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

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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.