{"id":{"repo_id":"de-montfort","oai_identifier":"oai:dora.dmu.ac.uk:2086/25155"},"canonical_url":"https://search.dev.ndltd.org/etd/de-montfort/oai:dora.dmu.ac.uk:2086/25155","repository":{"repo_id":"de-montfort","name":"De Montfort University","base_url":"https://dora.dmu.ac.uk/server/oai/request"},"display":{"title":"“You’ve got to own your depression” The role of ownership in the process of depression recovery: A qualitative exploration of the visual-verbal accounts of depression recovery utilising photography","abstract":"Background/Context: Depression is the leading cause of disability worldwide (WHO, 2021), within the UK alone this equates to 13.7% of the population or 7 million individuals experiencing and living with the debilitating condition (PHE, 2019; Mental Health Foundation, 2016). Over the last century depression, and indeed mental health in general, has grown and developed as a topic of research and subsequently the diagnostic and statistical manual of mental health (DSM) has been implemented to help guide and inform practitioner judgement. Now in its fifth edition (DSM-5-TR: APA, 2022) the DSM has moved from a singular understanding of depression to one which has variations and subtypes (Dodd et al. 2021; Allen, Rhoades, & Mazzoni, 2023; Hjordt et al., 2017) same fundamental underlying symptoms of: feelings of worthlessness; diminished interest or pleasure in activities; fatigue or loss of energy; poor concentration or indecisiveness; and recurrent thoughts of death and/or recurrent suicidal ideation or suicidal behaviours (American Psychological Association, 2013). There is a wealth of research surrounding depression (Oxenkrug, 2013; Blows, 2021; Schroder et al., 2022; Larkings et al., 2017; Dillon et al., 2014). Research trends have predominantly focused on the aetiology of depression (Nadeau et al., 2016; Genuchi & Mitsunaga, 2015; Su, D’Arcy, & Meng 2021) but despite advancements (Horwitz et al., 2016), there is still little understanding as to how depression occurs in individuals. Likewise, whilst this research has illuminated certain factors which could suggest an increased risk of depression (Wardenaar et al., 2014; Blomdahl et al., 2018), these factors are far ranging and suggest that almost every factor of an individual’s life could lead to a susceptibility to the mental health condition (Reynolds, Meng & Hall, 2020; Cutrona et al., 2005; Emslie et al., 1997). Depression may be complex, with many ways and avenues of exploration leading to wide-ranging approaches taken to study it, there are however several key points of view which have attempted to make sense of the condition (Kendler, 2005; Dillon et al., 2014). The most popular understanding stems through the biomedical perspective which considers depression to be a chemical imbalance within the brain (France, Lysaker, & Robinson, 2007 Blows, 2021; Schroder et al., 2022; Larkings et al., 2017) relating to levels of serotonin and/or dopamine, though the cause of this imbalance is subject to debate. Treatments for the condition are also complex (Spendelow, 2015; Johnson et al., 2017: Begun et al., 2003; Chamberlain et al., 1984; Lehmer, 1986) and not conclusively understood (Magavi, Reti, & Vas, 2017; Kennard et al., 2006; March et al., 2004) in the sense that no single treatment works for all people with depression and the rates of the effectiveness varies, as too are the approaches to treatment. Nevertheless, these treatments tend to be either pharmacological or non-pharmacological. Initial pharmacological treatments, such as selective serotonin reuptake inhibitors (SNRI’s: Weissman, 2014), were identified as a side effect for another condition (Tuberculosis: Healy, 2001) and whilst this coincidence has birthed the field of psychopharmaceuticals (Healy, 2001), these types of treatments have varied rates of efficacy (Fullagar, 2009). Non-pharmacological treatment like cognitive behavioural therapy (CBT: Seidler et al., 2016) also present differing rates of effectiveness (Blomdahl et al., 2018) but have demonstrated better outcomes for individuals in terms of alleviating and managing depressive symptoms (Wigand et al., 2019 Zimmermann, et al., 2020). However, some research suggests that rather than the type of treatment, it is the choices the individual makes in terms of their treatment which is more important (Fullagar, 2009; Spendelow, 2015). However, before an individual decides to seek help and receive treatment for their depression, barriers such as stigma (Gilkes, Perich & Meade, 2019; Allen, Rhoades, & Mazzoni, 2023; Wittenborn, Culpepper, & Liu, 2012) and culture (Perkins, Kelly, & Lasiter, 2015) can interfere with an individual’s help seeking behaviours. Additionally, depression was initially believed to only affect the female population (Prior, 1999; Bebbington, 1996; Paykel, 1991) and a lot of the early research predominantly explored female-only populations (Brownhill et al., 2005) which inadvertently created issues in the portrayal and understanding of depression in men (Scholz, Crabb, & Wittert, 2017) thereby adding a further layer of complexity to the understanding of depression. With the wealth of research, and the increased levels of complexity, some scholars have argued that there has been very little evidence to suggest that the field and understanding of depression has advanced at all over the last half century (Horwitz et al., 2016). Along with this, some scholars (Milasan, Bingley & fisher, 2020; Emslie et al., 2006; Whittle et al., 2015; Kelly et al., 2008; Wirback et al., 2017) have also called for a switch in research focus away from causes and symptoms and to approach depression from a point of recovery in order to advance the field. Recovery in a broad and general context, as a concept, has varied meanings and models (Davidson et al., 2005; Anthony, 1990, 1993, 2003; Deegan,1988; Spaniol & Koehler, 1994) and to date, the application and development of models or concepts relating to depression recovery specifically remain under-explored. However, since the switch in focus from maladaptive tendencies like the use of alcohol as a coping mechanism (e.g., Magovcevic & Addis, 2005) to proactive strategies like exercise (e.g., Gilbert, Earleywine, & Altman, 2021) and illness management (Simonds et al., 2014; Tew et al., 2012; Leamy et al., 2019) much of what is known about depression recovery fits with the broader concepts of recovery (e.g., Anthony, 1990). Though despite the shift towards recovery, how an individual with depression recovers is still not well established (Fogarty et al., 2018). This, therefore, called for further inquiry which goes beyond the typical methods of data collection (Doblyte & Jimenez-Mejias, 2017; Kopala-Sibley, & Zuroff, 2020) and captures the qualitative lived experience of those who have recovered from depression (Leamy et al., 2019; Ridge & Zieblan, 2006; Savel & Munro, 2017). An area of research methodology which has seen a rise in its implementation, especially within health contexts (Biosvert, 2003; Saunders & Eaton, 2018) and topics which the individual may find hard to communicate or express (Stutey et al., 2016; Tishelman et al., 2016; Biosvert, 2003; Saunders & Eaton, 2018), has come through the use of visual methods research, like photovoice (Clarke-Ibanez, 2004). There has been very little research to date has implemented visual methods in the exploration of depression alone. Additionally, the way in which photo methods or visual data collection has been implemented vary between studies. However, the studies which use participant generated photographs are akin to the use of art therapies, which have been used as alternative treatment methods for mental health (Blomdahl et al., 2018), and could lead to research which is beneficial for both parties (Han & Oliffe, 2016). Importantly, research which integrates visual data collection may reveal subtle, but key, processes that facilitate recovery in those who have experienced depression and potentially lead to treatment directives. Thesis statement & Aims: The complex nature of depression and the limited understanding of how to treat and manage the illness currently presents more questions than answers (France, Lysaker, & Robinson, 2007; Carlo et al., 2021). Exploring depression, from a point of recovery, may help to further the understanding of the illness and help guide and inform how best to approach treatment (Rush et la., 2006; Blomdahl et al., 2018). Qualitative recovery focused research is scarce compared to other literature