psychology

In this concluding essay, we review the case studies presented in this Special Issue and examine whether community psychology has a distinctive approach to defining and resolving the core ethical canons of the Belmont Report (1979): Respect for Persons, Beneficence, and Justice. For two of these Principles-Respect for Persons and Beneficence-community psychologists elaborate upon and extend their definitions to consider their meaning in community-based, social justice-oriented research. The field's approach to Respect for Persons is multilevel in nature; in addition to respecting individuals and their diverse identities, we also have obligations to respect our community partnerships, the communities with whom we work, and the populations and cultures represented in our work. Similarly, for community psychologists, Beneficence is a multilevel construct that considers risks and benefits at the group, community, and cultural levels of analysis. With respect to Justice, community psychologists' views of our ethical responsibilities are qualitatively different in meaning from the original Belmont Report and from disciplinary-specific interpretations of this principle in ethical guidance documents from psychology, sociology, and evaluation. Our valuing of social change demands that we contribute to individual and group empowerment and liberation, and in so doing, that we avoid collusion with oppressive systems. Thus, we define our ethical responsibilities for promoting Justice as more action-oriented than do other disciplines. The essay closes with an exploration of future directions for developing a comprehensive ethical framework for community psychology.

Burnout and compassion fatigue: prevalence and associations among Israeli burn clinicians

Acute health care environments can be stressful settings with clinicians experiencing deleterious effects of burnout and compassion fatigue affecting their mental health. Subsequently, the quality of patient care and outcomes may be threatened if clinicians experience burnout or compassion fatigue. Therefore, the aim of this descriptive, cross-sectional study was to evaluate the prevalence of burnout and compassion fatigue among burn clinicians in Israel. Fifty-five clinicians from Burns, Plastics and Reconstruction Surgery and Intensive Care completed four validated surveys to assess burnout (Maslach Burnout Inventory), depression (PRIME-MD), health-related quality of life (SF-8), and compassion fatigue (Professional Quality of Life version 5). Burn clinicians were compared with Plastics and Reconstruction Surgery and Intensive Care clinicians. This study identified a high prevalence of burnout (38.2%) among Intensive Care, Plastics and Reconstruction and Burns clinicians, with Burns clinicians having a greatly increased prevalence of burnout compared to Intensive Care clinicians (OR =24.3, P=0.017). Additional factors contributing to compassion fatigue were those without children (P=0.016), divorced (P=0.035), of a younger age (P=0.019), and a registered nurse (P=0.05). Burnout increased clinicians' risk of adverse professional and personal outcomes and correlated with less free time (P<0.001), increased risk of experiencing work-home disputes (P=0.05), increased depression (P=0.001) and decreased career satisfaction (P=0.01). Burnout was also associated with higher physical (mean difference =3.8, P<0.001) and lower mental (mean difference =-3.5, P<0.001) Quality of Life scores. Caring for burn survivors can lead to burnout, compassion fatigue, and vicarious trauma. Identifying strategies to abate these issues is essential to ensure improved clinicial environments and patient outcomes.

"There Are No Known Benefits . . .": Considering the Risk/Benefit Ratio of Qualitative Research

Institutional review boards (IRBs) are responsible for weighing the risks and benefits of research participation. Qualitative researchers note numerous instances where IRB ethical frameworks fail to align with the ethics of their research projects and point out that IRB understandings of the benefits and risks of research often differ from those of the participants they seek to protect. This qualitative cross-case research investigates participants' interview experiences in six qualitative studies that differed in their methods, subject of focus, and populations. Our findings indicate that contemporary IRBs' use of population "vulnerability" and topic "sensitivity" to assess project risk does not adequately determine the benefits, risks, or ethicality of research. We recommend that IRBs treat as real the evidence for benefits in qualitative research, recognize that sensitivity and vulnerability do not predict risk, and encourage researchers to attend to relationships in their projects.

Moral Stress and Job Burnout Among Frontline Staff Conducting Clinical Research on Affective and Anxiety Disorders

There has been increased attention on job-related stress and burnout experienced by clinicians working with vulnerable and at-risk populations, including effects on personal mental health, therapeutic decision-making, and job effectiveness. Little is known, however, about the job-related stressors and symptoms of burnout experienced by clinical research staff working with similar populations, especially in terms of moral stress they may experience when adherence to scientific procedures appears to conflict with their personal commitment to address the clinical needs of their research participants or role as health care provider. In this national study, 125 frontline research workers conducting clinical research studies with individuals diagnosed with affective and anxiety disorders completed an online survey including measures assessing research work related moral stress, job burnout, organizational ethics climate and organizational research support. Results indicated that younger research workers, those whose research work was part of a graduate assistantship and perceptions of higher participant research risk were associated with higher levels of moral stress and job burnout. Supportive organizational climates were associated with lower levels of moral stress and job burnout. Recommendations for clinical research workers, supervisors and clinical training directors are discussed.

