Exploring uses of visual arts-based interventions for mental health of marginalized populations: a scoping review

BACKGROUND

The intentions of this scoping review are to determine current uses of visual arts-based interventions for mental health and trauma support of marginalized populations, and to identify current gaps in knowledge in this emergent field.

METHOD

Six databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, JSTOR) were searched for relevant studies. Following the PRISMA guidelines, 38 articles met the inclusion criteria.

RESULTS

Most interventions focused on improving the mental health of participants, or to provide opportunities for participants to process their experiences of mental health. Participants reported increased well-being, experiences of relaxation and/or distraction, and processing of mental health experiences. They perceived arts-based interventions as helpful and developed mutual social support with other participants.

CONCLUSION

Arts-based interventions have the potential to inform the development of culturally safe and relevant mental health care for marginalized populations beyond current mainstream mental health practices.

Assessing the mental health needs of Yazidi adolescents and young adults in an Iraqi Kurdi IDP Camp: a focus group study

BACKGROUND

Internally displaced people (IDP) in Iraq are 1.2 million (as March 2023). Protracted refugee status endangers the mental health, especially of minorities who survived persecution and conflict, such as the Yazidis. This study aims to identify the mental health needs of Yazidi adolescents and young adults (AYA) in the IDP camp of Bajed Kandala (Iraqi Kurdistan).

METHODS

A focus group discussion (FGD) study was conducted between April and August 2022. The FGDs involved AYAs, as well as the staff of the clinic of the Bajed Kandala camp. An inductive approach was adopted referring to the 'theme' as the unit of content analysis of the text. All FGDs were recorded and transcribed. The analysis was carried out independently by two researchers. The inter-rater agreement was assessed through the Cohen's k.

RESULTS

A total of 6 FGDs were conducted. The participants were 34 of whom 21 (61.8%) females with a median age of 18.5 years (IQR 17.0-21.0). A total of 156 themes were found as relevant to the objective of this study. Four main areas and twelve subareas of needs in mental health were identified. The interrater agreement over the main area and subareas was good (κ = 0.78 [0.95CI 0.69-0.88], κ = 0.82 [0.95CI 0.73-0.91], respectively). The four areas had a similar frequency: Activities (28.2%), Individual (27.6%), Social relationships (22.4%) and Places/setting (21.8%). The subareas 'community' and 'internal resources' were labelled as negative 85.7% and 61.9% of the time, respectively. These sub-areas referred to stigma and self-stigma towards mental health. The subarea 'female condition' was always considered as negative, as well as the subareas 'camp' and 'tent' referring to housing as an important social determinant of mental health.

CONCLUSIONS

Community stigma and self-stigma are two still important factors preventing the achievement of mental well-being. Alongside these, a gender gap in mental health was identified in the FGDs. These factors should be taken into account in order to guide future mental health interventions in refugee camps.

Understanding how classroom drama workshops can facilitate social capital for newly arrived migrant and refugee adolescents: Insights from Denmark

Art-based interventions, such as classroom drama workshops (CDWs), increasingly form part of a collection of mental health-promoting activities introduced in school settings. While research points to the potential benefits of CDWs for the mental well-being of refugee and migrant adolescents, the mechanisms to such improvement are less understood. In this article we respond to the need for qualitative evidence of how CDW interventions affect refugee and migrant adolescents' experience. The study draws on eight focus group discussions (FGDs) with 41 adolescents, four semi-structured interviews with teachers and a school coordinator, and written documents from two drama therapists. Our thematic analysis revealed that the CDWs were found to foster trust and improve social relations in the classroom-key facets of bonding social capital. Several processes were described as being linked to these changes. Participants spoke about how the CDWs were facilitated in an emancipatory and safe manner, creating social spaces where the adolescents could have fun together, share, and bear witness to each other's stories, as well as experiencing a sense of agency. In some cases, however, activities in the CDWs crossed the learners' psychological boundaries, which led to withdrawal and a loss of trust. We conclude that whilst CDWs have the potential to facilitate bonding social capital amongst refugee and migrant adolescents and their teachers, this potential hinges on how the CDWs are facilitated.

