Introduction

At Competence Centre for Transcultural Psychiatry (CTP) research is highly weighted and closely linked to the clinical practice. The dynamic research environment at CTP contributes to developing the clinical work and to attracting qualified and motivated employees.

Much of the research at CTP is conducted as clinical projects involving the participation of referred outpatients. The patient target group includes:

1. Trauma-affected refugees.
2. Citizens of different ethnic origin than Danish with a mental disorder, where the patient's cultural background is estimated to play a significant role in how the disorder develops, and in how the disorder is comprehended, assessed and treated.
   

The first group have trauma-related mental disorders, posttraumatic stress disorder and/or depression, which typically occurred after the experiences of persecution, imprisonment or war. The second group of patients consists of immigrants or refugees with a mental disorder in which there is a need for assessment by specialists. The diagnoses in this group are mixed, and the group is highly heterogeneous.

The objective of this research strategy is to clarify visions and goals and to ensure continuity and quality of the research. The strategy is complementary to the research strategies of Mental Health Services in the Capital Region of Denmark and Mental Health Center Ballerup.

1. Vision

All refugees and immigrants with mental disorder may be offered specialised assessment as well as evidence-based and efficient treatment on an equal footing with citizens of Danish descent. As a result, their symptoms can be reduced, functioning increased, and well-being improved all the while Danish healthcare costs are curbed.

2. Goals

2.1 To contribute with new knowledge about the best possible evidence-based treatment offered to trauma-affected refugees in order to implement this knowledge in clinical practice at CTP as well as in other treatment facilities that treat the same target group.

2.2 To contribute with knowledge about how cultural factors affect:

• Symptoms of mental disorders
• The patient's acceptance and compliance in relation to treatment

This knowledge is implemented in clinical practice in order to offer these groups of citizens specialised assessment and efficient treatment at CTP and at other treatment facilities with the same target group. 

2.3 To sustain and develop CTP as a clinic where research and clinical practice are intertwined and interact in an on-going process. This means that research results impact the treatment offered, and the treatment offered is carried out as part of the research.

2.4 To become both a national and an internationally recognised leading research unit within transcultural psychiatry.

3. Strategy

At CTP results and lessons learned from each completed trial will be presented and discussed both in a forum with clinicians from CTP and in the advisory group. The purposes are to discuss how the results ought to influence clinical practice and to plan future research. 

3.1 Clinical research regarding treatment of trauma-affected refugees
One of the primary research interests of CTP is to research the treatment offered to our patient group. In 2009 we started a coherent chain of randomised trials, and the chain continues. This chain of research allows the results and clinical experience from randomised trials to contribute to the design of future projects. The randomised trials, which focus on trauma-affected refugees, are numbered consecutively: Psykiatrisk Traume Forskning (Psychiatric Trauma Research) (PTF) 1, 2, 3 etc. Due to the time that passes before the data from one randomised trial is translated into new hypotheses and new knowledge, data from for example PTF1 can be used in the design of PTF5 and so forth. Results from the various tests will continue to be an important part of the development of treatment at CTP.

The following applies to randomised trials carried out at CTP:

• Pilot studies, in which a new treatment method is tested, are relevant prior to the completion of some of the randomised trials.
• The overall treatment effect is studied and questions concerning the efficacy of different treatment elements are sought addressed in detail.
• The type and duration of treatment that suits the individual patient will be elucidated. Based on the evidence, the treatment offer will eventually be adapted to individual patient needs.
• To investigate the treatment effect in the longer term, there are 6 months follow-up in all randomised trials.
• There will be an opportunity for in-depth studies that connect to each randomised trial. These studies can focus on particular aspects relating to either the group of patients or the treatment.

3.2 Building a research database on trauma-affected refugees
The construction of a research database with data on trauma-affected refugees began once CTP was established. The database, titled Danish Database on Refugees with Trauma (DART), grows as the number of patients being treated at CTP increases. The data are collected in the clinical trials (see section 3.2 above). The database is invaluable in relation to opportunities for future analyses. Data are used for independent analyses, but can also be integrated with register data, for example, to obtain a better description of trauma-affected refugees' complex symptoms, psychiatric and somatic comorbidity and social circumstances. 

3.3 Clinical research focusing on the importance of cultural factors affecting the clinical picture, patient acceptability and the treatment compliance
With this transcultural focus we want to investigate what tools one can use to increase the clinician's knowledge about the impact of culture in patients with mental illness and a different ethnicity than Danish. The focus will be on tools that can contribute to a more thorough assessment and improved diagnostic as well as increased acceptability and adherence among patients in the treatment.

3.4 Establishing a research network
In order to exchange knowledge and ideas, and to develop joint research projects such as multicenter studies, CTP is establishing national and international networks.

4. Financing

CTP applies for funding from private and public bodies in order to finance research projects. Since research is an integral part of the clinical work, the data collection itself is largely cost-neutral.

5. Publications

CTP will attempt to pu​blish all knowledge generated. Results of interest to clinicians/practitioners will be passed on in relevant expert journals and disseminated through popular scientific publications. When there are results of the randomised trials, participants are informed in the form of a letter with a layman's summary of the results.

5.1 Authorship/co-authorship of scientific publications
CTP conforms to the principles of the Vancouver rules concerning co-authorship requirements:

• Substantial contribution to the study conception and design, acquisition of data, or analysis and interpretation of data.
• Drafting of the article or revision of the final version.
• Final approval of the version to be published.

All clinicians at CTP are highly involved in the research work. CTP clinicians carry out all inclusion and data collection of the clinical projects at CTP (except Hamilton interviews and follow-up interviews that are conducted by a team of medical students). Furthermore, through experience from their clinical work, clinicians contribute with hypotheses, which may lead to new research projects. Therefore, it is vital that these concerted efforts are respected and valued.

As long as there is compliance with the Vancouver rules, clinicians who are employed at CTP and who are interested in research should be offered the opportunity to participate in the planning of articles. It is recommended that details of authorship and co-authorship be stated already in the research protocol.