surrounding depression (Leamy et al., 2019). Implementing creative methodologies could help to further the understanding of the complex condition and expand on how recovery occurs, having been successfully implemented in a variety of research fields like chronic illness (e.g., Oliffe & Bottorff, 2007; Papaloukas, Quincey, & Williamson, 2017; Crogan et al., 2008). The use of photography appears the most popularised approach and the most widely implemented form of creative data collection. However, the application of these visual methods varies, and no set guidelines are in place for the implementation of them, therefore the first aim of this thesis is to establish through a scoping review how best to implement visual data collection in mental health research, specifically to the exploration of depression recovery. Understanding how to implement visual data collection provides only half of the basis to build and develop a method of data collection. The second aim is to develop a task orientated tool which guides participants in their exploration of their experiences. Gibson’s (2018) work with visual methods serves as a useful guide for adopting a visual approach to explore depression recovery. The primary aim of this thesis is to then inductively explore the lived experience of depression recovery asking the following questions: “What key elements do people focus on when communicating their recovery?” and “How do people express their recovery from depression verbally and photographically?”. The aim of this is to extract key elements that individuals focus on when describing their recovery and management of depression, and how they conceptualise their experience of depression and recovery. Methods: This research adopted an inductive approach and implemented reflexive thematic analysis (Braun & Clarke, 2022) as a way to explore the topic without being bound by a particular theoretical and potentially restrictive lens. Following the findings of a scoping review, and the subsequent development of a data collection tool, this study asked participants to explore and capture visually their experiences of depression and associated recovery photographically, and later discuss these photographs as part of an interview focussing on recovery processes. A total of twenty-two participants aged between 18 and 62 (6=M, 16=F) engaged with the photography task, 21 of whom attended and shared their experiences at interview. Participants collected and shared a total of 273 photographs and provided over 33 hours of interview data. Photographs were embedded within interview transcripts at the relevant point of discussion and both the visual and verbal data were analysed collectively in accordance with the guidelines for reflexive thematic analysis. Findings: Through reflexive thematic analysis five themes with a total of twelve subthemes were developed which explored how the participants communicated their visual-verbal depression recovery experiences through photographs, narratives, and how engaging with photo-methodology was received. Theme 1: Methodological empowerment, primarily explores and evaluates the photographic element developed for this research study. It draws on how the participants chose to use photography in how they shared, expressed and communicated their experiences as well as exploring how the participants found the process of taking photographs of their experiences. Theme 1 consists of two sub-themes: Freedom through Photography, and Evaluating the Process. Theme 2: Then and Now. Seeing the difference. This theme explores the difference in perspective that these participants held when looking back over their experiences of depression and the contrast in perspective they hold whilst experiencing a period of relative recovery. This theme consists of two sub- themes: The Darkness of Depression, and The Colour of Recovery. The remaining three themes all focus on the recovery process of these individuals, particularly their ownership of their situation. Theme 3: Their Recovery Process captured the first part in the participants’ recovery journey. It explores initial depressive experiences and critical points, how participants acknowledged and accepted the issue, and how they approached their depression. Within this theme, there are three subthemes: Being overwhelmed, Acceptance, and Learning. Theme 4 Their Recovery outcomes represented the second part of their recovery journey and examines what recovery means to the participants, what their depression and subsequent recovery means to them, and how their experiences have influenced them as people and their lives. This theme has three subthemes: What Recovery Means (to them), Personal Growth, and Wanting to Help. Theme 5: Their Advice for Recovery explores the third part of the participants recovery journey and looks at how experiencing depression and their recovery has influenced them insofar as wanting to help others who experience depression. This theme considers advice-giving, strategies and coping mechanisms as advocated by the participants, based on what helped their own recoveries. This final theme comprises two subthemes: What Worked (for them), and Taking Time. However, amongst the participants of the study, the emphasis they place on their ownership is worth noting. The central concept, and superordinate theme, of ownership is something which has been observed in other recovery literature (e.g., diabetes: Lee et al., 2019; smoking cessation Liebmann et al., 2019; HIV support: Farber, 2018; alcohol abuse recovery: Holzhauer et al., 2020) under a slightly different terminology (e.g., Self-determination: Piltch, 2016; Agency: Koch, 2018; Wood, Griffiths, & Paltoglou, 2021). These participants acknowledge and recognise their role in both their depression and their recovery and drawing on this factor in particular is one way in which this study contributes to the growing understanding of how best to encourage and facilitate recovery through depression. Implications & Applications for Research & Practice: The original contribution made by this thesis stems through the novel approach to data collection that explores depression recovery, notable the use of visual-methods which in turn facilitated the developed of the second contribution to this topic area, that is the importance of illness ownership surrounding depression recovery, Likewise, the findings are expected to have both academic and real-world impact and applications through recommendations for coping strategies, mood management, subtle symptom awareness, useful imagery to tackle stigma, and for future development, piloting and evaluation of a therapeutic tool to facilitate depression recovery. The findings also add to the growing consensus about the finding that whilst men and women may initially portray depression differently, their process of recovery is fundamentally the same, and their focus on proactive strategies rather than their treatment choices. These insights make for interesting material for practitioners looking to advise patients on their options as to how to engage in proactive and recovery orientated behaviours, and to consider how to promote to patients their role in both their depression and their recovery. There are plans to disseminate this research through interactive exhibitions which will make the photographs the main focus of an individual’s story, allowing academic and lay audiences to visualise what life may be like to live with and to recover through depression. The plans to have an exhibition and give voice to those who may be living in silence with depression and looking for ideas and opportunities to begin their own recovery journeys. Additionally, the photographic tool which was used to collect data has been developed further into a self-reflection task for improving mental health for users through exploring aspects of their experiences through photography. Recommendations for further research are directed towards developing the photography task further into a therapeutic tool that can be adapted as a smart phone application and rolled out alongside more traditional treatments options, and applied within a clinical setting.","abstract_html":"Background/Context: Depression is the leading cause of disability worldwide (WHO, 2021), within the UK alone this equates to 13.7% of the population or 7 million individuals experiencing and living with the debilitating condition (PHE, 2019; Mental Health Foundation, 2016). Over the last century depression, and indeed mental health in general, has