A photo is worth a thousand words: Using Photovoice to explore mental distress in adolescence in deprived areas of East London and Rio de Janeiro

青春期(10-19岁)的精神困扰是全世界日益关注的问题，高达20%的年轻人在一年内经历了精神健康问题。在全球范围内，心理健康不良的负担对年轻人比例最大的低收入和中等收入国家(LMIC)是最大的。在英国，患有可诊断精神健康问题的年轻人数量正在逐年增加，而伦敦东部是英国最贫困的地区之一，也是英国精神疾病发病率最高、人口最年轻的地区之一。有限的研究探索了青春期精神痛苦的实际生活经历，以及这种经历在不同国家是否有所不同。让青少年参与研究可能是具有挑战性的，而采访和问卷调查等传统方法不鼓励参与。传统的方法可能不会促进自我表达，而且会受到研究人员(成人)观点的影响。这一博士旨在通过调查一种名为PhotoVoice的基于艺术的研究方法是否可以接受的方式来理解青春期的精神痛苦，以克服之前研究的局限性。PhotoVoice是一种以摄影为基础的研究方法，参与者将他们的日常经历拍照，然后在一个小组中讨论围绕这些照片的故事。博士学位的总体目标是探索在两个不同的贫困城市地区--伦敦东部(英国)和里约热内卢(巴西)--青少年的精神痛苦经历。通过在两个不同的地点进行这项研究，我们将能够比较光语音作为一种方法的使用情况，以及在这两种情况下青春期精神痛苦的经历。具体地说，该博士将解决以下研究问题：1)PhotoVoice在这一人群中可以接受和可行吗？2)什么个人、文化和社会因素会影响痛苦的体验？3)PhotoVoice能否被用来为健康和社会政策提供信息？为了回答这些问题，一项系统的综述将探索以前在青少年中使用的基于艺术的研究方法；其次，PhotoVoice项目将探索与100名青少年(伦敦东部50名，里约热内卢50名)一起生活在情绪障碍(抑郁、焦虑或双相情感障碍)中的经历。将在两个环境下的艺术讲习班中进一步探讨这一问题，参加者人数较少(伦敦东区20人，里约热内卢20人)。最后，我们将通过旨在让当地社区参与的宣传活动，提高对这一群体需求的认识。这将包括一个画廊活动和摄影册，展示年轻人拍摄的照片和他们的故事。博士学位的一个关键成果将是参与式研究方法可接受性的证据，这是QMUL和ELFT合作伙伴都热衷于探索的。

Mental distress in adolescence (aged 10-19) is a growing concern worldwide, with up to 20% of young people experiencing mental health problems within a given year. Globally, the burden of poor mental health is greatest for low and middle-income countries (LMICs) where the proportion of young people is the greatest. In the UK, the number of young people with a diagnosable mental health condition is increasing year-on-year, and East London, one of the most deprived areas in the UK, has one of the highest rates of mental illness, and the youngest population in the country. Limited research has explored the actual lived experience of mental distress in adolescence and whether this experience differs across countries. It can be challenging to engage adolescents in research, and traditional methods such as interviews and questionnaires do not encourage participation. Traditional methods may not promote selfexpression and can be influenced by the researchers' (adult) point of view. This PhD aims to overcome limitations with previous research by investigating whether an arts-based research method called Photovoice is an acceptable way of understanding mental distress in adolescence. Photovoice is a photography-based research method that involves participants taking photographs of their everyday experiences, and then discussing the stories surrounding these photographs within a group. The overall aim of the PhD is to explore the experience of mental distress amongst adolescents in two different deprived urban locations, East London (UK) and Rio de Janeiro (Brazil). Through conducting the research in two different locations we will be able to compare the use of Photovoice as a methodology, and the experience of mental distress in adolescence within these two settings. Specifically, the PhD will address the following research questions:1) Is Photovoice acceptable and feasible with this population?2) What personal, cultural and social factors influence the experience of distress?3) Can Photovoice be used to inform health and social policy?To answer these questions, a systematic review will explore previous arts-based research methods that have been used with adolescents; secondly a Photovoice project will explore the experiences of living with an emotional disorder (depression, anxiety or bipolar disorder) with 100 adolescents (50 in East London and 50 in Rio de Janeiro). This will be explored further within an arts-based workshop in both settings with a smaller group of participants (20 in East London and 20 in Rio de Janeiro). Lastly, we will raise awareness of the needs of this population through dissemination activities aimed at engaging local communities. This will include a gallery event and photobook showcasing the photographs taken by the young people and their accompanying stories. A key output of the PhD will be evidence for the acceptability of a participatory research method, which both partners QMUL and ELFT are keen to explore.