Respondents

Thirty-five unique respondents completed the survey, after excluding four blank and two duplicate entries. Respondents’ roles comprised senior lecturers or above (20%; n = 7), post-doctoral researchers (20%; n = 7), health workers (11%; n = 4), non-government organisation (NGO) or voluntary sector practitioners (9%; n = 3), manager/directors (9%; n = 3), lecturers (9%; n = 3), PhD students (9%; n = 3), pre-doctoral researchers (9%; n = 3), administrators (3%; n = 1) and master's degree students (3%; n = 1).

Respondents reported experience of working in 25 LMICs (see Table 1); eight worked in more than one country. Seventy-four percent of respondents (n = 26) mentioned working in one of 11 sub-Saharan African countries, the commonest being South Africa (n = 8), Zimbabwe and Ethiopia (both n = 3). Forty percent (n = 14) of respondents mentioned working in one of eight Asian countries, the commonest being India (n = 6) and Sri Lanka (n = 2). Respondents also worked in Latin American (n = 3), Eastern European (n = 3) and Middle Eastern countries (n = 1). Forty percent (n = 14) were based or employed in the UK, 6% (n = 2) in Europe and 3% (n = 1) in the United States, with the remaining 51% (n = 18) based in LMICs. Respondents’ principal organisational affiliations (see Table 2) were universities (69%, n = 24), non-governmental organisations (17%, n = 6), healthcare organisations (9%, n = 3), international policy and non-university education institutions (3%, both n = 1).

Table 1 LMICs in which respondents had experience of working. Some respondents worked in more than one countryTable 2 Respondents’ principal organisational affiliation

Over-arching themes addressed current work on GBV and mental health in LMICs (supplementary file 2), barriers to researching this field, how to address them, research priorities and recommendations for networks to build capacity.

Barriers to research

Respondents identified staffing, funding, resource, sensitivity, gender norm and buy-in barriers to researching GBV and mental health in LMICs. High workforce turnover in services best-placed to address GBV and mental health and a lack of training in research design and conduct among front-line staff creates challenges. The tradition of providing short-term funding for brief projects in LMICs is an obstacle to longitudinal studies investigating causal relationships. Several respondents highlighted “extensive and difficult” ethical approval processes as barriers, “especially with vulnerable populations like children, adolescents and pregnant women”.

Practical barriers to conducting rigorous research in this field include the lack of open access metrics of violence exposure validated for LMICs, insufficient experienced, skilled interviewers to conduct qualitative research in some settings, and difficulty speaking to survivors privately, where “often family members will be present, which inhibits reporting of abuse”.

Cultural sensitivity and “taboo/inhibited responses” to asking about GBV and mental health and lack of awareness of their inter-relationship are barriers to researching them:

Women simply do not report their [domestic violence] cases because culturally, they should not share what happens in their marriage. Also, poverty forces most abused women to stay in abusive homes due to financial dependency.

Health worker, Zambia

GBV is often normalised or stigmatised, influencing people’s ability to disclose. A researcher from Zimbabwe said:

Among the clients who access [mental health] services there are some who report GBV but most of them do not have knowledge about the abuse, hence this kind of violence is considered as “normal violence” by the victims and the communities.

A UK-based health worker said:

People are generally silenced through violence and abuse. The stigma it carries… The lack of support [for] following up on mental health [problems]. Why would someone say exactly what they’re going through and feeling? This all impacts on the research being done.

Respondents highlighted barriers to recruiting diverse participants, raising:

The challenges of getting an intersectional approach, particularly given that stigma of people with mental health needs is an issue.

Policy Fellow, UK

A service manager from South Africa said that “prevailing patriarchal beliefs among local practitioners, researchers and senior health and social development officials” obstruct research progress. A post-doctoral researcher based in India highlighted that the risk of identifying GBV and mental health problems during research requires:

…supportive and trusting relationships with organisations working with these women and who would be able to continue supporting them once the research has done. But these research relationships need to be beneficial and not harmful to the organisation or the women, and this can take time to build (which we don't always have).