Art-based interventions and art therapy to promote health of migrant populations - a systematic literature review of current research

BACKGROUND

This review aims to identify and analyse studies on art-based interventions and art therapy that are intended to promote better physical, mental and social health outcomes in culturally and linguistically diverse migrant populations.

METHOD

A systematic literature review was used to address the following questions: 1) What published studies over the past five years examined health outcomes? 2) What are the identifying characteristics of the studies? 3) What kinds of effect did these studies describe? 4) What implications do the findings have for future research in this field?

RESULTS

Art-based interventions and art therapy can significantly reduce traumatic stress symptoms and anxiety, enhance well-being by giving people greater life satisfaction and hope, and improve the social behaviour of children and adolescents.

CONCLUSION

In order to address humanitarian concerns in this field, researchers may apply innovative approaches to engage people from a refugee background in meaningful reflections on their lives.

Traces of health-A landscape design task as a diagnostic aid for detecting mental burden? A qualitative focus group study

Background

Mental disorders are most common causes of illness worldwide. Studies on art and drawing tasks, such as the tree-drawing test have already proven their prognostic quality for the diagnosis of Alzheimer's disease, depression or trauma. In the depiction of art in public space, gardens and landscapes are one of the oldest human forms of artistic expression. This study thus aims at exploring the impact of a landscape design task as a prognostic tool to detect mental burden.

Materials and methods

A total of 15 individuals (eight female) aged between 19 and 60 years completed the Brief Symptom Inventory BSI-18 and the State Trait Anxiety Inventory (STAI-S) before being asked to design a landscape in a 3 × 3 m squared area. Material to be used included plants, flowers, branches, and stones. The complete process of landscape design was videotaped and the tapes were analyzed in a two-step focus group analysis from a group of gardening trainees, psychology students and students of arts therapies. Results were condensed in a second step into major categories.

Results

Scores of the BSI-18 showed a range of 2-21 points and STAI-S scores ranged between 29 and 54 points indicating a light to moderate mental burden. Focus group participants identified three mutually perpendicular major components associated with mental health: "Movement and Activity," "Material Selection and Design," and "Connectedness to the task." In a subsample of the three least and three most mentally stressed subjects (based on their GSI and STAI-S scorings), clear differences were found in body posture, action planning and the choice of material and aspects of design.

Discussion

In addition to the well-known therapeutic potential of gardening, this study for the first time showed that gardening and landscape design contains diagnostic elements. Our preliminary findings are in coherence with similar research indicating a high association of movement and design patterns with mental burden. However, due to the pilot nature of the study, the results should be interpreted cautiously. Based on the findings further studies are currently planned.

The Effect of Calligraphy as an Art Therapy Intervention Containing Religious Motifs, on the Anxiety and Depression in Adolescent Psychiatric Patients

This research was conducted to determine the effect of calligraphy on the anxiety and depression levels of adolescent psychiatric patients. It was conducted with adolescent psychiatric patients ages 14-17 in Turkey's Eastern Anatolia Region. They were allocated a calligraphy (n = 40) or a wait-list (n = 39) group. Those in the calligraphy group participated in 60-min calligraphy sessions for three weeks. The state anxiety levels of adolescents who applied calligraphy decreased gradually when compared with adolescents in the control group. The difference between the third-week mean post-test state anxiety scores of the adolescents in the calligraphy and control groups was significant (t = 2.34, p = .02). The trait anxiety scale and depression scale mean post-test scores of the adolescents in the calligraphy group were lower than in the control group. The difference between two groups was significant. Calligraphy can be potentially used as a beneficial method for reducing anxiety and depression.

