S3 Additional file 2
Screening for depression and IPV – the guidance offered by principlism.
Beneficence
Non-maleficence
Autonomy
Justice
The obligation to provide benefits and to
The obligation to avoid causing harm
The obligation to respect the decision-
The obligation of fairness in the
making capacity of the autonomous
distribution of benefits and risks
balance benefits against risks
person
Depression confers serious risks of harm for
Not screening is potentially more harmful
Although patients rarely make truly
All patients have an equal chance of
particularly mothers, children and society.
than associated stigma from receiving a
informed decisions about being screened,
being screened and will be no worse off
Incorporating screening in a study will
new diagnosis: as sufferers live their lives
they can determine whether they accept
than if screening had not been
identify those at-risk so that they potentially
without identification of their problem and
treatment or not by agreeing or not to
conducted. Future populations will
receive appropriate treatment and
this potentially confers greater
participate in an intervention study.
benefit by the reduced burden of
management.
distress/disability/illness with greater
depression on the health and social
‘cost’ to people and the community.
system if interventions are determined
Autonomy is thus respected in
to be effective.
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Depression
intervention studies because participants
Screening for those at-risk to identify
provide their informed consent.
potential depression and test an intervention
Studies
Screening is simply a tool that measures a
More will be learned about treatment
problem and so causes minimal harm when
effectiveness to distribute the benefits
administered. Using a tool to determine
fairly.
provides a benefit because an effective
intervention may be determined that prevents
future risk of individual and social suffering
eligibility for recruitment therefore also
and improves maternal and child outcomes.
causes minimal harm when administered.
IPV confers serious risks of harm but the risk
Screening to determine eligibility may do
Victims can judge whether to disclose or
All patients have an equal chance of
of harm from IPV is higher than the risk of
harm to a few individuals. There are risks
not and whether to take further action.
being screened and will be no worse off
harm from being screened. Screening for
of disclosure of IPV for intervention and
IPV allows victims potentially to receive
comparison participants. Further possible
support and prevent serious injury in the
harm could result with the potential for
Autonomy is respected in intervention
future.
stigma with disclosure.
studies because participants provide their
Effective interventions could reduce the
informed consent.
burden for victims, their families and
IPV
than if study had not been conducted.
communities, but not everyone receives
Study
Identification balances the risks of IPV
Screening avoids the potential for harm
disclosure against the benefits of prevention
caused by not treating an existing and
the intervention.
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and reduction in physical psychological
profound problem to individuals and
harm.
society.
3