Seriously Injured Urban Black Men's Perceptions of Clinical Research Participation

PURPOSE

Black men are uniquely vulnerable in American society and our health care system: they bear a disproportionate burden of injury, yet are underrepresented in clinical research. This study aimed to explore the reasons why urban Black men with serious injuries chose to participate in clinical research and their concerns about research participation.

METHODS

This qualitative study was conducted within the context of a larger study focused on psychological effects of serious injury in urban Black men; 83 Black men with serious injuries were recruited while hospitalized in an urban trauma center. Informed consent was obtained. Semi-structured interviews were conducted in participants' homes three months after discharge from the hospital and were audiotaped, transcribed, and de-identified. Thematic content analysis was used to identify themes about perceptions of participating in clinical research.

RESULTS

The mean age of our sample was 38.2 years, and the mean injury severity score was 10.7 (SD 9.6). The majority (53.2 %) of injuries was due to interpersonal violence, and 47 % were due to unintentional mechanisms. Eight reasons for research participation emerged from the data: human connection, altruism/community, self-improvement, compensation, gaining knowledge, curiosity/interest, low risk, and reciprocity.

CONCLUSIONS

A major finding was that injured urban Black men participated in clinical research for the opportunity for human and therapeutic connection. Despite some expressions of mistrust, participants were willing to participate for altruistic reasons rooted in community priorities, and as part of their recovery process post-injury.

Reasons for and reservations about research participation in acutely injured adults

PURPOSE

The purpose of this study was to explore the reasons adult patients seeking emergency department care for minor injuries agree to participate in clinical research and to identify their reservations about participating in a research study.

DESIGN AND METHODS

This is a secondary analysis of data from a longitudinal cohort study of 275 adults who sought emergency department care for physical injury and were followed over 12 months. At the final interview, participants were asked open-ended short-answer questions about their perception of participating in the study. Free text responses were analyzed using conventional content analysis.

FINDINGS

The final sample of 214 participants was composed equally of males and females, predominantly Black (54%) and White (42%), with a mean age of 41 years. Six themes about reasons for participation emerged from free text responses: being asked, altruism, potential for personal benefit, financial gain, curiosity, and valuing or knowledge of research. Most did not report reservations. Those reservations identified included time constraints, confidentiality, and whether patients felt well suited to fulfill the study requirements.

CONCLUSIONS

Although injured patients are identified by the research community as vulnerable, they are willing to participate in research studies for diverse reasons, and their participation is commonly associated with positive experiences.

CLINICAL RELEVANCE

Understanding perceptions of participants' experiences of being in a research study after acute injury can guide researchers to improve future study protocols and recruitment strategies in order to optimize participants' experiences. Recruitment and retention into clinical research studies is essential to build nursing science to enhance the recovery of injured individuals.

Reactions to research participation in victims of childhood sexual abuse

We examined whether adults with a documented or self-reported history of childhood sexual abuse (CSA) report more emotional reactions and negative responses to research participation and whether psychiatric symptoms play a moderating role in their reactions. Using a prospective cohort design, individuals with documented histories of CSA and non-abused matched controls were followed up and interviewed in adulthood (n = 460). Reactions to research participation were measured with a brief questionnaire. Concurrent symptoms of depression, anxiety, and PTSD were assessed via standardized measures. Results showed that those with a history of CSA, documented or self-reported, experienced similar reactions compared to controls. Psychiatric symptoms predicted stronger emotional reactions and more negative responses, but also greater personal benefit, regardless of CSA history.

Emotional risks to respondents in survey research

Some survey research has documented distress in respondents with pre-existing emotional vulnerabilities, suggesting the possibility of harm. In this study, respondents were interviewed about a personally distressing event; mood, stress, and emotional reactions were assessed. Two days later, respondents participated in interventions to either enhance or alleviate the effects of the initial interview. Results indicated that distressing interviews increased stress and negative mood, although no adverse events occurred. Between the interviews, moods returned to baseline. Respondents who again discussed a distressing event reported moods more negative than those who discussed a neutral or a positive event. This study provides evidence that, among nonvulnerable survey respondents, interviews on distressing topics can result in negative moods and stress, but they do not harm respondents.

A qualitative study of the views of patients with human immunodeficiency virus and childhood trauma on the consent process for a neurocognitive and neuroimaging study

AIM

To investigate the informed consent experiences of women with human immunodeficiency virus (HIV) and childhood trauma involved in a neurocognitive and neuroimaging study.