Photovoice Techniques and Art Therapy Approaches with Refugee and Immigrant Adolescents

This paper describes a program informed by art therapy and Photovoice approaches and techniques aimed at helping new immigrant and refugee teens to navigate personal and cultural identities by reflecting on their experiences as new residents in the US. Photovoice is a photography and social action method that encourages participants to photograph aspects of their daily lives, reflect on their meaning and significance and galvanize necessary changes. The program began in February 2020 at the Arab-American National Museum (AANM), but was adapted for an online format and re-framed towards a reflection on the COVID-19 pandemic. Broad questions teens explored included: What is good? What is challenging? What is sustaining during challenging times? What needs to change? and What about your culture and background are you proud of and wish to share with other US residents? Highlights of the sessions demonstrate how art therapy interventions paralleled photography-assigned themes of self, home, and community and encouraged group interaction and mutual support. A virtual museum exhibition culminated the program and reached community leaders. Self-reports from select participants highlight changes in posttraumatic stress, anxiety, and somatic symptoms over the course of programming.

A Systematic Review of Empirical Evidence on Art Therapy With Traumatized Refugee Children and Youth

The current global refugee crisis revealed that refugee children, youth, and adults are uniquely vulnerable to traumatic events. Yet, there are only a few studies available that report robust systematic data on art therapy interventions with mental health in recent refugee populations. The purpose of the study is to synthesize and evaluate (a) the available research evidence on the use of art therapy in reducing post-traumatic stress disorder (PTSD) levels in refugees, and (b) the quality of empirical evidence for each of the reviewed studies. The authors adopted the Council for Exceptional Children (CEC) evidence-based practice (EBP) standards and quality indicators to evaluate the methodological soundness of the reviewed studies and the evidence-based classification of art therapy as a treatment intervention. We systematically searched electronic databases of pertinent review articles for the period from 2010 to 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Systematic searches identified 70 research articles but yielded eight eligible journals as per the inclusion criteria. Results indicated that, though considered a promising treatment approach, art therapy is presently classified as an intervention that falls under the category of practice with insufficient evidence. The findings suggest the need for further methodologically sound experimental studies to strengthen the evidence behind art therapy as an intervention to reduce PTSD symptoms in refugees around the world.

Community-based interventions for improving mental health in refugee children and adolescents in high-income countries

BACKGROUND

An unprecedented number of people around the world are experiencing forced displacement due to natural or man-made events. More than 50% of refugees worldwide are children or adolescents. In addition to the challenges of settling in a new country, many have witnessed or experienced traumatic events. Therefore, refugee children and adolescents are at risk of developing mental health problems such as post-traumatic stress disorder, and require appropriate and effective support within communities.

OBJECTIVES

To assess the effectiveness and acceptability of community-based interventions (RCTs only) in comparison with controls (no treatment, waiting list, alternative treatment) for preventing and treating mental health problems (major depression, anxiety, post-traumatic stress disorder, psychological distress) and improving mental health in refugee children and adolescents in high-income countries.

SEARCH METHODS

Databases searches included the Cochrane Common Mental Disorders Controlled Trials Register (all available years), CENTRAL/CDSR (2021, Issue 2), Ovid MEDLINE, Embase, six other databases, and two trials registries to 21 February 2021. We checked reference lists of included study reports.  SELECTION CRITERIA: Studies of any design were eligible as long as they included child or adolescent refugees and evaluated a community-based mental health intervention in a high-income country. At a second stage, we selected randomised controlled trials.

DATA COLLECTION AND ANALYSIS

For randomised controlled trials, we extracted data relating to the study and participant characteristics, and outcome data relating to the results of the trial. For studies using other evaluation methods, we extracted data relating to the study and participant characteristics. W derived evidence on the efficacy and availability of interventions from the randomised controlled trials only. Data were synthesised narratively.