A senior researcher argued that:

The current generation of mental health leaders… do not know the special considerations of gender and violence and thus tend to overlook it in their programming. Yet, much of the funding goes to [them] and it’s tricky to break through as a younger researcher.

A range of practical, operational, ideological and leadership barriers was reported to hinder progress in researching the intersection between GBV and mental health in LMICs.

Addressing barriers

Respondents argued that addressing barriers is vital for “building the next generation of mental health researchers that have a theoretical and practical background in violence”. Recommendations included practical tools to facilitate research studies, fostering collaboration, GBV training and integrating trauma-informed perspectives across research and clinical care.

To build research capacity, respondents recommended a minimum outcome set for GBV and mental health research, to standardise their measurement across different LMICs. Standardised safety protocols that support GBV survivors must be integrated more uniformly into research designs, including appropriate reporting of abuse disclosures.

The need to strengthen collaborative approaches to co-produce research with mental health service users and GBV survivors in LMICs was highlighted. Bridges need to be built between health systems and services addressing social determinants of health:

We need much more awareness of social work strategies to tackle violence outside of the health system… and much more dialogue with non-health actors who are working on these issues.

Postdoctoral researcher, Latin America, Africa, Asia

Respondents recommended widespread, regular academic and practical training for “practitioners, researchers and officials” on asking about and responding to GBV. Training should address topics of “gender, human rights and values clarification”, to encourage prioritisation of GBV and its mental health consequences at the highest levels:

Build productive relationships with ministries of health and other relevant stakeholders… to encourage collaborative, multi-disciplinary research and responses. Top-down encouragement of collaboration may be necessary where repeated attempts at grassroots efforts have failed to address deep-rooted resistance.

Postdoctoral researcher, Europe, Asia

Engage key stakeholders early on, get buy in from policy makers and key influencers in the fields of health and research to help shift the conversation.

Predoctoral researcher, Latin America, Middle East, Asia

Specific training [35] was recommended for staff working in LMIC humanitarian settings. Such training should address:

Provision of psychological first aid to [violence] survivors… better education on recognition of IPV and follow up in humanitarian settings for front-line health providers.

Predoctoral researcher, Latin America, Africa, Asia

Respondents emphasised the importance of trauma-informed approaches. They highlighted the intersection of GBV with subsequent traumatic experiences of mental healthcare in LMICs:

How to avoid re-traumatising people through coercive practices within the mental health system (e.g. QualityRights initiatives)? And we need an understanding of the particular needs of vulnerable groups, such as people with severe mental illness, to inform support systems and care.

Postdoctoral researcher, Latin America, Africa, Asia

Vicarious trauma [36] experienced by staff working with GBV survivors and the need to support their self-care [37] were also emphasised.

Research priorities

Research priorities comprised contextual understanding of the intersection of GBV and mental ill-health in specific settings and evidence-based interventions to address them. Several respondents raised the aetiology of violence and abuse and how they impact mental health in different contexts:

Understanding the complex cultural/political/social/psychological and biological factors that lead to perpetration of violence (often by men) and thus identifying preventative strategies.

Senior researcher, Malawi

A post-doctoral researcher contended that:

The case that violence/abuse are important determinants of mental health is pretty strong already. What we’re missing is evidence of whether interventions that target violence/abuse can reduce mental health problems, which would be a powerful advocacy tool.

A majority of respondents prioritised research into effective interventions for different settings, especially those delivered by non-specialists or survivors through task-sharing approaches:

What are the common components of… evidence-based programmes that address both violence, abuse, and mental health? …For whom [are they effective]? What is the extent of scale up of these programmes?

Postdoctoral researcher, Europe, Africa, Asia

What is the effectiveness of non-specialised health worker delivery of mental health interventions for violence survivors? What is the impact of survivor-led interventions in post-conflict settings?

