Building resilience and resources to overcome depression and anxiety in young people from urban neighbourhoods in Latin America

Lead Research Organisation: Queen Mary, University of London
Department Name: Blizard Institute of Cell and Molecular

Abstract

Background
The numbers of people with depression and anxiety greatly increases during adolescence. Adolescents who live in big cities more commonly experience stressful events such as conflict, poverty, substance misuse and social isolation. This includes adolescents from Latin America - which is the most urban part of the world. Although many individuals experience stressful events, the majority do not develop either depression or anxiety. Furthermore, when people do experience them, up to half recover within a year. This raises the question of what helps people to prevent depression and anxiety, and what helps people recover. We have called these resilience factors. Our aim is to understand resilience factors so we can develop new approaches to treat depression and anxiety.

Objectives
The overall aim is to identify resilience factors that are linked to either prevention of depression and anxiety, or to recovery. We will focus on adolescents and young people who live in three large Latin American cities - Buenos Aires, Bogotá and Peru. To achieve this, we aim to:
1. Develop new ways of measuring resilience factors that can be used with adolescents and young people,
2. Identify which resilience factors prevent depression and anxiety,
3. Identify which resilience factors help adolescent and young people to recover from depression and anxiety within one year,
4. Develop case studies about existing approaches that promote prevention and recovery,
5. Build up the research skills and knowledge of researchers in Latin America,
6. Involve adolescents and young people through an interactive arts-based project.

Methods
The project is organised into six work packages (WPs). In the WP1, we will ask young people and staff who work in schools, youth organisations and healthcare services to help us develop new ways of measuring resilience factors to create an assessment tool. The new tool will be used in a study that will compare 1020 adolescents (15-16 years old) and oung people (20-24 years old) with depression and anxiety to 1020 adolescents and young people without. We will look at personal factors such as health behaviours and social factors including relationships. We will test if there are differences between the two groups. This will help us discover which factors are linked to prevention. The individuals who have depression and anxiety will be asked to complete the same measures after one year. We will compare individuals who recovered from depression and anxiety to those who did not. This will tell us about recovery. To promote prevention and recovery we will conduct interviews with participants who did and did not recover and with different stakeholders. This will help us identify areas of "good-practice" which we will write up as case studies. This may include initiatives such as health centres or social-groups in the community (WP4). So that researchers in Latin America can continue studying resilience and recovery, we will provide training and activities focused on research skills (WP5). Finally, we want to involve adolescents and young people in our research. To do this, we will run an arts-based project where we will ask those with depression and anxiety to use different materials such as photographs, films, and graffiti to document their experience. We will hold exhibitions to display the art. We hope this will encourage other young people to get involved in research (WP6).

Expected results
The project will lead to new knowledge about what prevents depression and anxiety and what help people recover. Understanding this will help us develop new approaches to improve the mental health of adolescents and young people and reduce the burden of mental disorders. Our communication methods will ensure the research is widely disseminated. Although the project focuses on Latin America, our learning will help other countries, including many Low and Middle Income countries, which are becoming more urban.

Technical Summary

pression and anxiety are leading causes of youth disability worldwide. Risk factors such as social isolation, conflict, internal displacement and poverty, are common in urban environments. Despite this, many adolescents and young people do not develop either condition and up to 50% who do experience an episode recover within a year. Our aim is to identify resilience factors associated with prevention and recovery from depression and anxiety in adolescents and young people from urban regions in three Latin American countries. To achieve this we will:

-Develop appropriate methods of assessing resilience factors in adolescents and young people in Argentina, Colombia and Peru,
-Identify resilience factors associated with prevention and recovery from depression and anxiety,
-Develop case studies of existing initiatives to amplify these factors,
-Engage stakeholders in a participatory arts-based project giving voice to adolescents and young people,
-Increase research capacity within Latin American institutions.