BACKGROUND

There is no previous research on the consent process for people with both HIV and childhood trauma, conditions that are syndemic in South Africa. Research on the consent process for each individual condition has shown that individuals with either of these conditions may be vulnerable research participants. This study aimed to investigate the opinions of the women involved in order to refine future consent processes and ensure that they are appropriate for this population.

METHODS

A qualitative semi-structured interview was conducted with women from Khayelitsha township in South Africa involved in a cohort study on neurocognitive and neuroimaging outcomes in HIV and childhood trauma, who agreed to participate in an interview immediately following their final study appointment.

FINDINGS

Aspects most frequently commented upon by participants during the interview were community recruitment, incentives for participation, quality of information provided, and misunderstandings and unexpected events. The overarching finding was that of therapeutic misconception; participants expected, and highlighted as incentives for participation, health benefits that were not part of the study. A minority of participants reported discomfort from questions concerning their traumatic experiences. Despite this, the consent process was well received and there was good understanding of confidentiality issues and the voluntariness of participation.

CONCLUSION

Full disclosure of true benefits from participation must be emphasised throughout the recruitment process. This is particularly important for participants with HIV who appear to participate because of perceived health incentives. Providing prior notification that questions about traumatic experiences will be asked may improve the experiences of participants. A generic but thoroughly conducted consent process is suitable in this population.

Female survivors of child sexual abuse: finding voice through research participation

It is unclear whether survivors of trauma are at risk of emotional or psychological distress when they participate in research because there is little data on the subjective experience of research study participants and how they make meaning from their participation in research. This qualitative descriptive study explored the experience of research participation by survivors of childhood sexual abuse. We interviewed 12 female survivors and identified themes. Participants noted both positive personal and societal benefits of study participation and reported no harm due to their research participation. Study findings can help researchers understand the perspectives of participants regarding the benefits of taking part in violence research and can help allay concerns over causing participants undue psychological distress.

Good intentions and dangerous assumptions: Research ethics committees and illicit drug use research

Illicit drug users are frequently identified as a ‘vulnerable population’ requiring ‘special protection’ and ‘additional safeguards’ in research. However, without specific guidance on how to enact these special protections and safeguards, research ethics committee (REC) members sometimes fall back on untested assumptions about the ethics of illicit drug use research. In light of growing calls for ‘evidence-based research ethics’, this commentary examines three common assumptions amongst REC members about what constitutes ethical research with drug users, and whether such assumptions are borne out by a growing body of empirical data. The assumptions that form the focus of this commentary are as follows: (i) drug users do not have the capacity to provide informed consent to research; (ii) it is ethically problematic to provide financial incentives to drug users to participate in research; and (iii) asking drug users about their experiences ‘re-traumatizes’ and ‘re-victimizes’ them.

Children's Perception of Research Participation: Examining Trauma Exposure and Distress

USING THE REACTIONS TO RESEARCH Participation Questionnaire for Children (RRPQ-C), this study examined perceptions of research participation among 181 school-aged children with and without trauma histories. As part of two larger studies, children completed non-trauma related tasks to assess emotion understanding and cognitive ability. Parents (and not children) reported on children's interpersonal (e.g., sexual abuse, physical abuse, witnessing domestic violence, witnessing community violence) and non-interpersonal (e.g., motor vehicle accidents, medical traumas, natural disasters) trauma exposure. Children's perceptions of costs and benefits of research participation and understanding of informed consent did not vary as a function of trauma exposure. The number of traumatic events experienced was unrelated to children's perceptions. Furthermore, children across trauma-exposure groups generally reported a positive cost-benefit ratio, and understanding of the consent information. Implications of these data are discussed.

Perceived benefits in trauma research: examining methodological and individual difference factors in responses to research participation

THIS STUDY EXAMINED METHODOLOGICAL and individual difference factors in relation to perceived benefits and cost-benefit ratios among adult participants in trauma-related research. In two samples (N's = 72 and 118), ethnically-diverse community participants completed trauma-related questionnaires plus an in-depth interview. In separate community (N = 213) and undergraduate (N = 130) samples, participants completed trauma-related questionnaires, but no interviews. Participants rated their perceptions of the research process using the Response to Research Participation Questionnaire (RRPQ). Cost-benefit ratios were favorable in all samples. The research procedures (questionnaires only versus questionnaires plus interviews) explained unique variance in RRPQ scale scores and cost-benefit ratios, as did trauma-related distress. Implications of these findings for developing trauma research protocols are discussed.