Manager/Director, Uganda

Overall, research priorities focused on characterising the relationship between GBV and mental ill-health in different LMIC contexts and developing feasible interventions to address them.

Network benefits

Respondents proposed three benefits of networks for violence, abuse and mental health research in LMICs. First, networks should facilitate knowledge and cross-cultural exchange, through visits to different research settings, and capacity building, by sharing educational and methodological resources. Second, they should foster collaboration, bringing members together for grant funding applications, training and advocacy. Third, networks like iVAMHN should research practical solutions, such as counselling skills training for health workers, or community awareness programmes about GBV and mental health.

In terms of exchange, respondents proposed exchanging learning from practice and research experience, sharing evaluation tools, good practice examples and disseminating findings. They proposed sharing datasets, to clarify the prevalence and risk factors for GBV and mental ill-health in different settings and tailor prevention and treatment interventions. Shared resources could include training materials, study protocols, freely available measurement tools, intervention manuals and open access publications. An interactive online repository of innovative programmes, alongside summaries of the evidence base [38] was suggested.

Respondents envisaged networks as incubation centres for new interventions, research strategies and practical policies. They emphasised the benefits to LMIC researchers of learning from peers’ work and experiences, staying up-to-date, reducing duplication and increasing study replication. Respondents were interested in hearing members’ views in response to this survey. They advocated network activities influencing real-world practice:

We should move away from… recommendations for practice…mostly read by other academics … [we need] a collective action process, in which DV centres in different institutions work together and in close collaborations with services and stakeholders, to produce actual change in DV practices.

Lecturer, UK

Respondents also emphasised mutual advantages to network members of sharing learning:

There could be significant benefits to LMIC researchers of collaborating and sharing resources with colleagues in HICs, with mutual benefits of knowledge and experience for HIC researchers.

PhD student, Ethiopia

Facilitating knowledge and cross-cultural exchange, capacity building, fostering collaboration and conducting research are potential benefits afforded by networks like iVAMHN.

Accessibility

Respondents emphasised the need to make network activities as accessible as possible. They proposed in-person network events hosted by members in different LMICs, with organisation shared between institutions and online access for those unable to travel or participate synchronously. “Clear and accessible communication channels”, online networking, sharing educational and research events and open access media, through a website, newsletters and social media, were recommended. Respondents proposed that networks should provide LMIC researcher bursaries and advocate for reduced and free conference places where possible. Only 29% (n = 10) were able to access funding to attend in-person events. Respondents emphasised the need to invest in LMIC early-career researchers, link them to work and research opportunities, and promote the field through editorials and other media.

Activities

A broad range of network activities was recommended, focused on disseminating knowledge and resources. These included online conferences, webinars and podcasts to ensure far-reaching, accessible learning, to capacity-build and up-skill members.

Respondents proposed that through networks, small groups of LMIC- and HIC-based members could share expertise and co-apply for competitive research grant funding. This could include co-production between researchers, GBV survivors and mental health service users, adhering to principles of participatory methods and prioritising ethics and safety.

Collaborative research suggestions ranged from epidemiological studies to intervention development and implementation. Ideas included uniform needs assessments and comparisons of GBV and mental health in different LMICs, capturing health worker perspectives, validating violence measurement tools in LMICs, incorporating mental health outcomes into violence intervention evaluations and evaluating survivor-led mental health interventions. Respondents highlighted the need for interventions tailored to the specific context.

The importance of multi-country and interdisciplinary collaborations was emphasised. Respondents proposed building links with larger networks, such as the African Alliance for Maternal Mental Health [39] and the International Marcé Society for Perinatal Mental Health [40], as well as LMIC violence practitioners, faith-based organisations and men’s groups. They proposed that a cohort of champions could influence change at regional and national levels and develop local links, to facilitate research and overcome administrative and ideological barriers.