Using Image-Based Measures to Assess Mental Health and Wellbeing: A Systematic Review

Text-based self-report questionnaires are the predominant approach to understanding adolescent mental health. There are challenges to (a) the accessibility of such measures (e.g., due to required reading age) and (b) the inclusivity of such measures (e.g., if marginalized and minoritized groups were not included during measure development). Image-based measures may address some of the challenges of text-based self-report measures. The aim of this review was to examine the existing evidence on image-based based mental health measures. We conducted a pre-registered systematic review in line with PRISMA guidelines. We searched PsycTests, PsycINFO, PubMed, and grey literature for self-reported image-based measures of mental health and wellbeing for young people 8–18 years published 2018–2023. From 5,533 hits (after removing duplicates) we screened 55 full texts and included seven measures. These measures use images to convey information when asking questions and enable participants to respond using images, or enable participants to respond using images only. The main reported benefits of image-based measures were accessibility and inclusivity in comparison to text-based measures. This was due to their short length, ease of completion, and accessibility for those with limited reading comprehension or with special educational needs. Marginalized and minoritized groups of young people were involved in the development of many of the included measures, including those with relevant lived experience. Participatory methods were used for developing most measures, which involves working with young people as researchers equally in the creation of a measure. Some of the measures were developed with experts by experience and/or using participatory methods. We call for further research to develop new and innovative image-based measures working with young people from diverse groups to further increase the accessibility and inclusivity of self-reported mental health questionnaires.