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visualizing Mental Health through the lens of Pittsburgh Youth University of Pittsburgh GRADUATE school of public health, dept. of behavioral and community health sciences

INTRODUCTION

One in five adolescents has experienced a serious mental health disorder at some point in their life, such as depression and/or anxiety disorders (NIH, 2019). In fact, young adults aged 18-25 years had the highest prevalence of any mental illness (25.8%) compared to other age groups according to 2017 data (SAMHSA, 2017). Adding to the urgency of addressing youth mental health, the COVID-19 pandemic that swept across the globe in late 2019 has exacerbated mental health concerns.

One of the hardest hit groups from COVID-19 is adolescents. Youth have lost critical supports, such as meeting with friends, their daily routines have been drastically interrupted, they’ve missed key milestones such as graduation ceremonies to celebrate their achievements, and many have taken on additional responsibilities in the home due to disruptions in parents’ work and childcare situations. A recent study conducted during COVID-19 found unusually elevated levels of anxiety symptoms among adolescents, particularly for panic symptoms such as difficulty breathing and negative feelings about the future. The pandemic is having a profound impact on wellbeing and research that identifies pathways back to health and recovery is critical.

Focus of our Study

In this project, a group of 8 youth in Pittsburgh, Pennsylvania, USA used a research method called Collaborative Filmmaking to create, analyze and screen films about youth mental health. The youth we were trained in digital filmmaking techniques and applied these skills to respond to two research prompts using their own creative voices.

1. What are the key stressors in your daily life? (e.g., things that are scary, create worry, cause stress, or make you anxious)

2. What are the key supports in your daily life? (e.g., things that make you happy, make you feel safe, bring you joy)

Youth participated in workshops, in person (before COVID-19) and via zoom (during COVID-19) to learn about filmmaking and exchange ideas for their films.
Graphic summarizing key stressors in the lives of Pittsburgh youth

After creating films about stressors and supports, each filmmaker sat down with the research team to co-analyze their films, and discuss key themes and messages in the films. The filmmakers also attended a group screening where they had the opportunity to watch and comment on each others' films. Findings from the films and discussions, including snippets from their films and direct quotes detailing their experience with mental health, are outlined below.

breakdown of Common Stressors

Education

The stressor experienced most frequently by participants in this study was educational stress. Educational stressors included Academic Pressure (such as grades, schoolwork, lack of sleep and free time due to school work, etc.), Relationships (such as with teachers and school administrators) and College Preparation.

“You’re probably wondering what in the world could stress and pressure teenagers. Well, let me tell you. Some of the things that stress me out are the education system in general, achieving good grades, large workload, and the whole college process from testing to the acceptance letter.”
“I don’t feel like I can talk to [teachers]. Just the way they talk to you about some of your grades, it just makes you feel stupid.”
Still Captures from Participant Films: Academic pressure, endless to-do lists, and not getting enough sleep were displayed and discussed in the films.

Personal and Social Stressors

In addition to educational stressors, youth highlighted a variety of personal and social stressors that influenced their mental health. Within this domain, a few themes emerged including social or cultural expectations, social media use, youth’s social lives, and community stressors. The most salient stressor appeared to be social or cultural expectations, and participants described expectations to include societal body image expectations, expectations related to religious or culturally-sanctioned practices, and pressures related to immigrating to the United States. A few of the participants were first- or second-generation immigrants, and described specific stressors related to maintaining their own cultural practices while also adjusting to United States culture and norms. Many felt pressure to make their family proud, and described feeling the need to be perfect.

