Counting What Counts: Epidemiologic Measurement and Generating Meaningful Findings

Quantitative data serve key purposes in global mental health. They tell us who is in need of care, how well that care is working, and what risk and protective factors are associated with mental health outcomes. It is therefore vital to ensure that our quantitative data are collected in ethical ways. A key concern is how we decide what to measure. In particular, whose goals and priorities are we attempting to meet – funders, other researchers, or the individuals and communities we hope to serve through our interventions? Additionally, we must consider how our measures are designed. Simple translation of screening tools is often insufficient for capturing mental health needs and experiences in a new setting. Mixed-method approaches to cultural adaptation can ensure that our tools are comprehensible, acceptable, and relevant and that they reflect what matters most. Although screening tools should ideally be validated, there are trade-offs to consider in validation studies. Finally, it is vital that epidemiologic data only be collected if procedures are in place for referring individuals identified as in need of care. Drawing on case studies from Haiti and Nigeria, I demonstrate some of the complexities of ensuring ethical measurement procedures in global mental health.