grown and developed as a topic of research and subsequently the diagnostic and statistical manual of mental health (DSM) has been implemented to help guide and inform practitioner judgement. Now in its fifth edition (DSM-5-TR: APA, 2022) the DSM has moved from a singular understanding of depression to one which has variations and subtypes (Dodd et al. 2021; Allen, Rhoades, & Mazzoni, 2023; Hjordt et al., 2017) same fundamental underlying symptoms of: feelings of worthlessness; diminished interest or pleasure in activities; fatigue or loss of energy; poor concentration or indecisiveness; and recurrent thoughts of death and/or recurrent suicidal ideation or suicidal behaviours (American Psychological Association, 2013). There is a wealth of research surrounding depression (Oxenkrug, 2013; Blows, 2021; Schroder et al., 2022; Larkings et al., 2017; Dillon et al., 2014). Research trends have predominantly focused on the aetiology of depression (Nadeau et al., 2016; Genuchi & Mitsunaga, 2015; Su, D’Arcy, & Meng 2021) but despite advancements (Horwitz et al., 2016), there is still little understanding as to how depression occurs in individuals. Likewise, whilst this research has illuminated certain factors which could suggest an increased risk of depression (Wardenaar et al., 2014; Blomdahl et al., 2018), these factors are far ranging and suggest that almost every factor of an individual’s life could lead to a susceptibility to the mental health condition (Reynolds, Meng & Hall, 2020; Cutrona et al., 2005; Emslie et al., 1997). Depression may be complex, with many ways and avenues of exploration leading to wide-ranging approaches taken to study it, there are however several key points of view which have attempted to make sense of the condition (Kendler, 2005; Dillon et al., 2014). The most popular understanding stems through the biomedical perspective which considers depression to be a chemical imbalance within the brain (France, Lysaker, & Robinson, 2007 Blows, 2021; Schroder et al., 2022; Larkings et al., 2017) relating to levels of serotonin and/or dopamine, though the cause of this imbalance is subject to debate. Treatments for the condition are also complex (Spendelow, 2015; Johnson et al., 2017: Begun et al., 2003; Chamberlain et al., 1984; Lehmer, 1986) and not conclusively understood (Magavi, Reti, & Vas, 2017; Kennard et al., 2006; March et al., 2004) in the sense that no single treatment works for all people with depression and the rates of the effectiveness varies, as too are the approaches to treatment. Nevertheless, these treatments tend to be either pharmacological or non-pharmacological. Initial pharmacological treatments, such as selective serotonin reuptake inhibitors (SNRI’s: Weissman, 2014), were identified as a side effect for another condition (Tuberculosis: Healy, 2001) and whilst this coincidence has birthed the field of psychopharmaceuticals (Healy, 2001), these types of treatments have varied rates of efficacy (Fullagar, 2009). Non-pharmacological treatment like cognitive behavioural therapy (CBT: Seidler et al., 2016) also present differing rates of effectiveness (Blomdahl et al., 2018) but have demonstrated better outcomes for individuals in terms of alleviating and managing depressive symptoms (Wigand et al., 2019 Zimmermann, et al., 2020). However, some research suggests that rather than the type of treatment, it is the choices the individual makes in terms of their treatment which is more important (Fullagar, 2009; Spendelow, 2015). However, before an individual decides to seek help and receive treatment for their depression, barriers such as stigma (Gilkes, Perich & Meade, 2019; Allen, Rhoades, & Mazzoni, 2023; Wittenborn, Culpepper, & Liu, 2012) and culture (Perkins, Kelly, & Lasiter, 2015) can interfere with an individual’s help seeking behaviours. Additionally, depression was initially believed to only affect the female population (Prior, 1999; Bebbington, 1996; Paykel, 1991) and a lot of the early research predominantly explored female-only populations (Brownhill et al., 2005) which inadvertently created issues in the portrayal and understanding of depression in men (Scholz, Crabb, & Wittert, 2017) thereby adding a further layer of complexity to the understanding of depression. With the wealth of research, and the increased levels of complexity, some scholars have argued that there has been very little evidence to suggest that the field and understanding of depression has advanced at all over the last half century (Horwitz et al., 2016). Along with this, some scholars (Milasan, Bingley & fisher, 2020; Emslie et al., 2006; Whittle et al., 2015; Kelly et al., 2008; Wirback et al., 2017) have also called for a switch in research focus away from causes and symptoms and to approach depression from a point of recovery in order to advance the field. Recovery in a broad and general context, as a concept, has varied meanings and models (Davidson et al., 2005; Anthony, 1990, 1993, 2003; Deegan,1988; Spaniol & Koehler, 1994) and to date, the application and development of models or concepts relating to depression recovery specifically remain under-explored. However, since the switch in focus from maladaptive tendencies like the use of alcohol as a coping mechanism (e.g., Magovcevic & Addis, 2005) to proactive strategies like exercise (e.g., Gilbert, Earleywine, & Altman, 2021) and illness management (Simonds et al., 2014; Tew et al., 2012; Leamy et al., 2019) much of what is known about depression recovery fits with the broader concepts of recovery (e.g., Anthony, 1990). Though despite the shift towards recovery, how an individual with depression recovers is still not well established (Fogarty et al., 2018). This, therefore, called for further inquiry which goes beyond the typical methods of data collection (Doblyte & Jimenez-Mejias, 2017; Kopala-Sibley, & Zuroff, 2020) and captures the qualitative lived experience of those who have recovered from depression (Leamy et al., 2019; Ridge & Zieblan, 2006; Savel & Munro, 2017). An area of research methodology which has seen a rise in its implementation, especially within health contexts (Biosvert, 2003; Saunders & Eaton, 2018) and topics which the individual may find hard to communicate or express (Stutey et al., 2016; Tishelman et al., 2016; Biosvert, 2003; Saunders & Eaton, 2018), has come through the use of visual methods research, like photovoice (Clarke-Ibanez, 2004). There has been very little research to date has implemented visual methods in the exploration of depression alone. Additionally, the way in which photo methods or visual data collection has been implemented vary between studies. However, the studies which use participant generated photographs are akin to the use of art therapies, which have been used as alternative treatment methods for mental health (Blomdahl et al., 2018), and could lead to research which is beneficial for both parties (Han & Oliffe, 2016). Importantly, research which integrates visual data collection may reveal subtle, but key, processes that facilitate recovery in those who have experienced depression and potentially lead to treatment directives. Thesis statement & Aims: The complex nature of depression and the limited understanding of how to treat and manage the illness currently presents more questions than answers (France, Lysaker, & Robinson, 2007; Carlo et al., 2021). Exploring depression, from a point of recovery, may help to further the understanding of the illness and help guide and inform how best to approach treatment (Rush et la., 2006; Blomdahl et al., 2018). Qualitative recovery focused research is scarce compared to other literature surrounding depression (Leamy et al., 2019). Implementing creative methodologies could help to further the understanding of the complex condition and expand on how recovery occurs, having been successfully implemented in a variety of research fields like chronic illness (e.g., Oliffe & Bottorff, 2007; Papaloukas, Quincey, & Williamson, 2017; Crogan et al., 2008). The use of photography appears the most popularised approach and the most widely implemented form of creative data collection. However, the application of these visual methods varies, and no set guidelines are in place for the implementation of them, therefore the first aim of this thesis is to establish through a scoping review how best to implement visual data collection in mental health research, specifically to the exploration of depression recovery. Understanding how to implement visual data collection provides only half of the basis to build and develop a method of data collection. The second aim is to develop a task orientated tool which guides participants in their exploration of their experiences. Gibson’s (2018) work with visual methods serves as a useful guide for adopting a visual approach to explore depression recovery. The primary aim of this thesis is to then inductively explore the lived experience of depression recovery asking the following questions: “What key elements do people focus on when communicating their recovery?” and “How do people express their recovery from depression verbally and photographically?”