“... I felt like being an immigrant is like a burden on its own, to be honest... it's like your whole family came to United States, left everything and they have left their whole life for you. And so now, you got to be the best...you want to be the one that that your mother’s like 'Oh yeah, that's my daughter.' You know, that kinda thing. Even in things that you do for you to kind of get that recognition, you just kind of got to be a bit better than the best... it just has to be perfect.”
Several youth mentioned that social media and other community stressors played a significant role in their lives.
Still Captures from Participant Films: (Left) Filmmaker shares words of advice from her experience, "I delete social media. I make real memories with real people in real life." (Right) A teenager looks at herself in the mirror as the filmmaker narrates, "Nowadays there is a social expectation to look and act a certain way. This can majorly affect teenagers negatively. It can make them feel self conscious and unhappy with themselves."

Some participants described more general societal pressures, such as going to college, finding a career, and becoming financially successful. Some participants described concern about financial obligations related to college, and were concerned about accruing debt. In this context, participants described feeling as though they had to conform to societal norms, and questioned whether or not this would result in long-term happiness.

“It is stressful to think of greater powers, such as the government, that do not have to function by morals or ethics of humans because they are above it.”
Still Capture from Participant Film: One filmmaker discussed higher powers and control, which students cannot escape.

Family

Family was described as a stressor by multiple participants. Several participants described the pressure to act as a positive role model for siblings and other family members.

“I’m the oldest sibling so there’s always the aspect of having to set a good example for my brothers and, like my family being immigrants. I’m the first person to go through high school and college and so that’s always its own stress. But they personally don’t have anything to do with that. I think it’s just the overall idea of being the first person in my entire family; even out of all my cousins, I’m the first. I’m the oldest so it’s just an expectation I have for myself to set a good example.”
Still Capture from Participant Film (Right): One youth's portrayal of quality time with friends and family

Sometimes family was also discussed as a support, as seen in the image below.

Still Capture from Participant Film: Youth shows baking with her family as a support for her mental health.

During our group discussion, one participant stated that she was the oldest child so she had to “maintain a standard” so her siblings could follow. She even went so far as to say her grades were not her own, but her and her family’s grade.

Another participant stated that she was the first family member to go to school in America, so they were all expecting a lot from her. She continued by saying: “And I know I have to do that, so that everyone else can see that it’s possible... but it’s a lot of pressure and it can be hard to maintain the standards of everyone else."

One more participant expressed similar experiences as the oldest child of an immigrant family. “As an immigrant, I have a lot of expectations and responsibilities to maintain, and that creates a lot of pressure. When there is pressure, there is anxiety and a whole lot of different mental health issues."

Health & Well-Being

Multiple participants described health-related stressors, including both mental health as well as physical health stressors. Mental health stressors described by the participants included specific diagnoses such as depression, anxiety, ADHD, eating disorders, as well as general feelings of sadness and loneliness. One participant described her own experiences with mental health stressors.

“I have felt anxiety, loneliness, worthlessness, hopelessness, depression, stress, sentiment, nostalgia, and sadness. I am someone with weakness. I am someone who struggles.”

While the participants cited mental health stressors more frequently than physical health stressors, several participants did address physical health issues, such as poor appetite and sleep disturbances.

Still Captures from Participant Films: (Left) Filmmaker contrasts her experiences before and after COVID-19 stating, "I don't really go to sleep that early anymore because I have nowhere to go the next day." (Right) Turning her life into a video game, one filmmaker used a creative approach to express which aspects of her life were supports and which were stressors. Here she demonstrates how early mornings are a stressor, and she starts her with with negative 2 points.
Social media led to many different feelings, from stress to a supportive way to connect with friends.

Social Media: Both a Stressor and Support

Most participants agreed that social media and phones are both stressors and a supports. However, in the group discussion, the participants strongly felt that it depends on the context and use of social media.

“I use my phone for so many different things, and a few of them are supports and some are stressors; I call my friends there and text them, but it can also be a stressor because of social media and Instagram and you see other people live their life and you feel insecure about your own.”
“This helps me because it makes me feel like I am not alone in whatever I am going through. Sometimes I call my friends because whenever we are talking, I leave behind the pressure and just be me.”
Still Capture from Participant Films: Filmmaker shows how she spends her free time on her phone and social media.