We will conduct a cross-sectional study of adolescents and young people to assess whether resilience factors differ between 1020 individuals with and 1020 without depression and anxiety to determine which factors may be associated with prevention. The group with either condition will be followed up for one-year in a prospective cohort study to compare those who do and do not recover. Good practice qualitative case studies involving multiple stakeholders will identify existing approaches to amplifying these resilience factors. Our particular focus is on urban environments in Latin America - the most urbanised region in the world, where youth make up a quarter of the population. Identifying resilience factors in this population is crucial for developing new approaches to reduce the burden of common mental disorders. The knowledge generated has the potential to generalise to other Latin American countries and LMICs with rapid urbanisation.

Planned Impact

Depression and anxiety are leading causes of disability worldwide particularly during adolescence where prevalence rapidly increases. This risk may be even greater where individuals are exposed to multiple stressors such as armed conflict, poverty, social isolation, trauma, displacement and violence. Adolescents and young people in urban environments may be more likely to experience these stress factors. Yet, despite the impact of depression and anxiety, many adolescents and young adults do not develop either condition, and up to 50% of young people recover from a single episode within a year. This raises the question of what factors protect and prevent individuals from developing these disorders, and which factors promote recovery should individuals experience either condition.

This project aims to identify resilience factors that are associated with the prevention of depression and anxiety and with recovery if, and when individuals experience either condition. Our focus is on adolescents and young adults, who represent a quarter of the population in Latin America - the most urbanised region of the world. The programme will focus on resilience factors that are amenable to intervention and change, and will be conducted in Argentina, Colombia and Peru. The programme has the potential to lead to the development of new approaches to reduce the burden of depression and anxiety for adolescents in Latin America and beyond. The main impact of the project will be:
1)Identification of resilience factors for preventing and promoting recovery from depression and anxiety in adolescents and young people,
2)Developing appropriate methods for assessing resilience factors in adolescents and young people from urban environments in Latin America,
3)Identifying case-studies of existing good practice which amplify and strengthen the identified resilience factors,
4) Engaging adolescents and young-people in participatory arts-based projects to give voice to their experience of depression and anxiety,
5)Building capacity of researchers, policy-makers and mental health services.

The following groups will immediately benefit:
a)Adolescents and young people who live in urban environments including those who experience multiple stressors due to urban living. The primary aim is to identify resilience factors for prevention and recovery from depression and anxiety that are amenable to intervention. This will generate new knowledge that can be used by individuals, communities and societies to strength resilience.

b)Healthcare professionals, youth workers and educators will benefit from a new understanding of resilience factors. This will include both personal and social resilience factors. Within the programme, we will identify case-studies of good practice that currently exist within each country. Within these case-studies, there will be a focus on upscale. By identifying existing approaches, sustainability will be prioritised.

c)Government organisations, charities and NGOs will gain a better understanding of the challenges faced by individuals with depression and anxiety, and the resources they use to overcome these. This will be highlighted in participatory project resulting in a short film and photography exhibition.

d)Academics: the project relies on close collaboration between academic institutions in the UK and Latin America. Through knowledge exchange visits and capacity building workshops, research and leadership capacity will be increased.

e)Members of the public: depression is a leading cause of disability for adolescents and young people, with many experiencing recurrent episodes into adulthood. Reducing such mental disorders will have wide societal and economic benefits, potentially for decades if young people at risk of or recovering from mental disorders find resources to avoid them in the future.

Publications

10 25 50
 
Description Brazil Accelerator Fund
Amount £7,300 (GBP)
Organisation Queen Mary University of London 
Sector Academic/University
Country United Kingdom
Start 03/2020 
End 03/2021
 
Description ESRC LISS-DTP programme (London Interdisciplinary Social Science - Doctoral Training Programme)
Amount £85,000 (GBP)
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 10/2020 
End 10/2023
 
Description Queen Mary University of London Humanities and Social Sciences (HSS) Collaboration Fund
Amount £10,000 (GBP)
Organisation Queen Mary University of London 
Sector Academic/University
Country United Kingdom
Start 01/2020 
End 07/2020
 
Title OLA Model for assessing resilience and resources 
Description Model that defines resilience and describes the concepts underlying the assessment of resources. 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2019 
Provided To Others? No  
Impact No notable impact yet 
 