MAIN RESULTS

We screened 5005 records and sought full-text manuscripts of 62 relevant records. Three randomised controlled trials were included in this review. Key concerns in the risk of bias assessments included a lack of clarity about the randomisation process, potential for bias is outcome measurement, and risk of bias in the selection of results. Primary outcomes There was no evidence of an effect of community-based interventions when compared with a waiting list for symptoms of post-traumatic stress (mean difference (MD) -1.46, 95% confidence interval (CI) -6.78 to 3.86: 1 study; low-certainty evidence), symptoms of depression (MD 0.26, 95% CI -2.15 to 2.67: 1 study; low-certainty evidence), and psychological distress (MD -10.5, 95% CI -47.94 to 26.94; 1 study; very low-certainty evidence).  There were no data on adverse events. Secondary outcomes Three trials reported on short-term changes in child behaviour, using different measures, and found no evidence of an effect of the intervention versus a waiting list (low to very low certainty). None of the trials reported on quality of life or well-being, participation and functioning, or participant satisfaction.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the efficacy and acceptability of community-based mental health interventions for refugee children and adolescents.

Effectiveness of creative arts-based interventions for treating children and adolescents exposed to traumatic events: a systematic review of the quantitative evidence and meta-analysis

BACKGROUND

The effect of interventions based on the creative arts for children and adolescents exposed to traumatic events was estimated for measures of post-traumatic stress disorder (PTSD) and other psychological symptoms.

METHOD

Using a pre-registered protocol, relevant journal articles were identified through searches of: PsycInfo; Psychology and Behavioural Sciences Collection; CINAHL and PsycArticles. Data were pooled using a random effects model, and effect estimates were reported as Hedges' g.

RESULTS

Pooled effect estimates indicated that arts-based interventions significantly reduced PTSD symptom scores compared to pre-intervention (15 studies, g = -.67, p < .001) and a control group (7 studies, g = -.50, p < .001). Significant reductions were also found for measures of negative mood, but results were mixed for externalizing problems and anxiety.

CONCLUSIONS

Despite variations in study quality, intervention approaches and types of trauma experience, the results tentatively suggest that creative arts-based interventions may be effective in reducing symptoms of trauma and negative mood.

Mental health of adolescents in Myanmar: A systematic review of prevalence, determinants and interventions

Adolescence is a developmental phase where mental disorders typically manifest and where platforms for response (including schools and health services) change rapidly. However, data to inform public mental health responses are limited, including in countries like Myanmar which has a large adolescent population and where mental health has been identified as a priority of policy. In this paper we sought to systematically review the peer-reviewed and grey literature to determine (i) the prevalence of mental disorder among adolescents in Myanmar, (ii) determinants of mental disorder and (iii) interventions that have been implemented and evaluated. Nine publications met inclusion criteria (7 peer-reviewed and 2 grey literature) that included 7 publications reporting prevalence, 6 reporting correlates and one an intervention. The available data from the 2016 Global School-based Health Survey highlight that depression (27.2%) and suicidal ideation (9.4%) are prevalent in Myanmar, and these rates are substantially higher than regional averages. The limited available data on correlates identified violence and bullying, alcohol and substance use, and home, family and community security and cohesion as being closely related to mental health for adolescents. Only one study focussed on interventions and this found mindfulness meditation training to be an effective approach for young people whose parents were affected by HIV. These findings underscore the need to address adolescent mental health in Myanmar, but also to invest in better data collection efforts.

Art Therapy for Psychosocial Problems in Children and Adolescents: A Systematic Narrative Review on Art Therapeutic Means and Forms of Expression, Therapist Behavior, and Supposed Mechanisms of Change