Common Supports

Next, our participants discussed common forms of support that were useful in clearing their heads and offering an outlet from daily stressors.

Graphic summary of key supports in the lives of Pittsburgh youth

Pets

Household pets were cited as strong support systems for a number of our participants. One participant in particular described her cat as “the most important thing in her life” and her “best friend” as the cat provided support when she was feeling overwhelmed.

Still Captures from Participant Films: Youth often relieved stress by playing with household pets.

COVID-19 & Quarantine

Although the pandemic took a toll on young adults' mental health, to our surprise, it was reported as a support for several youth participants as well.

These supports include:

  • Surrounding themselves with close friends and avoiding harmful friends
  • Less stress and pressure associated with texting and socializing with an entire friend group
  • Personal time to clear their heads
Still Capture from Participant Film: Filmmaker shows how getting outside and clearing her head is a support.

Music

A majority of the study participants mentioned that music is an essential part of their daily routine. Music appeared to serve numerous functions; participants often listened to music to boost their mood in the morning, while working on daily tasks, and when in need of a mental break.

Still Captures from Participant Films: Listening to music alleviates stress throughout the day.

Nature & Outdoors

Several participants seemed disheartened by their lack of free time, but found it beneficial to go outside, get fresh air, and appreciate nature.

Still Capture from Participant Film: One filmmaker narrates over the above visual, "So what is the answer to all this stress? I guess there's always the fact that the world is beautiful. I just wish I had more time to look at it."
Still Capture from Participant Film: In her video game-inspired film, the filmmaker shows getting outside as a support, which reduces her stress by 3 points.
Still Captures from Participant Films: Majority of the youth in this study emphasized the importance of nature and outdoor experiences in relieving stress.

Final Reflections

Participants frequently cited educational stress and academic pressure as a key stressor contributing to adverse mental health symptoms. Specifically, participants described academic pressure spanning from demands to achieve adequate grades, strained relationships with teachers and school administration, feeling as though help or accommodations were not delivered as requested, and stress related to college, including worries about the competitive application and admission process. These concerns appeared to have been magnified by the COVID-19 pandemic, in which participants described increased workload and difficulty navigating virtual school delivery. Participants also described sleep disturbances in the context of COVID-19, which further drove educational stress as some felt too tired to focus during school.

Interestingly, while academic stress emerged as the most common theme in this study, social stressors were less salient. Few participants highlighted peer stress, bullying, or friendship discord as a mental health stressor, which perhaps resulted in participants fixating on academic stressors. Given COVID-19-related social distancing, participants may have had less opportunity for adverse social or peer interactions.

Youth Films

References

Academic Stress. (n.d.). Skooli. https://www.skooli.com/blog/save-semester-ugly-start.

Family Reading. (n.d.). iStockPhoto. https://www.istockphoto.com/illustrations/family-reading.

Family. (n.d.). FreePik. https://www.freepik.com/free-photos-vectors/family.

Gossip. (n.d.). iStockPhoto. https://www.istockphoto.com/illustrations/gossip.

Javed B, Sarwer A, et al. (2020). The coronavirus (COVID-19) pandemic’s impact on mental helath. The International Journal of Health Planning and Management.

Mental Health Illustration. (n.d.). NoHat. https://nohat.cc/f/mental-health-illustration/comvecteezy429977-201907212148.html.

Mental Health. (n.d.). Vox. https://www.vox.com/22174464/covid-cases-anxiety-depression-mental-health.

Sakuma, H. (n.d.). Academic Stress. UMKC. https://info.umkc.edu/unews/top-5-stress-management-tips-for-college-students/.

Social Media. (n.d.). iStockPhoto. https://www.istockphoto.com/illustrations/social-media.

Smirni P, Lavanco G & Smirni D (2020). Anxiety in Older Adolescents at the time of COVID-10. Journal of Clinical Medicine.

Page developed by Korrina Gidwani, University of Pittsburgh.