# Ethical Issues and Challenges Regarding the Use of Mental Health Questionnaires in Public Health Nutrition Research

## TL;DR

This paper discusses ethical issues and challenges of using mental health questionnaires in public health research, offering practical solutions to protect participants.

## Contribution

The paper introduces preventative measures to address ethical concerns in using mental health questionnaires in epidemiological research.

## Key findings

- Using mental health questionnaires can incorrectly classify participants as depressed or non-depressed.
- Anonymous studies may prevent identifying participants needing referral to clinical services.
- Including questions on depression and suicidality increases participant burden and expectations.

## Abstract

Background: The use of mental health questionnaires is common in desk-based public health epidemiological research; however, the burden this might put on participants and researchers has been questioned and has not been previously addressed. This paper delves into the ethical issues and challenges of using such scales and questionnaires, providing a real-life case study where the Beck’s Depression Inventory-II was used. Methods/Results: The ethical considerations raised by using mental health questionnaires in public health epidemiological research include incorrectly identifying participants as depressed or non-depressed; inability to identify participants for referral procedures due to the anonymous nature of some research studies; an increased burden on participants through depression and suicidal questions; and the high expectation of participants towards the researcher. Preventative measures to reduce these challenges include choosing appropriate cut-off scores for correctly identifying participants; highlighting whether the mental health questionnaires used may elicit negative emotional or psychological reactions related to suicidality; specifying the criteria for referral to clinical services; detailing the intended referral processes; including approaches where the researcher directly connects participants with a psychological service provider; and including a passive referral method such as contact details for participants to initiate their own referrals to clinical care. Conclusions: This paper serves as a guide for researchers aiming to collect data on mental health through questionnaires. The ethical challenges discussed in this paper should be considered and reviewed at all stages of the research project.