. The aim of this is to extract key elements that individuals focus on when describing their recovery and management of depression, and how they conceptualise their experience of depression and recovery. Methods: This research adopted an inductive approach and implemented reflexive thematic analysis (Braun & Clarke, 2022) as a way to explore the topic without being bound by a particular theoretical and potentially restrictive lens. Following the findings of a scoping review, and the subsequent development of a data collection tool, this study asked participants to explore and capture visually their experiences of depression and associated recovery photographically, and later discuss these photographs as part of an interview focussing on recovery processes. A total of twenty-two participants aged between 18 and 62 (6=M, 16=F) engaged with the photography task, 21 of whom attended and shared their experiences at interview. Participants collected and shared a total of 273 photographs and provided over 33 hours of interview data. Photographs were embedded within interview transcripts at the relevant point of discussion and both the visual and verbal data were analysed collectively in accordance with the guidelines for reflexive thematic analysis. Findings: Through reflexive thematic analysis five themes with a total of twelve subthemes were developed which explored how the participants communicated their visual-verbal depression recovery experiences through photographs, narratives, and how engaging with photo-methodology was received. Theme 1: Methodological empowerment, primarily explores and evaluates the photographic element developed for this research study. It draws on how the participants chose to use photography in how they shared, expressed and communicated their experiences as well as exploring how the participants found the process of taking photographs of their experiences. Theme 1 consists of two sub-themes: Freedom through Photography, and Evaluating the Process. Theme 2: Then and Now. Seeing the difference. This theme explores the difference in perspective that these participants held when looking back over their experiences of depression and the contrast in perspective they hold whilst experiencing a period of relative recovery. This theme consists of two sub- themes: The Darkness of Depression, and The Colour of Recovery. The remaining three themes all focus on the recovery process of these individuals, particularly their ownership of their situation. Theme 3: Their Recovery Process captured the first part in the participants’ recovery journey. It explores initial depressive experiences and critical points, how participants acknowledged and accepted the issue, and how they approached their depression. Within this theme, there are three subthemes: Being overwhelmed, Acceptance, and Learning. Theme 4 Their Recovery outcomes represented the second part of their recovery journey and examines what recovery means to the participants, what their depression and subsequent recovery means to them, and how their experiences have influenced them as people and their lives. This theme has three subthemes: What Recovery Means (to them), Personal Growth, and Wanting to Help. Theme 5: Their Advice for Recovery explores the third part of the participants recovery journey and looks at how experiencing depression and their recovery has influenced them insofar as wanting to help others who experience depression. This theme considers advice-giving, strategies and coping mechanisms as advocated by the participants, based on what helped their own recoveries. This final theme comprises two subthemes: What Worked (for them), and Taking Time. However, amongst the participants of the study, the emphasis they place on their ownership is worth noting. The central concept, and superordinate theme, of ownership is something which has been observed in other recovery literature (e.g., diabetes: Lee et al., 2019; smoking cessation Liebmann et al., 2019; HIV support: Farber, 2018; alcohol abuse recovery: Holzhauer et al., 2020) under a slightly different terminology (e.g., Self-determination: Piltch, 2016; Agency: Koch, 2018; Wood, Griffiths, & Paltoglou, 2021). These participants acknowledge and recognise their role in both their depression and their recovery and drawing on this factor in particular is one way in which this study contributes to the growing understanding of how best to encourage and facilitate recovery through depression. Implications & Applications for Research & Practice: The original contribution made by this thesis stems through the novel approach to data collection that explores depression recovery, notable the use of visual-methods which in turn facilitated the developed of the second contribution to this topic area, that is the importance of illness ownership surrounding depression recovery, Likewise, the findings are expected to have both academic and real-world impact and applications through recommendations for coping strategies, mood management, subtle symptom awareness, useful imagery to tackle stigma, and for future development, piloting and evaluation of a therapeutic tool to facilitate depression recovery. The findings also add to the growing consensus about the finding that whilst men and women may initially portray depression differently, their process of recovery is fundamentally the same, and their focus on proactive strategies rather than their treatment choices. These insights make for interesting material for practitioners looking to advise patients on their options as to how to engage in proactive and recovery orientated behaviours, and to consider how to promote to patients their role in both their depression and their recovery. There are plans to disseminate this research through interactive exhibitions which will make the photographs the main focus of an individual’s story, allowing academic and lay audiences to visualise what life may be like to live with and to recover through depression. The plans to have an exhibition and give voice to those who may be living in silence with depression and looking for ideas and opportunities to begin their own recovery journeys. Additionally, the photographic tool which was used to collect data has been developed further into a self-reflection task for improving mental health for users through exploring aspects of their experiences through photography. Recommendations for further research are directed towards developing the photography task further into a therapeutic tool that can be adapted as a smart phone application and rolled out alongside more traditional treatments options, and applied within a clinical setting.","abstract_has_math":false,"creators":["Shaw, Nicholas"],"institution":"De Montfort University","degree_name":"PhD","degree_level":"Doctoral","degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2024,"date_issued":"2024-01","date_published":"2024-01","updated_at":"2026-07-24T06:18:54Z","subjects":[],"languages":[],"rights":[],"rights_urls":["https://dora.dmu.ac.uk/bitstreams/ca9a83cf-8b94-47aa-8185-6d4960be2363/download"],"identifier_entries":[]},"links":{"outbound_url":null,"outbound_label":null,"outbound_source":null},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Shaw, Nicholas"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.issued","label":"Date","values":["2024-01"]},{"key":"dc:publisher.department","label":"Dc Publisher Department","values":["Faculty of Health and Life Sciences"]},{"key":"dc:publisher.institution","label":"Dc Publisher Institution","values":["De Montfort University"]},{"key":"dc:relation.isreferencedby","label":"Dc Relation Isreferencedby","values":["https://hdl.handle.net/2086/25155"]},{"key":"dc:type","label":"Dc Type","values":["Thesis or dissertation"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Doctoral"]},{"key":"dc:type.qualificationname","label":"Dc Type