Title Sports Activity Questionnaire and Arts Activity Questionnaire 
Description These two questionnaires have been developed to assess sports and arts activities in adolescents and young people. It aims to assess, what, if any sports/arts activities are conducted, how often, whether they are conducted individually and/or as part of an organised group/organisation, reasons for taking part in these activities, and barriers to taking part in these activities. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2020 
Provided To Others? No  
Impact No notable impact yet 
 
Description OLA Collaboration with arts partners 
Organisation La Familia Ayara Foundation
Country Colombia 
Sector Charity/Non Profit 
PI Contribution The arts lead and research team have established good working relationships with each of the arts partners. We are bringing academic/scientific expertise regarding mental distress (depression and anxiety) in adolescents and young adults, as well as expertise and knowledge of the processes required for conducting high quality research. The research team will provide training and support in research methodologies and processes where needed. The research team also provides regular face-to-face and teleconference contact with the arts partners.
Collaborator Contribution The arts partners bring expertise, experience and knowledge in working with young people and their particular art form. They are skilled in working with young people through the arts to explore and express difficulties that young people might experience.The arts partners will combine their expertise with that of the local academic research team to use arts-based methods to conduct research activities with adolescents and young people. They will be instrumental in organising and recruiting young people to these research activities and the Lived Experience Advisory Panel (LEAP), and some of the research activities will take place in venues that are already known to them.
Impact This collaboration brings together the following disciplines: arts, psychiatry, psychology, epidemiology, medical statistics and public heath.
Start Year 2019
 
Description OLA Collaboration with arts partners 
Organisation La Plaza Theater
Country Peru 
Sector Private 
PI Contribution The arts lead and research team have established good working relationships with each of the arts partners. We are bringing academic/scientific expertise regarding mental distress (depression and anxiety) in adolescents and young adults, as well as expertise and knowledge of the processes required for conducting high quality research. The research team will provide training and support in research methodologies and processes where needed. The research team also provides regular face-to-face and teleconference contact with the arts partners.
Collaborator Contribution The arts partners bring expertise, experience and knowledge in working with young people and their particular art form. They are skilled in working with young people through the arts to explore and express difficulties that young people might experience.The arts partners will combine their expertise with that of the local academic research team to use arts-based methods to conduct research activities with adolescents and young people. They will be instrumental in organising and recruiting young people to these research activities and the Lived Experience Advisory Panel (LEAP), and some of the research activities will take place in venues that are already known to them.
Impact This collaboration brings together the following disciplines: arts, psychiatry, psychology, epidemiology, medical statistics and public heath.
Start Year 2019
 
Description OLA: Collaboration with research partners 
Organisation Cayetano Heredia University
Country Peru 
Sector Academic/University 
PI Contribution The contributions made by Prof. Priebe and the research team include expertise, guidance and support in setting up research teams to conduct research projects of various study designs to a high standard. This expertise, guidance and support has been given in the form of lectures to research team members and wider faculty members, training (face-to-face or over video conference), regular meetings and training events, and regular communications (by email, teleconference and video conference). Building research capacity is a key part of this collaboration. As part of this, the team has hosted researchers from partner institutions on longer residential stays in the research unit, allowing visiting researchers to attend training on different aspects of research, and to shadow clinicians in local mental health teams to learn about mental health services in the UK. This collaboration, which started as part of an NIHR Global Health Research Group, has resulted in further awards lead by Prof Priebe and Dr Bird.
Collaborator Contribution Our partners have set up research teams to conduct the research activities, working closely with the UK team to set up and conduct research studies of various study designs in their local context. This has required the expertise of the local principal investigators and senior researchers and also intellectual input of researchers to attend training as required. Our partners have brought in expertise as required, for example, experts to train local researchers to use Redcap for data collection, experts in qualitative research. They have hosted the UK team and partners for meetings as required, which included use of university facilities and visits to local mental health services and participating centres.
Impact This collaboration involves the following disciplines: psychiatry, psychology, epidemiology, trial methodology, public health, geography, arts. Outputs: https://doi.org/10.1186/s12888-019-2148-x doi: 10.1186/s12888-019-2381-3 Spanish language option for DIALOG+ app Brief Psychiatric Rating Scale training videos in English and Spanish DIALOG+ training videos in English and Spanish
Start Year 2017
 
