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

青少年（10-19岁）的精神困扰在世界范围内日益受到关注，在给定的一年内，高达20%的年轻人经历过心理健康问题。在全球范围内，低收入和中等收入国家（LMIC）的心理健康状况最差，年轻人的比例最高。在英国，患有可诊断的精神健康状况的年轻人人数逐年增加，而东伦敦是英国最贫困的地区之一，精神疾病发病率最高，人口也是全国最年轻的地区之一。有限的研究探讨了青少年精神痛苦的实际生活经历，以及这种经历是否因国家而异。让青少年参与研究可能具有挑战性，而访谈和问卷调查等传统方法并不鼓励参与。传统方法可能无法促进自我表达，并且可能受到研究人员（成人）观点的影响。该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是理解青春期精神困扰的可接受方式来克服以前研究的局限性。Photovoice是一种基于照片的研究方法，参与者拍摄他们日常经历的照片，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青少年在两个不同的贫困城市地区，东伦敦（英国）和里约热内卢（巴西）之间的精神痛苦的经验。通过在两个不同的地方进行研究，我们将能够比较使用Photovoice作为一种方法，以及在这两种环境中青少年的精神痛苦经历。具体来说，博士将解决以下研究问题：1）Photovoice是否可以接受和可行？2)什么样的个人、文化和社会因素会影响痛苦的体验？3)Photovoice能否用于宣传卫生和社会政策？为了回答这些问题，一个系统的回顾将探讨以前的艺术为基础的研究方法，已用于青少年;其次，一个Photovoice项目将探讨生活与情绪障碍（抑郁症，焦虑症或双相情感障碍）的经验与100名青少年（50在东伦敦和50在里约热内卢）。这将在两种环境下举办的一个以艺术为基础的讲习班上进一步探讨，参加者人数较少（东伦敦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照片集，展示年轻人拍摄的照片及其伴随的故事。博士的一个关键产出将是参与式研究方法的可接受性的证据，这两个合作伙伴QMUL和ELFT都热衷于探索。

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.