Qualificationname","values":["PhD"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:rights","label":"Dc Rights","values":["https://dora.dmu.ac.uk/bitstreams/ca9a83cf-8b94-47aa-8185-6d4960be2363/download"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://dora.dmu.ac.uk/bitstreams/30374771-d211-40e6-8a08-1c0aebab74fd/download"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Background/Context: Depression is the leading cause of disability worldwide (WHO, 2021), within the UK alone this equates to 13.7% of the population or 7 million individuals experiencing and living with the debilitating condition (PHE, 2019; Mental Health Foundation, 2016). Over the last century depression, and indeed mental health in general, has grown and developed as a topic of research and subsequently the diagnostic and statistical manual of mental health (DSM) has been implemented to help guide and inform practitioner judgement. Now in its fifth edition (DSM-5-TR: APA, 2022) the DSM has moved from a singular understanding of depression to one which has variations and subtypes (Dodd et al. 2021; Allen, Rhoades, & Mazzoni, 2023; Hjordt et al., 2017) same fundamental underlying symptoms of: feelings of worthlessness; diminished interest or pleasure in activities; fatigue or loss of energy; poor concentration or indecisiveness; and recurrent thoughts of death and/or recurrent suicidal ideation or suicidal behaviours (American Psychological Association, 2013). There is a wealth of research surrounding depression (Oxenkrug, 2013; Blows, 2021; Schroder et al., 2022; Larkings et al., 2017; Dillon et al., 2014). Research trends have predominantly focused on the aetiology of depression (Nadeau et al., 2016; Genuchi & Mitsunaga, 2015; Su, D’Arcy, & Meng 2021) but despite advancements (Horwitz et al., 2016), there is still little understanding as to how depression occurs in individuals. Likewise, whilst this research has illuminated certain factors which could suggest an increased risk of depression (Wardenaar et al., 2014; Blomdahl et al., 2018), these factors are far ranging and suggest that almost every factor of an individual’s life could lead to a susceptibility to the mental health condition (Reynolds, Meng & Hall, 2020; Cutrona et al., 2005; Emslie et al., 1997). Depression may be complex, with many ways and avenues of exploration leading to wide-ranging approaches taken to study it, there are however several key points of view which have attempted to make sense of the condition (Kendler, 2005; Dillon et al., 2014). The most popular understanding stems through the biomedical perspective which considers depression to be a chemical imbalance within the brain (France, Lysaker, & Robinson, 2007 Blows, 2021; Schroder et al., 2022; Larkings et al., 2017) relating to levels of serotonin and/or dopamine, though the cause of this imbalance is subject to debate. Treatments for the condition are also complex (Spendelow, 2015; Johnson et al., 2017: Begun et al., 2003; Chamberlain et al., 1984; Lehmer, 1986) and not conclusively understood (Magavi, Reti, & Vas, 2017; Kennard et al., 2006; March et al., 2004) in the sense that no single treatment works for all people with depression and the rates of the effectiveness varies, as too are the approaches to treatment. Nevertheless, these treatments tend to be either pharmacological or non-pharmacological. Initial pharmacological treatments, such as selective serotonin reuptake inhibitors (SNRI’s: Weissman, 2014), were identified as a side effect for another condition (Tuberculosis: Healy, 2001) and whilst this coincidence has birthed the field of psychopharmaceuticals (Healy, 2001), these types of treatments have varied rates of efficacy (Fullagar, 2009). Non-pharmacological treatment like cognitive behavioural therapy (CBT: Seidler et al., 2016) also present differing rates of effectiveness (Blomdahl et al., 2018) but have demonstrated better outcomes for individuals in terms of alleviating and managing depressive symptoms (Wigand et al., 2019 Zimmermann, et al., 2020). However, some research suggests that rather than the type of treatment, it is the choices the individual makes in terms of their treatment which is more important (Fullagar, 2009; Spendelow, 2015). However, before an individual decides to seek help and receive treatment for their depression, barriers such as stigma (Gilkes, Perich & Meade, 2019; Allen, Rhoades, & Mazzoni, 2023; Wittenborn, Culpepper, & Liu, 2012) and culture (Perkins, Kelly, & Lasiter, 2015) can interfere with an individual’s help seeking behaviours. Additionally, depression was initially believed to only affect the female population (Prior, 1999; Bebbington, 1996; Paykel, 1991) and a lot of the early research predominantly explored female-only populations (Brownhill et al., 2005) which inadvertently created issues in the portrayal and understanding of depression in men (Scholz, Crabb, & Wittert, 2017) thereby adding a further layer of complexity to the understanding of depression. With the wealth of research, and the increased levels of complexity, some scholars have argued that there has been very little evidence to suggest that the field and understanding of depression has advanced at all over the last half century (Horwitz et al., 2016). Along with this, some scholars (Milasan, Bingley & fisher, 2020; Emslie et al., 2006; Whittle et al., 2015; Kelly et al., 2008; Wirback et al., 2017) have also called for a switch in research focus away from causes and symptoms and to approach depression from a point of recovery in order to advance the field. Recovery in a broad and general context, as a concept, has varied meanings and models (Davidson et al., 2005; Anthony, 1990, 1993, 2003; Deegan,1988; Spaniol & Koehler, 1994) and to date, the application and development of models or concepts relating to depression recovery specifically remain under-explored. However, since the switch in focus from maladaptive tendencies like the use of alcohol as a coping mechanism (e.g., Magovcevic & Addis, 2005) to proactive strategies like exercise (e.g., Gilbert, Earleywine, & Altman, 2021) and illness management (Simonds et al., 2014; Tew et al., 2012; Leamy et al., 2019) much of what is known about depression recovery fits with the broader concepts of recovery (e.g., Anthony, 1990). Though despite the shift towards recovery, how an individual with depression recovers is still not well established (Fogarty et al., 2018). This, therefore, called for further inquiry which goes beyond the typical methods of data collection (Doblyte & Jimenez-Mejias, 2017; Kopala-Sibley, & Zuroff, 2020) and captures the qualitative lived experience of those who have recovered from depression (Leamy et al., 2019; Ridge & Zieblan, 2006; Savel & Munro, 2017). An area of research methodology which has seen a rise in its implementation, especially within health contexts (Biosvert, 2003; Saunders & Eaton, 2018) and topics which the individual may find hard to communicate or express (Stutey et al., 2016; Tishelman et al., 2016; Biosvert, 2003; Saunders & Eaton, 2018), has come through the use of visual methods research, like photovoice (Clarke-Ibanez, 2004). There has been very little research to date has implemented visual methods in the exploration of depression alone. Additionally, the way in which photo methods or visual data collection has been implemented vary between studies. However, the studies which use participant generated photographs are akin to the use of art therapies, which have been used as alternative treatment methods for mental health (Blomdahl et al., 2018), and could lead to research which is beneficial for both parties (Han & Oliffe, 2016). Importantly, research which integrates visual data collection may reveal subtle, but key, processes that facilitate recovery in those who have experienced depression and potentially lead to treatment directives. Thesis statement & Aims: The complex nature of depression and the limited understanding of how to treat and manage the illness currently presents more questions than answers (France, Lysaker, & Robinson, 2007; Carlo et al., 2021). Exploring depression, from a point of recovery, may help to further the understanding of the illness and help guide and inform how best to approach treatment (Rush et la., 2006; Blomdahl et al., 2018). Qualitative recovery focused research is scarce compared to other literature surrounding depression (Leamy et al., 2019). Implementing creative methodologies could help to further the understanding of the complex condition and expand on how