Description OLA: Collaboration with research partners 
Organisation Pontifical Xavierian University
Country Colombia 
Sector Academic/University 
PI Contribution The contributions made by Prof. Priebe and the research team include expertise, guidance and support in setting up research teams to conduct research projects of various study designs to a high standard. This expertise, guidance and support has been given in the form of lectures to research team members and wider faculty members, training (face-to-face or over video conference), regular meetings and training events, and regular communications (by email, teleconference and video conference). Building research capacity is a key part of this collaboration. As part of this, the team has hosted researchers from partner institutions on longer residential stays in the research unit, allowing visiting researchers to attend training on different aspects of research, and to shadow clinicians in local mental health teams to learn about mental health services in the UK. This collaboration, which started as part of an NIHR Global Health Research Group, has resulted in further awards lead by Prof Priebe and Dr Bird.
Collaborator Contribution Our partners have set up research teams to conduct the research activities, working closely with the UK team to set up and conduct research studies of various study designs in their local context. This has required the expertise of the local principal investigators and senior researchers and also intellectual input of researchers to attend training as required. Our partners have brought in expertise as required, for example, experts to train local researchers to use Redcap for data collection, experts in qualitative research. They have hosted the UK team and partners for meetings as required, which included use of university facilities and visits to local mental health services and participating centres.
Impact This collaboration involves the following disciplines: psychiatry, psychology, epidemiology, trial methodology, public health, geography, arts. Outputs: https://doi.org/10.1186/s12888-019-2148-x doi: 10.1186/s12888-019-2381-3 Spanish language option for DIALOG+ app Brief Psychiatric Rating Scale training videos in English and Spanish DIALOG+ training videos in English and Spanish
Start Year 2017
 
Description OLA: Collaboration with research partners 
Organisation University of Buenos Aires
Country Argentina 
Sector Academic/University 
PI Contribution The contributions made by Prof. Priebe and the research team include expertise, guidance and support in setting up research teams to conduct research projects of various study designs to a high standard. This expertise, guidance and support has been given in the form of lectures to research team members and wider faculty members, training (face-to-face or over video conference), regular meetings and training events, and regular communications (by email, teleconference and video conference). Building research capacity is a key part of this collaboration. As part of this, the team has hosted researchers from partner institutions on longer residential stays in the research unit, allowing visiting researchers to attend training on different aspects of research, and to shadow clinicians in local mental health teams to learn about mental health services in the UK. This collaboration, which started as part of an NIHR Global Health Research Group, has resulted in further awards lead by Prof Priebe and Dr Bird.
Collaborator Contribution Our partners have set up research teams to conduct the research activities, working closely with the UK team to set up and conduct research studies of various study designs in their local context. This has required the expertise of the local principal investigators and senior researchers and also intellectual input of researchers to attend training as required. Our partners have brought in expertise as required, for example, experts to train local researchers to use Redcap for data collection, experts in qualitative research. They have hosted the UK team and partners for meetings as required, which included use of university facilities and visits to local mental health services and participating centres.
Impact This collaboration involves the following disciplines: psychiatry, psychology, epidemiology, trial methodology, public health, geography, arts. Outputs: https://doi.org/10.1186/s12888-019-2148-x doi: 10.1186/s12888-019-2381-3 Spanish language option for DIALOG+ app Brief Psychiatric Rating Scale training videos in English and Spanish DIALOG+ training videos in English and Spanish
Start Year 2017
 
Description Talk to the GCRF research cross disciplinary network (a resource orientated approach to mental health care - our GCRF journey) - Victoria Bird 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The event was aimed at Cross disciplinary working and to learn from current experience with GCRF grants.
Year(s) Of Engagement Activity 2020