Trauma in people with intellectual and developmental disabilities: reactions of parents and caregivers to research participation

Generally, studies have revealed that only a minority of people are bothered by participation in research on traumatic stress. Severity of traumatic events and subsequent responses are typically unrelated to negative reactions. We included 386 family members and caregivers (respondents) of people with intellectual and developmental disabilities (focus people). Focus people (ages 4-82) had a wide range of physical and intellectual disabilities, medical and behavioral problems, and exposure to potentially traumatic events. The measures of impact of research participation (based on J. I. Ruzek & D. F. Zatzick's [2000] Reactions to Research Participation Questionnaire [RRPQ]; S. Folkman and R. S. Lazarus's [1986 , 1988 ] Emotional Responses to Participation Scale) showed good psychometric properties. Response to participation was highly skewed toward good understanding of informed consent, valuing participation, and minimal negative reactions. Number of traumatic events was related, positively, to only one RRPQ subscale: Valuing Participation. Implications for research and clinical work are discussed.

Trauma and Sex Surveys Meet Minimal Risk Standards

Institutional review boards assume that questionnaires asking about “sensitive” topics (e.g., trauma and sex) pose more risk to respondents than seemingly innocuous measures (e.g., cognitive tests). We tested this assumption by asking 504 undergraduates to answer either surveys on trauma and sex or measures of cognitive ability, such as tests of vocabulary and abstract reasoning. Participants rated their positive and negative emotional reactions and the perceived benefits and mental costs of participating; they also compared their study-related distress with the distress arising from normal life stressors. Participants who completed trauma and sex surveys, relative to participants who completed cognitive measures, rated the study as resulting in higher positive affect and as having greater perceived benefits and fewer mental costs. Although participants who completed trauma and sex surveys reported slightly higher levels of negative emotion than did participants who completed cognitive measures, averages were very low for both groups, and outliers were rare. All participants rated each normal life stressor as more distressing than participating in the study. These results suggest that trauma and sex surveys pose minimal risk.

Research Ethics in Victimization Studies

Research ethics, especially the protection of research study participants, has been an enduring concern of investigators and scholars of victims of violence. Previous work has analyzed the overt and hidden risks of harm to study participants through poorly designed and implemented protocols, cross-cultural insensitivity, unjust exclusion of certain victim types, and neglect to ensure safety of research staff. This article extends this work by calling for greater attention to exploiting participants and victims as a class of persons. The need for this wider view derives from concern about the academic research environment with its emphasis on research, publication, and extramural funding. The authors argue that compliance with federal regulations and IRB directives is necessary but insufficient to conduct truly ethical research. Recognition of the unique pressures that researchers face in the context of the economically competitive university is required to delineate and manage exploitation risks. Such pressures have sometimes led to the rush from print to practices and policies with unintended harmful results for victims of violence as a class of persons. The authors suggest a number of strategies for researchers to define and manage the dangers of engaging in this type of unethical conduct.

Respondents' experiences of completing a retrospective web-based, sexual trauma survey: does a history of sexual victimization equate with risk for harm?

This study investigated respondents' experiences of completing a retrospective web-based survey exploring sexual revictimization. The original survey provided a link to a separate mixed-methods survey assessing the impact of participation. Of the original 481 respondents, 234 completed this follow-up survey. Eighty percent were female and 52% reported histories of sexual victimization (SV). Newman, Willard, Sinclair, and Kaloupek's (2001) Reactions to Research Participation Questionnaire was adapted to suit this web-based design, and several open-ended questions were included. The statistical analysis revealed that those who experienced SV reported higher levels of distress and personal benefit and were less likely to be inconvenienced by participation. However, higher levels of benefit did not always compensate for greater levels of distress, particularly for those with more recent and more extensive histories of SV. The thematic analysis of the qualitative responses is discussed and suggestions are offered for the design of more ethically sensitive research protocols and practices.

Undergraduate women's reactions to body image and eating disorder research

The purpose of the study was to determine college women's (N = 405) reactions to body image and eating disorder research as well as predictors of negative reactions. Results suggested that the majority of women (94%) did not experience negative reactions and reported benefits to participating. Regression analyses revealed that disordered eating and poorer body esteem were predictive of negative reactions to research participation. Additional analyses were conducted to better understand those participants (N = 26; 6%) who reported negative reactions. Overall, results indicated that body image and eating disorder research is not distressing for the vast majority of participants.

Overview of research addressing ethical dimensions of participation in traumatic stress studies: autonomy and beneficence

One element of the design of human research studies is ethically informed decision-making. Key issues include the safety, costs, and benefits of participation. Historically, much of this decision-making was based on opinion rather than formal evidence. Recently, however, investigators in the traumatic stress field have begun to collect data that are relevant to these decisions. In this article, the authors focus on issues emanating from the ethical concepts of autonomy and respect for persons and beneficence and nonmaleficence, and then summarize relevant evidence from studies with trauma-exposed individuals. Discussion addresses implications of this evidence for research practice and policy, and identifies some potentially informative data collections opportunities for future trauma studies.