recovery occurs, having been successfully implemented in a variety of research fields like chronic illness (e.g., Oliffe & Bottorff, 2007; Papaloukas, Quincey, & Williamson, 2017; Crogan et al., 2008). The use of photography appears the most popularised approach and the most widely implemented form of creative data collection. However, the application of these visual methods varies, and no set guidelines are in place for the implementation of them, therefore the first aim of this thesis is to establish through a scoping review how best to implement visual data collection in mental health research, specifically to the exploration of depression recovery. Understanding how to implement visual data collection provides only half of the basis to build and develop a method of data collection. The second aim is to develop a task orientated tool which guides participants in their exploration of their experiences. Gibson’s (2018) work with visual methods serves as a useful guide for adopting a visual approach to explore depression recovery. The primary aim of this thesis is to then inductively explore the lived experience of depression recovery asking the following questions: “What key elements do people focus on when communicating their recovery?” and “How do people express their recovery from depression verbally and photographically?”. The aim of this is to extract key elements that individuals focus on when describing their recovery and management of depression, and how they conceptualise their experience of depression and recovery. Methods: This research adopted an inductive approach and implemented reflexive thematic analysis (Braun & Clarke, 2022) as a way to explore the topic without being bound by a particular theoretical and potentially restrictive lens. Following the findings of a scoping review, and the subsequent development of a data collection tool, this study asked participants to explore and capture visually their experiences of depression and associated recovery photographically, and later discuss these photographs as part of an interview focussing on recovery processes. A total of twenty-two participants aged between 18 and 62 (6=M, 16=F) engaged with the photography task, 21 of whom attended and shared their experiences at interview. Participants collected and shared a total of 273 photographs and provided over 33 hours of interview data. Photographs were embedded within interview transcripts at the relevant point of discussion and both the visual and verbal data were analysed collectively in accordance with the guidelines for reflexive thematic analysis. Findings: Through reflexive thematic analysis five themes with a total of twelve subthemes were developed which explored how the participants communicated their visual-verbal depression recovery experiences through photographs, narratives, and how engaging with photo-methodology was received. Theme 1: Methodological empowerment, primarily explores and evaluates the photographic element developed for this research study. It draws on how the participants chose to use photography in how they shared, expressed and communicated their experiences as well as exploring how the participants found the process of taking photographs of their experiences. Theme 1 consists of two sub-themes: Freedom through Photography, and Evaluating the Process. Theme 2: Then and Now. Seeing the difference. This theme explores the difference in perspective that these participants held when looking back over their experiences of depression and the contrast in perspective they hold whilst experiencing a period of relative recovery. This theme consists of two sub- themes: The Darkness of Depression, and The Colour of Recovery. The remaining three themes all focus on the recovery process of these individuals, particularly their ownership of their situation. Theme 3: Their Recovery Process captured the first part in the participants’ recovery journey. It explores initial depressive experiences and critical points, how participants acknowledged and accepted the issue, and how they approached their depression. Within this theme, there are three subthemes: Being overwhelmed, Acceptance, and Learning. Theme 4 Their Recovery outcomes represented the second part of their recovery journey and examines what recovery means to the participants, what their depression and subsequent recovery means to them, and how their experiences have influenced them as people and their lives. This theme has three subthemes: What Recovery Means (to them), Personal Growth, and Wanting to Help. Theme 5: Their Advice for Recovery explores the third part of the participants recovery journey and looks at how experiencing depression and their recovery has influenced them insofar as wanting to help others who experience depression. This theme considers advice-giving, strategies and coping mechanisms as advocated by the participants, based on what helped their own recoveries. This final theme comprises two subthemes: What Worked (for them), and Taking Time. However, amongst the participants of the study, the emphasis they place on their ownership is worth noting. The central concept, and superordinate theme, of ownership is something which has been observed in other recovery literature (e.g., diabetes: Lee et al., 2019; smoking cessation Liebmann et al., 2019; HIV support: Farber, 2018; alcohol abuse recovery: Holzhauer et al., 2020) under a slightly different terminology (e.g., Self-determination: Piltch, 2016; Agency: Koch, 2018; Wood, Griffiths, & Paltoglou, 2021). These participants acknowledge and recognise their role in both their depression and their recovery and drawing on this factor in particular is one way in which this study contributes to the growing understanding of how best to encourage and facilitate recovery through depression. Implications & Applications for Research & Practice: The original contribution made by this thesis stems through the novel approach to data collection that explores depression recovery, notable the use of visual-methods which in turn facilitated the developed of the second contribution to this topic area, that is the importance of illness ownership surrounding depression recovery, Likewise, the findings are expected to have both academic and real-world impact and applications through recommendations for coping strategies, mood management, subtle symptom awareness, useful imagery to tackle stigma, and for future development, piloting and evaluation of a therapeutic tool to facilitate depression recovery. The findings also add to the growing consensus about the finding that whilst men and women may initially portray depression differently, their process of recovery is fundamentally the same, and their focus on proactive strategies rather than their treatment choices. These insights make for interesting material for practitioners looking to advise patients on their options as to how to engage in proactive and recovery orientated behaviours, and to consider how to promote to patients their role in both their depression and their recovery. There are plans to disseminate this research through interactive exhibitions which will make the photographs the main focus of an individual’s story, allowing academic and lay audiences to visualise what life may be like to live with and to recover through depression. The plans to have an exhibition and give voice to those who may be living in silence with depression and looking for ideas and opportunities to begin their own recovery journeys. Additionally, the photographic tool which was used to collect data has been developed further into a self-reflection task for improving mental health for users through exploring aspects of their experiences through photography. Recommendations for further research are directed towards developing the photography task further into a therapeutic tool that can be adapted as a smart phone application and rolled out alongside more traditional treatments options, and applied within a clinical setting."]