Factors Affecting the Mental Health of Youth in Rural Puebla, Mexico: A Photovoice Project

Background and Purpose: Mental health problems are responsible for a substantial burden of disease among adolescents globally. When left untreated, mental health problems in adolescence can negatively impact one’s developmental trajectory. Yet the mental health of adolescents, particularly of those residing in Latin America’s rural areas, has been historically understudied and underserved. In order to effectively address the growing need for culturally-appropriate mental health services for youth in rural areas, where services are often inexistent and mental health remains highly stigmatized, there is a critical need to better understand the perspectives, experiences, and preferences of youth from rural communities in regards to mental health. Through a multi-sector collaboration involving university students and faculty and local foundation and school representatives, this study aimed to identify contributing and deterring factors affecting youth’s mental health. Centering the voices of youth themselves as experts in their own experiences can lead to actionable strategies that are desirable by the local community.

Methods: Photovoice is a participatory method used to affect change via direct experiences of disenfranchised communities. Nineteen middle school students and twenty-four high school students from two rural communities in Puebla, Mexico participated in four photovoice workshops at their school. Youth took pictures of (1) what contributed to their emotional wellbeing and (2) what difficulted their emotional wellbeing. Youth utilized the SHOWeD method to describe their photos: (a) What do you See here?, (b) What is really Happening here?, (c) How does this relate to Our mental health?, (d) Why does this condition or situation Exist?, and (e) What can we Do about it? Youth pile-sorted their pictures and narratives generating codes and categories through group discussions.

Two representatives from a local community-based organization (CBO) served as liaisons between the research team and local school administrators. Medical and psychology social service externship students from a Mexican university assisted with facilitating the small group sessions. Additionally, the two CBO representatives assisted with the planning, setting up, and implementation of the project. Data was analyzed using polytextual thematic analysis, which has been deemed well-suited for analysis of multimodal data.

Findings: Youth from rural communities in Mexico across middle and high school identified several factors that contributed to their emotional wellbeing, including the natural environment (i.e. sunsets, animals, plants), positive relationships (friendships and family), and hobbies (i.e. sports, music, games). Factors that deterred to youths’ emotional wellbeing included loss of loved ones due to migration, diminished crops due to drought, and loss of animals and natural environments due to harmful human actions. Youth also discussed how substance use is common in their communities which contributes to relational violence and economic hardship.

Conclusion and Implications: Photovoice is an effective method to assess mental health needs of youth from rural areas. Youth provided positive feedback about their experience in the project and reported feeling empowered and invested in the health and wellbeing of themselves and their communities. Recommendations were made based on emerging themes for improving the emotional wellbeing of youth in areas with limited metal health services.