Background: Art therapy (AT) is frequently offered to children and adolescents with psychosocial problems. AT is an experiential form of treatment in which the use of art materials, the process of creation in the presence and guidance of an art therapist, and the resulting artwork are assumed to contribute to the reduction of psychosocial problems. Although previous research reports positive effects, there is a lack of knowledge on which (combination of) art therapeutic components contribute to the reduction of psychosocial problems in children and adolescents. Method: A systematic narrative review was conducted to give an overview of AT interventions for children and adolescents with psychosocial problems. Fourteen databases and four electronic journals up to January 2020 were systematically searched. The applied means and forms of expression, therapist behavior, supposed mechanisms of change, and effects were extracted and coded. Results: Thirty-seven studies out of 1,299 studies met the inclusion criteria. This concerned 16 randomized controlled trials, eight controlled trials, and 13 single-group pre-post design studies. AT interventions for children and adolescents are characterized by a variety of materials/techniques, forms of structure such as giving topics or assignments, and the use of language. Three forms of therapist behavior were seen: non-directive, directive, and eclectic. All three forms of therapist behavior, in combination with a variety of means and forms of expression, showed significant effects on psychosocial problems. Conclusions: The results showed that the use of means and forms of expression and therapist behavior is applied flexibly. This suggests the responsiveness of AT, in which means and forms of expression and therapist behavior are applied to respond to the client's needs and circumstances, thereby giving positive results for psychosocial outcomes. For future studies, presenting detailed information on the potential beneficial effects of used therapeutic perspectives, means, art techniques, and therapist behavior is recommended to get a better insight into (un)successful art therapeutic elements.

Mental health interventions in Myanmar: a review of the academic and gray literature

BACKGROUND

Recent political changes in Myanmar provide opportunities to expand mental health (MH) services. Given Myanmar's unique situation, we felt a need to assemble and interpret available local information on MH in Myanmar to inform service design, rather than simply drawing lessons from other countries. We reviewed academic and gray literature on the experience of MH problems in Myanmar and the suitability, availability, and effectiveness of MH and psychosocial programming.

METHODS

We searched: (1) Google Scholar; (2) PubMed; (3) PsychInfo; (4) English-language Myanmar journals and databases; (5) the Mental Health and Psychosocial Support (MHPSS) Network resources website; (6) websites and (7) local contacts of organizations identified during 2010 and 2013 mapping exercise of MHPSS providers; (8) the Myanmar Information Management Unit (MIMU) website; (9) University libraries in Yangon and Mandalay; and (10) identified local MH professionals.

RESULTS

Qualitative data suggest that MH conditions resulting from stress are similar to those experienced elsewhere. Fourteen intervention evaluations were identified: three on community-level interventions, three on adult religion-based practice (meditation), four adult psychotherapeutic interventions, and four child-focused interventions. Support for the acceptability and effectiveness of interventions is mostly anecdotal. With the exception of two rigorous, randomized control trials, most evaluations had serious methodologic limitations.

CONCLUSIONS

Few evaluations of psychotherapeutic or psychosocial programs for people from Myanmar have been published in the black or gray literature. Incorporating rigorous evaluations into existing and future programs is imperative for expanding the evidence base for psychotherapeutic and psychosocial programs in this context.

Acoustic and Perceived Measurements Certifying Tango as Voice Treatment Method

Voice disorders are affecting everyday life in many levels, and their prevalence has been studied extensively in certain and general populations. Notably, several factors have a cohesive influence on voice disorders and voice characteristics. Several studies report that health and environmental and psychological etiologies can serve as risk factors for voice disorders. Many diagnostic protocols, in the literature, evaluate voice and its parameters leading to direct or indirect treatment intervention. This study was designed to examine the effect of tango on adult acoustic voice parameters. Fifty-two adults (26 male and 26 female) were recruited and divided into four subgroups (male dancers, female dancers, male nondancers, and female nondancers). The participants were asked to answer two questionnaires (Voice Handicap Index and Voice Evaluation Form), and their voices were recorded before and after the tango dance session. Moreover, water consumption was investigated. The study's results indicated that the voices' acoustic characteristics were different between tango dancers and the control group. The beneficial results are far from prominent as they prove that tango dance can serve stand-alone as voice therapy without the need for hydration. Also, more research is imperative to be conducted on a longitudinal basis to obtain a more accurate result on the required time for the proposed therapy.