},{"key":"dc:format.checksum.md5","label":"Dc Format Checksum Md5","values":["c3732c4eacbcf8f14e2491e8744ef92b","bd41181d9a4c38b5ebacc69a027024d9","f5d7e48c1d9160e48c4803852686cf7c"]},{"key":"dc:title","label":"Title","values":["“You’ve got to own your depression” The role of ownership in the process of depression recovery: A qualitative exploration of the visual-verbal accounts of depression recovery utilising photography"]}]}],"canonical_facts":{"dc:creator":["Shaw, Nicholas"],"dc:date.issued":["2024-01"],"dc:description.abstract":["Background/Context: Depression is the leading cause of disability worldwide (WHO, 2021), within the UK alone this equates to 13.7% of the population or 7 million individuals experiencing and living with the debilitating condition (PHE, 2019; Mental Health Foundation, 2016). Over the last century depression, and indeed mental health in general, has grown and developed as a topic of research and subsequently the diagnostic and statistical manual of mental health (DSM) has been implemented to help guide and inform practitioner judgement. Now in its fifth edition (DSM-5-TR: APA, 2022) the DSM has moved from a singular understanding of depression to one which has variations and subtypes (Dodd et al. 2021; Allen, Rhoades, & Mazzoni, 2023; Hjordt et al., 2017) same fundamental underlying symptoms of: feelings of worthlessness; diminished interest or pleasure in activities; fatigue or loss of energy; poor concentration or indecisiveness; and recurrent thoughts of death and/or recurrent suicidal ideation or suicidal behaviours (American Psychological Association, 2013). There is a wealth of research surrounding depression (Oxenkrug, 2013; Blows, 2021; Schroder et al., 2022; Larkings et al., 2017; Dillon et al., 2014). Research trends have predominantly focused on the aetiology of depression (Nadeau et al., 2016; Genuchi & Mitsunaga, 2015; Su, D’Arcy, & Meng 2021) but despite advancements (Horwitz et al., 2016), there is still little understanding as to how depression occurs in individuals. Likewise, whilst this research has illuminated certain factors which could suggest an increased risk of depression (Wardenaar et al., 2014; Blomdahl et al., 2018), these factors are far ranging and suggest that almost every factor of an individual’s life could lead to a susceptibility to the mental health condition (Reynolds, Meng & Hall, 2020; Cutrona et al., 2005; Emslie et al., 1997). Depression may be complex, with many ways and avenues of exploration leading to wide-ranging approaches taken to study it, there are however several key points of view which have attempted to make sense of the condition (Kendler, 2005; Dillon et al., 2014). The most popular understanding stems through the biomedical perspective which considers depression to be a chemical imbalance within the brain (France, Lysaker, & Robinson, 2007 Blows, 2021; Schroder et al., 2022; Larkings et al., 2017) relating to levels of serotonin and/or dopamine, though the cause of this imbalance is subject to debate. Treatments for the condition are also complex (Spendelow, 2015; Johnson et al., 2017: Begun et al., 2003; Chamberlain et al., 1984; Lehmer, 1986) and not conclusively understood (Magavi, Reti, & Vas, 2017; Kennard et al., 2006; March et al., 2004) in the sense that no single treatment works for all people with depression and the rates of the effectiveness varies, as too are the approaches to treatment. Nevertheless, these treatments tend to be either pharmacological or non-pharmacological. Initial pharmacological treatments, such as selective serotonin reuptake inhibitors (SNRI’s: Weissman, 2014), were identified as a side effect for another condition (Tuberculosis: Healy, 2001) and whilst this coincidence has birthed the field of psychopharmaceuticals (Healy, 2001), these types of treatments have varied rates of efficacy (Fullagar, 2009). Non-pharmacological treatment like cognitive behavioural therapy (CBT: Seidler et al., 2016) also present differing rates of effectiveness (Blomdahl et al., 2018) but have demonstrated better outcomes for individuals in terms of alleviating and managing depressive symptoms (Wigand et al., 2019 Zimmermann, et al., 2020). However, some research suggests that rather than the type of treatment, it is the choices the individual makes in terms of their treatment which is more important (Fullagar, 2009; Spendelow, 2015). However, before an individual decides to seek help and receive treatment for their depression, barriers such as stigma (Gilkes, Perich & Meade, 2019; Allen, Rhoades, & Mazzoni, 2023; Wittenborn, Culpepper, & Liu, 2012) and culture (Perkins, Kelly, & Lasiter, 2015) can interfere with an individual’s help seeking behaviours. Additionally, depression was initially believed to only affect the female population (Prior, 1999; Bebbington, 1996; Paykel, 1991) and a lot of the early research predominantly explored female-only populations (Brownhill et al., 2005) which inadvertently created issues in the portrayal and understanding of depression in men (Scholz, Crabb, & Wittert, 2017) thereby adding a further layer of complexity to the understanding of depression. With the wealth of research, and the increased levels of complexity, some scholars have argued that there has been very little evidence to suggest that the field and understanding of depression has advanced at all over the last half century (Horwitz et al., 2016). Along with this, some scholars (Milasan, Bingley & fisher, 2020; Emslie et al., 2006; Whittle et al., 2015; Kelly et al., 2008; Wirback et al., 2017) have also called for a switch in research focus away from causes and symptoms and to approach depression from a point of recovery in order to advance the field. Recovery in a broad and general context, as a concept, has varied meanings and models (Davidson et al., 2005; Anthony, 1990, 1993, 2003; Deegan,1988; Spaniol & Koehler, 1994) and to date, the application and development of models or concepts relating to depression recovery specifically remain under-explored. However, since the switch in focus from maladaptive tendencies like the use of alcohol as a coping mechanism (e.g., Magovcevic & Addis, 2005) to proactive strategies like exercise (e.g., Gilbert, Earleywine, & Altman, 2021) and illness management (Simonds et al., 2014; Tew et al., 2012; Leamy et al., 2019) much of what is known about depression recovery fits with the broader concepts of recovery (e.g., Anthony, 1990). Though despite the shift towards recovery, how an individual with depression recovers is still not well established (Fogarty et al., 2018). This, therefore, called for further inquiry which goes beyond the typical methods of data collection (Doblyte & Jimenez-Mejias, 2017; Kopala-Sibley, & Zuroff, 2020) and captures the qualitative lived experience of those who have recovered from depression (Leamy et al., 2019; Ridge & Zieblan, 2006; Savel & Munro, 2017). An area of research methodology which has seen a rise in its implementation, especially within health contexts (Biosvert, 2003; Saunders & Eaton, 2018) and topics which the individual may find hard to communicate or express (Stutey et al., 2016; Tishelman et al., 2016; Biosvert, 2003; Saunders & Eaton, 2018), has come through the use of visual methods research, like photovoice (Clarke-Ibanez, 2004). There has been very little research to date has implemented visual methods in the exploration of depression alone. Additionally, the way in which photo methods or visual data collection has been implemented vary between studies. However, the studies which use participant generated photographs are akin to the use of art therapies, which have been used as alternative treatment methods for mental health (Blomdahl et al., 2018), and could lead to research which is beneficial for both parties (Han & Oliffe, 2016). Importantly, research which integrates visual data collection may reveal subtle, but key, processes that facilitate recovery in those who have experienced depression and potentially lead to treatment directives. Thesis statement & Aims: The complex nature of depression and the limited understanding of how to treat and manage the illness currently presents more questions than answers (France, Lysaker, & Robinson, 2007; Carlo et al., 2021). Exploring depression, from a point of recovery, may help to further the understanding of the illness and help guide and inform how best to approach treatment (Rush et la., 2006; Blomdahl et al., 2018). Qualitative recovery focused research is scarce compared to other literature surrounding depression (Leamy et al., 2019). Implementing creative methodologies could help to further the understanding of the complex condition and expand on how recovery occurs, having been successfully implemented in a variety of research fields like chronic illness (e.g., Oliffe & Bottorff, 2007; Papaloukas, Quincey, & Williamson, 2017; Crogan et al., 2008). The use of photography appears the most popularised approach and the most widely implemented form of creative data collection. However, the application of these visual methods varies, and no set guidelines are in place for the implementation of them, therefore the first aim of this thesis is to establish through a scoping review how best to implement visual data collection in mental health research, specifically to the exploration of depression recovery. Understanding how to implement visual data collection provides only half of the basis to build and develop a method of data collection. The second aim is to develop a task orientated tool which guides participants in their exploration of their experiences. Gibson’s (2018) work with visual methods serves as a useful guide for adopting a visual approach to explore depression recovery. The primary aim of this thesis is to then inductively explore the lived experience of depression recovery asking the following questions: “What key elements do people focus on when communicating their recovery?” and “How do people express their recovery from depression verbally and photographically?”. The aim of this is to extract key elements that individuals focus on when describing their recovery and management of depression, and how they conceptualise their experience of depression and recovery. Methods: This research adopted an inductive approach and implemented reflexive thematic analysis (Braun & Clarke, 2022) as a way to explore the topic without being bound by a particular theoretical and potentially restrictive lens. Following the findings of a scoping review, and the subsequent development of a data collection tool, this study asked participants to explore and capture visually their experiences of depression and associated recovery photographically, and later discuss these photographs as part of an interview focussing on recovery processes. A total of twenty-two participants aged between 18 and 62 (6=M, 16=F) engaged with the photography task, 21 of whom attended and shared their experiences at interview. Participants collected and shared a total of 273 photographs and provided over 33 hours of interview data. Photographs were embedded within interview transcripts at the relevant point of discussion and both the visual and verbal data were analysed collectively in accordance with the guidelines for reflexive thematic analysis. Findings: Through reflexive thematic analysis five themes with a total of twelve subthemes were developed which explored how the participants communicated their visual-verbal depression recovery experiences through photographs, narratives, and how engaging with photo-methodology was received. Theme 1: Methodological empowerment, primarily explores and evaluates the photographic element developed for this research study. It draws on how the participants chose to use photography in how they shared, expressed and communicated their experiences as well as exploring how the participants found the process of taking photographs of their experiences. Theme 1 consists of two sub-themes: Freedom through Photography, and Evaluating the Process. Theme 2: Then and Now. Seeing the difference. This theme explores the difference in perspective that these participants held when looking back over their experiences of depression and the contrast in perspective they hold whilst experiencing a period of relative recovery. This theme consists of two sub- themes: The Darkness of Depression, and The Colour of Recovery. The remaining three themes all focus on the recovery process of these individuals, particularly their ownership of their situation. Theme 3: Their Recovery Process captured the first part in the participants’ recovery journey. It explores initial depressive experiences and critical points, how participants acknowledged and accepted the issue, and how they approached their depression. Within this theme, there are three subthemes: Being overwhelmed, Acceptance, and Learning. Theme 4 Their Recovery outcomes represented the second part of their recovery journey and examines what recovery means to the participants, what their depression and subsequent recovery means to them, and how their experiences have influenced them as people and their lives. This theme has three subthemes: What Recovery Means (to them), Personal Growth, and Wanting to Help. Theme 5: Their Advice for Recovery explores the third part of the participants recovery journey and looks at how experiencing depression and their recovery has influenced them insofar as wanting to help others who experience depression. This theme considers advice-giving, strategies and coping mechanisms as advocated by the participants, based on what helped their own recoveries. This final theme comprises two subthemes: What Worked (for them), and Taking Time. However, amongst the participants of the study, the emphasis they place on their ownership is worth noting. The central concept, and superordinate theme, of ownership is something which has been observed in other recovery literature (e.g., diabetes: Lee et al., 2019; smoking cessation Liebmann et al., 2019; HIV support: Farber, 2018; alcohol abuse recovery: Holzhauer et al., 2020) under a slightly different terminology (e.g., Self-determination: Piltch, 2016; Agency: Koch, 2018; Wood, Griffiths, & Paltoglou, 2021). These participants acknowledge and recognise their role in both their depression and their recovery and drawing on this factor in particular is one way in which this study contributes to the growing understanding of how best to encourage and facilitate recovery through depression. Implications & Applications for Research & Practice: The original contribution made by this thesis stems through the novel approach to data collection that explores depression recovery, notable the use of visual-methods which in turn facilitated the developed of the second contribution to this topic area, that is the importance of illness ownership surrounding depression recovery, Likewise, the findings are expected to have both academic and real-world impact and applications through recommendations for coping strategies, mood management, subtle symptom awareness, useful imagery to tackle stigma, and for future development, piloting and evaluation of a therapeutic tool to facilitate depression recovery. The findings also add to the growing consensus about the finding that whilst men and women may initially portray depression differently, their process of recovery is fundamentally the same, and their focus on proactive strategies rather than their treatment choices. These insights make for interesting material for practitioners looking to advise patients on their options as to how to engage in proactive and recovery orientated behaviours, and to consider how to promote to patients their role in both their depression and their recovery. There are plans to disseminate this research through interactive exhibitions which will make the photographs the main focus of an individual’s story, allowing academic and lay audiences to visualise what life may be like to live with and to recover through depression. The plans to have an exhibition and give voice to those who may be living in silence with depression and looking for ideas and opportunities to begin their own recovery journeys. Additionally, the photographic tool which was used to collect data has been developed further into a self-reflection task for improving mental health for users through exploring aspects of their experiences through photography. Recommendations for further research are directed towards developing the photography task further into a therapeutic tool that can be adapted as a smart phone application and rolled out alongside more traditional treatments options, and applied within a clinical setting."],"dc:format.checksum.md5":["c3732c4eacbcf8f14e2491e8744ef92b","bd41181d9a4c38b5ebacc69a027024d9","f5d7e48c1d9160e48c4803852686cf7c"],"dc:identifier.uri":["https://dora.dmu.ac.uk/bitstreams/30374771-d211-40e6-8a08-1c0aebab74fd/download"],"dc:publisher.department":["Faculty of Health and Life Sciences"],"dc:publisher.institution":["De Montfort University"],"dc:relation.isreferencedby":["https://hdl.handle.net/2086/25155"],"dc:rights":["https://dora.dmu.ac.uk/bitstreams/ca9a83cf-8b94-47aa-8185-6d4960be2363/download"],"dc:title":["“You’ve got to own your depression” The role of ownership in the process of depression recovery: A qualitative exploration of the visual-verbal accounts of depression recovery utilising photography"],"dc:type":["Thesis or dissertation"],"dc:type.qualificationlevel":["Doctoral"],"dc:type.qualificationname":["PhD"]},"updated_at":"2026-07-24T06:18:54Z"}